Welcome to Dr. James Wilson's Adrenal Fatigue Blog

Bad Marriage Raises Stress Levels For Men and Women

Your relationship could be literally killing you, and it may be more important to fix a bad marriage than fix a time with your doctor for that next check-up. A recent study has shown that men and women who are in bad marriages take that stress to work with them, thereby increasing their risk of developing heart disease and diabetes and other chronic complaints stemming from stress.

"What is happening is that marital problems are spilling into the workplace," said Brandeis University's Rosalind Barnett, one of the study's authors, in a news release. "And if these tensions persist over time, there could be serious health problems."

In the study, which was published in the journal Annals of Behavioral Medicine, Barnett and colleagues looked at 105 middle-aged married adults -- 67 men and 38 women -- to determine the relationship between the quality of their marriage and several physical and mental stress indicators.

Participants' feelings about their marriage were assessed using a standardized scale. Then, their blood pressure and levels of the stress-related hormone cortisol, determined from saliva samples, were checked throughout a working day. Those who expressed more marital concerns had higher blood pressure during the workday. They also had higher morning cortisol levels, with fewer changes in levels over the course of the day than those with fewer marital concerns. People who scored worse on the marital quality scale also reported feeling more stress.

Over time, high cortisol levels can increase your risk for obesity, diabetes, depression, immune problems and more, while high blood pressure raises the risk of heart attack and stroke. Contrary to what some may expect, these effects were seen in both men and women.

"It's generally assumed that primary relationships are more critical to women's psychological well-being than men's, but this is not the case," Barnett said. "When there is marital concern, men and women are equally affected." Annals of Behavioral Medicine, 2009

Comment by Eric Bakker, ND:

Here is yet another study highlighting the relationship with emotional conflict creating long term ill health by way of altering the sensitive stress mechanism of the human body. Countless studies have shown that high cortisol levels (a hormone produced by the adrenal gland) which stays high can lead to many chronic degenerative diseases for which pharmaceutical drugs are conveniently prescribed by your doctor. There are some enlightened doctors however who do understand the relationship with stress and health, and here are a few comments I received from doctors who use Dr. Wilson's Adrenal fatigue Program in their clinics. A doctor I know here in New Zealand has been using Dr. Wilson's Adrenal Fatigue Program successfully in his primary practice for the past two and a half years. His comments: "The more patients I see in primary care, the more I can see the connection with many of their presenting complaints and stress. In fact, if I placed half of my primary care patients on Dr. Wilson's Program I could reduce my workload at least by half." Another doctor I spoke with in the South Island of New Zealand mentioned that he used to treat depression as a "disease in its own right" but after studying Dr. Wilson's work has seen that many cases of depression actually stem from adrenal exhaustion (and altered cortisol levels) in men women. His comments: "Many cases of depression I see in patients seems to be connected to their level of stress and tiredness, and once I got used to treating their fatigue and stress patterns, their depression lifted and in some cases disappeared."

 

Chronic Fatigue Syndrome and Morning Cortisol Levels

Medical professionals would do well to look at their fatigued patients in terms of their morning cortisol levels. By allowing their patient’s adrenal glands to function at optimal levels, cortisol levels become normalized, allowing their bodies to more effectively regulate blood sugar levels optimizing not only energy production, but optimizing health and wellness in general. Dr. Wilson, the “stress” doctor and world authority on fatigue, stress and adrenal function actually coined the phrase “adrenal fatigue” in 1998. Dr. Wilson found through his extensive research spanning over 30 years that there is almost no part of the body which is not affected to some degree by cortisol. The following study highlights the importance of salivary cortisol testing correlating with fatigue and appeared in the March 2008 issue of JCEM, Journal of Clinical Endocrinology & Metabolism, one of the four journals published by The Endocrine Society.
 
People who suffer from chronic fatigue syndrome (CFS) often endure months of persistent fatigue, muscle pain, and impaired memory and concentration. Understanding the physiological changes that accompany CFS, however, has been difficult, but a new study accepted for publication in the Journal of Clinical Endocrinology & Metabolism (JCEM) reveals that abnormally low morning concentrations of the hormone cortisol produced by the adrenal glands, may be correlated with more severe fatigue in CFS patients, especially in women.

