Adrenal Stress Index
The adrenals are two small glands, each weighing 3 to 5 grams, that are located above the kidneys. The adrenals have one of the highest rates of blood flow per gram of tissue, and the highest content of Vitamin C per gram of any tissue in the body. Each adrenal gland is composed of two separate functional entities. The outer zone, or cortex, accounts for 80% to 90% of the gland, and secretes adrenal steroids (Cortisol, DHEA(S) and Aldosterone). The inner zone, or medulla, comprises 10% to 20% of the gland, and secretes the catecholamines adrenaline and nor-adrenaline. Cortisol, DHEA and adrenaline are the three main adrenal stress hormones. The Adrenal Rhythm & Its Importance The human adrenal gland does not secrete its steroid hormones at a constant level throughout the day. The hormones are actually released in a cycle with the highest value in the morning and the lowest value at night. This is easily understood by looking at Figure 1. This 24-hour cycle is called the circadian rhythm. An abnormal adrenal rhythm can influence many functions of the body, some of which are listed below. 1. Energy production Abnormal adrenal function can alter the ability of cells to produce energy for activities of daily living. People who have a hard time rising in the morning, or who suffer with a low energy level during the day, often have abnormal adrenal rhythms and poor blood sugar regulation. The maintenance of a stable blood sugar level depends on food choice, lifestyle, adrenal function and insulin activity. This panel measures stress hormones and insulin, to help ferret out causes of fatigue, cravings and obesity. 2. Muscle & joint function Abnormal adrenal rhythms are known to compromise tissue healing. Reduced tissue repair and increased tissue breakdown can lead to muscle and joint breakdown with chronic pain. 3. Bone health The adrenal rhythm determines how well we build bone. If the night cortisol level is elevated and the morning level is too high, our bones do not rebuild well, and we are more prone to the osteoporotic process. Stress is the enemy of the bones. In postmenopausal women, the effect of stress worsens due to the female hormone imbalances. 4. Immune health Various immune cells (white blood cells) cycle in and out of the spleen and bone marrow for special conditioning, and possible nourishment and instructions. This immune system trafficking follows the cortisol cycle. So, if the cycle is disrupted, especially at night, then the immune system is adversely affected. Short and long-term stress is known to suppress the immune response on the surfaces of our body as in lungs, throat, urinary and intestinal tract. With the reduction in the surface antibody (called secretory IgA), the resistance to infection is reduced and allergic reactions are believed to increase. 5. Sleep quality The ability to enter REM sleep cycles, i.e. regenerative sleep, is interrupted by high cortisol values at night and in the morning. Chronic lack of REM sleep can reduce the mental vitality and vigor of a person and induce depression. 6. Skin regeneration Human skin regenerates mostly during the night. With higher night cortisol values, less skin regeneration takes place. So, a normal cortisol rhythm is essential for optimal skin health (See Figure 2). 7. Thyroid function The level of Cortisol at the cell level controls thyroid hormone production. Quite often, hypothyroid symptoms such as fatigue and low body temperature are due to an adrenal maladaptation. 8. Grain intolerance & stress About 12-18% of the U.S. population suffers from a genetic intol- erance to grain. Specifically, a high incidence occurs in Celtic, Germanic, and Nordic derivation. The gut becomes inflamed within 30 minutes after consuming the grains and this can lead to an adrenal stress response, increased cortisol and reduced DHEA. (Several other functions that go beyond the scope of the pamphlet are also cortisol and DHEA dependent.) The Adrenal Stress Index™ (ASI™) Four saliva samples are used in the ASI™ for the following ten tests: 4 x Cortisol Helps evaluate stress response 2 x Insulin Helps investigate blood sugar control DHEA Helps determine stress adaptation Secretory IgA Helps evaluate toll on immunity17-OH Progesterone Helps determine adrenal reserve Gluten Antibodies Helps identify grain intolerance Your health care provider can use the findings in this panel to recommend customized treatment and preventive measures that may include diet and lifestyle changes, hormones, botanicals and vitamins. Advantages of the ASI™
Abnormal adrenal rhythm can influence:
Do you need the ASI™ Test? To determine if the ASI™ is the appropriate test for assessing your health condition, ask your physician for a stress questionnaire. The score can help your doctor determine a course of action. The ASI™ is mostly ordered for individuals that suffer from:
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Saliva Tests Included: Clinical Purpose: 4 Cortisol Tests (Free Fraction) Allows rhythm integrity assessment Reveals normalcy or fatigue of adrenals DHEA(S) (Free Fraction) Evaluates the anabolic anti-stress potential Is a marker of adrenal adaptation or deterioration (see Diagram 2) 17-Hydroxyprogesterone Is the major precursor of cortisol Helps determine cause of low cortisol output in weak adrenal glands (see Diagram 1) 2 Insulin Tests (Fasting and after meal) Evaluates glycemic control Helps rule out insulin resistance Total Salivary SIgA Evaluates impact of stress on the immune system Gliadin Antibodies (For grain intolerance) Indicator of subclinical gluten intolerance, a contributor to gut inflammation and stress Test ExplanationCortisol Rhythm Description: The panel utilizes four saliva samples (1, 2). Saliva cortisol reflects the Free (bioactive) Fraction of serum cortisol. The test report shows the twenty-four hour diurnal cortisol rhythm generated in response to real life stress. Therapeutic value: The test results facilitate the diagnosis of stress maladaptation and adrenal fatigue. With this data, you can narrow your choices to the most appropriate modalities of treatment. DHEA(S) Description: The panel measures the average DHEA(S)* level for the day using multiple samples. Therapeutic value: The cortisol to DHEA relationship, presented in Diagram 2, highlights the many facets of stress maladaptation. The cortisol to DHEA ratio helps determine the projected time for recovery, and the substances (hormones, supplements, botanicals) that promote this recovery. The cortisol to DHEA ratio regulates a multitude of functions, as expressed in Diagram 2. * Salivary DHEA(S) is found at about 0.1% of its plasma concentration. Serum fluctuations in DHEA(S) concentrations are accurately and rapidly reflected in salivary levels (3). DHEA(S) indicates Free Fractions of both DHEA & DHEA-Sulfate. 