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Hompes MethodPractitioner Training Level II

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Lesson Thirty-Two –Adrenal Testing

Adrenal Stress Testing - Intro

• So far in this module we’ve discussed the concept of physiological stress and also some of the main metabolic / endocrine changes that happen during the stress response:

– General Adaptation Syndrome (Selye)

– HPA Axis

– Sympathomedullary response

– Inflammatory, immune, water/electrolyte regulation, nutrient loss


• Assuming the Selye GAS is correct/accurate (which it may not be), how do we use functional lab testing to look at hormone levels and identify which of the three GAS phases a client or patient is in?


• It’s also pertinent to enquire as to how useful this testing is at the start of a program because remember that you’re going to very quickly offload stress from a client/patient’s body using Hompes Method I principles, then removing bad bugs, etc. What effect will these actions have on a test that’s assessing adrenal function (or other hormones)?


• In other words:

– What is an adrenal test going to look like on day one versus day 60 or 90?

– If the adrenal output changes significantly (improves or declines) during that process, why bother testing it up front?

– Is it better to test once you’ve gotten your clients and patients living healthier lifestyles?

– Could an adrenal test and some adrenal support accelerate their outcome?


• Hold these questions in your mind as we go through the next section on adrenal stress index testing.


• The first thing to say about adrenal testing is that unless a client/patient has some really obvious or serious symptoms relating to adrenal function, the adrenals probably won’t be tested. The thyroid is considered far more than the adrenals, which is odd to say the least (frankly it’s ridiculous and surely must be close to being negligence).


• Thus, we’re in a really nice position to offer any form of reasonably accurate adrenal function assessment to help our clients and patients and they truly do appreciate this.

http://blog.adrenalfatigue.org/adrenal-fatigue/what-is-adrenal-fatigue/

http://blog.adrenalfatigue.org/adrenal-fatigue/what-is-adrenal-fatigue/


• A physician may test cortisol levels using blood or urine. They’ll generally only look at cortisol if they suspect one of two conditions:

– Addison’s disease

– Cushing’s disease

Addison’s Disease (NHS)

• Addison’s disease (also known as primary adrenal insufficiency or hypoadrenalism) is a rare disorder of the adrenal glands.

• It affects the production of two essential hormones called cortisol and aldosterone.

• About 8,400 people in the UK have Addison's disease.

• It can affect people of any age

• It's most common between the ages of 30 and 50. It is also more common in women than men.

• It’s usually autoimmune.


• Early stages symptoms of Addison’s disease are similar to other more common health conditions such as depression or flu. You may experience:

– Fatigue (lack of energy or motivation)

– Muscle weakness

– Low mood

– Loss of appetite and unintentional weight loss

– Increased thirst


• Over time, these problems may become more severe and you may experience further symptoms, such as:

– Dizziness

– Fainting

– Cramps and exhaustion

– Small areas of darkened skin.

http://www.nhs.uk/Conditions/Addisons-disease/Pages/Symptoms.aspx

http://www.nhs.uk/Conditions/Addisons-disease/Pages/Symptoms.aspx

Addison’s Disease (NHS) - Diagnosis

• Low blood pressure• Hyper pigmentation of skin• Synacthen stimulation test (manmade ACTH)• Blood tests:

– Na (low)– K (high)– Cortisol (low)– Aldosterone (low)– ACTH (high) – Glucose (low)– Adrenal antibodies (positive/high)

Cushing’s Disease (NHS)

• Cushing’s syndrome, also known as hypercortisolism, is a collection of symptoms that develop due to very high levels of a hormone called cortisol in the body. Symptoms include:– Weight gain

– Thinning skin that bruises easily

– Reddish-purple stretch marks on the thighs, stomach, buttocks, arms, legs or breasts

– Fat deposits that develop in the face, causing it to become round

– Decreased interest in sex


• Cushing’s syndrome often develops as a side effect of treatment with corticosteroids. Corticosteroids are widely used to reduce inflammation and treat autoimmune conditions. People who take high doses of corticosteroids, long-term, often have a build-up of cortisol in their blood. This type of Cushing’s syndrome is sometimes called iatrogenic Cushing’s syndrome.


