Adrenal Saliva Testing

Functional Adrenal Stress Profile Saliva Testing

  1. Cortisol (4 x day)
  2. Averaged DHEA-S
  3. Estradiol
  4. Estriol
  5. Estrone (plus V only)
  6. Testosterone (AM)
  7. Melatonin (bedtime)
  8. Progesterone (bedtime)

Efficacy of Salivary Testing

Salivary Cortisol:

  1. Under real life situations
  2. Circadian cycle
  3. Unbound bioactive hormone
  4. Treatments are very specific

Serum Cortisol:

  1. Apprehension due to anticipation
  2. No circadian cycle
  3. Total hormone level
  4. Treatment options are limited

 

Evaluating the Cortisol circadian (24-hour) rhythm along with DHEA-S provides an accurate assessment of adrenal function and can reveal maladaptation to stressors. Salivary (free fraction) hormone testing determines the bioactive values at the cellular level, thereby providing a functional assessment of the effects of environmental and physiological stressors.

Clinical Notes

1. Low DHEA is a normal finding in children below the age of 14 and DHEA augmentationis not recommended.
2. Licorice alone may not be effective in cortisol augmentation when morning cortisol is < 5nM. In extreme cases it may be necessary to augment with 15 mgs of Hydrocortisone temporally until underlying cause is addressed.
3. Pregnenolone augmentation is necessary when the cortisol burden is very depressed <23 or >85
4. Cortisol augmentation is contraindicated in diabetic or pre-diabetic patients.
5. The adrenal protocols listed do not take into consideration patients on thyroid, as improving adrenal function (augmenting DHEA and pregnenolone) can significantly improve thyroid function, thereby reducing the amount of thyroid medication necessary. Given this possibility it is suggested that any patient on thyroid should be closely monitored and lower dosages of pregnenolone and DHEA should be initially. considered.

Supplement Products

Pregnenolone

  1. Pregnenolone Liquid
  2. Pregnenolone Cream
  3. Pregnenolone Capsule

DHEA

  1. DHEA Liquid
  2. DHEA Liposomal
  3. DHEA Cream

Adrenal Adaptive

  1. Adrenal Support Formulas
  2. Multi-Mineral
  3. Pantethine
  4. Ginseng (American/Asian)
  5. Cortisol Suppression
  6. Phosphatidylserine (Soy Free)

Licorice

  1. Licorice Liquid
  2. Licorice Paste
  3. Licorice Formulas (Metagenics licorice Plus)

Glandular

  1. Adrenal Cortex

Adrenal/DHEA Restoration

High Cortisol:DHEA Ratio:

  1. Pregnenolone
  2. DHEA
  3. Adrenal Adaptive
  4. Cortisol Suppressive

Low Cortisol:DHEA Ratio:

  1. Licorice Extract
  2. Adrenal Adaptive
  3. Adrenal Glandular
  4. May require prescription cortisol in extreme cases
  5. Lifestyle Changes

Adrenal Stress Testing Protocols

  • Elevated 8:00 am cortisol levels are suggestive of a hyper-stimulated adrenal gland engaged in glucose counter-regulation during sleep. Nocturnal hypoglycemia.
  • Depressed 8:00 am cortisol levels are suggestive of adrenal hypofunction.
  • Elevated Noon and 4:00 pm cortisol levels are suggestive of a tendency towards hypoglycemia.
  • Depressed 4:00 pm cortisol levels are suggestive of a hypofunctional gland with poor glucose counter regulation and an afternoon performance slump.
  • Elevated 11:00-12:00 midnight cortisol levels are indicative of hypothalamic- pituitary hyperactivity, insensivity to negative feedback, or endogenous biological depression.
  • Low DHEA is a normal finding in children below age of 14 and DHEA augmentation is NOT recommended.
  • If augmenting with DHEA and thyroid medication, closely monitor the patient and reduce thyroid medication accordingly.
  • Cortisol augmentation is contraindicated in diabetic or pre-diabetic patients.
  • Licorice will not suffice when cortisol levels are less than 5 nM.
  • Pregnenolone augmentation is necessary when cortisol burden is very depressed <23 or the daily burden of cortisol is >85

