I was fortunate to have attended a seminar about nutrition and soft tissue injuries in June of 1993. One of many valuable things I learned was the existence of a laboratory test to measure stress hormones. I became the first doctor in New York state to begin using salivary analysis for the adrenal hormones cortisol and DHEA. In June of 1997, I was on NBC news for a story about a "new stress test". It was all about the Adrenal Stress Index test, which was introduced by Diagnos Techs Laboratory. I was unpleasantly surprised when I watched the segment on T.V. and heard critiques of the test from two conventional medicine doctors. One of these doctors, an "anti-quackery" activist, embarrassed himself by stating that the Adrenal Stress Index test could not be a valid test because the adrenal hormones appear at too low a concentration in saliva to be measured - only parts per billion. He was correct about the concentration of these hormones in saliva. However, the fact is that technology allows us to measure down to parts per trillion! 
 

The adrenals are a pair of small glands located atop the kidneys (one on each side). One of the important duties of these glands is to produce the long-acting stress hormones, cortisol and DHEA. It may seem intuitive that stress hormones are bad -  we don't want much of those. True, we don't want too much of those, but too little is also bad. It's the "Goldilocks principle" - we want our level of stress hormones to be just right. Many critical functions are regulated in part by the stress hormones. Some of these include: energy production, immune function, tissue repair, sleep-wake cycle, mood, memory, reproductive function, detoxification...virtually every body organ and function is influenced by these hormones.

There is a normal "baseline" level of these hormones that are secreted by the adrenal glands, circulate throughout the body and influence the activity of other organs. Typically, under stress, production of these hormones is increased. This allows for changes within the body to better deal with whatever is challenging it. If we are being chased by a "saber-toothed tiger" it is helpful to have protein broken down to sugar to fuel quick energy production for example. What if the "saber-toothed tiger" never goes away? It doesn't matter if that tiger is imaginary. The effects on our stress response will be the same. Many people in our society are dealing with saber-toothed tigers all day. Our mental stress is our own "fault" to some degree; most of us could be doing a better job in dealing with it. This is one of the important factors in achieving healthy adrenal function - stress management. This can take the form of meditation. deep breathing, psychological counseling, guided imagery, and listening to relaxing music to name a few. Some other tools include coherence training as taught by the Institute of Heart Math, massage, and acupuncture.

Importantly, physical type stressors have the same effects on our adrenal glands as does mental-emotional stress. Inflammation and blood sugar dysregulation are two common forms of physiological stress. Dietary factors are major contributors to both blood sugar swings and chronic inflammation. Some other underlying issues that cause inflammation include: infections, dysbiosis (imbalanced intestinal flora), environmental toxins, inadequate sleep, biomechanical stress, obesity, and eating foods your immune system doesn't tolerate. Among the many vicious cycles that can get established in the body, mental stress and blood sugar problems can contribute to inflammation and vice versa.
 

Short episodes of stress are not deleterious. When the stress is prolonged trouble begins. Initially what happens typically is that cortisol levels remain elevated and DHEA levels plummet. This puts the body into a catabolic state where everything begins to breakdown - from muscle, to bone, to intestine, to brain. For detailed discussions of this, see my articles: DHEA - The Real Story and Stress-Proof Your Brain. 
 

Commonly, if there is not appropriate intervention to reverse this downward spiral, the individual winds up with exhausted adrenal glands that can no longer produce adequate cortisol or DHEA. This stage of stress adaptation is called adrenal fatigue or adrenal exhaustion. The effects in the body are somewhat different with low cortisol. Cortisol is a major anti-inflammatory hormone. It helps to reduce inflammation. Without adequate cortisol, pain and inflammatory conditions develop and worsen. Cortisol also helps to normalize drops in blood sugar. Inadequate cortisol output therefore results in low blood sugar. People with adrenal fatigue commonly experience exhaustion, lethargy, lack of motivation, fatigue after exercise, low blood sugar, anxiety, allergies, depressed immune activity, autoimmune disorders, headache, hypothyroidism, chronic fatigue syndrome, fibromyalgia, environmental sensitivities, low blood pressure, seasonal and atypical depression, and poor stress tolerance. DHEA is a major precursor of male and female sex hormones in older men and women. Adrenal exhaustion therefore can have negative effects on bone, muscle, body fat, skin, arteries, mood, libido, sexual function, blood sugar, and more.

