Factors that encourage the body to begin producing cortisol again

Welcome @stevieb, Mayo Clinic Connect is not monitored by doctors or medical professionals. We are all patients like yourself and can only share our experience with health conditions and can't share medical advice. There is a discussion on Kratom that you might find helpful - Has anyone heard of Kratom or tried it?: https://connect.mayoclinic.org/discussion/kratom-1/.

Have you discussed your question about the circadian rhythm's affect on stimulating the body to produce cortisol with your rheumatologist or doctor?

What dose of Prednisone are you on at year 3? I have been on prednisone for almost two and have a lot of aches and pains the lower I go! It’s as if the body does not want to get off of it! Where did you hear about this herb as I’m always looking for a more natural approach?

Please note: since I'm a " newbie " I can't post active links. So I've removed the HTTPS: and I replaced the period with a dot. Hope you can figure out how to get to these great videos on cortisol.

I have found several methods to help reduce the Prednisone and to function comfortably .
In 3 years of Prednisone I have never gotten down below 6mgs
(I'm at 7mg now)
But I have neve heard a Rheumatologist or Endocrinologist describe why with all the Cortisol producing techniques I found (no help from those two doctors!)
..... why the body should make enough cortisol to sustain itself if I keep taking Prednisone!

I discovered Kratom before I was diagnosed with PMR.
Before diagnosed I thought my problem were just that I was a 70 year old large wave surfer paying for some rough wipeouts!

I use Mitra Speciosa (Kratom) to relieve aches, fatigue, ans depression.
mitragaiaDOTcom/
Order the "Special Green Malay"

Andrew Hubberman - stimulating Cortisol and the Circadian Cycle
youtu DOTbe/JPX8g8ibKFc?si=g52aFbBF3zQv_zmQ
watch from at least 21:30 to 30:00

youtuDOTbe/gR_f-iwUGY4?si=jjYW71Irk26F9OZi

Here's another good video about why adrenal fatigue is inaccurate, and what is an accurate description of cortisol stimulation : youtuDOTbe/-wmzrW4VO_Y?si=5OCVXE4B0-G5PmqC

I also use a Chinese Herbalist's tonic to help weaning down. This person is a very experienced practitioner that would require at least one in person visit to Washington DC.

Hope this helps!
Steven

Yes.
Both have been useless in terms of going beyond various simplistic strategies. ... "basically wean down until you get sick, increase when you get sick"
There are a few valid studies about increasing Cordisol. But the source is typically Neurologists.
In the back of the bottom of the eye is a receptor that when exposed to sunlight in the morning increases cortisol. When I winter surf in ultra cold water, supposedly it increases dopamine and cortisol....
Herbs and diet can keep the cortisol peaked in the morning and appropriately low in the evening.

What I wanr know that Rheumatologists and Endocrinologists can't explain is how can the natural stimulation of Cordisol "take over" to the needed level as long as I'm taking Prednisone? I'm 73, I surf all the time, yoga, super high protein diet, my wife is a long time acupuncturist. I can create comfort and be really active with the right tools, but at a certain level of Prednisone (currently 6mg) I'm going to get sick with flares

"basically wean down until you get sick, increase when you get sick"

That sums it up nicely!

Taper prednisone slowly until you feel lethargic and your body aches from symptoms of adrenal insufficiency. That assumes you haven't already had a flare of PMR. With a low cortisol level you won't be able to regulate your inflammation levels very well. Since you won't know if you are having a PMR flare or symptoms of adrenal insufficiency and possibly both, increase your prednisone dose again until you feel better. Repeat this process and try to taper your prednisone dose again. If at first you don't succeed try and try again.

The only thing that stopped this cycle for me was a different treatment that stopped me from having PMR flares. My treatment with a biologic which didn't suppress my adrenal function allowed me to stay on low dose (3 mg or less) of prednisone. This allowed my adrenal function to gradually improve in 6 months time. The whole process took a year to have an "adequate" cortisol level. Then and only then could I discontinue prednisone while still on the biologic. This compares to the 12 years that I tried to taper off prednisone with but mostly without other ineffective steroid sparring medications.

For some people, depending on how long they have taken prednisone, their adrenal function may never improve. On the bright side, for most people, their adrenal function will eventually improve assuming their prednisone dose is low enough.

Getting off prednisone is the best way to improve your adrenal function and regain an adequate cortisol level. Otherwise it is a Catch-22.

Wow! what was the "biologic"!?

"For some people, depending on how long they have taken prednisone, their adrenal function may never improve."
So then what???
I'm at 4 mg for the fourth or fifth time. I have some days where fatigue does set in but not every day. Only MTX and Plaquenil have been suggested neither of which I want to take. I feel tempted to have a little caffeine as a perk but a vertigo Meniere's episode is stopping me. Meniere's can be worse than pmr. Right now I have Achilles tendonitis with a bone spur making walking difficult. My heel is hurting already and I haven't gotten out of bed yet.

Can your adrenals really never recover? Anybody on permanent low dose prednisone?

According to my endocrinologist, a maintenance dose of prednisone for the rest of my life would be needed if my adrenal function didn’t improve.

Even after I got off prednisone, my endocrinologist said I shouldn’t hesitate to take prednisone again. She said my adrenal function was “adequate” for “normal days” but my cortisol level probably wasn’t adequate for more stressful days.

I have been off prednisone for 2 years so my cortisol level isn’t checked anymore unless I have symptoms of adrenal insufficiency.

Most of my bad days are due to non-physical stress. But I also feel like my susceptibility to stress is much greater. Previous to PMR I thought of my self as "Mr. Always Calm". Now it's almost embarrassing the low level of stress that can initiate a flare My biggest concern with continued Prednisone use the potential for brittle bones. My orthopedic surgeon buddy says the only reason my bone density tests come back normal is the high level of resistance and weight traing I do. And so even if that training itself initiates flares, it's worth it.

There are many kinds of stress … emotional, physical, environmental, etc.

I talk to a therapist every few months about barriers to weight loss. Everything is fair game to discuss so we have pleasant conversations.

Once near the end of a talk session, I told her that I wanted to tell her about something that I was “curious” about. I thought I was composed enough to talk about something but soon the tears were flowing so I stopped talking.

The therapist was glad I showed her the response I have whenever I THINK about trigeminal neuralgia. The therapist said I had elements of medical induced traumatic stress.