DHEA

Stress due to lifestyle, mental or physical exhaustion, body inflammation, or disease contributes to an excessive production of cortisol which can not only deplete your reserves of cortisol, but also deplete your levels of DHEA. Low DHEA contributes to decreases in energy, fatigue, memory loss, libido loss, aching joints, bone density loss, muscle mass loss, lower immunity, and subsequent heart disease. Low cortisol and DHEA contributes to adrenal fatigue which affects thyroid function and thyroid function affects adrenal function.

I've done the Adrenal Stress Index test and the lab results confirm on a scale of 1 to 7, with one being the highest, my DHEA-cortisol correlation spectrum is at a 5, or "low reserves". Eliminating stress from your life allows the body to heal and DHEA reserves are able to increase back to normal. Unfortunately, I've done as much as I can figure out to eliminate inflammation and I have no idea how to reduce the adrenaline rushes I get with menopausal hot flashes other than hormone replacement drugs. I'm sure these oddities contribute to my low DHEA levels.

Dr. Kharazzian suggests taking DHEA to jump-start the adrenals prior to thyroid supplementation and since I'm constantly tired, I figured it couldn't hurt. He says don't take it for more than a month and other physicians have instructed no more than a 5 mg dosage. When requesting it from my new naturopath, I saw a micro-expression of surprise in her eyes and her body jumped a little. Considering she doesn't have much of a personality, I took this to be a show of horror. She very quietly said without much explanation she doesn't prescribe DHEA and it was not advisable. I have read overdosing on DHEA is common due to its accumulation in fat cells, but that's all I knew. Well, I also knew how sensitive I am to everything so the lowest dosage possible was my personal recommendation. I knew enough about the warnings to convince her I wasn't planning on abusing it so she changed her mind and prescribed exactly what I wanted: sublingual one mg. for one month.

The benefits of DHEA make it sound like some kind of miracle drug: energy, stamina and strength, increase in libido, weight loss, reduction in menopausal symptoms, increase in confidence and assertion, reverses bone loss, reverses asthma, reverses depression, and beneficial to those suffering from Crohn's Disease and lupus. According to all the propaganda, if you are going to take a drug, this sounds like the one to choose!

But what are the side effects of DHEA? Since I've now thrown all caution to the wind and have become a drug addict, I was curious what overdosing looks like.  There are plenty of websites, articles, and comments online that list the side effects. Many warn others not to even start taking DHEA and some even claim it'll ruin your life. Side effects include:

hormonal imbalance
hair loss
blood pressure increase
liver damage
heart arrhythmia or palpitations
glaucoma
perspiration odor
acne
breast swelling
facial hair (women)
erectile dysfunction (men)
insomnia
restlessness
irritability
aggression
severe personality changes

It's also addictive. Don't stop taking DHEA cold turkey or you may experience withdrawal symptoms like back pain, moodiness, sleeplessness, fatigue, body pain, weakness, and hot flashes. Since all these symptoms sound like me without DHEA, I had high hopes taking it might alleviate some of my constant discomfort.

I found this website very interesting:  http://www.raysahelian.com/dhea.html

It looks as if Mr. Sahelian is promoting DHEA supplementation, but he also includes information from those who have taken DHEA and experienced the side effects. Many warn others never to start taking DHEA because the side effects don't always subside immediately after cessation and it may take months before feeling normal again. I think most of the issue is with high doses over 10 mg and taking it for long periods of time or more than a month. Some admit to taking it for up to a year which is a common prescription for those suffering from depression.

I received the sublingual form which goes under the tongue with directions to take it on an empty stomach. It is also important to wait to eat or drink anything for 30 minutes to an hour. Do not swallow at all until it's dissolved. However, if one must swallow due to a large accumulation of saliva, limit swallowing to once or twice. I always have lots of saliva so I knew this would be a problem. The tablets are large so the dissolving also creates liquid and because of this it's hard to keep them in place.

