Hi folks - 3 months ago a saliva adrenal test showed I had depressed cortisol levels in the morning, with my levels staying mostly flat throughout the remainder of the day (typical cortisol levels are highest in the morning and then taper off throughout the day).

My doc prescribed oral hydrocortisone, 10mg in the am, 5mg in the afternoon, and a saw a drastic reduction in my inflammation, fatigue, and problems getting out of bed upon waking. Over the last few months, I have tapered off on the prescription, and am now taking 5mg in the am, 0mg in the afternoon, with the same improved results at the higher level.

The problem is: if I take any fewer than the 5mg dosage in the a.m. my symptoms come raging back. I am concerned about being on steroids (even at this low level) for too long of a period, and am looking for a suitable alternative. I have heard licorice is a good alternative, but not sure how to dose, or by what means. Tea? Tincture?

Any help is appreciated.

Hi there,

I too have had the adrenal stress index (ASI) saliva test and like you my morning cortisol was depressed, corresponding with my complete inability to get going until lunchtime. I have the added problem of my cortisol levels rising in the evening which gives me a lot of trouble getting to bed and going to sleep. You can check out my results in the EiR blog if you're interested - My Adrenal Stress Index (ASI) Test Results.

Glad to hear you have had some good results with the hydrocortisone. The lack of energy and drive that comes with adrenal fatigue is horrible. I think you're sensible to look for more natural alternatives to hydrocortisone despite the benefits. There is a feedback mechanism that means any cortisol/hydrocortisone you add to the body may over the long run result in the body producing less cortisol itself - and then you're in a worse position than you were to begin with. Having said that the studies I have seen that have found evidence of this negative feedback have used much higher dosages i.e. 20-40mg/day. Still, the risk is there.

From my personal experience I would recommend you give ginseng a go first if you haven't already. For me it acts quickly and doesn't have any side-effects, other than being overstimulating if I take too much. Panax ginseng is most potent so if this is too powerful it's worth trying Siberian which is a bit gentler.

I have also tried licorice in the form of capsules and found it to be very effective. It reportedly blocks the enzyme (11beta-hydroxysteroid dehydrogenase) which converts cortisol to the less active cortisone, thus increasing cortisol levels in the body. My experience is that it does indeed do this. It had me waking up at 7am and feeling able to get up and get on with the day - something I hadn't been able to do for years. However, it quickly began to overstimulate me so I stopped taking it after only 10 days. The worrying part is that the effects did not fully wear off after I stopped taking licorice. I continued to feel overstimulated with a pounding heart and inability to relax. This has in fact persisted for years. I should note that my nervous system and stress response were highly sensitive before I took the licorice so others may get the benefits without the side-effects but I just wanted to warn you. If you look at information on major reputable health websites you will find warnings about it causing high blood pressure and heart problems in some people, so it is definitely something that should be used with caution. Effective but risk would be my conclusion on licorice - so perhaps not such a safe alternative to hydrocortisone!

Besides ginseng and licorice you could look into other herbs referred to as adaptogens - all are used for their ability to help the body cope with stress and promote vitality.

All the best.

Excellent, thanks for the post, Maff. I have the same pattern in the evening as well, where my cortisol levels, although unchanged through most of the day, are in the high end of the "reference range" nearing the midnight hour. I have recently starting having a cup of chamomile tea and a dose of melatonin just before bed, and they have helped immensely with insomnia. I started on 3mg of melatonin, but found it caused me to be very foggy and fatigued come morning, so I have backed off to 1mg nightly with great results.

As far as the Siberian Ginseng, I tried it awhile back before the hydrocortisone, but I did not see any results. Glad to hear that this may only be because it is too weak. I will research Panax and see if that is a better fit.

As for the licorice, I will take your comments into account before proceeding; I have read that it is important to limit the amount of glycyrrhizic acid taken (35mg max), as it does produce some of the side effects you mentioned. Thinking of maybe starting with a tincture so I can start off as slow as needed.

