Description: The panel utilizes four saliva samples (1 , 2). Saliva cortisol reflects the Free (bioactive) Fraction of serum cortisol. The test report shows the twenty-four hour diurnal cortisol rhythm generated in response to real life stress.



Therapeutic value: The test results facilitate the diagnosis of stress maladaptation and adrenal fatigue. With this data, you can narrow your choices to the most appropriate modalities of treatment.

Description: The panel measures the average DHEA(S)* level for the day using multiple samples.

Therapeutic value: The cortisol to DHEA relationship is presented in a visual graph that highlights the degree of stress maladaptation. This information helps determine the projected time for recovery, and the substances (hormones, supplements, botanicals) that promote this recovery. Cortisol to DHEA ratio regulates many functions as listed below.



* Salivary DHEA(S) is found at about 0.1% of its plasma concentration. Serum fluctuations in DHEA(S) concentrations are accurately and rapidly reflected in salivary levels (3). DHEA(S) indicates Free Fractions of both DHEA & DHEA-Sulfate.

Description: The panel measures 17-OHP1 level in order to evaluate efficiency of conversion of adrenal precursors into cortisol. Certain adrenal fatigue patients who are genetically predisposed to low production of cortisol will not benefit from exogenous supplementation of pregnenolone or progesterone.

Therapeutic value: By identifying the sub-population of maladapted and adrenal fatigued individuals who show impaired 17-OHP1 conversion to cortisol, two things are avoided:

1. Treating these patients with precursors (when instead they need cortisol supplements to restore their adrenal health).
2. Pursuing further pituitary related tests and treatments (when they are not needed in this subpopulation).

Description: The panel includes fasting and postprandial insulin measurements. The insulin values are used to diagnose insulin resistance, functional insulin deficit (Pre-Diabetes) and also correlate elevated cortisol with insulin to help explain glycemic dysregulation problems. (See Glycemic Dysregulation section)

Therapeutic value: The combined results of insulin and cortisol can help in designing an effective glycemic control treatment plan that may include life style modifications, nutritional support and botanical supplementation.

Description: The panel evaluates mucosal immunity by using SIgA as a stress impact biomarker. SIgA values are sensitive to increased cortisol/DHEA ratio and sympathetic tone (See Diagram 2).

Therapeutic value: By detecting depressed mucosal immune function in certain patients, a number of therapeutic modalities may be invoked, ranging from botanical supplementation to control of heart rhythm variability.

Description: The panel includes a gliadin antibody measurement that allows detection of subclinical grain intolerance in affected individuals, even in the absence of overt celiac disease.

Therapeutic value: This test allows objective identification of grain intolerant patients, who should restrict their gluten intake to reduce inflammation and adrenal stress.

Common Adrenal Related Symptoms

Inadequate Adrenal Function- Weight Loss / Anorexia Progressive Fatigue / Lethargy Hypoglycemia Diffuse Muscle & Joint Pains Hypercalcemia Low Serum Sodium / Salt Cravings Skin Hyperpigmentation High Serum Potassium Anemia / Lymphocytosis Lightheadedness upon standing Abdominal Pain / Diarrhea

Hyperactive Adrenals- Weight gain / Truncal Obesity Emotional Lability / Depression Glucose Intolerance Insulin Resistance Osteopenia / Fractures Hypertension / Sodium Retention Thin hyper pigmented skin / Striae Sleep Disturbance Poor Concentration / Memory Loss Menstrual Dysfunction / Impotence Increased Blood Lipids

Chronic Pain/Fibromyalgia: An adequate adrenal response can maintain a higher pain threshold (4). The ASI™ is used to evaluate the stress impact of chronic pain and inflammation on adrenal adaptation. A proper diagnosis of low cortisol or DHEA with circadian rhythm disruption is imperative. Subsequent hormone replacement and rhythm correction will improve the individual's pain tolerance (7, 8).
Chronic Fatigue syndrome (CFS): A common HPA axis defect in CFS is impaired corticotrophin release (5). As a result low cortisol and eventual adrenal atrophy may be observed. Depleted adrenals with flat rhythms are often seen on the ASI™ panel (6). Simultaneous use of several therapies can help improve the debilitating CFS.
Glycemic Dysregulation: Chronic hypoglycemia can impair normal adrenal function by repetitive over-stimulation of cortisol production. Recurring expo- sure 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.
Allergies/Autoimmune Disorders: 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 (9). More recently, German researchers reported that disruption of the adrenal axis and cytokine relationships lead to predisposition and aggravation of autoimmune diseases (10). The findings of the ASI™ help identify patients with autoimmune diseases and adrenal problems who can benefit from cortisol supplements.
Depression/ADD: Several recent publications (11, 12) 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 successfully diagnosed with the ASI.™ Subsequent interventions to rectify the time specific cortisol elevations (during day or night) are usually effective when applied under proper supervision (13, 14).