The first and second day I avoided swallowing and spit once the tablet was dissolved. The third day I thought about how much drug I might be wasting and wouldn't it be more effective if I swallowed the one time and whatever didn't dissolve under my tongue would then be digested? That's me overthinking ways to make this work, of course. That was a mistake. Five hours later I became sick to my stomach and it lasted all day. The tablets are sweet so I wasn't quite sure if it was a synthetic sweetener the pharmacist may have added to improve taste or the DHEA. Probably the DHEA. I also read for people who are digesting the pill form, to take them with high-fat food to alleviate any digestive problems. Granted, no matter what kind of drug, herb or supplement I try, the third or fourth day is when I start feeling the side effects. I've been told it's because my body doesn't detox and that's the overload or accumulation point.

So day four I felt very hopeful and I went back to dissolving under the tongue and no swallowing at all. I was convinced that this was the answer and if I could just keep taking the drugs, I would again, be on the road toward better health.

Nope. About five hours later the queasy sick feeling started again. It didn't seem to be as bad as the day before, but bad enough to make me want to curl up in bed and stay there for the rest of the day. On top of the constant fatigue, nausea is a real waste of time. I'm not sure what to do about being so susceptible to side effects as I've been liver cleansing all week which is where much anything would accumulate and I'm not sure if I'm not swallowing the DHEA, why does it affect my digestive system?

However, the purpose behind taking the DHEA was to jump-start the adrenals so the thyroid medication would be most effective. It's really all about the thyroid medication.

On to the thyroid drugs! Crossing my fingers.

Drugs

It's that time of the year where I get the courage to go to a new doctor and try something new for the fatigue, muscle weakness, muscle pain, and all-encompassing feeling of blah. The diet has helped a lot and I think that is the reason I'm rarely totally exhausted now, but it's not quite enough. I want to be able to function better and not feel so...blah...all the time.


I've been reading a lot on thyroid hormone prescriptions lately, but I'm definitely not an expert on this information. Here are the basics: There are two categories: natural and synthetic. The natural sources are dessicated thyroid or thyroid extract and the source is from porcine or bovine thyroid. Yep, real thyroid from pigs or cows. The brand names are Armour, Naturethroid, and Westhroid. Because they are from natural sources, they have natural levels of both T3 and T4 and seemed to be well-tolerated by many.


The other category is synthetic or derived from laboratory-produced chemicals. Levothyroxine is the most commonly used and well-tolerated by most. Brand names include Synthroid, Levoxyl, Liothyronine, and Levothroid. These are often just T3 as it is expected the patient will convert the T3 to T4, but based on my recent readings not everyone is capable of this conversion and some are even sensitive to T3 which can cause problems.


In the past I've tried Armour dessicated thyroid and various forms of levothryoxine. I've not tolerated any thyroid replacement hormone well. Armour made me nauseous for six straight weeks, sustained -released levothyroxine kept me away all night and made me nauseous all day long, and non-sustained-released levothyroxine made me so ill and in pain I almost took myself to the hospital. Through all the discomfort I continued hoping it would improve my energy level and fatigue, but nothing did. These prescriptions are very expensive so each failure is incredibly frustrating and financial discouraging.


According to Dr. Datis Kharazzian who saved my life with his dietary protocol and book Why Do I Still Have Thyroid Symptoms When My Lab Tests Are Normal, intolerance is often caused by the fillers used in these pills. I attempted to correct this by using compounded pharmaceuticals so I could control what goes into each pill. Still, adding something like a time-released feature takes an extra chemical and the pills must have some kind of filler. This came as a surprise to me. You can't just put the drug in the capsule without a filler? No. I'm learning.

Unfortunately I wasn't told this until after I received pills filled with Avicel, a filler that made me feel like I was painfully digesting shards of glass. I know it was the filler because I replace the sustained-released pill with this one and I assumed they would have the same ingredients minus the time-releasing chemical. Nope, someone thought they needed to add an unknown filler without consulting me first. When I called the pharmacy and asked why I was so sick, I found out I should have had a choice of fillers. You can't imagine how irritated I was to throw a $100 bottle of pills away. So...what is Avicel? Wood pulp. It sounds fairly harmless. Another pharmacist told me problems with Avicel are rare unless I have an allergy to pine. Well, there you have it. My whole family is allergic to pine so it stands to reason I would be as well. Also, I always hear about how rare side effects are and I can state with absolute certainty if there is a "rare" side effect of any kind, I will have it. I'm just that sensitive.