"We’re learning more and more about the complexities of the illness that is chronic fatigue syndrome," said William C. Reeves, M.D., with the Centers for Disease Control and Prevention in Atlanta, Georgia, and lead author of the study. "This research helps us draw a clearer picture in regards to how CFS affects people, which ultimately will lead to more effective management of patients with CFS."
 
For their study, the researchers screened 19,381 residents of Georgia, selecting 292 people who had CFS, 268 who were considered chronically unwell, and 163 who were considered well to participate. The researchers then measured free cortisol concentrations in saliva, which was collected on regular workdays, immediately upon awaking and 30 minutes and 60 minutes after awakening. The data indicated different profiles of cortisol concentrations over time among the groups, with the CFS group showing an attenuated morning cortisol profile.

Study participants were purposely screened and enrolled from the community, rather than from volunteers identified at a specialty referral clinic. The purpose of this study design was to provide results that would be more generalized to the population suffering from CFS. In this study, women with CFS exhibited significantly lower morning cortisol profiles when compared with well women.
 
This study confirms previous research indicating that CFS is related to an imbalance in the normal interactions among the various systems of the body that work together to manage stress. "People with CFS have reduced overall cortisol output within the first hour after they wake up in the morning, which is actually one of the most stressful times for the body," Dr. Reeves said. "We need further studies to better understand the relationship between morning cortisol levels and functional status of a patient suffering from CFS."

Founded in 1916, The Endocrine Society is the world’s oldest, largest, and most active organization devoted to research on hormones, and the clinical practice of endocrinology. Today, The Endocrine Society’s membership consists of over 14,000 scientists, physicians, educators, nurses and students in more than 80 countries. Together, these members represent all basic, applied, and clinical interests in endocrinology. To learn more about the Society, and the field of endocrinology, visit http://www.endo-society.org.
 
If the Endocrine Society takes salivary cortisol and CFS seriously enough to publish these results in their prestigious journal, why does the medical profession (and particularly the endocrinologists) not take note and finally regard that low morning cortisol is linked with fatigue, with adrenal fatigue to be more precise?

Eric Bakker ND

Sleep Disruptions Can Be Adrenal Fatigue

One major thing I have gained from Dr. Wilson’s vast understanding of the role of hypopthalmic - pituitary - and adrenal function (the HPA axis) is that an excellent night’s sleep is very much the result of a balanced HPA axis. If you suffer from a cortisol imbalance, you will not only have energy disturbances, you will have sleep disturbances! Do you have an issue with sleep? Then please read this article. I know it may seem a bit top heavy on the technical side, but if you slowly go through the material it will make a lot of sense. You can gain a great amount of understanding about stress, insomnia and energy by understanding Dr. Wilson’s work. Here is an excellent article from Dr. Wilson regarding sleep and cortisol.

Eric Bakker ND

Stress and adrenal function affect sleep, particularly the circadian pattern of cortisol secretion by the adrenal glands. Circulating cortisol normally rises and falls throughout the 24 hour daily cycle, and is typically highest at around 8 AM and lowest between midnight and 4 AM. Both high and low nighttime cortisol levels can interrupt sound sleep. Stress normally causes a surge in adrenal hormones like adrenaline and cortisol that increase alertness, making it more difficult to relax into sound sleep – especially when they remain high or rise and fall irregularly through the night. Frequent or constant stress can chronically elevate these hormone levels, resulting in a hypervigilant state incompatible with restful sleep.

If this is the reason for poor sleep, anything that reduces stress and enhances the ability to handle stress may improve sleep. This can include relaxation, breathing and/or meditation techniques, certain yoga postures, healthy lifestyle changes, and stress-relieving life alterations. Refraining from vigorous exercise in the evening and taking time to consciously relax before going to bed may calm the adrenals and help lower cortisol and adrenaline levels.

When the adrenals fatigue, adrenal hormone levels may become low, leading to another possible source of nighttime sleep disruption – low blood sugar. Cortisol plays an important role in maintaining blood sugar (glucose) levels around the clock. Although blood glucose is normally low by the early morning hours, during adrenal fatigue cortisol levels may not stay sufficient to adequately sustain blood glucose. Low glucose signals an internal alarm (glucose is the main fuel for all cells, including brain cells) that disrupts sleep so the person can wake up and refuel.
 
