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Question: I am taking prednisone for a health condition but do not like the side effects. What do you think about taking adrenal cortex extract instead and which brand do you recommend?

Answer: Let me widen your question a bit to make it more general for our readers. That is, what is the best approach to weaning one's self from the long-term use of prednisone and other steroid drugs? Interestingly, about 10-20 percent of the new patients who come to see me have this very concern. These can be people with a wide variety of complaints from asthma (steroid inhalers), rheumatoid arthritis (often maintained on long-term prednisone), colitis (usually they are using cortisone enemas), skin rashes (usually long-term topical cortisone preparations), polymyalgia rheumatica, lupus, many kidney diseases, and so on.

The initial reaction of these patients to the use of these medicines was nothing short of miraculous--pains vanish, bloody diarrhea clears up, and difficult skin problems melt away. Unfortunately, for most people this is the classic Faustian bargain. For within a short time, not only do the original symptoms return, necessitating higher doses, but the side effects of cortisone begin to show up.

The side effects of cortisone, prednisone, and similar drugs are legendary. They include diabetes, osteoporosis, edema of the face, mood swings, stomach ulcers and, very importantly, adrenal suppression. In other words, your own adrenal glands shut off their production of these valuable hormones. Why not, since they essentially have been "told" by the prednisone that the adrenals are no longer needed. This bargain, then, becomes a nightmare as the effectiveness of the drugs wears off, side effects become more serious and the patient is unable to stop taking the medication.

Of all the tragic situations I have dealt with in my practice, this all-too-common occurrence stands at the top of the list.What are we to do? The first answer is to recognize that by definition, if a certain condition will improve with the use of cortisone, then somewhere in its etiology must be an adrenal weakness. That this fact is denied by the medical profession does not make it less true. Therefore, for any condition that is treated in normal medicine with steroid drugs like prednisone or cortisone we should instead be strengthening the adrenal glands.

To do this, we refer to some basic physiology. First, we are dealing with the adrenal cortex, not the medulla (which makes adrenaline). The hormones that the adrenal cortex makes are all derived from our best friend--cholesterol. Yes, cholesterol is the precursor to all the valuable adrenal hormones that help us deal with stress, inflamation and trauma, and that help our body to heal. Therefore adrenal insufficiency (lack of adrenal cortical hormones) is a fat deficiency. So the first step is simple and logical: eat more fat, especially cholesterol-rich animal fat. One of these fats should be cod liver oil to supply vitamin A. The adrenal cortex cannot make adrenal hormones out of cholesterol without vitamin A.

Second, adrenal cortical hormones that control inflammation and other metabolic events are in the class of chemicals called glucocorticoids; their primary function is to regulate sugar balance. You will make their job much much easier if you don't eat any simple sugar and limit your total daily carbohydrate consumption to 75 grams per day. (Read Life Without Bread by Wolfgang Lutz for more information on this.)

Third, cut back on caffeine and caffeine-related substances (such as the bromine in tea) as much as possible. Caffeine works by stimulating the adrenal medulla to produce adrenaline. Then the adrenal cortex must work doubly hard to produce the "chill out" cortisoid hormones.

Fourth, the two major nutrients the adrenal cortex needs to do its job are vitamin B6 and vitamin C. These should be obtained from food sources or whole food supplements. One good source of all three of these vital nutrients is raw milk, which is probably why raw milk fasts have successfully treated many cortisone-related illnesses. Drenamin from Standard Process Laboratories combines these nutrients along with the adrenal protomorphogen to help stimulate the rebuilding of the organ. The beginning dose is 3 tablets 3 times per day.

With many patients, even with hard work on diet and supplements it is still difficult to wean off the prednisone, especially the last 2-5 mg. In these cases I do use an adrenal cortex extract from American Biologics For some, it is the only thing that works. Usually 2-3 drops per day is enough, but often we need to double this amount. I usually keep this going for 6 weeks after the prednisone has been stopped to avoid relapses. All the time during this treatment the diet and Standard Process supplements should continue.

A final word. The adrenal gland is the processor of stress in our bodies. It is there to help us adapt. When we become exhausted by life, on a mental or physical level, our adrenal glands often fail to keep up, and illness ensues.

I define stress as anything that forces us to live contrary to what our inner guide is telling us is right for us. I want to emphasize that we need to follow our inner guide--not our parents, not the church, not our culture, not government nor anyone or anything else. So many people with adrenal illnesses live a life of "should." To me, that is stress. In our comprehensive approach to illness this aspect of our health must be considered as vitally important.

This article appeared in Wise Traditions in Food, Farming and the Healing Arts, the quarterly magazine of the Weston A. Price Foundation, Fall 2003.

About the Author

Thomas Cowan, MD, discovered the work of the two men who would have the most influence on his career while teaching gardening as a Peace Corps volunteer in Swaziland, South Africa. He read Nutrition and Physical Degeneration by Weston Price and a fellow volunteer explained the arcane principles of Rudolf Steiner's biodynamic agriculture. These events inspired him to pursue a medical degree. Cowan graduated from Michigan State University College of Human Medicine in 1984. After his residency in Family Practice at Johnson City Hospital in Johnson City, New York, he set up an anthroposophical medical practice in Peterborough, New Hampshire. Dr. Cowan has served as vice president of the Physicians Association for Anthroposophical Medicine and is a founding board member of the Weston A. Price Foundation.

Dr. Cowan is the author of The Fourfold Path to Healing (New Trends Publishing), a companion book to Nourishing Traditions by Sally Fallon. He a board member of the Weston A. Price Foundation, a regular contributor to our "Ask the Doctor" column and the Foundation's quarterly journal, and has lectured throughout the US and Canada. He has three grown children and currently practices medicine in San Francisco where he resides with his wife Lynda Smith Cowan.

His book The Fourfold Path to Healing is now available from NewTrends Publishing, http://www.newtrendspublishing.com/. Visit Dr. Cowan's website at http://www.fourfoldhealing.com.

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