Posted by Dr. James Wilson on Thu, Oct 08, 2009
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.
Posted by Dr. James Wilson on Mon, Oct 05, 2009
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.
Posted by Dr. James Wilson on Thu, Oct 01, 2009
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.