Low nighttime blood glucose can also result from inadequate glycogen reserves in the liver. Cortisol causes these reserves to be broken down into glucose that is then available to the cells. When low cortisol and low glycogen reserves coincide, blood glucose will most likely drop, disrupting sleep. Waking between 1 AM and 3 AM may indicate low blood sugar resulting from inadequate glycogen reserves in the liver, low adrenal function and cortisol, or both. This is often the culprit when panic or anxiety attacks, nightmares, or fitful, restless sleep occur between 1 and 4 AM.
 
If low blood sugar is disrupting sound sleep, supporting healthy adrenal function and dealing with the adrenal fatigue may contribute long term to sound sleep. Also having a healthy snack before bed can help fortify the body’s nighttime energy reserves. The snack should be one or two bites of food that contains protein, unrefined carbohydrate, and high quality fat, such as half a slice of whole grain toast with peanut butter or a slice of cheese on a whole grain cracker. Eating or drinking sugary, refined foods will only aggravate the problem. Sometimes exercising before bed can help, since exercise tends to raise cortisol levels.

Lack of sleep can be a significant body burden that, in itself, can contribute to adrenal fatigue. Every time the wake/sleep cycle is altered, it takes several days to weeks for the body and cortisol levels to adjust. In fact, sleep ranks with diet and regular exercise as an essential component of a healthy life. People on alternating shifts with less than three weeks between shift changes are continually hammering their adrenal glands and may become very susceptible to adrenal fatigue.
 
Chronic lack of sleep is now regarded as a health hazard and has been associated with several possible health consequences. These include lowered immunity with increased susceptibility to infections, impaired glucose tolerance, low morning cortisol levels, and increased carbohydrate cravings. Lack of sleep can also elevate circulating estrogen levels, upset hormonal balance, and slow healing and prolong the recovery period. These are in addition to the decreased alertness and concentration that most people experience when missing an inordinate amount of sleep.

The consensus from research and clinical observation is that it is necessary to sleep an average of eight hours per day. Some people need even more in the beginning phases of recovery from adrenal fatigue. A saliva cortisol test done at night and compared with daytime levels and with the test standards for those times will
help determine if either high or low cortisol may be interfering with sound sleep. If cortisol is a likely culprit, cortisol levels will be significantly higher or lower than normal for those times.

Yours in health,

Dr. James Wilson

Minimizing Adrenal Fatigue & Letdown After a Stressful Event

The letdown that almost invariably follows an illness, a stressful event or even the holiday season is largely attributable to adrenal fatigue. However, with proper adrenal support you can often minimize or avoid the letdown and maintain a healthy ability to handle stress.

To understand why letdown occurs, it is helpful to know a little about the pattern of physiological adjustments your body makes in response to stress -- regardless of its source.

Primarily through adrenal hormones, you prepare for the same physical "fight or flight" reactions as did primitive man, even though modern day stress rarely requires that you physically fight or flee.

Your initial stress reaction produces a large rise in cortisol, adrenaline and other adrenal hormones that mobilize your energy, mental and physical resources to take action. This lasts for a few minutes to a few hours -- essentially how long it might take you to fight or run away from a threat. At the end of this alarm phase there is a recovery period lasting a few hours to a few days (depending upon the magnitude of the stress) when levels of cortisol and other adrenal hormones drop and remain low. This is a natural letdown phase during which you likely feel more tired and listless and want to rest. At this time your adrenals are temporarily fatigued and less able to respond to stress. The more fatigued or depleted your adrenals were at the time of the initial alarm, the longer and more debilitated your letdown.

If stress continues, your adrenals adapt to handle it by producing slightly elevated levels of hormones, particularly cortisol, in a kind of constant semi-alarm phase. This phase can last for weeks, months or even for many years. However, your body's prolonged biochemical readiness for "fight or flight" without commensurate physical action causes increasing problems in your body the longer it goes on, and it becomes another source of stress. If stress persists beyond your adrenal's capacity to maintain this higher function, or another stressful event occurs, your adrenals may eventually become depleted, leaving you in the more lasting letdown of adrenal fatigue and no longer able to respond adequately to stress.

