I’m so glad I did this. Last week I returned to my naturopath (named Dr. Love, no joke) to get the results of my adrenal function test. This test involved taking saliva samples four times during one day (before breakfast, lunch and dinner and at bedtime). My naturopath gave me a kit with four test tubes to spit into, and a plastic envelope to mail the samples across the country in to Rocky Mountain Analytical labs. They tested my saliva for my cortisol level from each sample and graphed how it fluctuated during the day. 1 also had my overall DHEA level tested.
Cortisol, also known as the ‘stress hormone’s is produced by the adrenal glands (endocrine glands that sit on top of the kidneys). Cortisol regulates many of the body’s responses to stress, including blood sugar levels, metabolism, immune responses, blood pressure, and central nervous system activation. Although high levels of cortisol are released, alongside adrenalin, to initiate the ‘fight or flight’ response to stressful situations, it also plays a role in day-to -day functioning. Cortisol is released in the morning to help you become alert and focused. It is supposed to decline gradually during the day so that by evening you feel sleepy and ready for bed. The green shading on the graph in Fig. 1 shows this downward curve. There is a normal range in the population, with people on the upper end going from 7.0 to 1.3 ng/mL from a.m. to p.m. and people on the low end of the range going from 1.0 to 0.2 ng/mL.
My results: my cortisol curve is all off. I start the morning at 2.8 ng/ml, decrease to 1.4 by mid-afternoon, then increase back up to 2.6 and finally tapering off at 1.0 ng/mL at bedtime. This explains my mid-afternoon slump and energetic evenings. Dr. Love also pointed out that I go from being in the bottom 50% of the normal cortisol range in the morning and afternoon, but by evening I am in the upper 50%, and trying to fall asleep with a relatively high level (l.0 ng/mL cortisol). This is probably contributing to my night time insomnia.
I also have a low overall DHEA level. The normal range is 1.2-8 ng/mL, and my level was 1.4. DHEA is produced in the adrenal glands, and is a precursor hormone for estrogens and androgens (male and female sex hormones). This hormone helps to counter the effects of cortisol in some tissues, such as the brain and heart, and supports a healthy immune system. Studies have demonstrated that DHEA supplementation can help improve mood and sexual interest in women with adrenal fatigue. My naturopath recommended 1 start with 5 mg per day (a fairly low dose). So far, I have found that my energy is more sustained, even on days where I slept poorly. However, my PMS symptoms were much worse, which the doctor said indicated the dose was too high. At the moment I am trialing taking 5 mg, 3x per week. If my energy goes down, then I will try adding adrenal extracts. In order to improve my circadian rhythm, I am also taking 6m of sustained / time release melatonin at night. This stuff is quite effective! | have been sleeping through the night more regularly since I started. (I found regular melatonin did not have this effect). Melatonin reduces cortisol, so this will help with those elevated night time levels. I occasionally add 1 mL of licorice tincture on really tired days (it helps slow the breakdown of cortisol in the body, so whatever you do produce stays around longer). However, prolonged use of licorice has side effects like hypertension, so it is not good to use as a regular supplement.
Overall it was great to finally have some clarity about my energy levels. If you have the opportunity, I recommend doing an adrenal panel test if you have poor sleep and daytime fatigue!
Note: After a trial period, my energy has been much better, but I had significant PMS symptoms. My naturopath lowered the does to 5mg every other day, and the side effects went away, but my energy is still better. My sleep is also much more consistent, with the only factor disturbing it usually being stomach problems if I ate something I am intolerant too.
I was also made aware of a great new book about Adrenal Fatigue called The Adrenal Fatigue Solution by Dr. Eric Wood and Fawne Hansen. I had previously read a book on adrenal fatigue several years ago, but a lot of research has been done since. This book presents the research in an accessible, easy to read way, along with naturopathic treatments. I hope to post a full review soon. They also have a helpful website http://adrenalfatiguesolution.com/ with a lot of information there. (For full disclosure, the authors contacted me to review the book and provided me with a free copy. I genuinely feel it is a helpful resource on the topic, and have not been compensated for saying so).