How Do I Know When to Reduce My Stress Dose?

A question I see often in ALL of the adrenal insufficiency support groups groups is, “How do I know when to reduce my stress dose?” Here is how I know:

About 3 weeks ago I injured my back. I’m prone to annular tears between my lumbar and sacral spine. I was in a lot of constant pain and could hardly move. So I had to stress dose. (Double my normal dose, but as a “sick” profile NOT doubling my normal basal program.) I couldn’t afford the $200 self pay for the chiropractor, so I decided to treat it with CBD and yoga. It was very painful and difficult to do yoga when it hurt to move, but it was also effective, so steadily it has gotten better.

So now here I am back to my “normal”, which does include some back pain, but manageable. I’ve been on my 60mg profile for this whole 3 weeks. Seems like a long time, but I have certain signs I look for to know when it’s time to reduce. I’ve found over the years that if I drop my dose down too soon or too quickly then I sabotage myself and make the whole process much longer and more challenging. Even with my stress dose I was feeling exhausted, not a whole lot of appetite, and I was feeling overwhelmed with all the tasks piling up around the house.

Things have been slowly improving and I started to wonder when it was time to reduce the dose. Today I saw ALL the signs. Before you reduce your dose from an injury use this checklist:

**NOTE: This only pertains to stress dosing. Do not change your daily replacement dose based on this criteria. Please discuss all dosage decisions with your doctor.**

1. Pain is well controlled.

I’m still taking CBD twice daily and doing yoga a few times a week to keep my back stretched and strengthened.


2. Energy is good.

I had a very productive day and checked everything off my to do list for once. I cleaned up the house, did laundry, baked, even had time to read.

3. In control.

As in not overwhelmed or frustrated.


4. Appetite is good.

I have been more hungry today than in the last week. More than normal hungry, so that’s a big clue.


5. Waking up earlier.

I try to be out of bed by 8, but on pain days that’s a struggle. I know I’m feeling better when I’m out of bed on time with no issues.

It was pointed out by another knowledgeable cortisol pumper that one thing NOT on my checklist is weight. I do not use my weight to determine when to decrease my stress dose. Fluctuations in weight can be misleading and sometimes can be due to water retention from being less active while sick or injured, or weight gain can be from…not sure the polite way to say this…being full of poop. Its not uncommon for people to get a little constipated while sick, on pain medications or antibiotics. Antibiotics can kill off intestinal flora which can cause some GI upsets long after whatever infection caused you to need the antibiotics in the first place.

Sadly, all too often I see people with adrenal insufficiency cause themselves so much unnecessary suffering because they think they look puffy, or their scale went up 5-10lbs, or they’re just afraid of possible weight gain. They disregard their current quality of life and begin a difficult and sometimes traumatic steroid decrease too soon. I’ve been guilty of this myself plenty of times, enough that I’ve finally learned my lesson.

I hope this helps someone out! It always feels like a gamble deciding when to reduce. Sometimes I think steroid guilt drives us to cut down too soon and we suffer longer.

**NOTE: This only pertains to stress dosing. Do not change your daily replacement dose based on this criteria. Please discuss all dosage decisions with your doctor.**

UPDATE: Please check out thecortisolpump.com a comprehensive and research based guide to cortisol pumping!

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