Stress intensifies the demands on your body -- nutrients are used up faster than they can be replaced by food, toxic by-products rapidly build up, and every organ and gland (including your brain) is asked to work harder. Your adrenal glands must respond to every stress you experience by producing hormones that help your body cope with the stress and maintain homeostasis.

When you can anticipate stressful times, you can make a significant difference to how you will feel and the amount of letdown you will experience by paying attention to what your body needs and stepping up your level of self care. The following tips should minimize letdown, and help you bounce back more quickly, become more stress hardy, sustain good energy, experience more refreshing sleep, and remain calm, clear-headed, focused and steady.

• Eat what your body needs to function optimally by choosing fresh, wholesome food. When your adrenals are stressed, it is especially important to eat regular meals morning, noon and evening which each contain protein, healthy fat and complex carbohydrate.
  

• Avoid foods that stress your body, such as sugar, white flour/refined grains,hydrogenated oils, excessive additives and junk food.

• Minimize substances that over-stimulate your adrenals, such as caffeine.

• Exercise regularly and make sure you get up and move around frequently throughout the day to help keep that “fight or flight” reaction from creating further internal stress.

• For at least ten minutes a day take a mental break – concentrate on your breathing, meditate or focus on something peaceful.

• Take dietary supplements specifically designed to support and strengthen your adrenal glands for at least a month leading up to the anticipated stressful time, as well as for as long as needed afterward. Look for supplements, like the ones suggested below, formulated by an expert in stress to provide your adrenals and stressed body with precise forms, amounts, and ratios of high quality, natural ingredients they can optimally assimilate and utilize to enhance your health and minimize letdown.  The right supplements can make a world of difference.
  
  
• If you are stressed and having difficulty staying balanced during the day, tend to feel anxious or mildly depressed, or are having trouble sleeping, look for a combination of organic herbs designed to support the Hypothalamus/Pituitary/Adrenal (HPA) axis and adrenal function to help balance you during the day and promote sound sleep at night.
  
  
• Adrenal hormone production is very nutrient intensive, so supplementing with the precise nutrients your adrenals need to make these hormones can help you feel good and maintain a healthy response to stress. To enhance your response to and feel better while under stress, look for a combination of vitamins and minerals formulated in precise ratios, forms and amounts to replenish the specific nutrients used up by stress, facilitate the production of adrenal hormones, and support adrenal health.
  
  
• To replenish the vitamin C that gets rapidly used up during stress, look for a true sustained release supplement that provides a steady supply of an optimal amount of vitamin C, plus a 1:2 ratio of bioflavonoids to vitamin C to enhance the vitamin C activity and help protect your tissues from the oxidizing damage of stress, as well as trace minerals to neutralize the acidity of vitamin C so it’s easier on your stomach.
  
  
• If you have been depleted by stress, your adrenal glands may need deep replenishment and extra support to maintain healthy function and adequately respond to further stress. Look for a hormone-free multiglandular that contains adrenal, hypothalamus, gonad and pituitary concentrates designed to provide natural building blocks that fundamentally support and strengthen the structure and function of the adrenals and other glands affected by stress.
  
  
• Many people who feel stressed also experience energy lows at in the morning, mid-afternoon, or after exertion. To help temporarily bolster your energy at these times, look for a caffeine- free energy booster that is designed specifically to both provide support to your adrenals and naturally enhance your energy levels.
  

By taking steps to bolster and protect your health from stress, you can minimize the debilitating letdown that often occurs during and/or after a stressful event, and discover a new level of steadiness and stamina that allows you to enjoy life more fully, even in stressful times.

 

 

Sleep & Adrenal Fatigue

People are becoming more aware of the ravages of stress and how it leaks into every corner of their lives. Of course, increased stress means increased sleep disturbances for many. Less sleep means they experience more stress the day after. This pattern continues in a vicious cycle, making stress and sleep loss in terms of hours and quality intimately interconnected.

