Last week I conducted an Adrenal Stress Index Test (ASI) which involved filling four little test tubes with saliva at specific times throughout the day (8am, noon, 4pm, and midnight). This is a surprisingly difficult thing to do as you need a good amount of bubble-free saliva in each sample. Your mouth also has to be clean so as not to contaminate the sample with food particles!
The ASI measures levels of the adrenal hormones cortisol and DHEA whose levels naturally vary slightly throughout the day. These hormones help us deal with stress and provide energy and a sense of well-being. When levels aren't optimal we feel drained and fatigued and other functions such as blood sugar control and immune system function suffer.
Some of the symptoms associated with abnormal levels of adrenal hormones include:
- Fatigue
- Feeling Drained
- Hypoglycaemia/Blood Sugar Imbalance
- Dizziness Upon Standing
- Insomnia
- Not Feeling Rested on Waking
- Poor Stress Tolerance
- Depression
- Poor Exercise Tolerance
- Recurrent Infections
- Allergies
- Chemical Sensitivies
- Lack of Mental Alertness
These symptoms tend to occur primarily when cortisol and/or DHEA are too low but the same symptoms may result from an excess.
After completing my ASI saliva samples last week I had mailed them directly to the lab and got the results back a couple of days ago. First off I'd like to show you a sample cortisol profile which shows healthy cortisol production throughout the day:
There are two important factors to consider with the ASI results:
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The levels of hormones produced
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The rhythm of production
This examples shows that the cortisol levels are in the middle of the normal range all the way through the day. They also show the correct rhythm. Most cortisol is produced in the morning when we need a boost to get us out of bed and ready for the day's activities. The levels then drop off but remain sufficient to sustain daily activity before dropping off to near zero at midnight to allow for healthy deep sleep (stages 3 and 4).
Now my cortisol results for comparison:
As you can see, although my cortisol levels are within the reference range throughout the day (just!), the graph looks nothing like the healthy example. Instead of cortisol levels being highest in the morning they are near the bottom of the normal range, increasing by noon, and then dropping off again to the borderline of normal by 4pm. Significantly, my cortisol production rather than dropping steadily during the evening only tails off very slightly meaning that by midnight my levels are at the very top end of normal.
Now for the interpretation:
These results fit very well with my symptoms throughout the day. I find it very hard to wake up and get moving in the morning (low cortisol), generally waking around 9am and not getting out of bed until 10am. I then find that I am able to be most productive between 10am and 2pm. This is when I like to get significant work on The Environmental Illness Resource website completed. After this I notice a significant drop in energy and motivation and feel lethargic which is reflected in my cortisol production with the low point at 4pm. At night I feel exhausted and tired but am unable to relax. I also find it hard to get myself off to bed so despite being tired I end up getting to bed later than I should i.e. midnight or later. This is all to be expected when cortisol production is higher than it should be.
Now my DHEA results:
note: DHEA-S is the sulphated form of DHEA and is often described as the storage form of the hormone. It is found in much higher concentrations in the blood than DHEA itself.
DHEA-S levels should follow a similar pattern to the example of a normal cortisol result shown above. As you can see my DHEA-S levels follow the same erratic pattern as my cortisol levels. In this case however the unusally timed high points are even more pronounced and go significantly above the normal reference range. The role of DHEA-S (and DHEA) is less well understood than that of cortisol but it is though to provide a counterbalance to the actions of cortisol. The high levels at night in theory then should help me to relax and get a good night's sleep.....unfortunately this is not the case.
Strangely I have found in the past that DHEA supplements have provided me with enormous benefit in a great number of symptoms (e.g. energy, sleep quality, stress tolerance, well-being, blood sugar balance). Confusing when it now seems my levels of DHEA-S are only slightly during a few hours in the afternoon.
One explanation could be a licorice supplement I took for a while a year ago which initially provided me with more energy and motivation and allowed me to wake earlier and get more done during the day. However the benefits soon wore off and I now feel more stressed than ever. Licorice is known to boost the action of cortisol by slowing its breakdown and possibly making the body's cells more sensitive to it. It may also effect other hormones such as DHEA.