Recently I read not only should you watch for fillers, but prior to thyroid therapy, one needs to make sure their adrenals are working properly to allow the thyroid medication to be effective. I tried licorice root, but it didn't seem to make a difference. Astragalus, another herb, is also used for this but according to Dr. Kharazzian, if you are TH1 dominant, this will worsen an autoimmune condition. Based on information, I thought I was TH2 dominate which is common with chemically sensitive people. Astragalus made me crash with exhaustion.

DHEA is another method to support adrenal function. You can buy DHEA supplements over the counter, but they are often high dosages and filled with additives and fillers. My new doctor said she avoids prescribing DHEA because it stores to toxic levels very quickly. Dr. Kharazzian suggests sublingual DHEA as it is less likely to store as quickly and is more effective. He suggests not to ever take it for longer than four weeks. It's only to jump-start the adrenals and once you feel a difference, stop taking it or your adrenals will shut down and stop working on their own. I found this to be interesting since so many of my friends take it continuously as an adrenal booster. The sources for DHEA are synthetic (chemical), wild yam or soy. My new pharmacist says the company uses yam. Perfect. I don't want chemicals or soy.

In addition, it is advised to do a liver cleanse before starting these drugs and this will help avoid any side effects and assist in the effectiveness of the drug. There are many herbal remedies that will detox your liver, but I like avoiding drugs when possible especially since I react to so many. Instead I started drinking beet juice and eating beets.

The reluctant patient

My new naturopath doesn't seem to be very knowledgeable and as a friend recently said, that is the concern with naturopaths or any doctor: will they know more about my condition than I already do? Not usually. But I need them to be receptive to my requests and at least respectful to my knowledge. Even this is difficult as most doctors want to be put on a pedestal and worshipped for their expensive advice. They often treat patients as stupid subordinates who are expected to nod politely, not talk too much, and be very compliant. Too much power play which for me ends up to be a waste of money and a personality conflict. This new doctor, however, was receptive. I told her exactly what I wanted, but left it open to her advice. In the end her "plan" for me was to eat vegetables at every meal and at least one fruit a day. Really? Was she not listening to me when I went into great detail about my diet? I pretty much kindly, but assertively bullied her into some prescriptions. She also suggested astragalus tea and I decided to try it since it only cost $1.50, but it didn't go well. I know I don't do well with herbs. I should have known better.

She was hesitant about DHEA, but I think my own concerns about its toxicity and proper usage must have given her some confidence. She agreed to prescribe a very low dosage (1 mg), for a short time (30 days), sublingual form, just to jump-start the adrenals. I interrogated the pharmacist so much that when it came time to make the sublingual tablets she waited to ask me about which kind of filler to use. (THANK YOU!) My choice was gelatin (horse hooves) or ethyl alcohol. I started to laugh when she said ethyl alcohol. Really? After all the questions I asked about chemicals, fillers and toxicity why would anyone think I would choose ethyl alcohol?  I'm so glad she gave me a choice. I'm not excited about gelatin, but it is gluten-free and might even strengthen my fingernails. She also said they add a flavor. Hmmm...nope. I don't want a flavor. She said she didn't know if DHEA would be bitter, but I decided to chance it. The tablets are weird:

Little squares of colorless, wiggly JELLO. Put one under your tongue on an empty stomach and no swallowing until it dissolves. I was surprised they tasted sweet so I wonder if someone added something to it or if the gelatin comes sweetened. This is the issue. They can add anything without your knowledge. I don't even want to think about what is in the over the counter form. Thirty sublingual tablets were $50.

I also received a prescription for dessicated (pig) thyroid (Thyroid USP) which is much like the old Armour Thyroid that was re-formulated a few years back. My previous experience with natural thyroid was the stuff loaded with unknown fillers which may have caused the nausea. I asked about the fillers in advance and they gave me a list of types (this is when I found out about Avicel being pine-based) and then off hand it was mentioned they could use rice flour. Rice flour!? Although the thought of raw flour stuck to my stomach like glue wasn't appealing, I know I can tolerate rice flour. I'd have to buy a bag of rice flour myself and bring it in. I'm not sure why they don't have their own supply. I forgot to ask if I could use coconut flour as rice isn't on my diet, and later I was told it would depend on the texture so I'll try that next.