If stress has somewhat depleted the adrenal glands, which is often the case, people under stress do not wake feeling rested. Cortisol, an adrenal hormone, is needed to allow that person to wake feeling refreshed and bouncing out of bed in the morning. It is also important to induce an alpha wave, a requirement for the first phase of sleep. If cortisol is low, falling asleep is difficult. Cortisol is also necessary to maintain good blood sugar levels throughout the day and night. If cortisol is low during the day people wake feeling tired and often need coffee, cola and other caffeinated beverages to get going and to keep going during the day. This over consumption of caffeine not only causes blood sugar to rapidly rise and then precipitously fall an hour and a half later, but also tends to interfere with sleep that night. The resulting lack restful sleep creates more stress the next morning and perpetuates the cycle of low cortisol and difficulty sleeping. This low adrenal function is a frequent occurrence in both sleep disturbance and inadequate response to stress. During adrenal fatigue, a condition where the adrenal glands are not able to keep up with the demands placed on them, people often have problems managing their stress and sleeping well.

There can be several reasons for sleeplessness with adrenal fatigue. If you are waking between 1:00 and 3:00 AM, your liver may be lacking the glycogen reserves needed for conversion by the adrenals to keep the blood glucose levels high enough during the night. Blood sugar is normally low during the early morning hours but, if you are experiencing adrenal fatigue, your blood glucose levels may sometimes fall so low that hypoglycemic (low blood sugar) symptoms wake you during the night. This is often the case if you have panic or anxiety attacks, nightmares, or sleep fitfully between 1:00 and 4:00 AM. To help counteract this, have one or two bites of a snack that contains protein, unrefined carbohydrate, and high quality fat before going to bed, such as half a slice of whole grain toast with peanut butter or a slice of cheese on a whole grain cracker.

Both too high and too low nighttime cortisol levels can cause sleep disturbances. To determine if this is a problem for you, simply do a saliva cortisol test at night and compare your night sample levels with your own daytime levels and with the test standards for those times. To do the night test, take a saliva sample at bedtime, another if you wake up during the night and a third when you wake up in the morning. Write the time each sample was taken on the vial and in your notebook on a separate sheet of paper. If cortisol is the culprit, your cortisol levels will be significantly higher or lower than normal for those times. If your nighttime cortisol levels are too low, you may sleep better when you exercise in the evening, before going to bed because exercise tends to raise cortisol levels. If your nighttime cortisol levels are too high, try doing one of the relaxation or meditation exercises to calm you down before going to bed. The specific yoga posture called the alternate leg-pull can be quite helpful in getting to sleep or returning to sleep. This is a basic yoga posture that almost any yoga book or video will describe but an instructor is preferable because there is some subtlety to doing this posture.

Here is a list of some additional things you can do to improve your sleep:

• Above all, go to bed before 10:30 PM and stay in bed until 9:00AM as often as possible, even if it is just on the weekends. It is amazing how restorative sleeping until 9:00 AM is for the adrenals.
• Be sure to get enough physical exercise during the day. Try varying the kinds of exercise you do, their intensity or when you exercise. Many people have told me swimming at night helps them sleep.
• Certain postures in yoga, ta'I chi and qi gong can also be helpful. Check with a teacher of these disciplines to find out which postures or exercises would specifically help you.
• Avoid coffee, caffeine containing beverages and chocolate because they act as stimulants. These can interrupt sleep patterns and increase morning lows. Even if they are consumed early in the day, they can disrupt sleep and make the next morning harder to negotiate.
• Some people are photosensitive and watching television or looking at at computer screen keeps their melatonin from rising and inducing sleep. If you are having difficulty going to sleep and usually are staring at a TV or computer screen late at night, try having an 8:00 PM limit on these visual stimuli.
• If your cortisol levels are low late at night, try exercising in the evening, as exercise raises cortisol levels and may afford you a sound night's sleep.
  
• There are particular nutritional supplements that can be beneficial. Often melatonin (0.3-1.3 mg) taken 30 minutes before bedtime helps establish normal sleep patterns. Calcium citrate (500mg) taken with 50 mg of 5-hydroxytriptophan (5HTP) at night before retiring is also relaxing and helps many people sleep throughout the night. Trace mineral tablets taken at the evening meal also help relax the body. Adrenal extracts taken ½ hour before bedtime often help those with adrenal fatigue fall asleep and remain asleep. If your adrenal fatigue is moderate or severe, try this one first.
• The hypothalamus is very important in regulating sleep. Although accurately testing hypothalamic function is complicated, a simple test you can do yourself is to try takig one to four tablets of hypothalamus extract and 10-40mg of manganese before bedtime and see if your sleep improves. Sometimes the hypothalamus tablets need to be combined with the adrenal extracts to normalize sleep.
  
