The Adrenal Stress Index

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2 Stress, Who Me? Really? 2

3 Why Evaluate The Adrenals? 1. All living beings are subjected to stress (internal/external stress) 2. By measuring the different aspects of the stress response we can intelligently focus our treatment 3. Knowing the normal rhythmic changes of the adrenal hormones allows us to pinpoint when during the daily cycle is the dysfunction 3

4 Chronic Stress Causes 1. High cortisol output causes high catabolic states (breakdown of tissues for making energy). The increased cortisol output is maintained in the absence of apparent stressors. 2. Resets the DHEA output to a lower set-point which reduces the proanabolic activity of DHEA that antagonizes the cortisol effect. This leaves a person in a catabolic state. 3. Reduction in brain sensitivity to cortisol following high and prolonged levels. Hippocampal cells actually die from excess cortisol which leads to learning / recall impairment. 4

5 Cortisol (adrenal) ACTH (pituatary) CRH (hypothalamus) Stress Emotions Digestive Injury Inflammation Pain Food, Gylcemic Dysregulation Sleep Diagnos-Techs Lab The Platinum Standard in Clinical Salivary Analysis Since

6 Adrenal Stressors Emotional triggers Anger Fear Worry/anxiety Guilt Depression Overwork (physical or mental strain) Late hours/insufficient sleep Chronic, severe or prolonged infections Surgery Trauma/injury Excessive exercise Temperature extremes Toxic exposure Chronic inflammation Chronic pain Chronic illness Chronic/severe allergies Light cycle disruption awake at night, asleep during the day 6

7 Symptoms of Adrenal Dysfunction Excessive fatigue Weakness Nervousness/irritability Depression Apprehensions Inability to concentrate Moments of confusion Poor memory Feelings of frustration Light-headedness Dizziness upon standing Low blood pressure Insomnia Premenstrual tension Craving sweets Headaches Alcohol intolerance Muscle spasms, tics Hypoglycemia Excessive hunger Epigastric discomfort Dyspepsia (indigestion) Alternate diarrhea and constipation Palpitations Poor resistance to infections Food and/or inhalant allergies Dry and thin skin Scanty perspiration Tenderness in adrenal area Low body temperature Unexplained hair loss Difficulty building muscle Weight control problems Tendency to inflammation Increased susceptibility to cancer, osteoporosis, autoimmune illness 7

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9 The Saliva Test Includes: * 4 Cortisol Tests (Free Fraction) * DHEA(S) (Free Fraction) * 17 Hydroxy - progesterone * 2 Insulin Tests (Fasting and Non-Fasting) * Total Salivary SIgA * Gliadin Antibody 9

10 Why Saliva? 1. Blood mixes Free Fraction and Bound in 1 test result 2. Saliva, naturally filters and gives only Free Fraction 3. Tissue level as opposed to blood vessel level 4. The thought of needles and the pain of the blood draw itself raises cortisol levels 5. Circadian Rhythm s 4 samples, lab is not open or convenient late at night. 10

11 4 Cortisol Tests (Free Fraction) Salivary Cortisol (nm) Clock Time 11

12 The Adrenal Response Is A Continuum Initial stress response * ( ) Stress resolution * ( ) Chronic stress * ( ) 12

13 Most Common Abnormal Cortisol Findings Waking Cortisol --- High Nocturnal Hypoglycemia. Waking Cortisol --- Low Adrenal Hypofunction Noon & 4 PM --- High Hypoglycemia Tendency 4 PM Cortisol --- Low Hypo-functioning gland with poor glucose regulation 13

14 DHEA & DHEA(S) Is an anabolic hormone, building the body. Pooled sample, reflects daily adrenal capacity to produce androgens. Chronic Stress can cause an altered response to ACTH which can cause a low DHEA level while the cortisol rises. The correlation between salivary free cortisol and DHEA(S) gives you the details of how to best treat your patient. It is not one size fits all adrenal problems. 14

15 1 Adapted to stress (adrenals are responding) 2 Adapted with DHEA slump 3 Maladaption Phase 1 4 Maladaption Phase 2 5 Non-adapted, low reserve Salivary Cortisol nm Reference zone An excellent tool to determine in what phase going towards General Adaptation Syndrome the patient is. 6 High DHEA Salivary DHEA (S) ng/ml 7 Adrenal fatigue 15

16 17 hydroxy progesterone 1. Measures the efficiency of converting adrenal precursors into cortisol 2. If the 17 oh prog is normal, then you know that using pregnenolone or progesterone will not be helpful for adrenal rejuvenation Pregnenolone 17 Hydroxy Progesterone Cortisol 16

17 2 Salivary Insulin Tests (fasting and postprandial) Diagnoses Insulin Resistance Diagnoses Functional Insulin Deficit (pre-diabetes) Correlating an elevated cortisol with insulin levels helps to explain glycemic regulation problems 17