• Diagnosis can be challenging, particularly when the symptoms are mild.

• The symptoms of Cushing’s syndrome are similar to those of other, more common conditions, such as an underactive thyroid and high blood pressure you may be referred for a number of different tests.

• It could be several months before Cushing's syndrome is confirmed.

• Your GP will want to know whether you are taking any medication because the use of corticosteroids is the main cause of Cushing’s syndrome.


• If Cushing's syndrome is suspected, the amount of cortisol in your body will be measured using one or more of the following tests:

– Urine test

– Blood test

– Saliva test (see below)


• A saliva test is most accurate when it is carried out in the middle of the night, so you may be asked to stay in hospital overnight (??? – DH)

• Before taking a urine test, you may be given a medication called dexamethasone. If you are otherwise healthy, dexamethasone should decrease your cortisol levels. If your cortisol levels are unaffected, it could be due to Cushing’s syndrome.

Adrenal Testing

• It’s important for you to be aware of Addison’s and Cushing’s, but the main reason I discussed them is to lead us into limitations of standard medical testing for adrenal function (especially cortisol):

– Single blood test

– Single urine test

– Single saliva test

Cortisol Blood Test

• There are huge limitations in using a single test for cortisol levels because cortisol production and secretion varies tremendously over the course of a 24 hour period. Realistically, you can’t use a blood test to assess circadian cortisol rhythm as you’d need to take your own blood or be in a clinic. It’s totally inconvenient.

Cortisol Urine Test

• A 24-hour cortisol urine test measures the total amount of free cortisol excreted into the urine in a 24-hour period. Blood tests only measure cortisol levels at a particular time in the diurnal/circadian cycle.

Cortisol Saliva Test

• Cortisol saliva tests are convenient and can be done at home. They measure the “free” fraction of cortisol, which is theoretically the cortisol that’s available to the cells for use (this is controversial).

Cortisol Saliva Test

• For our purposes as functional medicine practitioners, we can use the saliva tests to look at cortisol rhythm. At the same time, we can look other hormones in the saliva – DHEA, progesterone, oestrogens, testosterone, etc.

Cortisol Circadian Rhythm

“In humans, the amount of cortisol present in the blood undergoes diurnal variation; the level peaks in the early

morning (approximately 8 am) and reaches its lowest level at about midnight-4 am, or three to five hours

after the onset of sleep. Information about the light/dark cycle is transmitted from the retina to the paired suprachiasmatic nuclei in the hypothalamus.”

http://en.wikipedia.org/wiki/Cortisol

http://en.wikipedia.org/wiki/Cortisol


http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3475279/



“Circadian rhythm of cortisol in 33 individuals with 20-minute cortisol profiling. Peak cortisol levels are

reached at around 08:30 and nadir cortisol levels at around midnight. The peaks of cortisol at noon and

around 18:00 represent meal-induced cortisol stimulation. (Reproduced with permission from The

Endocrine Society and Debono et al. [2009]”




http://drjockers.com/healthy-adrenal-rhythm-test/

http://drjockers.com/healthy-adrenal-rhythm-test/

The Adrenal Stress Index Test

• All the major private labs run ASI tests [Metametrix(as was), Genova, Diagnost-Techs]. The test involves taking four saliva samples at different times of day to map out the cortisol rhythm:

– 8am

– Noon

– 4-5pm

– 11pm-midnight


• When you prepare your client/patient for taking the test, it’s important to standardise the test because cortisol is volatile:

– Food intake needs to be the same on both days

– Meals eaten at the same time

– Exercise levels need to be the same (ideally none)

– Same environmental conditions (e.g. how much light exposure at 11pm?


• When I did my first ASI, there’s no question that my environment influenced the result. One of my cortisol readings was ridiculously high relative to all the others and this, I believe, was due to an argument I’d had with my girlfriend around 30min before I collected the sample.