• There are also several herbs commonly used to promote better sleep such as hops (whole plant), catnip (leaves), valerian (root) and licorice (root). Although not known as a sedative, the herb ashwagandha can help indirectly through its ability to normalize cortisol and sex hormones, both of which can produce sleep disturbances.

If none of these help and your life is being deleteriously affected by lack of or interrupted sleep, check your local area for the location of the nearest sleep center. Several cities around the country have these centers that specialize in helping individuals determine the cause of their sleep disturbances.

Take Short Horizontal Rests During the Day

During the day, you will probably notice that you have particular times when you feel more lethargic, cloudy headed, tired or have other symptoms of adrenal fatigue. Try to schedule your breaks so that when these occur, you can physically lie down for 15-30 minutes. Lying down is much more restorative than sitting for the person with adrenal fatigue.

Adrenal Cell Extracts & Cortisol in Adrenal Fatigue

Probably the most reliable way of rebuilding the adrenals from adrenal fatigue is the use of extracts from liquid or powdered porcine adrenal glands. The first recorded use of an adrenal extract was in 1898 when Sir William Osler administered a crude preparation of adrenal cells to a person with Addison's disease. Since 1918, when they became commercially available, adrenal cell extracts have been a valuable and powerful form of therapy and have been used by thousands of medical doctors in the treatment of non-Addison's type of adrenal fatigue.

Adrenal cell extracts, also known as adrenal cortical extracts, are the liquid or powder extracts of the adrenal cortex. Their action is to support, fortify and restore normal adrenal function, thereby enhancing adrenal activity and speeding recovery. Adrenal cell extracts are not replacement hormones - in fact, the best type of extract to use has been processed to remove the adrenal hormones. What they provide are the essential constituents for adrenal repair, including the adrenal cell contents, such as nucleic acids (adrenal cell RNA and DNA) and concentrated nutrients, in the form and proportion used by the adrenals to properly function and recover from stress.

Various types of adrenal cortical extracts have been used orally and as injectables since the end of World War I and have rarely produced unwanted side effects. They have been, and continue to be, a fundamental part of the treatment protocol for adrenal fatigue used effectively for over 80 years, and provide significant value for alleviating all levels of adrenal fatigue.

Today, by combining our knowledge of adrenal cortical extracts with lifestyle modifications, dietary supplements and herbal formulas, we can stabilize people with adrenal fatigue and accelerate their recovery more efficiently than ever before.

Coritsol vs Adrenal Cell Extracts

It is important to understand the difference between adrenal cell extracts and natural or synthetic cortisol and cortisol-type steroids such as cortisone, prednisone, prednisolone and many other forms of adrenal steroid hormones. Adrenal cell extracts that have been processed to remove adrenal hormones nourish and help rebuild adrenal cells. As these cells recover, they can once again produce the proper amount of the various hormones needed for the many functions performed by the adrenal glands. By this means, they tend to normalize adrenal function. In contrast, corticosteroids, whether natural or synthetic, tend to reduce or shut down the activity of the adrenal glands. This happens because the brain senses the presence of these cortisol substitutes and, in response, withholds the signal of adrenalcorticotrophic hormone (ACTH) it would otherwise send to the adrenal glands to make more adrenal hormones. Thus, corticosteroids suppress the functions of the adrenal glands, over-riding the normal feedback loops that regulate and balance adrenal hormones. In spite of the fact that this action can produce dramatic initial improvements in symptoms, these symptomatic improvements come with a heavy price.

Because corticosteroids mask the symptoms of adrenal fatigue and, when used in excess, depress immune function, the person taking them is at greater risk from stress and infection. Such therapy can become more hazardous than the original disease. Corticosteroids may have quick and dramatic symptomatic results, but unless they are used in their natural form and in physiologic doses that mimic the natural secretion of cortisol, they make the adrenals weaker rather than stronger.

It is difficult to get off a corticosteroid drug once on one for a while. People get caught in the "catch-22" that if they stop taking the corticosteroids, they crash and their symptoms return worse than ever because adrenal activity is suppressed. So they keep taking them, but the longer they take them, the harder it is for the adrenals to regain proper function.

