The salivary test I took to evaluate adrenal function is known as a Adrenal Stress Index (ASI). You spit into a cup 4 times in one day – upon waking, at noon, at 5:00PM, and then before bed. The purpose is to evaluate the amount of cortisol in the system at various points in the day, as well as the level of DHEA. A normal cortisol pattern looks like this:
Relatively high in the morning, and falling over the course of the day. The finely dotted line in the diagram is what’s ideal and represents “normal” adrenal function. Notice how nicely it falls right in the middle of the “acceptable” range throughout the day?
Mine looks like this:
Mine follows the right basic structure…high in the morning and lower the rest of the day, but upon looking at it carefully it’s clear that my cortisol levels during the day (the 2nd and 3rd test at Noon and 5:00PM) are barely higher than my nighttime cortisol level, just before I fall asleep at night. It’s good that it’s not too high, but too low is no party either. No wonder I struggle to get through the day if I don’t have caffeine (I had no caffeine the day of the test). So what does this all mean?
My current doc doesn’t practice this kind of medicine. She didn’t even feel comfortable ordering tests, let alone interpreting them. She referred me to a gynecologist. I made an appointment (it’s not till May) but I may cancel before then because I don’t see how that will be useful. I could look for a naturopathic doctor, but I suspect a lot of them are quacks. I don’t mind spending a lot of money out of pocket for lab tests, even though I’d be lying if I said it wasn’t difficult laying out hundreds and hundreds of dollars on lab testing…but the result is hard evidence…verifiable scientific data. I can’t bring myself to call up someone with N.D. after their name and go pay them $300-400 to look at my labs and advise me. Plus, I suspect they’ll want to set up a whole treatment plan including an expensive intake session, several consultations…all of which would be out of pocket and about 90 miles away. No thanks. I’ll use the internet. If I’m wrong, I’m still likely to be better off than if I had done nothing. Maybe at some point I’ll pay for a consult with Dr. Kruse himself. Considering the options out there he’s actually fairly cost-effective ($250).
Anyway, onward with my research and self-diagnostics.
I’m aware of Dr. Sarah Myhill from the Livin La Vida Low Carb podcast. I’ve heard her speak and liked her. On her website she discusses some possible interpretations for the results of your Adrenal Stress Index. Before I get into that though, here are my ASI test results, once again:
|DHEAS||15.4||2 – 23|
|Cortisol – Morning||9.6||H||3.7 – 9.5|
|Cortisol – Noon||1.3||1.2 – 3.0|
|Cortisol – Evening||0.9||0.6 – 1.9|
|Cortisol – Night||0.5||0.4 – 1|
DHEAS is actually on the high side for someone my age – probably because I’ve been taking a DHEA supplement. Here’s a graph:
Unfortunately I started taking the supplement before getting a baseline, so I don’t know what my DHEA level was at the start of my Leptin Reset. Too bad. I had no idea what I was doing (still don’t really, but now at least I understand the importance of testing).
Cortisol levels low, DHEA borderline or normal. This probably represents the gland beginning to recover after a long rest. DHEA may be used to help patients feel better whilst they continue their programme of rest and rehabilitation.
So according to her, perhaps my adrenals have been taxed but are now on the mend. She doesn’t really address the situation of high AM cortisol and low subsequent levels.
ZRT Labs, who did the testing, returned the following comments with my lab results:
Morning cortisol is high, but levels drop to normal the remainder of the day. The high morning cortisol seen in these test results may indicate a situational stressor (emotional, physical) or low blood sugar level (hypoglycemia), which often occurs in the morning after overnight fasting. Acute situational stressors (e.g., anxiety over unresolved situations, travel, work-related problems, wedding, holiday season, etc.) can raise cortisol levels, which is a normal response to the stressor. Symptoms commonly associated with high cortisol include sugar craving, fatigue, sleep disturbances, anxiety, and depression. If cortisol remains elevated throughout the day (usually associated with a high night cortisol) and over a prolonged period of time (months/years) excessive breakdown of normal tissues (muscle wasting, thinning of skin, bone loss) and immune suppression can eventually result.
They also say this about my testosterone level (a bit off topic here, but I think it’s interesting):
Testosterone is high-normal, which likely is due to the use of oral DHEA therapy. DHEA therapy increases the level of both DHEAS and testosterone. Elevated testosterone may be associated with symptoms of androgen excess (increased facial/body hair, acne, loss of scalp hair). If these symptoms are/become problematic lowering of DHEA dosage is worth considering.
Haven’t seen any of that yet…so steady as she goes, I suppose. Dr. Kruse says that with his patients he aims for hormone levels that are normal-high for people in their 20s. Well, that’s where my DHEA and testosterone are right now…so I’ll keep going with the current supplement.
What I would like to know is what it means to have somewhat high cortisol in the AM and lowish cortisol the rest of the day….and if there’s any way to correct this. I’ll have to keep researching.