Two interesting points from your blog post I wanted to comment on as well:

1) DHEA. I have recently started taking a sublingual 5mg dose in the morning, but do not have anything to report yet. My saliva tests showed reduced DHEA in addition to the depressed cortisol.

2) Tribulus. My doctor just mentioned this to me as an additional supplement, so glad to hear you saw some good results. Have you heard/used rhodiola or pantothenic acid as well? These were mentioned by my doc in the same context of tribulus.

Would it be helpful for you or others on the forum if I posted my saliva tests as well? I used a lab called Diagnos-Techs, Inc out of Washington state, and in additional to providing results, they offer a great restoration plan tailored to my results, including some of the methods you discuss on your blog post.

Excellent site, btw. Great resource.

No problem! Isn't it infuriating having your diurnal cortisol production essentially the opposite of what it should be. I would give anything to be full of energy and awake in the mornings and tired but relaxed in the evening. Like you I have found that melatonin is a help for sleep (I also take 1mg before bed) but it can't restore my circadian rhythm to nomal by itself unfortunately. Some research has suggested phosphatidylcholine (PS) supplements might reduce nighttime cortisol levels and improve sleep quality but I have been unable to find a definitive guide to form, dosage, or what time to take it. I experimented with it but didn't notice any benefit.

I would think it would be worth you looking into Panax Ginseng if Siberian didn't do anything for you. It is much more potent in my experience.

Yes the problems with licorice are related to the effects of glycyrrhizic acid on mineralocorticoid receptors. It apparently makes them much more sensitive which can result in elevations in blood pressure etc. I'm not sure that explains entirely what I have experienced but it's certainly possible. When you have ME/CFS, gut issues, adrenal fatigue and more...reactions can be very idiosyncratic! Do be very careful if you try it and please let me know if it agrees with you.

DHEA worked wonders for me (until it began giving my liver a hard time). I didn't mention it in my previous post as you said you wanted to come off steroid hormones and it would fall into that bracket. I do feel it is probably best to replace both cortisol and DHEA (by whatever means) if they are both low on an ASI to get the most benefit. My own experience is that they work together and tend to balance each other's actions. I found I got a lot of benefit from 10mg every other day. Obviously best to start low and keep the dose as low as possible with something like this.

Tribulus is also very good and for me at least helps a lot with adrenal fatigue symptoms. Taking 750mg/day makes me feel similar to when I was taking DHEA - but the effect is milder. The bonus of Tribulus is that it supports liver health rather than giving the liver extra work, as DHEA does. Tribulus promotes bile flow and has been shown to increase glutathione levels in a few studies I came across a few years back.

I've tried Rhodiola more than once for extended periods because it has so much positive research and anecdotal reports. Does nothing at all for me though. Pantothenic acid and vitamin C are both important nutrients for the adrenal glands and adrenal hormone production so that's the rationale there. Again, I haven't noticed a tangible improvement when taking substantial dosages unfortunately.

I have had an ASI from Diagnostech before but it didn't come with interpretation or recommendations - perhaps my doctor didn't order them. It would be great to see your report. Could you post them in a blog do you think? If you can't figure that out let me know or you could add the file to your next forum post.

Thanks re: the site. It's not perfect but I do my best and hopefully it is helping a good few people out there!

Quick update: Since my last post I am now down to 2.5mg hydrocortisone / day with no reactions!

I have accomplished this by decreasing the dosage slowly by 1mg / week, and supplementing my regiment with Pantothenic Acid (as Pantethine), Tribulus, additional Vitamin C, and Mucuna Pruriens.

So far so good!

Glad to hear things are going to plan!

Tribulus and Mucuna Pruriens particularly should give you many of the benefits of the hydrocortisone from my experience with them all.

I would just caution that the effects of steroid hormones take a while to wear off even after you have lowered the dosage so it may take a while for you to see how your body is truly reacting. Sounds like you're doing great so far though so I hope it continues and you have a smooth transition!