Adrenal Stress Index
New Hormone Testing Service Monitors
Cortisol/DHEA Levels
June 1998
By Jerry Stine
With the current availability of supplemental DHEA
(dehydroepiandrosterone) and Pregnenolone, nutritional supplement users now have access to
a selection of powerful substances that may profoundly affect human health and longevity.
Because these new supplements exert powerful regulatory effects, proper timing and dosage
are critical to obtain maximum benefit from their use. In order to enable our customers to
accurately determine proper dosages and balance, VRP has arranged to work with The
Lifespan Institute to provide convenient and affordable testing and counseling.
The Adrenal Glands
The adrenals are two small glands, each weighing approximately four grams, that lie atop
the kidneys. The adrenals have one of the highest rates of blood flow of any tissue, and
contain the highest amount of vitamin C per gram of any tissue in the body.
Each adrenal gland is composed of two distinctly different zones, the large outer cortex, and the smaller inner medulla. The adrenal cortex secretes cortisol, DHEA and aldosterone, while the medulla produces vital catecholamines such as norepinephrine and adrenaline. Adrenaline, norepinephrine, DHEA and cortisol are the body’s four major stress hormones. The adrenals don’t secrete hormones constantly throughout the day, but instead release them cyclically, with the highest levels in the morning and the lowest levels at night (Fig. 1). Any abnormality in the quantity of adrenal output or rhythm can disturb vital body functions and lead to serious health problems.
Increased Cortisol Levels
While hormone replacement therapy has been used by physicians for many years, the hormones
that were commonly used were limited in scope, and were primarily synthetic analogs of
natural hormones. The most commonly used of these hormones consisted of synthetic thyroid,
and various synthetic analogs of estrogen, progesterone, testosterone and cortisol. What
is new in the arena of hormone replacement is not only (1) the recent introduction of
natural forms of estrogen, progesterone, and testosterone; (2) growing awareness of the
superiority of natural thyroid over the synthetic variety; but (3) more recently, the wide
availability of DHEA and pregnenolone.
A commonly overlooked aspect of DHEA and pregnenolone replacement is the critical relationship between DHEA and cortisol, (an important glucocorticoid hormone synthesized by the adrenal cortex). Cortisol’s role in human health ranges from promoting protein synthesis to counter-regulating the activity of insulin and glycogen synthesis. Cortisol is also required for the production of prostaglandins, maintaining cellular response to catecholamines, and regulating adrenergic receptor functions.
Under conditions of physiological and psychological stress, cortisol is released in high amounts. Increased cortisol production is linked to obesity, suppressed thyroid function, and a host of other serious health consequences. This condition, a precursor to Cushing’s syndrome (Fig. 2.), was designated “hyperadaptosis” by Vladimir Dilman, and described in his book, The Neuroendrocrine Theory of Aging.
Effects of Cortisol Imbalance on Health
Low Energy
People who are constantly tired, have difficulty getting up in the morning and suffer from energy slumps often have abnormal adrenal rhythms.Muscle Atrophy
Excess cortisol decreases muscle protein synthesis and reduces muscle mass. Reduced tissue repair and increased tissue breakdown can lead to muscle and joint injury and chronic pain.Impaired Bone Repair and Increased Bone Loss
Cortisol inhibits hormones required for calcium deposition. If cortisol levels remain chronically elevated, bone growth and repair is suppressed, and osteoporosis may result.Thyroid Dysfunction
Hypothyroid symptoms such as fatigue and low body temperature are often due to adrenal dysfunction. In fact, anyone concerned about hypothyroidism should first insure that their adrenal function is normal. If thyroid replacement is used without first addressing an adrenal problem, further exacerbation of the adrenal dysfunction will probably result.Depressed Immune System
Several key aspects of immune function follow the cortisol cycle. If this cycle is disrupted, then immunity can be severely impaired.Impaired Sleep Quality
Elevated night cortisol can interrupt REM (Rapid Eye Movement) sleep, the body’s regenerative sleep mode—thereby reducing mental vitality and vigor—and leading to depression.Poor Skin Regeneration
Human skin is regenerated mostly at night. With higher night cortisol levels, less skin regeneration takes place.Impaired Growth Hormone Release
Growth hormone production declines rapidly after age 30, and this decline correlates directly with the effects and symptoms of aging. Maintenance of one’s youthful GH production is a paramount goal of any anti-aging program. Unfortunately, cortisol antagonizes GH, and moderate elevations of cortisol after 10:00 pm (as little as 5%), causes disproportionate inhibition of GH release.
DHEA/Cortisol Balance
A critical marker of overall hormonal health is the ratio of serum cortisol to DHEA. Under
normal conditions, cortisol is held in balance (or homeostasis) with DHEA. DHEA production
begins to decline after about age 25, dropping by about 80-85% of peak production levels
by age 75. Cortisol levels, on the other hand, rise and remain elevated during the
afternoon and evening in response to stress. The effect of this alteration in adrenal
rhythm, or imbalance of cortisol and DHEA, can have serious adverse effects on our health.