Adrenal Recovery Protocol

  1. Removal of the Stressors
  2. Sleep
  3. Avoid Caffeinated Beverages
  4. Maintain Glycemic Control
  5. Avoid or Minimize TV and Computers
  6. Exercise
  7. Minimize Concept Shifting (Multi-tasking)
  8. Complete the Elimination Phase (6 weeks)
  9. Shift toward Metabolic Type
  10. Optimize Metabolic Ecology
  11. Nutritional Supplementation
  12. Never Skip Breakfast
  13. No Sugar
  14. Use Salt (Sea Salt)

Adrenal Protocols

Reference Chart:

  1. MorningCortisol(7:00–8:00AM)=C1
  2. NoonCortisol(11:00–12:00PM)=C2
  3. AfternoonCortisol(4:00–5:00PM)=C3
  4. NighttimeCortisol(11:00–11:59PM)=C4

What is total cortisol?

If less than 23 and/or greater than 85 then pregnenolone should be prescribed

What is total DHEA?

If DHEA is less than 7 ng/ml then DHEA should be prescribed. (Note: Although the reference range for salivary DHEA is 2 to 10 ng/ml, the idealoptimal range is 7.0 to 8.0 ng/ml)

Are individual cortisols elevated?

If C1 is elevated:

  1. Rule out high glycemic meal before bedtime
  2. Rule out 3rd shift occupation resulting in a circadian reversal
  3. Rule out parasitic infection (check for monocytes > 7 and eosinophils >3)
  4. Elevated cortisols should be treated with Phosphatidylserine.

Are individual cortisols depressed? If yes, then licorice extract is recommended

Exceptions:

Licorice is contraindicated in patients suffering with hypertension.

If individual cortisol levels are less than 5nM, licorice is likely to NOT be effective. In these cases a prescription of hydrocortisone may be indicated.

DHEA Protocol Guidelines

The maximum recommended dose should not exceed 20 mg per day. The typical dose is 3-7 drops after breakfast and 3-7 drops after dinner

Female

  1. Week 1: Use 5 drops A.M. only
  2. Week 2: Use 5 drops twice daily thereafter

Males

  1. Week 1: Use 5 drops A.M. only
  2. Week 2: Use 5 drops twice daily
  3. Week 3 and beyond: Use 7 drops twice a day thereafter.

Possible Side Effects include:

Headaches, light headedness, stomach discomfort, acne, breast tenderness, excess mucous, female spotting.
Alternative Protocol in the event of side effects:
In the event patient experiences any of the above side effects it is recommended to decrease the dose to 1 drop twice a day and gradually titrate up to the optimal dosage.

Pregnenolone Protocol Guidelines

Pregnenolone is only prescribed when the total cortisol burden is either less than 23 and/or greater than 85.

Phosphatidylserine Protocol Guide

Dosages and Prescription
A common dose is 100mg 20 to 30 minutes before each of the elevated cortisols. For example, if the morning and evening cortisols are elevated then 100mg should be taken 20 to 30 minutes before morning cortisol time (7:00 – 8:00 AM) and 20 to 30 minutes before evening cortisol time (11:00 – 11:59PM)

Licorice Protocol Guide

Whole Licorice Root Extract (Glycyrrhiza) from BioMatrix
Dose: recommend 5 drops under tongue morning, noon and afternoon but never in the evening.
Licorice Plus from Metagenics
Dose: recommend one tablet with each depressed cortisol time.

Additional Support

  1. Adrenal Adaptive
  2. Support Adrenals from Biomatrix
  3. Recommend taking two in morning and two at noon. Never take in late afternoon and evening
  4. Support Minerals from Biomatrix
  5. Recommend three tablets before bedtime
  6. Allergy Research Pantethine
  7. One capsule in morning and noon

Adrenal Adaptive

  1. Pure Encapsulation Panax Ginseng
  2. Bovine Adrenal Cortex – Adrenal from Pure Encapsulations
  3. Recommended one capsule between meals (3-4 per day)
  4. Support Adrenals from Biomatrix
  5. Recommend taking two in morning and two at noon. Never take in late afternoon and evening
  6. Support Minerals from Biomatrix
  7. Recommend three tablets before bedtime
  8. Bovine Adrenal Cortex
  9. Adrenal from Pure Encapsulations
  10. Recommended one capsule between meals (3-4 per day)

Re-testing Recommendations

Re-testing needs to be performed approximately 6 weeks following the start the patient’s protocol