18 Total Salivary SIgA Measure how stress affects your patient s immune system via the status of their mucosal health. SIgA is a direct marker of cortisol induced immunosuppression an indirect marker of the sympathetic/parasympathetic tone infers when gi evaluation is needed for food intolerances and infections (parasitic, fungal, viral) functions as: viral and toxin neutralization, plasmid elimination, inhibition of bacterial colonization Is adversely affected by stress which is mediated by increased cortisol and or catecholamine levels 18

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20 The Gliadin Antibody* *Gliadin is a glycoprotein found in Gluten Screens for Gliadin (from grains) Intolerance (active, subclinical or latent). Gliadin/Gluten Intolerance exerts ongoing inflammatory stress on the adrenals 12-14% of the US population is Gliadin/Gluten sensitive. Gliadin/Gluten is found in wheat, oats, rye and barley. 20

21 KEY: Whether Cortisol is High (acute reactionary) Or Cortisol is Low (chronic stress, burned out adrenals), the CAUSE for the Stress Must be Addressed. Main Causes of Adrenal Stress 1. Emotional stress 2. Food stress (sugar, caffeine, carbs, nicotine) 3. Sleep stress 4. Digestive stress 5. Inflammation Possible Treatment Options 1. HeartMath, yoga, therapy 2. Healthy whole foods diet with vegetables, protein and carbs 3. Proper sleep hygiene, magnesium, melatonin, valerian 4. As per comprehensive GI panel 5. Decrease inflammation Diagnos-Techs Lab The Platinum Standard in Clinical Salivary Analysis Since

22 Adrenal Stress Index Elevated Cortisol High Cortisol is an expression of high sympathetic tone. Make sure the patient did not take any sympathetic agonist on the day of the test: coffee, ephedra, adrenal glandular, cortaid cream. Treatment Suggestions: 1. Glycemic dietary balance 2. Decrease inflammation (Bos-welya) 3. DHEA 4. Seriphos optimizes central control over adrenal output 5. Adrenal Nutrients Diagnos-Techs Lab The Platinum Standard in Clinical Salivary Analysis Since

23 Depressed and Elevated Cortisol DHEA 2 (3-10) 17 OH Prog 18 Treatment Suggestion: 1. Morning Hydrocortisone or whole licorice extract 2. Night time Seriphos 3. DHEA 4. Glycemic dietary control 5. Adrenal Nutrients Hint: Hydrocortisone or Licorice are not indicated if the patient has pre-diabetes or diabetes or borderline or high blood pressure. Cortisol Augmentation Guide Cortisol Value (nm) Cortisol Dose AM Value AM Dose mg mg < mg Noon Value Noon Dose < mg Afternoon Value Afternoon Dose <3 5 mg or less Diagnos-Techs Lab The Platinum Standard in Clinical Salivary Analysis Since

24 The Adrenal Stress Index DHEA 1 (3-10) 17 OH Prog <15 Treatment Suggestion 1. Morning Hydrocortisone 2. *licorice will not suffice when cortisol is less than 5 nm 3. Night time Seriphos 4. DHEA 5. Glycemic dietary control 6. Adrenal Nutrients Hint: If augmenting with DHEA and thyroid medication, monitor the patient closely and reduce thyroid medication as needed. Cortisol Augmentation Guide Cortisol Value (nm) Cortisol Dose AM Value AM Dose mg mg < mg Noon Value Noon Dose < mg Afternoon Value Afternoon Dose <3 5 mg or less Diagnos-Techs Lab The Platinum Standard in Clinical Salivary Analysis Since

25 Mucosal Barrier Screen Result (Salivary) Salivary Secretory IgA ( normal: mg/dl ) Anti-Gliadin SigA ( positive >15 U/ml ) Gliadin Sensitivity Overt Celiac multiple vitamin and mineral deficiencies, steatorrhea, general weakness, diarrhea, bone pain Subclinical: mild enteritis, occasional loose stools, fat intolerance, marginal vitamin and mineral status, fatigue, accelerated osteoporosis Treatment depends on severity: rotation or reduction in gluten intake VS complete avoidance Hint: If SIgA is >60 rule out yeast overgrowth and other oral infections Check B12 and Folic Acid If low (because of bowel inflammation) supplement with them Diagnos-Techs Lab The Platinum Standard in Clinical Salivary Analysis Since

26 Mucosal Barrier Screen Result (Salivary) Salivary Secretory IgA ( depressed: < 20 mg/dl ) Anti-Gliadin SigA ( positive >15 U/ml ) Treatment for Low SiGA Optimize Cortisol/DHEA balance Balance sympathetic/parasympathetic activity Rule out inherited IgA production deficit Exercise Program Vitamin E supplementation Botanical Adaptogen (Amlaplex) Diglycerinized Licorice Diagnos-Techs Lab The Platinum Standard in Clinical Salivary Analysis Since

27 Most Frequently Ordered Panel Identifies what in the stress reaction needs treatment Objectively shows the patient the strength of their immune system Explains many symptoms that fall through the classical medical evaluation A powerful tool that improves patient compliance for lifestyle change 27

28 Stress, Who Me? Absolutely! 28

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