Hormones
Disclaimer. This web site is for research and educational purposes only. The information given in this site is not intended to replace a therapeutic practitioner relationship.
There are strong interactions between the immune system, the nervous system, the digestive system and the hormonal system.
Below I discuss some of the hormones that relate to CFS/FMS. These are just the ones that I have had dealings with in my patients. There are others that I am not familiar with and so don't include.
The Adrenal System: Cortisol, DHEA
Long term (that is, chronic) stress can lead to adrenal fatigue or adrenal exhaustion. This is basically equivalent to burnout. There are various hormonal patterns when it comes to adrenal exhaustion.
If cortisol and DHEA are too high, it may mean that you system is still in 'fight, flight' mode and not yet completely exhausted. In this case therapies are needed that calm the adrenal system. This will include de-stressing activities. Calming herbs and minerals may also be beneficial. For example Valerian and magnesium.
If cortisol and DHEA are flat or low it suggests that the adrenals may be exhausted. You may be in burnout. In this case, you are likely to benefit from things that nourish and build up the adrenals. This may include vitamin C, B vitamins, glandular extracts and herbs such as Eleutherococcus (Siberian ginseng), Panax ginseng and Ashwagandra (Withania). You may also benefit (if you don't have high blood pressure) from increasing your dietary salt intake. Occasionally, for low DHEA or low cortisol I have prescribed a course of supplementary hormones. The plan is to withdraw these as soon as you can. However, they can sometimes be needed to help someone through a difficult patch.
The Thyroid: Thyroxine (T4), Tri-iodothyronine (T3)
The adrenals and the thyroid tend to work in tandem. So, if your adrenals are low, they tend to pull down the thyroid. Likewise, if the thyroid is low, it may pull down the adrenals. In practical terms this means you need to generally treat these two systems together. To assess if the thyroid is low, you need to take into account symptoms as well as pulse, temperature and blood pressure. These all tend to be low or low-normal in persons with low thyroid function.
For temperature, I use maximum temperature. In menstruating women this should be in the first half of the cycle, before ovulation. Your temperature under the tongue or using an ear gauge should not be less than 36.5 degrees C between 2 and 4pm in the afternoon between. If your temperature is below 36.5 deg C at this time, then in my opinion you have a cold body syndrome. One common cause of cold body syndrome is low thyroid. Thyroid blood tests may also be useful. To check the thyroid thoroughly you need at least the TSH, Free T4, T3, Reverse T3 (RT3), Thyroid autoantibody (anti -thyroid peroxidase and anti-thyroglobulin) levels and adrenal hormones (cortisol and DHEA). If you have a high RT3 or a low T3/RT3 ratio then you may have Reverse T3 dominance. This is a condition where the body, usually in response to a major stressor, is shunting too much T4 into the inactive RT3. RT3 tends to block the active T3 thus producing a low thyroid hormone state at the tissue level. Removing the stressor can resolve RT3 dominance, but sometimes a special course of T3 therapy is needed too.
I have normally found RT3 dominance to be a secondary issue that clears up once the primary stressor is found and treated. The best book currently that I have read on the thyroid is Dr. Datis Kharazzion's “Why do I still have low thyroid symptoms when my lab tests are normal?".
Gonadotrophin system: Testosterone, oestrogen and progesterone.
Low levels of these hormones can contribute to fatigue and maybe muscle ache. Unless severe deficiencies are in my experience a more peripheral issue. Andropause and menopause are important considerations, though, and should not be taken lightly. Low testosterone may be the result of sleep deprivation, over exercise or zinc deficiency. Saliva or blood levels of these hormones are relatively easy to test for and evaluate. If low, hormonal supplementation or herbal therapy may be recommended.
One special area of concern is low oestrogen at menopause contributing to leptin resistance and weight gain. Ladies with CFS are particularly prone to putting on weight at menopause. There are no easy answers. However, I have found the so called “HCG Diet” to generally work. Getting to bed at a decent time and not eating much in the evening and at a regular time are helpful. Also, it is important to deal with any low thyroid issues, sleep apnoea and joint problems interfering with exercise. Low vitamin D and other sleep problems can also contribute to leptin resistance and weight gain.
Other hormones: Melatonin, Growth Hormone, 1,25 Dihydroxyvitamin D.
Melatonin.
This hormone is produced in the healthy pineal gland in the brain in response to indirect sunlight hitting the retina of the eye. This does NOT mean that you should look at the sun to get melatonin! You should never look directly at the sun. However, looking towards the sun with closed eyelids would normally be very good for melatonin production. However, some people get a build up of calcium in the pineal gland that interferes with melatonin production. Such persons do not produce much usable melatonin from sun exposure and will therefore likely do better using a melatonin supplement. A script for melatonin is often needed in Australia. Melatonin can help with sleep, mood and weight management (it is know to promote normalising of leptin levels).
Growth hormone.
To be frank, I don't have a lot of clinical experience with this hormone. Only a few of my patients have been able to afford it. And in those patients, I did not prescribe it. However, it does seem to be quite powerful at increasing energy levels. It also has potential to assist with weight management and as a treatment for osteoporosis. Growth hormone levels do naturally decrease with aging.
1,25 Dihydroxyvitamin D.
This is the form of vitamin D after it has been activated in the kidneys. It is also called calcitonin. High levels of 1,25 Dihydroxyvitamin D may be a subtle indicator of chronic active infection with a 'cell wall deficient' bacteria such as mycoplasma or chlamydia pneumoniae. These bacteria appear to interfere with the vitamin D dependent parts of the immune system so as to hide from detection within the host. Taking vitamin D supplements can potentially aggravate this problem, so it is important to evaluate whether or not the active version of vitamin D should be measured, rather than the intermediate form which is most commonly measured (25 Hydroxyvitamin D)
Below I discuss some of the hormones that relate to CFS/FMS. These are just the ones that I have had dealings with in my patients. There are others that I am not familiar with and so don't include.