Salivary analysis of cortisol and DHEA measures the biologically active free hormone. This is more meaningful than measuring total hormone, most of which is protein-bound and inactive. Total hormone is what is measured from blood specimens. Saliva is also valuable because it is a practical way of evaluating the circadian output; cortisol levels fluctuate over the day. High levels of cortisol in the early morning help to wake us up. Abnormally low morning cortisol is the first sign of adrenal fatigue. Levels of cortisol should gradually fall over the day. Low nighttime cortisol is conducive to physical and mental regeneration during sleep. Elevated nighttime cortisol is associated with insomnia and depression. The Adrenal Stress Index test analyzes cortisol from four saliva specimens collected in one day: early morning, noon, late afternoon, and midnight. The lab constructs a graph from the cortisol measurements and shows how the individual's circadian rhythm compares with normal. I have seen quite a variety of cortisol secretion patterns with this test. Taking into account mental stress, exercise and dietary factors on the day the samples are collected can aid interpretation of the results. I tell my patients to stick to their typical routine on the day of the test. If you normally skip breakfast and that causes a compensatory rise in your noon cortisol, that is good to learn with the test. The Adrenal Stress Index test plots a ratio of cortisol to DHEA, which helps to determine if the patient is prone to tissue breakdown.
 

Abnormal Adrenal Stress Index test results should be treated by investigating and addressing the possible contributing stressors. Again, the most common ones are mental-emotional, inflammation, and swings in blood sugar. However, removing the precipitating stressors is often not enough. Without some help, the hypothalamic-pituitary-adrenal system can remain locked in a hyper stress response mode. Additionally, restoration of normal adrenal hormone output in adrenal exhaustion, and physical "healing" of the adrenal glands is facilitated by some targeted therapies. For example, a short course of pregnenolone can supply the precursor for cortisol and DHEA production, restoring normal hormone levels and taking strain off the adrenals. Pregnenolone is a hormone that is manufactured in the body from cholesterol and is available as a supplement. Cortico-B5B6 is a good formula for adrenal exhaustion. It contains vitamin C, which is more concentrated in the adrenal glands than any other tissue. It contains bioflavonoids, which help to strengthen the adrenal gland capillaries, which are overworked in stressful states. Cortico B5B6, as the name implies, contains effective amounts of vitamins B5 and B6. Vitamin B5 plays an important role in adrenal hormone production and vitamin B6 normalizes cellular response to cortisol.

When the adrenal glands are overworked, the individual feels stressed, and/or the adrenal hormones are out of balance, there are a number of other nutritional supplements that can be of benefit. Certain products are calming and help to reduce feelings of stress. NuSera, L-Theanine, and inositol are a few such supplements backed by research. In cases of low cortisol, licorice root (glycyrrhiza glabra) can be used to help to raise cortisol levels. Other supplements, like phosphorylated serine, lower cortisol levels. There are quite a few valuable adaptogenic herbs. Adaptogens are substances that have normalizing effects, whether activity is too low or too high. I use several different adaptogenic formulas with my patients - mostly those produced by Metagenics. The one I use the most is Adreset, which is particularly good for adrenal fatigue.(See sidebar for more on Adreset).

I recommend everyone have an analysis of their adrenal hormones. The single best test for this, in my opinion, is the Adrenal Stress Index (see sidebar for more). Evaluating and treating adrenal imbalance can be the missing piece to solving complex health puzzles.

  
  "A Natural Approach to Autoimmune Disease"

Webinar presented by Joseph Debé, DC, DACBN, CDN

Date: Thursday, December 11th, 2014

Time: 7:00 PM-9:00 PM, EST

Investment:

LIDA Members: Free

Non-LIDA Members: $25

Non-LIDA Member Students: $5

This Webinar Has Been Approved For 2 CPE Credits By The CDR.

This webinar will give an overview of the role of alternative interventions for autoimmune conditions. Potential contributing factors to autoimmunity will be reviewed. Learn two probable explanations for autoimmunity affecting females three times more than males. The critical roles of dysbiosis, food sensitivity, and leaky gut syndrome in compromising immune tolerance will be highlighted. The concept of "cross reactions" will be discussed. Targeted nutritional and lifestyle interventions to reduce inflammation and modulate lymphocyte phenotype will be reviewed. Functional medicine lab tests to personalize the program and identify potential contributing factors to the autoimmune process in the individual patient will be discussed.

To register for this event, please click on the link: http://eatrightli.org/autoimmune-webinar.html

You will receive an email confirmation shortly after. Information for webinar access will be emailed to you 48 hours prior to the live webinar date.

If you have any further questions, please contact Tracey Giambertone at: traceygiambertone@gmail.com.

Please note a recording of this webinar will be archived for one year after the live date. Please plan accordingly.