Interviewer: Gail Edgell
Gail Edgell: Could you tell us what DHEA is?
Dr. Cabeca: DHEA is an adrenal hormone. It is produced by the adrenal glands, which are the glands that sit above the kidneys. The adrenal glands are responsible for our “fight or flight” response system. What do I mean by that? In ancient times, if our ancestors were under stress — they faced a tiger when they were out hunting, for example — the adrenal glands would kick in and pour out the hormones that they needed to react. As the adrenalin gets pumped out, the body responds appropriately. The other hormone that is pumped out is cortisol. It also helps you respond to stress, keeps you awake and alert, with a heightened awareness. Then it decreases inflammation in the body to calm things back down.
In the 21st century, we are bombarded with stress. Women have many hats to wear — that of mother, friend, worker, professional, car-pool advocate, etc. They just have so many roles that they don’t get a chance to have an adrenal recovery, which can lead to adrenal fatigue. One way that we monitor that is to look at the adrenal hormones DHEA and cortisol. When we look at DHEA in the blood, we look at DHEA sulfate; when we look at it in saliva, we look at DHEA. We look at cortisol to monitor its production throughout the day, to see the adrenal response or adrenal stress response throughout the day.
Gail Edgell: How does this change as a woman gets into her 40s and 50s?
Dr. Cabeca: Often, a woman’s adrenal hormones, just like her ovarian hormones, tend to decrease with age. As a woman ages, DHEA can also decrease. DHEA is responsible for many of the same factors that I talked about with testosterone: muscle strength, memory, energy, cognition. When it starts to deplete, it decreases the adrenal reserve. She is more likely to get viruses, the flu, colds and not recover as well after a surgery. And the body is not pumping out as much cortisol, which is a natural anti-inflammatory. This causes more arthritis and muscle aches as well. So we want to maintain adrenal hormones at the optimal level.
Gail Edgell: Can they be replaced with food or supplements? How can women get more DHEA in their bodies?
Dr. Cabeca: The first thing I recommend is therapeutic lifestyle changes. With adrenal fatigue, you’re just tired and worn out. You need to start living within your adrenal reserve. The way you do that is by modifying the things you normally do. For example, if you’re running carpool and volunteering for many jobs at work or school, you need to start saying “No.” Cut back on what you are doing and learn to live within your adrenal reserve.
Adrenal fatigue is a burnout experienced because of a response to stress or illness, cancer, chemotherapy, medications. All of them can affect the function of the adrenal glands. When I have a patient, I measure their DHEA — typically in the blood, while I am measuring other sex steroids such as estrogen, progesterone and testosterone. I may measure aldosterone as well. I also will have the patient do morning, noon, midafternoon and evening salivary collections. That way, I can not only see DHEA but also cortisol levels at those four specific points. They should be nice and high in the morning — we wake up energetic and ready to start the day — and then go to an even, low range in the evening.
Some patients will have a flat line there. They will tell me that even though they’ve slept eight hours, they don’t feel rested, or they wake up tired. That also gives me an idea of what is going on with their adrenal glands — that is classic for adrenal fatigue. The symptoms are the ones we’ve described but also food cravings and abdominal weight gain. That complaint that a woman has gained 3 inches in the waist and it just keeps piling on, that’s an imbalance in hormones, often estrogen dominance but also a response to cortisol. The body is working to pump out cortisol in a response to stress, and she is piling it all on in the middle and saving it for later. But later never comes because she is always under stress.
Gail Edgell: Really, the first line of defense with getting your adrenals under control is to look at how stressful your life is and what kind of adjustments you can make. Can you take out something and perhaps put in yoga, meditation, deep breathing, something that is going to lower your stress level?
Dr. Cabeca: Absolutely. And get enough rest. You cannot heal your adrenals unless you are sleeping. I like my patients to sleep a good eight hours a night or more. Without adequate sleep, the body cannot regenerate itself to deal with the stresses of the next day.
Secondly, begin taking supplements to nourish your adrenal glands. The basic foundation includes a high-quality multivitamin and mineral supplements as well as essential fatty acids — that is, the omega-3 fatty acids, typically 3 grams a day. It’s important to know that the adrenal glands contain more Vitamin C than any organ in the body. And you can burn through a year’s supply of B vitamins in a few weeks of extreme stress. It’s important to restore this deficiency by supplying adequate amounts of these vitamins. Sometimes, I have to prescribe hydrocortisone or DHEA as a supplement. I also like to use some Chinese or Native American herbs, commonly ashwagandha, Siberian ginseng, rhodiola, licorice root. And then, if I need to use hormones, I use DHEA and pregnenolone.
Gail Edgell: Could you sum up what we have learned about DHEA?
Dr. Cabeca: Identify your stressors. Gain control over your stressors. Rest, and get a good night’s sleep. Improve your diet, and evaluate what your body needs. Listen to what it’s telling you, and live within your adrenal reserve. When you have your hormone levels tested, ask that your DHEA level be tested, too. If you’re testing in the blood, you’re looking at DHEA sulfate; if you’re testing in the saliva, you’re looking at DHEA and a cortisol stress panel. Typically, you want your results to be in the higher range of “normal” lab results because you want to be in optimal health. If you have a good level of DHEA, then you have a better defense system, and you will have more energy.
One more thing that I want to mention that we don’t talk about enough is just to be patient. You can’t get in shape overnight, especially if you have adrenal fatigue or depleted DHEA. It’s probably one of the hardest hormones to get back up. Surrender your bad habits. Stop your caffeine intake — you will actually have more energy. Caffeine is one of the body’s main stressors. Excess alcohol and sugar can all deplete your DHEA and affect you cortisol and adrenal glands. Live within your adrenal reserve, and be good to yourself. Be patient, and take the time you need to heal.
I have more information on my Web site, www.cabecahealth.com, and I am glad to answer any questions.
Note: This article is an edited transcript of an audio interview. Changes have been made.