The Adrenal System: Cortisol, DHEA
Long term (that is, chronic) stress can lead to adrenal fatigue or adrenal exhaustion. This is basically equivalent to burnout. There are various hormonal patterns when it comes to adrenal exhaustion.
If cortisol and DHEA are too high, it may mean that you system is still in 'fight, flight' mode and not yet completely exhausted. In this case therapies are needed that calm the adrenal system. This will include de-stressing activities. Calming herbs and minerals may also be beneficial. For example Valerian and magnesium.
If cortisol and DHEA are flat or low it suggests that the adrenals may be exhausted. You may be in burnout. In this case, you are likely to benefit from things that nourish and build up the adrenals. This may include vitamin C, B vitamins, glandular extracts and herbs such as Eleutherococcus (Siberian ginseng), Panax ginseng and Ashwagandra (Withania). You may also benefit (if you don't have high blood pressure) from increasing your dietary salt intake. Occasionally, for low DHEA or low cortisol I have prescribed a course of supplementary hormones. The plan is to withdraw these as soon as you can. However, they can sometimes be needed to help someone through a difficult patch.
The Thyroid: Thyroxine (T4), Tri-iodothyronine (T3)
The adrenals and the thyroid tend to work in tandem. So, if your adrenals are low, they tend to pull down the thyroid. Likewise, if the thyroid is low, it may pull down the adrenals. In practical terms this means you need to generally treat these two systems together. To assess if the thyroid is low, you need to take into account symptoms as well as pulse, temperature and blood pressure. These all tend to be low or low-normal in persons with low thyroid function.
For temperature, I use maximum temperature. In menstruating women this should be in the first half of the cycle, before ovulation. Your temperature under the tongue or using an ear gauge should not be less than 36.5 degrees C between 2 and 4pm in the afternoon between. If your temperature is below 36.5 deg C at this time, then in my opinion you have a cold body syndrome. One common cause of cold body syndrome is low thyroid. Thyroid blood tests may also be useful. To check the thyroid thoroughly you need at least the TSH, Free T4, T3, Reverse T3 (RT3), Thyroid autoantibody (anti -thyroid peroxidase and anti-thyroglobulin) levels and adrenal hormones (cortisol and DHEA). If you have a high RT3 or a low T3/RT3 ratio then you may have Reverse T3 dominance. This is a condition where the body, usually in response to a major stressor, is shunting too much T4 into the inactive RT3. RT3 tends to block the active T3 thus producing a low thyroid hormone state at the tissue level. Removing the stressor can resolve RT3 dominance, but sometimes a special course of T3 therapy is needed too.
I have normally found RT3 dominance to be a secondary issue that clears up once the primary stressor is found and treated. The best book currently that I have read on the thyroid is Dr. Datis Kharazzion's “Why do I still have low thyroid symptoms when my lab tests are normal?".
Gonadotrophin system: Testosterone, oestrogen and progesterone.
Low levels of these hormones can contribute to fatigue and maybe muscle ache. Unless severe deficiencies are in my experience a more peripheral issue. Andropause and menopause are important considerations, though, and should not be taken lightly. Low testosterone may be the result of sleep deprivation, over exercise or zinc deficiency. Saliva or blood levels of these hormones are relatively easy to test for and evaluate. If low, hormonal supplementation or herbal therapy may be recommended.
One special area of concern is low oestrogen at menopause contributing to leptin resistance and weight gain. Ladies with CFS are particularly prone to putting on weight at menopause. There are no easy answers. However, I have found the so called “HCG Diet” to generally work. Getting to bed at a decent time and not eating much in the evening and at a regular time are helpful. Also, it is important to deal with any low thyroid issues, sleep apnoea and joint problems interfering with exercise. Low vitamin D and other sleep problems can also contribute to leptin resistance and weight gain.
Other hormones: Melatonin, Growth Hormone, 1,25 Dihydroxyvitamin D.
Melatonin.
This hormone is produced in the healthy pineal gland in the brain in response to indirect sunlight hitting the retina of the eye. This does NOT mean that you should look at the sun to get melatonin! You should never look directly at the sun. However, looking towards the sun with closed eyelids would normally be very good for melatonin production. However, some people get a build up of calcium in the pineal gland that interferes with melatonin production. Such persons do not produce much usable melatonin from sun exposure and will therefore likely do better using a melatonin supplement. A script for melatonin is often needed in Australia. Melatonin can help with sleep, mood and weight management (it is know to promote normalising of leptin levels).
Growth hormone.
To be frank, I don't have a lot of clinical experience with this hormone. Only a few of my patients have been able to afford it. And in those patients, I did not prescribe it. However, it does seem to be quite powerful at increasing energy levels. It also has potential to assist with weight management and as a treatment for osteoporosis. Growth hormone levels do naturally decrease with aging.
1,25 Dihydroxyvitamin D.
This is the form of vitamin D after it has been activated in the kidneys. It is also called calcitonin. High levels of 1,25 Dihydroxyvitamin D may be a subtle indicator of chronic active infection with a 'cell wall deficient' bacteria such as mycoplasma or chlamydia pneumoniae. These bacteria appear to interfere with the vitamin D dependent parts of the immune system so as to hide from detection within the host. Taking vitamin D supplements can potentially aggravate this problem, so it is important to evaluate whether or not the active version of vitamin D should be measured, rather than the intermediate form which is most commonly measured (25 Hydroxyvitamin D)
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