Maintaining Your Personal Hormonal
Balance
Advances in personal adrenal management have been propelled recently by the
over-the-counter availability of DHEA and pregnenolone—both of which are crucial
substances for adrenal balancing. The primary reason most people take DHEA or pregnenolone
is to reverse or offset the effects of aging. But when considering their use, it is
important to look at the overall picture of adrenal function. As beneficial as these
nutritional hormones can be to any anti-aging program, neither substance can correct other
aspects of adrenal dysfunction that are almost always present in people with low DHEA
levels. Specifically, supplemental DHEA will not, by itself, correct abnormal cortisol
levels or rhythm. In order to retard or reverse some aspects of the aging process, optimum
balances and rhythm of these hormones should be maintained.
Adrenal Exhaustion
“Adrenal exhaustion” is a term that has been popularly applied to conditions of
low energy, poor immune function, and a host of other maladies. Many people consider these
symptoms to be due to the adrenals being “worn out,” and not able to produce
adequate adrenal hormones. In reality, it is the chronically elevated
“hyperactivity” of the hypothalamo-pituitary-adrenal (HPA) axis that causes
these symptoms. The first and most common sign of this hyperactive HPA (i.e.
hyperadaptosis or Stress Maladaptation Syndrome) is too much cortisol output—not too
little. One substance that has historically been used in treating this condition has been
oral or injectible dehydrated bovine adrenal tissue, or adrenal cortical extract (ACE). It
is believed that the adrenal tissue gives the adrenals a rest and helps them regenerate.
There continues to be a role for adrenal tissue products. However, instead of using them empirically, new adrenal tests, such as the Adrenal Stress Index (ASI) allow us to properly determine who needs them, how much is required, and when they should be administered. Such advanced testing leads to a more accurate analysis of adrenal dysfunction and enables health care professionals to more precisely recommend adrenal balancing strategies and products.
Breakthrough in At-Home Adrenal Hormone
Testing
Five years ago, a new laboratory examination called the Adrenal Stress Index (ASI) became
available to clinicians. ASI made possible, for the first time, the detailed assessment of
one’s adrenal hormone cycles by simultaneously measuring serum cortisol and DHEA
levels throughout the day. The ASI test is a simple, non-invasive test that uses four
saliva samples to measure the adrenal rhythm and to obtain a DHEA-to-Cortisol correlation.
Measurements are gathered from four specimens collected throughout the day (8 am, 12 noon, 4 pm and 11 pm). The results of an ASI test allow for an in-depth analysis of one’s adrenal cycle, and can contribute to the design of a more precise, personalized approach to balancing adrenal functions.
Advantages of the ASI Test
The ASI test is non-invasive, and can be performed wherever you are. Saliva is collected
under real-life conditions—there are no stressful blood draws or urine samples to
carry around. With standard blood and urine testing, a number of borderline adrenal
conditions are often missed or altered due to the unusual nature and trauma of visiting a
physician’s office, and the invasive nature of collecting samples. This is not the
case with the ASI, because it is a time-specific and stress-free test.
Salivary Adrenal Testing
When properly obtained, salivary hormone levels are very accurate and reflect the level of
hormones that are active at the cellular level—which is what we want to know. In an
article about salivary testing for adrenal assessment, the July 1996 Townsend Newsletter
For Doctors stated “Assessment of free cortisol and DHEA …in saliva is an
economical, convenient, non-invasive, and stress-free procedure. Saliva samples may be
collected at home or at work, thus avoiding the cost and time invested in repeated visits
to laboratories. Free cortisol levels in saliva reflect the free plasma levels.”
Blood levels show both the bound and free fractions of the hormones. The bulk of most
hormones are bound to other proteinaceous structures in the blood and are not available at
the cellular level. It is possible to do a free fraction measurement of a hormone in
blood, although it is quite costly. Saliva levels are the free fraction only and directly
reflect the tissue levels of the hormone. This ability of saliva to show the tissue-active
levels of DHEA and Cortisol is why ASI is considered a functional test.
Who Should Take The Adrenal Stress Index
Test?
The ASI is an appropriate test for anyone considering the use of DHEA and/or pregnenolone
as part of an anti-aging or life-extension program. The ASI is also commonly ordered for
individuals experiencing any of the following:
• Chronic stress
• Lack of vitality
and energy
• Muscle and joint
pain
• Migraine
headaches
• Osteoporosis
• Sleep
disturbances
• Poor memory
• Alcohol
intolerance
• Stress
maladaptation
• Low sex drive
• Low body
temperature
The ASI does not diagnose a specific pathology, but rather evaluates fundamental regulatory systems of the body. This makes the ASI an extremely useful tool in assessing and designing a precise longevity and health optimizing program. (Next month we will explore in greater detail the implementation of ASI test results along with some examples of adrenal rebalancing programs).
Vitamin Research Products Inc.
3579 Hwy. 50 East, Carson City, NV 89701
1-702-884-1300, fax 1-702-884-1331
1-800-877-2447, fax 1-800-877-3292
VRP's HomePage http://www.vrp.com
email: [email protected]
Disclaimer: This information may be copied and distributed freely as long as all text remains intact, unchanged and with Vitamin Research Products, Inc. listed as source. Commercial use or commercial distribution may not occur without the express written permission of Vitamin Research Products, Inc.
No information in this article should be taken as a recommendation. If you have any questions about the relationship between nutritional supplements and your health, seek the advice of a qualified physician.