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Good information to know about prednisone.
Polymyalgia Rheumatica (PMR) | Last Active: Jul 1 8:15am | Replies (29)Comment receiving replies
So, what can anyone, including docs, do to adjust this cortisol level?
I think it requires testing and close monitoring and most docs don't want to deal with that today. They like pred because it's quick. I don't know how they handle the barrage of complaints about the side effects, which must drive them crazy, and surely they don't have the time to deal with all of them, but that's not my problem. They prob have stock answers at the ready.
At any rate, here's what I found as a first response to the question about how docs adjust cortisol levels:
"Doctors can treat high cortisol levels, also known as hypercortisolism, with medications that control cortisol production in the adrenal glands. These medications include:
Ketoconazole, Osilodrostat (Isturisa), Mitotane (Lysodren), Levoketoconazole (Recorlev), Metyrapone (Metopirone), and Mifepristone (Korlym, Mifeprex).
Medicines to control cortisol production at the adrenal gland include ketoconazole, osilodrostat (Isturisa), mitotane (Lysodren), levoketoconazole (Recorlev), and metyrapone (Metopirone). Mifepristone (Korlym, Mifeprex) is approved for people with Cushing syndrome who have type 2 diabetes or high blood sugar. Jun 7, 2023"
Things we can do to help lower cortisol:
"Here are some things you can do to adjust cortisol levels:
Exercise
Regular exercise can improve cortisol levels in the long term, but some studies suggest that the best intensity level is unclear. The Physical Activity Guidelines for Americans recommend 150 minutes of moderate-intensity exercise and two days of muscle-strengthening activities per week. It's also important to stay hydrated, especially during hot weather.
Stress management
Try relaxation techniques like deep breathing, meditation, or journaling. You can also try spending time with supportive people, taking time for yourself, or setting boundaries in your relationships.
Diet
Eat a balanced diet that includes 30 different types of plants per week, like live yogurt, kimchi, kombucha, kefir, and sauerkraut. Avoid foods that increase cortisol, like caffeine, alcohol, saturated fats, and simple sugars.
Supplements
If recommended by a doctor, supplements like magnesium, vitamin B12, folic acid, and vitamin C can help regulate cortisol levels. "
Getting enough sleep and being out in nature were also suggested.
Best to all.
Replies to "So, what can anyone, including docs, do to adjust this cortisol level? I think it requires..."
I think Dr treating PMR have a pretty tough job. They disease requires long term steroid use.(>two weeks). Its also about the only thing right now that works over night. They try to do some due diligence to make sure its not something else. But they know when they start you on the prednisone it will work over night and you most likely will not be able to taper off. Most testing for how your cortisol is doing requires you be on less than 4mg of prednisone. By then most everyone is having a flare and its almost impossible to reliably test. The patient becomes its own worst enemy. Dr's just try to make it work. I know of no other drug right now that can treat inflammation for PMR as well as corticosteroids. All the things you mentioned are great and yes we should be doing them but how many of us do. The steroid replaces our bodies cortisol. The body has plenty to fight inflammation with this increase in prednisone. Its when you start to taper off the prednisone then you run short because your adrenal system has shut down. All the drugs you mentioned and Cushing's disease are over produced cortisol. Our problem is our bodies have shutdown production or adrenal insufficiency. I know of no other drug that replaces cortisol in our body other than corticosteroids.
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Excellent response!! There really isn't much that can be done to increase cortisol levels.
The treatment for a low cortisol level is a synthetic cortisol like Prednisone or some other corticosteroid. We just have to hope our adrenal function will improve as we taper our Prednisone dose lower. Most of the time that will happen as long as we aren't constantly increasing our dose. It can be very uncomfortable to taper off Prednisone.