I think the capsules are gelatin and I wasn't given a choice. This is another question I failed to ask and I've found only with experience does one know WHICH questions to ask. I'm learning. Previous pharmacies have used tiny capsules that are about the third of the size of normal ones, but I received normal size which seems to be an excessive amount of rice flour. There is often a vegetarian or vegetable capsule, but again, I wasn't offered a choice. I requested an extremely low dosage of thyroid (30 mg.) to avoid shocking my system and I'll work up to find a suitable level. The doctor called it into the pharmacy, unfortunately, as I really wanted to double check what they were doing before they did it. I didn't really want to pay for a 90 day supply in case after my normal four days they made me ill, but they were already formulated by the time I went in. Ninety capsules cost $95. OUCH. But this is how the compounding pharmacy works. If I only received, for instance, 14 capsules they would have cost me around $70 due to the effort it takes to create the pills individually by hand.

So...

First step: liver cleanse with beet juice
Second step: jump-start my adrenals with DHEA
Third step: thyroid replacement therapy

I am ready for another pharmaceutical adventure, or, hmmm, experiment. At this point I feel like I've done everything in my power to be successful. Wish me luck!

The Elimination Experiment, or Fatigue Testing

After five doctors and no answers, I'm determined to figure out why I'm always tired so I'm attempting some elimination tests.

The Paleo-Hashimoto's diet I been on has been very successful. I have not had any episodes of exhaustion. The "exhaustion" is when I am so tired I can barely move, lifting my arm takes enormous effort, and the only thing I am capable of doing is lying in bed. I'm not tired or sleepy and I can't sleep, I just can't seem to move. It's very frightening. It's the memory of those exhaustion episodes that helps me maintain my will power and keeps me from eating gluten and chocolate. I believe it's the gluten that provoke the autoimmune attacks on my thyroid.

The underlying fatigue started when I moved into this house eight years ago, maybe even a few years prior although it wasn't very apparent. I don't feel like exercising. I can often work through the fatigue with walking, gardening or projects, but no bike riding or stretching/exercising and even sitting still and reading feels like great effort. I experience the fatigue more in the spring and summer, and most often in the afternoon. I feel so tired I just want to nap, usually around 2pm to about 5pm.


Fatigue Theories:

Hay fever allergies are known for symptoms of fatigue and it's a little coincidental that most of my fatigue takes place in the spring and summer. As a child I lived in the country, dealt with hay fever, and as soon as I came of age I headed to the city where all my hay fever issues went away. I've now moved back to the country to get out of the pollution. There isn't much I can do about hay fever other than take drugs like Benadryl. Benadryl will clear up the respiratory symptoms like runny nose, sneezing, and sinus congestion, but it also causes fatigue. If all this fatigue is caused by hay fever allergies, my only alternative would be to move back to the city where I don't have allergies, but then I would have to suffer chemical exposures which are worse.

Air-borne chemicals  During the spring and summer the city sprays the streets, sidewalks and parks with herbicides and my neighbors spray their lawns. I do notice during the spring and summer there are days when if I go for a walk my lungs start feeling heavy and hurt. In addition, when my neighbor does laundry, it stinks to high heaven and pollutes the whole neighborhood. Incredibly toxic. Is it causing the fatigue?  Other than staying inside all summer, there isn't much I can do about air-borne chemicals other than to continue to do what I can to avoid exposure.

Mold  In the dirt? In the air? Spring and summer is when the ground and air warms. Does it activate mold growth? Every now and then if I dig in the garden, I become very tired. Might be a correlation or the correlation is the exercise? I don't know. I'll not dig in the dirt and use it as a test.

Computers and electromagnetic field exposures  I can keep track of the time I spend on the computer, but other than that it is another uncontrollable variable as I have to work.

Water-borne chemicals  I tend to feel tired once a month consistently and this leads me to believe there might be a connection to the city's water treatments and the fatigue I experience. I love soaking in the bathtub. I can take very short showers and see if that makes a difference and during the time period in question, avoid bathing all together and use it as a test.

Adrenal fatigue  Any number of things can contribute to adrenal fatigue, but stress is the number one factor.  I tend to be very reactive to emotions and sensitive to stress, but I don't have much on a daily basis. Bathing in hot water affects body temperature and puts a lot of stress on one's adrenals which could also affect energy levels. I have done some experimentation with adrenal support and nothing has made a difference. I'm at a loss for what else to try. No bathing might make a difference.

