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Dr. Lowe How to Prepare Patient-to-Patient Fibromyalgia Research Foundation
The Metabolic Treatment |
June 7, 2003 Dr. Lowe: You’ve misunderstood the statement by Dr. Durrant-Peatfield on page 99 of his book. Dr. Durrant-Peatfield, of course, is extremely knowledgeable about cortisol and DHEA, and his statement on that page—like the content of his entire book—is clear, which this is one of many reasons that I strongly recommend the book to patients. Despite its clarity, however, I can see how you might misinterpret the statement. Inside the cells of the adrenal cortex is an enzyme that’s dependent on the vitamin panthothenic acid. When cholesterol enters the adrenal cells, this enzyme converts it to pregnenolone. Dr. Peatfield explains quite correctly that pregnenolone is the "pro-hormone" of the adrenal cortex. This means that it’s the hormone from which all the other hormones of the adrenal cortex are derive. Some of the pregnenolone is converted to cortisol. But some patients’ adrenal cortex cells don’t convert pregnenolone to cortisol at a normal rate. As a result, the patients’ cortisol levels may decrease. As Dr. Durrant-Peatfield writes, in these patients, the pregnenolone that would have been converted to cortisol may instead be converted to DHEA. This may raise the patients’ DHEA levels, and it may increase the ratio of DHEA to cortisol. Researchers have found this pattern—an increased ratio of DHEA to cortisol—in patients with panic disorder.[2] In summary, cells of the adrenal cortex may use less pregnenolone to produce cortisol, and this may divert more pregnenolone into the pathway that leads to DHEA. If so, lab tests may show a low ratio of cortisol to DHEA. This does not mean, however, that DHEA has suppressed the cortisol level. As Dr. Durrant-Peatfield suggests, it simply means that the cells of the adrenal cortex have increased their production of DHEA at the expense of cortisol. References June
6, 2003 Dr. Lowe: The question of whether DHEA will lower a patient’s cortisol level is interesting. Unfortunately, it’s one for which we don’t have a definite answer. The reason is that study results are contradictory. In one study, the cortisol level of healthy older men and women was lower after they took 200 mg of DHEA each day.[1] In another study, though, the secretion of cortisol at night in healthy men didn’t decrease after they took a single dose of 500 mg of DHEA.[2] In another study, perimenopausal women took 50 mg of DHEA for three months. Their blood cortisol level was 13% lower at the end of the study.[3] But in still another study, the cortisol level of schizophrenic patients taking 100 mg of DHEA each day didn’t decrease.[4] Also, researchers gave 12 health rhesus monkeys huge amounts of DHEA for eight weeks. The equivalent dose of DHEA for a 150-pound human being would be 4090 mg for the first four weeks and 5114 mg for the second. During the eight weeks, the monkeys' cortisol levels decrease.[5] With such mixed study results, we simply can’t conclude that DHEA will or won’t lower a particular patient’s cortisol level. To learn whether it will or won’t, we must test the patient’s cortisol response to DHEA on an individual basis. References |
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