What is clear from my ASI test results is that my circadian rhythm (body clock) is completely out of sync with what it should be. I have too much cortisol at night which affects the quality of my sleep and not enough in the morning to get me going. In effect this is a double whammy making my body exhausted and totally unprepared for the day ahead. As a chronic fatigue syndrome (ME/CFS) sufferer this is not so unusual as the illness is thought to have a major component of endocrine dysfunction so hormone levels can be all over the place.
From my current knowledge and some reading I have done since receiving the results of my ASI it seems in terms of treatment I need to make sure I get to sleep much earlier and improve the quality of that sleep through whatever means possible. Boosting cortisol and DHEA levels in the morning (without over doing it)would be helpful too. Perhaps taking DHEA supplements in the morning in the past normalised the rhythm of my adrenal hormone production and brought about the improvement in symptoms........but this is purely conjecture.
I have not yet had any feedback on the results from a medical professional. The test was ordered for me by Dr. Sarah Myhill and I am awaiting her opinion on the results. I will update here when I receive it....
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written by Tricia, October 29, 2008
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written by Maff, November 03, 2008
Great to hear that my postings have been helpful and encouraging to you. In the end it is we who are responsible for our own health so knowledge is key. I hope you find information on this and other websites that will help you improve your own health.
As a follow up to this blog post I have found researched rebalancing of the circadian rhythms so am now working on measures to achieve this. Some important issues appear to be:
- Getting to bed early (by 10 pm)
- Waking and eating breakfast by 7-8am
- Eating regular meals throughout the day
- Eating protein foods throughout the day
- Using supplements including phosphatidyl serine and deglycerinized licorice (DGL) to lower raised nighttime cortisol
- Using stimulating supplements to raise low morning cortisol
A great article on the subject is - How to Age Rapidly - Or Not!
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written by chillnthemost, December 01, 2008
Which is better
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written by Maff, December 02, 2008
If you have had low cortisol on saliva testing that is a good indication there may be a problem (adrenal fatigue/ ME/CFS etc). Cortisol levels rise fairly quickly in response to stress so your high blood cortisol test result could easily be simply the result of having blood taken being a fairly stressful event!
Using either method the most important thing is to see how your cortisol levels vary throughout the day. They should be highest in the morning to kickstart your day and slowly tail off, being lowest at night to allow for restful sleep (see first graph in the original blog post). If your cortisol doesn't follow this pattern (like mine!) then there is a problem.
Given your low cortisol salivary test results I'd advice you to investigate this area of your health further and discuss retests with your doctor to confirm the results. Good luck!
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written by Roderick Williams, December 11, 2008
I was looking at how adrenal function is affected by mercury poisoning when I came across a set of charts showing ASI test results during chronic fatigue progression. This one stood out:
http://www.chronicfatigue.org/ASI 4.html
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written by Maff, December 13, 2008
Thanks for sharing that link. That site gives a good overview of the various stages of adrenal fatigue and the graphs really serve to illustrate what is going on. Of course they are generalizations and don't fit everyone exactly. My graph shows a lot more variation throughout the day for example.
If you'd like to share what you found out about mercury and adrenal function it would be great if you'd write a blog entry or perhaps email me a short article if you have the time/energy.
Take care.
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written by Shah, April 24, 2009
Four years ago I used to spend long hours up at night on the computer. I used to average 4-5 hours of sleep and then a compensatory nap in the evening after school. Being on top of my grade, I had a lot going for me, but for some reason I started to feel dumber, and fast. I went through a lot of emotional stress at that point as well and now years later, my symptoms just get worse, with new ones coming and going. There is no doubt that something is seriously wrong with my body (hypoglycemia and blood sugar imbalance being key to my problems as well as 4 AM insomnia), and life style changes just aren't enough anymore to fix things. I know exactly how you are feeling with all your mentioned symptoms and I am just looking for an answer. Thanks to your brilliant post, I have more lead now on my investigation.
Life really is a long journey of learning. Maybe fixing my adrenal issues can make me an even healthier person than I would have otherwise been had none of this happened. I live in Toronto, so my first step will be to seek out a medical professional who can assist me in running an ASI test.
I hope someday I can end this Half Life. God Bless us All.
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written by Maff, April 24, 2009
I'm really glad you found this post so useful. Adrenal issues have been pivotal to my health issues and blood sugar imbalances and disturbed sleep are cardinal symptoms so it is definitely something I'd recommend you look in to.
