ShaunP.>
Hi Carol, I am sure I have posted here a while back and I just posted it the new board last week so it seems to be a issue needs to be revisited often. If you and your daughter understand what is happening that is causing the weight problem in relation to her hc replacement it may help. I agree with Sandra, the diet pill route is not the answer and I am suprised a doctor would suggest it for a 13 year old. He/she does not have a good grasp of nutrition and CAH.
Dick is the resident Bio-chemistry Professor on the Addisons board and he always posts informatively on a wide range of issues. This was his explanation on gluconegenisis and the fact that when you eat in relation to the hc doses will affect your weight. I hope this helps. TCShaunP
Hi All,
I have posted on the timing and the doses of cortisol replacement in relation to weight control before, but I can?t find what I wrote in my files. I believe that Lita?s situation was the catalyst for this discussion. So here goes. Remember that I am not a physician.
Bottom Line for Smaller Bottoms: You want to spread your cortisol replacement dose out through the day and divide it into at least three doses, with the largest does in the morning and the smallest in the evening. You want to find the minimum effective dose of replacement under this regimen which leaves you feeling really well and enables to respond to minor ?stress and emergency?. You should eat regular well-balanced meals of appropriate size (including breakfast). You need regular exercise. Here is the rationale.
One, but certainly not the only, functions of cortisol in the body is to stimulate the process known as gluconeogenesis. This word is a real mouth full so lets take it apart. Gluco as in glucose = blood sugar, the main carbohydrate building block in nature; neo = new; genesis = begin or beginning. So cortisol stimulates the conversion of fat and protein in our bodies to glucose for energy and for all the construction processes our body depends upon. The process is reversible. The foods that we eat can be converted into protein and fat and cortisol is the mediator that facilitates all of this molecular interconversion.
If you take a big dose of cortisol/HC/prednisone, and the body is not fighting an infection or some other emergency, then there is a lot of gluconeogenesis (sugar synthesis) that takes place as long as there is cortisol in your blood stream to stimulate it. If you take a smaller dose then there is less glucose synthesis and utilization. Remember that after its absorption, the level of cortisol decreases as it is metabolized and excreted. The time that this takes is measured by its half-life, the time it takes to reduce its concentration by 50%. There are a number of factors which affect half-life: our genetics, other drugs we are taking, and most importantly for women, those female hormones that are made either in your ovaries or taken by replacement. So for a woman with a normal menstrual cycle, the half-life of cortisol will vary somewhat through cycle. This means that the amount of cortisol in the blood stream, which can facilitate glucose synthesis (and possible weight gain), will also vary. Some take prednisone because they need, or do better on a cortisol replacement with a longer half life. Brad (below) seems to need a really high level of cortisol replacement in his blood stream so he take dexamethasone which has the longest half life of all the cortisol replacements used.
As all diabetics know, glucose utilization in our bodies is also controlled by insulin. For those who have normal pancreatic function insulin secretion increases as the blood sugar level increases. Insulin makes you hungry. In short, a big dose of cortisol at one time can stimulate your appetite and you eat more.
OK, so how do we control this process to maintain our weight at an ?ideal level?. Some of you may be tempted to really cut your cortisol replacement dose in order to achieve a good weight, but remember that cortisol is needed for many body functions. It should be obvious from the presentation above that our dose level is important. We want to take the minimum dose level that will allow us to feel well, really well! We also want to space it out through the day in manner that mimics more normal body secretion. This is best done by taking it at three different times a day, with the highest dose in the morning. For a 30 mg HC person like me, my dose is 15 mg first thing in the AM, 10 mg shortly after lunch, and 5 mg around 6 PM. Others do it differently. This is better than 20-10. We want to take the cortisol so that we are using the glucose derived from our food or our body molecules as energy or for essential cell building, but not for conversion to fat. If we take too much HC all at once, and eat a large meal, then the HC will shift the body into a fat synthesis motif. Those of you with thyroid problems may have more difficulty getting the adjustment made. I think that Katherine and Jenn, among others have worked this out well. Katherine takes her HC at four different times during the day. Obviously exercise is very important, as is regular, and nutritious eating.
Now, how are you going to attack that Thanksgiving feast?
The best to all!
Dick