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From the Townsend Letter
November 2012

Glucocorticoids Are Orthomolecular Hormones
review by Owen Fonorow
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Safe Uses of Cortisol
by William Mck. Jefferies, MD
Charles C. Thomas Pub. Ltd., 3rd edition
©2004; paperback; $46.95; 208 pp.

Safe Uses of Cortisol, 3rd edition,saved my life. It authoritatively corrects a major error in the training and common knowledge of modern medical doctors. Cortisol, like every other hormone, diminishes with age, and most people can benefit from cortisol replacement therapy. Jefferies's book documents how replenishing this hormone, contrary to current medical thinking, can have wondrous therapeutic effects, especially in those of us with adrenal insufficiency.

When patients with adrenal insufficiency are treated according to these principles, they can live perfectly normal, healthy lives. In some respects, they seem to be healthier than many persons without adrenal insufficiency in that they often appear to have more energy, less fatigue, and a greater resistance to at least some types of infection.

Medical doctors have been indoctrinated that cortisol replacement is dangerous, and knowing that levels vary constantly, they generally neglect cortisol levels in patients. This neglect promotes a potentially disastrous hormone deficiency, leading to much unnecessary pain, illness, and early death.

It is important to understand that glucocorticoid "drugs"; for example, hydrocortisone, prednisone, methyl prednisolone, Cortef, and so on, are cortisol or one of its analogs. This was news to me, and may be news to many doctors. Taking one of these drugs is little more than hormone replacement, although equivalent dosages differ among them in milligrams. For example, 1 mg of prednisone or methyl prednisolone is equivalent to 5 mg hydrocortisone. The unstressed human body makes about 35 mg of cortisol (the equivalent of 7 mg of prednisone) in the adrenal cortex every day. Prescriptions that exceed these dosages are dangerous.

Cortisone and hydrocortisone (cortisol) are different. Hydrocortisone, less any fillers, is the bioequivalent of cortisol and this was the hormone given to almost all of Jefferies's patients in the case studies.

The title of the book has also been changed to Safe Uses of Cortisol, since cortisol is the glucocorticoid normally produced by the human adrenal cortex and cortisone must be converted to cortisol before it can produce its characteristic beneficial effects.

With doctors wrongly taught about cortisol, (and ferocious in their belief that what they were taught is correct), it is not surprising that most people are afraid of these steroids. However, after one learns that glucocorticoids are orthomolecular natural hormones, the substantial fear that has been created about their use can subside. The author's consistent theme is that low dosages, what he terms physiologic dosages, below what the body would otherwise endogenously produce, can be safely administered with a wide-spectrum therapeutic potential.

To illustrate the safety of his approach, developed over 50 years as a practicing endocrinologist, Jefferies treated infertility with physiologic dosages of cortisol. The hormone was given by him during the full term and resulted in more than 200 pregnancies. The author then monitored the healthy offspring for another 30 years.

That cortisone and cortisol are normal hormones of the adrenal cortex implies that in physiologic dosages they must be safe.

This implication is confirmed by the clinical experience of patients with adrenal insufficiency or congenital adrenal hyperplasia. When give suitable maintenance dosages, they can take cortisone or cortisol indefinitely without undesirable side effects and enjoy perfectly normal health. Other patients in our clinics have received small, physiologic dosages of cortisone or cortisol for various conditions that will be described later, totaling over one thousand patients years of experience. Other than an occasional incidence of acid indigestion, usually resulting from taking the steroid on an empty stomach, or a rare instance of the patient being allergic to an ingredient in the filler of the steroid tablet, no undesirable side effects whatsoever have occurred.

It is not generally realized that the dangerous side effect of glucocorticoid therapy occurs only with certain dosages and not with others. That there is a tremendous difference between the effects of small "physiologic" dosages and those of larger "pharmacologic" dosages has not been emphasized.

I happen to be in my late 50s. After a long undiagnosed respiratory illness that required hospitalizations and constant monitoring by teams of specialists, I began to suspect that my problems might be related to low cortisol. Not one doctor agreed, nor could even one medical doctor explain why a cortisol replacement worked so well. Then, when a second rheumatologist refused to prescribe methyl prednisolone (a cortisol analog) after I had found it useful, telling me that this steroid was "the most dangerous drug that he prescribes," I began research hoping to find the reasons why and how a hormone could be dangerous. Fortunately, I found Safe Uses of Cortisol. It was easy to read and explained everything about my recent illness. The only thing that the book does not explain: If this information was already so well known, why don't highly trained doctors know about it? (And thus why did I have to spend two weeks in intensive care during two separate hospitalizations?)

