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:
- Feeling Drained
- Hypoglycaemia/Blood Sugar Imbalance
- Dizziness Upon Standing
- Not Feeling Rested on Waking
- Poor Stress Tolerance
- Poor Exercise Tolerance
- Recurrent Infections
- 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:
The levels of hormones produced
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....
About: Matthew Hogg ("Maff")
Diagnosed with M.E./chronic fatigue syndrome aged only 11 years old and subsequently associated illnesses including irritable bowel syndrome (IBS) and multiple chemical sensitivity (MCS). Despite his own struggles he has constantly sought to educate and support others suffering from such "invisible illnesses" through his website, The Environmental Illness Resource. He fully recovered from MCS using his own approach and holds a Bachelor of Science Degree in Nutritional Health.