17-Hydroxyprogesterone (17-OHP1) Description: The panel measures 17-OHP1 level in order to evaluate efficiency of conversion of adrenal precursors into cortisol. Certain adrenal fatigue patients who are genetically predisposed to low production of cortisol will not benefit from exogenous supplementation of pregnenolone or progesterone. Therapeutic value: By identifying the subpopulation of maladapted and adrenal fatigued individuals who show impaired 17-OHP1 conversion to cortisol, two things are avoided: 1. Treating these patients with precursors (when instead they need cortisol supplements to restore their adrenal health). 2. Pursuing further pituitary related tests and treatments (when they are not needed in this subpopulation). Insulin Description: The panel includes fasting and postprandial insulin measurements. The insulin values are used to diagnose insulin resistance, functional insulin deficit (Pre-Diabetes) and also correlate elevated cortisol with insulin to help explain glycemic dysregulation problems (See Glycemic Dysregulation section). Therapeutic value: The combined results of insulin and cortisol can help in designing an effective glycemic control treatment plan that may include lifestyle modifications, nutritional support and botanical supplementation. Secretory IgA (SIgA) Description: The panel evaluates mucosal immunity by using SIgA as a stress impact biomarker. SIgA values are sensitive to increased cortisol//DHEA ratio and sympathetic tone (Diagram 2). Therapeutic value: By detecting the depressed mucosal immune function in certain patients, a number of therapeutic modalities may be invoked, ranging from botanical supplementation to the controlling of the heart rhythm variability. Gliadin Antibodies Description: The panel includes a gliadin antibody measurement that allows detection of subclinical grain intolerance in affected individuals, even in the absence of overt celiac disease. Therapeutic value: This test allows objective identification of grain intolerant patients, who should restrict their gluten intake to reduce inflammation and adrenal stress. Clinical Presentation of Adrenal DisturbancesBelow is a summary of common clinical findings in adrenal gland dysfunctions: Inadequate Adrenal Symptoms Hyperactive Adrenals Symptoms Weight loss/Anorexia Weight gain/Truncal obesity Progressive Fatigue/Lethargy Emotional Lability/Depression Hypoglycemia Glucose Intolerance Diffuse Muscle & Joint Pains Insulin Resistance Hypercalcemia Osteopenia/Fractures Low Serum Sodium/Salt Cravings Hypertension/Sodium Retention Skin Hyperpigmentation Thin hyperpigmented skin/Striae Clinical Applications of the ASI™ Chronic Pain/Fibromyalgia: An adequate adrenal response can maintain a higher pain threshold (4). The ASI™ is used to evaluate the stress impact of chronic pain and inflammation on adrenal adaptation. A proper diagnosis of low cortisol or DHEA with circadian rhythm disruption is imperative. Subsequent hormone replacement and rhythm correction will improve the individual’s pain tolerance (7, 8). Chronic Fatigue syndrome (CFS): A common HPA axis defect in CFS is impaired corticotrophin release (5). As a result low cortisol and eventual adrenal atrophy may be observed. Depleted adrenals with flat rhythms are often seen on the ASI™ panel (6). Simultaneous use of several therapies can help improve the debilitating CFS. Glycemic Dysregulation: Chronic hypoglycemia can impair normal adrenal function by repetitive overstimulation of cortisol production. Recurring exposure to high cortisol will impair insulin activity, and invariably lead to insulin resistance and beta-cell exhaustion (Diabetes). The ASI™ panel investigates the Insulin-Cortisol relationship under real life conditions to allow targeted and meaningful interventions. This panel is useful in the following clinical situations: rapid weight gain and obesity, deranged blood lipids, sugar blues, early diabetes and associated emotional disturbances. Allergies/Autoimmune Disorders: More than fifty years ago, Dr. W. Jefferies (Author of “Safe Uses of Cortisol”) discovered that patients with environmentally triggered allergies and autoimmune diseases dramatically benefited when given cortisol for other purposes (9). More recently, German researchers reported that disruption of the adrenal axis and cytokine relationships lead to predisposition and aggravation of autoimmune diseases (10). The findings of the ASI™ help identify patients with autoimmune diseases and adrenal problems who can benefit from cortisol supplements. Depression/ADD: Several recent publications (11, 12) report a hyperactive HPA axis in depressed patients. Elevated midnight salivary cortisol is now considered one of the best tests in diagnosing endogenous depression. Other anomalies in cortisol rhythm usually accompany the midnight elevation. On the other hand cortisol elevations and rhythm disruptions throughout the day are typical of attention deficit disorders (ADD). The anomalous cortisol findings in depression and ADD can be successfully diagnosed with the ASI.™ Subsequent interventions to rectify the time specific cortisol elevations (during day or night) are usually effective when applied under proper supervision (13, 14). |