Diet  I've done well to reduce my intake of bad foods, but I still have my guilty pleasures and most of them are NOT on my Paleo-Hashimoto's diet. Although I don't eat a lot of the forbidden foods, every now and then I do treat myself.  Dried fruits are high in carbohydrates and affect blood sugar, and I'm addicted to raisins and dates as snacks. Yogurt (dairy) is known for inflammation, and unfortunately, when I get bored with the same old foods I treat myself with high fat, no sugar, plain yogurt. Potatoes are also high in carbohydrates (sugars) even though I eat them rarely, I haven't stopped completely. Grains are not on the diet either and I rarely eat gluten-free grain products with rice flour, potato flour or other substitutes, but every now and then for something different, I do. Rice is a carbohydrate and even though I don't eat it nearly as much as I did prior to starting this diet, I start feeling discombobulated if I go without it for up to two weeks. I also eat a lot of eggs, more than any human should consume. Are they causing fatigue? Let's find out. Can I give up these foods for three weeks? I'll need to add some recipes to my diet that will keep me full and satisfied like more beef and lamb.

Chronic Fatigue Syndrome  One doctor suggested chronic fatigue, but I don't seem to have the other symptoms that accompany this condition. If so, there is nothing I can do about it.

Menopause and Hormonal Changes  Maybe. Not much I can do about this, either. Old people feel tired and nap a lot. I'm in that in between stage - I'm not old enough to retire, but I'm old enough to start feeling like I should. Damn.


Elimination Plan:

For three weeks I am not to soak in hot baths. Brief showers only except between the 19th and 25th when I sponge bathe in distilled water. No eating problematic foods (eggs, yogurt, dried fruit, potatoes or rice, gluten-free flours) for three weeks. I can't avoid the outside which would be ideal, but I can't stop what little exercise I'm getting and it's summer. I need sunshine for vitamin D. I'll keep track of everything I'm eating as well as anything unusual that I do or that happened during the day, for instance, air pollution encounters, labor-intensive projects, when I take a shower, and how often I'm on the computer.

Notes and Highlights:

The first day: NO FATIGUE. The second, third, fourth, fifth, sixth, seventh, and eighth days: NO FATIGUE.  Even after strenuous work, walking, or computer time, I didn't feel the normal afternoon fatigue. There were a few days when I felt a little tired around 6pm, but nothing that stopped me from functioning. I had high hopes that I was doing something right until the evening of the ninth day.

Day eight I was exposed to long grass and my hay fever symptoms went crazy. Later that night, I wanted to eat eggs. I couldn't stop thinking about them. It's the only thing I wanted to eat, but I didn't. Sinuses were painfully raw and respiratory tract was uncomfortably congested. The next day allergy symptoms were still bothering me, but not as bad. Later that night I started pacing around the kitchen like a caged animal. I'm hungry, but nothing looks good. I didn't eat rice although I know it would have stopped me from pacing. Tenth day woke up tired and stayed that way all day crashing around two in the afternoon and sleeping for two hours. Allergies?? Or maybe coming down off of allergies?

Around day five I started feeling like I want to exercise! Nothing strenuous, just stretching and movement, but normally I don't even feel like I'm capable of any kind of exertion.

After a week of no raisins or dates, I didn't even care. I really thought I'd have problems giving up the sugary stuff.

Air-borne chemical encounters clearly gave me headaches and migraines usually within a few minutes and the intensity depended on the encounter. Getting one whiff of that sickly-sweet laundry detergent wafting over from my neighbor's house nearly killed me one morning. I ran back into the house and stayed there for a few hours with the windows closed until I thought their laundry was done. Didn't seem to have any correlation to fatigue, though.

Around day seventeen I was COLD. My whole body cold. And hungry. I wanted to take a bath just to warm up, but instead crawled into bed for about an hour. Didn't sleep because I wasn't tired. Hungry all day, but nothing sounded satisfying. Later in the day I wanted to eat eggs. I didn't. I ate rice...I couldn't wait any longer.

The Challenges:

I added a "forbidden" for one day and stop for four days to see what happens.