A basic principle is that supplemental cortisol does not increase the total amount of cortisol in the bloodstream when administered below what the body would otherwise make; that is, the body senses, and the brain controls, the total amount of cortisol, or what you might call a "set point." Small doses of supplemental cortisol simply means that the adrenals are asked to create less, effectively resting them and giving them more capacity for stress. It turns out that the replacement dosage (determined in part from adrenalectomized breast cancer patients) is 35 to 40 mg of hydrocortisone (or 7 to 8 mg prednisone), or exactly what I determined through trial and error that I required for symptomatic relief of severe rheumatoid arthritis symptoms. The most common physiologic dosage used by Jefferies in his case studies was about half the replacement dosage.

Strangely, this dosage is constant and does not vary much based on gender or body weight.

The cases studies cover a variety of conditions. They include girls, in puberty, whose small breasts developed normally on the recommended physiologic dosages, to cases of male and female acne clearing, to solving infertility and miscarriage problems, to eliminating chronic fatigue and "autoimmune" and other syndromes caused by hormonal imbalances. Basically the same physiologic dosage treatment was successful in all cases. The explanation is that after the adrenal cortex becomes fatigued or atrophies, the increasing signals from the brain (hypothalamus-pituitary-adrenal [HPA] axis) trying to stimulate cortisol production can lead to imbalances of other hormones produced by the adrenals. Jefferies's cases illustrate that resting the adrenals with subreplacement cortisol leads to all sorts of miracles that seem to bear no direct relationship with the known functions of cortisol.

Jefferies begins the 3rd edition by describing the effect that the influenza virus has on the pituitary (which emits a hormone controlling cortisol levels.)

In the seven years that have elapsed since Safe Uses of Cortisol, Second Edition was published, an important question that was raised at that time has been answered. We now know that the influenza virus attacks the human body by impairing the production of adrenocorticotropic hormone (ACTH), which, in turn, impairs the production of cortisol, the only hormone that is absolutely essential for life.

Jefferies had observed as early as the 1960s that for some reason, cortisol levels go down (rather than up) in the beginning of the flu, the opposite of how a "stress" hormone should react. He suspected the flu was attacking the ACTH production in the pituitary. His 1971 paper about this was rejected by medical journals because of a “lack of evidence.” Later a team in 2004 duplicated his results with a larger population and published the result. Among many other implications, it means that an ideal treatment for the flu (and other infections) is cortisol or one of its analogs.

For more severe illnesses, such as acute influenza, immediately increasing the dosage of cortisol to 20 mg four times daily until they feel completely well, which usually occurs within three or four days, then decreasing to 15 mg four times daily for one day, then to 10 mg four times daily for one day, then to the basic dosage (section assumes adrenal fatigue) of 5, 7.5, or 10 mg four times daily there after, is usually adequate. In some severe illnesses, it may be necessary to increase the dosage of cortisol to as much as 120 mg daily (30 mg four times daily), in order to achieve optimum clinical improvement. Once this has been achieved, tapering the dosage by 20 mg daily until the maintenance dosage is reached has usually been satisfactory.

Medical doctors, medical students, and patients who read this book, after the cognitive dissonance passes, will learn about a wide variety of treatable conditions caused by the general lack of or inability to make enough cortisol. Everyone makes some cortisol, or they wouldn't be alive more than a day or two. But doctors don't realize that the production can become significantly impaired, leading to a wide variety of painful symptoms caused by generalized inflammation.

Currently, finding a properly educated physician will always be the most difficult part of cortisol hormone replacement. This is one reason why I think that this book will prove even more valuable to the alternative medical doctors. Patients cannot obtain cortisol without a prescription, but all medical doctors with the legal authority to write the prescription have being taught wrong and thus they are entirely ignorant about safe usage. Most doctors are unwilling to prescribe long-term cortisol, deferring to rheumatologists. Rheumatologists avoid these drugs like the plague. The result is that long-term prescriptions are almost impossible to obtain, leaving patients with unrecognized adrenal insufficiency in pain. The doctor who reads Safe Uses of Cortisol will be able prescribe cortisol safely, and thus satisfy a potentially high demand. (Patients are brainwashed against these drugs too, but as the many cases illustrate, the benefits and alleviation of symptoms are so dramatic, that patients will continue with the program, once they are assured of its safety.)

Ironically, I came to understand that both my rheumatologists were correct: Doctors who have not read Safe Uses of Cortisol (or found equivalent knowledge elsewhere) cannot safely prescribe cortisol or one of its analogs. Alternative doctors can easily fill this void after reading this book.


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