I don't know any possible medical professionals to recommend in Toronto, so apologies, but I wish you luck.
I like your 'Half Life' phrase. Here's hoping we all come through it stronger for the experience. Take care.
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written by Finn, May 06, 2009
What are the accepted "normal" levels for cortisol at differnt times of day? from the looks of your sample graph it has normal in the 20's or 30's, but my lab test (saliva cortisol) gave me the "normal" as roughly never going above 6.3 in the early morning. This is a huge difference since my results were always on the high end of normal, and could either be interpreted as normal in the morning (5.7) or very low, depending which set of standards I go by. Thanks for any comments/insights. it's tough getting good info on this issue.
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written by Maff, May 07, 2009
I had my saliva cortisol measured by Lab 21 in the UK who set the normal morning range at 12-33 nmol/L (nanomoles per litre). I know that this is roughly the range that most labs here use. Your result of 5.7 in the morning would therefore indicate markedly low cortisol levels and you would no doubt feel incapable of dealing with any level of stress and have great difficulty getting going until they came up significantly later in the day, if at all. If your lab is saying 5.7 is a high normal result all I can suggest is that the results are not in nmol/L. If you could check and also let me know the name of the lab I'll do some further investigation.
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written by Finn, May 07, 2009
About a couple of my symptoms: Sometimes I wake up have no trouble getting going, though I feel strangely hyper/wired. Could this still fit in to having very low cortisol? This week has been different though, and I have actually been quite groggy and tiredfor the first hour or two of the morning. But it's been confusing me, the wired feeling in the morning. I should add that I often wake up between 4-6, and then have terrible sleep, going in and out, having strange, fever-like dreams. Then I feel tired when I get up.
Sorry, don't mean to barrage you with questions, but it's so nice to talk to other people who are also figuring out similar issues as mine.
Thanks
Finn
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written by Maff, May 08, 2009
Thanks for providing more information. Your results make a lot of sense now. Since they are in ng/ml (correct, nanograms per millilitre!) the range given by the lab is correct and your cortisol is actually at the high end. The symptoms you describe are exactly what you would expect to see from slightly elevated levels. Cortisol is a hormone involved in the long term adaptation to stress and as such it has a stimulating effect, helping give us energy and motivation to overcome problems and deal with danger.
As you can see from my cortisol results above I have borderline low levels in the morning and as a result I can't get going until around 10-11am. I feel sleepy until then and can't muster the motivation to tackle anything particularly productive. I have tried various approaches to treatment and one of the things I tried was licorice which contains a chemical called glycyrrhizin which prevents the breakdown of cortisol in the body, increasing blood levels. When taking this I quickly became "wired" and was waking up at 5-6am and having very disturbed sleep. I have used it on and off in lower amounts since just to give me a boost.
In your case you need to lower your morning cortisol. I have tried to find a way to do this so that I could take it to lower my high night time levels and improve my sleep quality. Unfortunately the options don't seem to be as clear cut as for raising low levels. Here's a few links to have a look at though:
http://www.ei-resource.org/art...y-or-not!/
http://www.ei-resource.org/tre...ficinalis/
http://supplementspot.com/heal...ol-levels/
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written by Finn, May 10, 2009
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written by Maff, May 10, 2009
Yes I have tried DHEA and found it very helpful. It is the only thing capable of making me feel relaxed and able to cope with stress. It greatly improved my sleep, blood sugar balance, energy, and mood. I also attribute my recovery from MCS at least in part to DHEA. Unfortunately being a steroid hormone it has the potential for side-effects. In my case my liver was unable to handle a daily dose of DHEA and it caused symptoms of toxic hepatitis (pale stools, abdominal pain, general fatigue, aches and pains, and jaundice). I am currently trying to find ways to compensate for this. The herb Tribulus terrestris seems to be my best bet as it protects the liver while also having many of the stress-busting effects of DHEA, itself!
If you try DHEA I recommend you start with a low dose (say 5-10mg per day) and give it at least a week before increasing by 5mg until you notice any improvement. Keep your eye out for side-effects such as liver problems, changes in mood, and acne.