RICE: no negative effects, felt better, no hunger and no fatigue

GLUTEN-FREE CUPCAKE WITH SUGAR: YUM! I couldn't help myself. I was awake later than usual (lots of energy), I seem to have more hot flashes, and slightly tired about four hours later with slight headache, but no crashing type of fatigue.

EGGS: The cravings indicated eggs might be an issue, maybe associated with hay fever? Eggs are really high in zinc which assists detoxification. As soon as I ate them I kept having to clear my throat. Then I ate them again and again all day. I felt a little tired at the bewitching hour (2:00pm), but not much and no crashing. I ate them again and had no reaction at all.

YOGURT: The yogurt was heavenly, I slept good after, and awoke with lots of energy the next morning. It's not yogurt!

POTATOES: Yum! I baked them as French Fries in olive oil. No fatigue. I do wonder if I ate them a lot or repeatedly for days if they would also produce fatigue. So several weeks later I tried that and experienced no fatigue.

GLUTEN-FREE PANCAKES: These are made with rice flour and some other stuff. I eat them so infrequently, maybe once every two or three months so it's been a while since I've had them. I went picking blueberries and thought this would be a good opportunity to make blueberry pancakes and test the reaction. I ate one pancake and felt really awful. About an hour later the headaches started and then I crashed and slept for two hours. All before noon! Fatigue and headaches the rest of the day.

BATH: I was getting a strange rash on my calves before I started this experiment which only got worse every time I took a bath. It nearly all went away during the bathing elimination phase.  I took a fast dip in a cool bath thinking a hot bath was causing the rash, and my calves started burning anyway. I had planned to take hot baths the whole day to test the fatigue, but if one short cool dip would cause the burning, I decided to wait to add hot baths later. I took that cool dip when the chemicals in the water are at their worst.

About a week later, I just wanted a bath and it was time to do a bath challenge. To soak in hot water. It was wonderful. Two hours later I did it again. I felt tired immediately after and crashed, sleeping for two hours. Took another bath and the headaches and nausea started. I jump in the shower with a gallon of heated distilled water and tried to rinse the water off. Even so, I woke up the next morning with nausea, pain in my lower back, a headache and fatigue and later that afternoon, crashed and slept for one hour. It took two days to recover and the whole time I felt groggy and tired. Is it the chemicals in the water? I've had problems with them in the past. Or is it the heat stressing my adrenals? I have no idea. Maybe both. But the rash didn't come back with the second bath. I think maybe the rash and nausea are from the chemicals and the fatigue is from the heat.

DRIED FRUIT: Oh, raisins and dates...my addiction. I was surprised it was so easy to give them up. For me, dried fruit might as well be straight sugar. I had a bad feeling and almost considered not using them as a test, but I needed to confirm. I bought a small bag of dates and immediately felt sick after eating some. Ate a few more of the dates the next day and around 2pm crashed for nearly FOUR hours. Good to know.

DIGGING IN THE DIRT/MOLD THEORY:  This was the last test. I cut all my lettuce and gave it to the food bank then the next morning I dug out all the roots. I dug deep and got my nose down in the dirt to make sure the exposure was good. No fatigue at all.


Conclusion:

Besides the normal dietary restrictions of gluten, sweeteners, dairy, tomatoes, mushrooms, pork, shellfish, high glycemic fruits, juices, junk food and processed foods:

*Stay away from hot baths.
*Stay away from bath during city treatment periods.
*Stay away from flours or grains (other than rice).
*Stay away from dried fruits.

*Limit egg intake.

*Continue limiting rice intake no more than once every ten days.

*Avoid potatoes and yogurt because they aren't on the Paleo-Hashimoto's diet, but if I treat myself, I know these items not causing the fatigue.

*Hay fever reeks havoc on my body. Oh well.

*Stay away from chemicals. Knew that.

The closer I get to following Dr. Kharrazian's Hashimoto's diet, the better I feel. The rice is still a cheat but I don't have a clue why it makes me insane not to eat it. I'll avoid potatoes and yogurt, also cheats, even though they don't affect me. That random fatigue episode after the hay fever reaction is puzzling, but I feel closer to an answer. Non-scientific tests done at home without laboratory control are really inconclusive at best. I have no idea if combinations of things create the fatigue or other variables, but this is the best I could do.

The plan and challenges took about two months total. I'm so tired of eating pot roast...