Adrenal Stress Index: Patient Overview
The Adrenal Rhythm and Its Importance
The human adrenal glands do not secrete steroid hormones at a constant level throughout the day. The hormones are actually released in a cycle, with
the highest value in the morning and the lowest value at night when functioning properly. This 24-hour cycle is called the circadian rhythm and is depicted
below in Figure 1
An abnormal adrenal rhythm can influence many functions of the body, some of which are described below.
Abnormal adrenal function can alter the ability of cells to produce energy for the activities of daily life. People who have a hard time rising in the
morning, or who suffer from low energy throughout the day, often have abnormal adrenal rhythms and poor blood sugar regulation.
The maintenance of a stable blood sugar level depends on food choice, lifestyle, adrenal function and insulin activity. The Adrenal Stress Index™ panel
measures stress hormones and insulin, to help ferret out the causes of fatigue, cravings and obesity.
Muscle and Joint Function
Abnormal adrenal rhythms are known to compromise tissue healing. Reduced tissue repair and increased tissue breakdown can lead to muscle and joint wasting
with chronic pain.
The adrenal rhythm determines how well we build bone. If the night and morning cortisol levels are elevated, our bones do not rebuild well, and we are
more prone to osteoporosis. Stress is the enemy of the bones. In postmenopausal women, the effect of stress worsens due to female hormone imbalances.
Various immune cells (white blood cells) cycle in and out of the spleen and bone marrow. The immune system trafficking follows the cortisol cycle. If the
cycle is disrupted, especially at night, then the immune system is adversely affected.
Short- and long-term stress is known to suppress the immune response in the lungs, throat, urinary tract and intestines. With reduction in the surface
antibody (called secretory IgA), the resistance to infection is reduced and allergic reactions are believed to increase.
The ability to enter REM sleep cycles and experience regenerative sleep is interrupted by high cortisol values at night and in the morning. Chronic lack
of REM sleep can reduce a person’s mental vitality, vigor and induce depression.
Human skin regenerates mostly during the night. With higher night cortisol values, less skin regeneration takes place. Therefore a normal cortisol rhythm
is essential for optimal skin health.
The level of cortisol at the cell level controls thyroid hormone production. Often, hypothyroid symptoms such as fatigue and low body temperature are due
to an adrenal maladaptation.
Chronic Fatigue Syndrome (CFS)
A common HPA axis defect in CFS is impaired corticotrophin release. As a result,
low cortisol and eventual adrenal atrophy may be observed. Depleted adrenals with
flat rhythms are often seen on the ASI™ panel. Simultaneous use of several therapies
can help improve the debilitating effects of CFS.
Chronic hypoglycemia can impair normal adrenal function by repetitive overstimulation
of cortisol production. Recurring exposure to high cortisol will impair insulin
activity, and invariably lead to insulin resistance and beta-cell exhaustion
(diabetes). The ASI™ panel investigates the insulin-cortisol relationship under
real-life conditions to allow targeted and meaningful interventions. This panel is
useful in the following clinical situations: rapid weight gain and obesity, deranged
blood lipids, sugar blues, early diabetes and associated emotional disturbances.
More than fifty years ago, Dr. W. Jefferies (author of Safe Uses of Cortisol) discovered
that patients with environmentally triggered allergies and autoimmune diseases dramatically
beneﬁted when given cortisol for other purposes. More recently, German researchers reported
that disruption of the adrenal axis and cytokine relationships lead to predisposition
and aggravation of autoimmune diseases. The ﬁndings of the ASI™ help identify patients
with autoimmune diseases and adrenal problems who can beneﬁt from cortisol supplements.
Several recent publications report a hyperactive HPA axis in depressed patients. Elevated
midnight salivary cortisol is now considered one of the best tests in diagnosing endogenous
depression. Other anomalies in cortisol rhythm usually accompany the midnight elevation. On
the other hand, cortisol elevations and rhythm disruptions throughout the day are typical
of attention deﬁcit disorders (ADD). The anomalous cortisol ﬁndings in depression and ADD
can be diagnosed successfully with the ASI™. Subsequent interventions to rectify the
time-speciﬁc cortisol elevations (during the day or night) are usually effective when applied
under proper supervision.