It is important to remember that corticosteroids suppress adrenal function in proportion to the dosage. For this reason, it is important that steroid treatment should be withdrawn slowly, never abruptly.

Conversely, adrenal cell extracts adrenal function and, when taken over time, naturally strengthen the capacity of the adrenals for healthy function. Once the adrenal glands are responding sufficiently, a gradual step-down program can be initiated to reduce and even eliminate the need for adrenal cell extracts. In recovering from adrenal fatigue and stress, it is important to allow adequate time for the optimal adrenal function to become fully established before beginning a reduction schedule.

Problems Interpreting Cortisol Lab Tests in Adrenal Fatigue

Complicating the problem of proper interpretation of laboratory data in adrenal fatigue is the fact that steroid hormones occur in more than one form in your body, but most lab tests measure only one. Cortisol, for example, takes on three forms in your blood: 1) unattached to any other substance (free), 2) loosely bound and, 3) tightly bound to blood proteins. The most common measurement for hormones is the amount of hormone not attached to anything, called the free circulating hormone. However, this usually represents a meager 1% of the total amount of hormone available. It does not measure the bound hormones, which act as reserves and become free hormones if needed. This reserve can be critical to proper physiological function. For example, very low circulating cortisol levels can be brought to within normal range by the administration of a synthetic cortisol. But people taking synthetic cortisol cannot withstand stress as well as people with naturally normal cortisol levels, even though blood tests for both show normal free circulating cortisol levels. One reason for this is that although free circulating cortisol levels are increased by taking the synthetic cortisol, levels remain low of tissue bound cortisol that provides reserve stores in cases of emergency (stress). Blood tests can often be deceptive because they do not typically give you the whole picture. Therefore, even though both healthy people and people taking cortisol might show normal free cortisol levels, their response to stress will probably differ considerably. The test results would give a very deceptive picture of "normal" in the case of the person receiving the drug, as it tests only the most superficial layer of cortisol availability.

In adrenal function, the extreme low on a bell curve is Addison's disease and the extreme high is Cushing's disease. The other 95% represents an enormous variation in levels of adrenal function that is usually disregarded by lab computers and overlooked by doctors because the scores in this range do not fall into either of the two extreme or "diseased" categories. By default, any scores falling within this range (95%) are considered "normal" The end result of basing laboratory test scores on statistics rather than on signs and symptoms is that many people who have mild to moderately severe adrenal fatigue are never accurately diagnosed; they look "normal" on the tests.

Stress is a factor that significantly affects adrenal hormone levels. Your cortisol level tested after a quiet, relaxing morning will be very different from your cortisol level tested when you are under stress before you arrive at the lab. To obtain a typical value, have your test on a typical morning.

How & Why I Use Saliva Hormone Tests for Adrenal Fatigue

I use the saliva hormone test to confirm the other signs and symptoms of adrenal fatigue. I start with a saliva cortisol screening test that measures cortisol levels at four different times during the day: between 6-8AM (within one hour after waking) when cortisol levels are highest; between 11AM-12PM; between 4-6PM; and between 10-12PM. This shows how your cortisol levels vary during the day – something you cannot easily do with blood or urine tests.

Another way I like to use the saliva test, when possible, is to compare samples taken when a patient is experiencing an energy high or low with samples taken during a regular day when the patient is feeling relatively normal (baseline samples). After we have a baseline, these patients carry around some spare vials to take saliva samples at times when they are feeling especially good or especially bad. Again, they record the symptoms(s) they were experiencing, as well as the date and time. They also record the date and time on each vial and send them off to the lab. This is an excellent way to determine whether the lows and highs you experience correspond to relatively low and high cortisol levels.

I also usually measure DHEA-S levels with the saliva test, as well, because the adrenals are the primary source of DHEA-S (but not necessarily of DHEA). Adrenal fatigue syndrome often involves decreased DHEA-S. The DHEA-S level is a direct indicator of the functioning of the area within the adrenal glands that produces sex hormones (the zona reticularis). Saliva tests for testosterone, the estrogens, progesterone and other hormones can also be done, if needed, and may be of value in working with adrenal fatigue. Testosterone and DHEA-S levels are two of the most reliable indicators of biological age. Testosterone and DHEA-S levels below the reference range for the person’s age may be indicators of increased aging. If the cortisol levels are also decreased, the three tests together further indicate chronically decreased adrenal function.