Phosphatidylserine seems to be the natural treatment of choice for high cortisol levels. I am planning on trying it in the near future to see if it helps my sleep quality if taken in the evening. I'll post my experiences on the site sdo we can compare. Good luck with it.
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written by Luke, May 12, 2009
I can't imagine how you found Lab 21! They don't come up when you search in Google for Adrenal/Cortisol test, as I have multiple times over the last year.
They are friendly when you call them. And the test price is lower than I expected.
Two links I found that might be of interest to you and anyone reading this site because of:
a. Insomnia (of the kind where you get to sleep easily but sleep lightly and wake up at night) OR
b. Chronic Fatigue
http://www.health-spy.com/adrenal.html
http://www.health-spy.com/insomnia.html
It's taken 3 years of trial and error to me understand that my insomnia is likely linked to a stress/sleep hormonal imbalance.
That site shows understanding of the problem that's better than anywhere else I've seen. He (or she) writes about Insomnia/CFS in terms of 2 hormonal balances:
Daytime Cortisol / Night time Cortisol
Daytime Melatonin / Night time Melatonin
I won't go into too much detail, but it's there I learned that low day time Cortisol is associated with higher secretions at night with resultant waking.
Luke
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written by Luke, May 12, 2009
If you check out this link I mentioned above, the page gives multiple alternative supplements that stimulate Cortisol production.
Go here: http://www.health-spy.com/adrenal.html and go to the section "Treatment of Hormonal and Neurotransmitter Deficiency and Imbalance:"
He lists about 12 adaptogens/stimulants for stimulating Cortisol and also talks about 5 HTP for increasing secretion of Melatonin. 5 HTP has helped me improve my sleep. That's how I knew I probably had hormone related problems. Actually that's not when I first suspected: I'd been taking about 3.5g of Ornithine per night and it helped me sleep better when nothing else did. I couldn't figure out why, but finally discovered that it increases secretion of Growth Hormone.
That's what gave me this new scent of an underlying cause: an imbalance in hormones. We'll see where it leads...
Luke
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written by Maff, May 12, 2009
Thanks for posting those links. They do a great job of explaining the hormonal disturbances that many people visiting this site will be experiencing.
It does seem to be a common pattern that people with low morning cortisol tend to have higher levels at night that then interfere with sleep quality. I'm glad you have had success with ornithine. I personally didn't get any benefit from it so am planning on trying phosphatidylserine as an alternative.
I also didn't get any benefit from 5-HTP so instead use melatonin itself. This is available as a nutritional supplement OTC in the US and can be bought online in the UK. Just search for melatonin and you should find online suppliers no problem.
I'm glad you're starting to uncover the problems underlying your health problems. Adrenal and thyroid hormone imbalances, as well as neurotransmitter imbalances, have turned out to be the major contributors to many of my symptoms. This knowledge opens the door to many powerful treatment options.
DHEA as I have highlighted before is a potent steroid hormone which should be treated with respect and used with caution. However, at sensible dosages it's unlikely that the majority of people will experience liver problems. I just want to make people aware that it is a possibility if they aren't careful. Of course it is advisable to work with a doctor when dealing with hormonal therapy.
Good luck with everything Luke. Come back and let us know how you get on.
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written by Finn, May 12, 2009
I have a somewhat "off topic" question: Have you tried betaine HCL for ensuring proper digestion? I'm asking because I'm realizing (for the umpteenth time) that I probably have low stomach acid. And it seems likely that it's been that way for years. I came across an article that listed "hormonal imbalances" as an effect of prolonged hypochlorydia. To which I thought, "Duh! of course. Why haven't I taken care of this yet?" And then I remember: About a year ago a nutritionist/chiro I saw had me try the stuff, and it seemed to have the opposite effects it was meant to. It caused some bloating, gas, stomachache, and a warmer than usual feeling in my stomach.
But it's really been bugging me, because lots of my symptoms point towards LOW stomach acid, yet I can't handle the stuff. I've been thinking maybe my stomach lining is too weak/sensitive right now, and if I could protect it with certain supplements, maybe I could start digesting my food more fully.
It's just funny, my focus (or obesession) of my health goes in cycles; "Oh it's my thyroid that's the problem!" or "Oh it's my adrenals that are the problem!" or "Oh it's the way I react tp stress that's the problem!" but it ALWAYS comes back full circle to, "Oh yeah, if I could just digest all this good food I'm eating, I would start feeling better."