• Thus, get your client/patient to keep a journal of what they do on the day of the test and make sure they repeat that day as closely as possible when they retest. Failure to do this means that you wont have a comparable retest.


• My experience with the labs is:

– Diagnostechs seemed to report very low results that didn’t seem to reflect client wellness, energy levels and symptoms.

– Metametrix seemed to reveal “normal” results, even in people who were worn out, not sleeping and felt generally unwell.

– Biohealth seems to always produce reasonable results that reflect client/patient symptoms, but I have had problems with them, too.


• I’ve used Biohealth for the majority of my adrenal testing and am reasonably happy with the results and outcomes. I’ve come to be familiar with working by their numbers. Occasionally we get weird DHEA results that go sky high for no apparent reason and it’s not clear whether they’re outlying/rogue results or whether there’s some kind of response in some people’s adrenals that leads to elevated DHEA even though cortisols are very low.


• Because cortisol is so volatile, I recognise we’re not going to get perfect results. But I’m looking for patterns and I’m often times using the test as a left-brain client motivation tool.

Sample Report 1 – MB Initial Test

Sample Report 1 – MB Retest

Sample Report 3 – TR Initial

Sample Report 4 – MG Initial

Sample Report 4 – MG Retest

Timing & Sequence of Adrenal Work

• I was taught in my first functional medicine training to work with the adrenals first to:

– Improve energy production:

• Digestion

• Detoxification

• Sex hormone balance

• Thyroid

– Up regulate immune response:

• Improved outcomes in bug-killing and gut healing

Timing & Sequence of Adrenal Work

• An ASI is an inexpensive entry level test, but I’m not 100% sure it’s the best way to go. My angle is this: why support the adrenals while there’s still so much stress on the body? Why not work quickly and efficiently to remove as much stress as possible, then support the adrenals?

• Note: you can look at it both ways – there’s no right or wrong.

Interpretation: Stages of Adrenal Fatigue

http://www.drhagmeyer.com/natural-treatments/stages-of-adrenal-fatigue-part-ii/

http://www.drhagmeyer.com/natural-treatments/stages-of-adrenal-fatigue-part-ii/

The Steroid Pathways


• Stage I:

– High total cortisol; possible declining DHEA.

• Stage II:

– Cortisols high or low during the day; normal total cortisol; declining DHEA.

• Stage III:

– Cortisol low across the board with low DHEA.


• Common observations:– High morning cortisol > often an infection causing

inflammation at night due to immune response.

– Low morning cortisol > disrupted sleep and also thyroid issues (adrenaline may be high – Ray Peat).

– High noon cortisol > blood sugar issues due to skipped breakfast/lack of morning snack.

– Low afternoon cortisol > poor lunch choices or possibly due to compensation of high cortisol in the morning or at noon.

– High nighttime cortisol due to “training” effect of staying up late, partying or exposure to too much light.


• You’re going to see results that don’t quite fall into the three categories. You’re also going to see results that don’t seem to fit any of the categories. Don’t worry – it’s ok to have rogue results now and again. The key is to not get flustered when speaking with your client or patient and find the best fit.

Fixing The Adrenals

• In the next lesson we’ll look at this in detail, but the key steps are:– Remove bad foods.

– Eat more good foods.

– Improve blood sugar (macronutrient ratios and food timing).

– Optimise bed time and bed time habits (e.g. snack).

– Check exercise habits and optimise.

– Do the functional medicine work – bad bugs, good bugs, optimise digestion, support liver, optimise nutrient status.

– Rebuild adrenal health and restore endocrine balance.

Fixing The Adrenals

• In specifically rebuilding the adrenals, it’s prudent to consider four approaches:

– Nutrition and lifestyle only

– Herbs

– Glandular formulations

– Bioidentical hormones

Thank You!

• As always, thanks a million for tuning in and consuming this info. It’s been my pleasure sharing this wisdom with you. In Lesson Thirty-Three we’ll look at specific products and protocols for supporting and rebuilding the adrenals!

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