If a doctor does not use the saliva hormone tests, piecing together a correct diagnosis of adrenal fatigue from other laboratory tests is more difficult. Most laboratory tests are designed to look for “disease” states in the human body and adrenal fatigue is not a disease. In addition, there has never been a reliable urine or blood test that checks for, and can definitively diagnose, mild forms of hypoadrenia.

The main reason I prefer the saliva test is that it gives clearer and more direct indications of hormone levels at the actual site where they are utilized – inside the cell. None of the blood or urine tests typically give you as much useful information about your adrenal function as you will get from the combined use of the adrenal fatigue questionnaire from page 61 in the my book, Adrenal Fatigue: The 21st Century Stress Syndrome, clinical self-tests, and saliva hormone tests.

Saliva Hormone Testing for Adrenal Fatigue

Saliva hormone testing measures the amounts of various hormones in your saliva instead of in your blood or urine. It is the best singe lab test available for detecting adrenal fatigue and has several advantages over other lab tests in determining adrenal hormone levels. Saliva hormone levels are more indicative of the amount of hormone inside the cells where hormone reactions take place. Blood, on the other hand, measures hormones circulating outside the cells, and urine measures the spillover of hormones out of the blood and into the urine. Although blood and urine hormone tests have their uses, neither of them correlates with the hormone levels inside the cells. The level of a hormone circulating in the blood or excreted in the urine does not necessarily reveal how much of that hormone is getting into the cells. However, saliva testing for hormone levels is simple, accurate and reliable, and many studies have confirmed its accuracy as an indicator of the hormone levels within cells.

Besides providing this nice little peek at hormone levels inside the cells, saliva tests are easy to perform. All you have to do is spit into a small vial. The tests are non-invasive (no needles) and you do not even have to go to a laboratory to complete them. This means that they are an extremely useful way to monitor your degree of adrenal fatigue and your progress over time because they can be repeated as often as needed. Saliva tests are also less expensive than blood tests for adrenal function. They can be done by many health practitioners other than medical doctors, such as chiropractors and naturopaths, who may not have laboratory privileges in your state, but who perhaps know much more about adrenal fatigue than your family doctor or specialist. Some labs will run this test for you without a physician’s signature, so it is possible to order the kit and do the test yourself. You can even obtain a saliva kit by mail and then send it back to the lab from anywhere in the United States. However, unless you know how to interpret a hormone test, it is far better to have a health practitioner familiar with saliva tests and adrenal fatigue do the interpretation for you. The health practitioner’s experience and understanding of how particular test results relate to your whole health pattern is something that is difficult to provide yourself. In this case it is important to find a practitioner who has experience with adrenal hormone testing and its subtle interpretations, which is unfortunately not widely known to mainstream doctors -- even many endocrinologists.

The best way to determine your particular adrenal hormone (cortisol) status is to use the saliva test that measures your cortisol levels several times per day. Typically, laboratories testing hormonal content of saliva have test kits that take samples four or more times per day. You merely carry around a few small tubes and, at designated times of the day, you spit into one of the tubes and recap it. The samples usually do not need to be refrigerated and can be sent by mail to the laboratory. For a list of laboratories that do accurate and reliable saliva testing, as well as a list of doctors familiar with this test, see our website at http://adrenalfatigue.org. By measuring your saliva hormone levels at least four times per day, you will be able to see for yourself where your cortisol levels are compared to the norms. After you receive your report, you can see whether low cortisol levels may be responsible for the feelings of fatigue that you experience during particular times of day. Because saliva hormone levels correlate well with the amount of hormone inside the cells (tissue levels) and samples can be taken as needed without inconvenience or adverse side effects, saliva testing is often more useful than blood or urine testing of hormone levels.

British Work Stress - 65% higher risk of Heart Attack

LONDON (Reuters) - Work really can kill you, according to a study providing the strongest evidence yet of how on-the-job stress raises the risk of heart disease by disrupting the body's internal systems.

Read post and commentary by Dr. Eric Bakker, ND here.