Any thoughts/past experiences? Right now I'm just convinced that this could be a huge piece of the puzzle. Just makes sense. My health struggles "started" about 4 years ago, and I recall a bout of chronic heartburn/mild reflux shortly beforehand.
Thanks
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written by Luke, May 13, 2009
Just in response to your post.
I've done very well with iherb.com as a supplier to the UK. Great prices, great delivery and shipping (very reasonable shipping charge with USPS).
I was using Now Foods Ornithine 500mg up to ELEVEN tablets per night. Crazy I know. It came from a recommendation from Hulda Clark who talks about Ornithine in relation to parasites and says to take as many as you need until you sleep better. I followed this advice with no adverse effects. I took up to 11 but have been able to reduce to the dose now to 7. I did 2 parasite cleanses after which I still needed Ornithine so I knew it was nothing to do with that. Great prices for that product on iherb.com.
As you know, dose really matters and often, to get noticeable effects from food supplements we are talking BIG doses over the RDA.
Also, to clarify Dr Michael Murray ND suggests to take up to 300mg of 5-HTP. Now Foods 100mg worked for me recently, but stopped. I like to take as little as possible of stuff. I was disheartened of course. Then I increased the dose to 200mg and am now sleeping well again. If you search 5 htp in google UK you'll see Murray's site 5htp.com. I closely followed his recommendations to ALSO accompany the 5htp with Magnesium, and Vitamin B12 and B6, in high dosage.
I'm just explaining the complications of either Ornithine or 5HTP to anyone reading.
NDs - Naturopathic doctor's - lead the way in this new kind of modern natural medicine and the new illnesses. But where can I find find one to help me? Some do publish their advice freely, in simple English.
You might try iherb for melatonin.
Good luck and courage,
Luke
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written by Maff, May 13, 2009
Finn - I tried betaine HCL for a little while but then had a gastrogram which showed my digestive secretions (stomach acid, digestive enzymes etc) to be normal. A gastrogram involves swallowing a capsule with a pH sensor that is tracked by a computer. By measuring pH as it passes through your stomach and intestines it can determine if you are producing enough stomach acid and other substances important for proper digestion. It does sound like you have sufficient stomach acid if you experienced a burning sensation and other symptoms when taking betaine HCL. In fact, this is used by many naturopaths and nutritionists as a cheap and quick indicator of stomach acid status. In those with hypochlorydia they often suggest increasing the dosage of betaine HCL until the person experiences these exact symptoms. When this point is reached they are advised to reduce this amount by one or two capsules and take that with each meal. You are absolutely right that efficient digestion is vital to the health of the rest of the body. It does sound like you have normal stomach acid levels but perhaps you may want to look into having a gastrogram carried out. In the mean time you might want to try a digestive enzyme supplement to see if that helps.
Luke - Thanks for posting your experiences with supplements and iherb.com for other readers. I'm not sure if you have seen but we actually sell supplements through iherb.com here at EIR! I have personally used them for many years but usually use DHL. When the Pound was strong it wasn't that much extra to pay over USPS and is much quicker (orders typically arriving in 3-4 days).
I also like to take the lowest amount of supplements that is beneficial. I think this is a wise position for anyone to take. I haven't taken ornithine in those amounts but know it to be safe so it may well be worth another go. I have taken 300mg 5-HTP with the cofactors you mention for an extended period and experienced no benefit. Everyone is different however and I'm glad to hear you are deriving benefit from this.
Just to explain Luke's recommendations further. 5-HTP is an amino acid derivative and the precursor to the neurotransmitter serotonin. Serotonin is vital for stable moods and a deficiency is associated with depression and anxiety. At night serotonin is further converted into melatonin - the "sleep hormone". So taken at night 5-HTP supplements in theory are converted to melatonin and therefore help with sleep. Magnesium, zinc, various B vitamins, and vitamin C all play a role in the conversion of 5-HTP to serotonin and melatonin so may also help with sleep when taken with 5-HTP. Have a look at this page for a diagram representing the role of vitamins and minerals in the production of serotonin - http://www.understand-andcure-...5-htp.html
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