The use of physiologic, subreplacement doses of cortisol has proven to be a godsend for many of my patients with these and other conditions. A young, healthy person produces 20–30 mg of cortisol per day. My starting dose of slow-release biologically identical cortisol is 1.25–2.5 mg per day, and I adjust the dosage incrementally as symptoms warrant. Along with this, I also recommend that patients take dehydroepiandrosterone (DHEA), another hormone produced by the adrenal glands. The amount of DHEA produced by the adrenal cortex is greater than that of any of the other adrenal hormones, including the androgens (androstenedione and testosterone) and the estrogens (estradiol, estrone, and estriol).
Levels of DHEA and its derivative, DHEAS, peak in young adulthood and then begin to decline. By the age of seventy, your DHEA level may be less than a fifth of what it was at the age of twenty. In elderly adults, higher levels of DHEA correspond with better health and longevity. When blood levels are low, supplemental DHEA often enhances energy, immunity, and libido.
A healthy diet is also important for anyone with adrenal insufficiency. If low blood sugar is a problem, you may find it helpful to eat several small meals during the day. Make sure to include adequate protein and reduce or eliminate refined carbohydrates, caffeine, and alcohol, all of which stress the adrenal glands.
Nutritional supplements are also vital. You can find more on this important topic in appendix C, but for now, I want to mention one nutrient in particular that is crucial to healthy adrenal glands: vitamin C. The adrenal cortex has the highest concentration of vitamin C of all the organs in the body, and the cells of this gland use it at a higher rate than any other cells. Vitamin C enhances immunity, which is often impaired in those with adrenal insufficiency. During times of stress, our bodies excrete vitamin C more rapidly, making our need for this vitamin even greater.
I advise all of my adult patients to supplement with 3,000–6,000 mg of vitamin C per day. A slow-release buffered form is best to prevent over acidity of the stomach and to ensure sustained blood levels throughout the day.