Saliva Cortisol and the Adrenal Stress Index Panel
Normally cortisol is 10 times higher in the morning than at night. How much stress you are under, and what you eat can also cause it to fluctuate during the day. Therefore, a single blood tests can not tell you much. You need to have multiple sample to make sure you don’t miss something. Saliva cortisol has several advantages over blood. First, it is a more true representation of how much cortisol each cell is actually getting. Secondly, saliva cortisol can be collected just about anytime and anywhere. This allows for multiple collections during the day. Saliva cortisol can also be collected when you are most under stress. That’s often when people need their cortisol tests.
The adrenal stress index panel is a test used by my go to lab for saliva hormones, Diagnostechs. The panel measures cortisol and other markers useful for assessing adrenal fatigue. More on the ASI panel at the bottom of this page.
The following sample cases show the advantage of saliva cortisol collection over blood tests.
Low cortisol through the entire day
In this case saliva cortisol is sub-optimal during the whole day. This is someone who is tired all the time and needs adrenal support. Support for other systems is probably needed as well. This could be working on diet, infections, detoxification, emotional stress. What the exact support needed is depends on the rest of the intake.
Elevated morning cortisol
This person can have several symptoms. One may be high blood sugar. Cortisol raises blood sugar, so if it’s spiking during the night then someone may have high blood sugar while they sleep. Sometimes people eat well and have normal blood sugar during the day, but when their doctor tests them, they are become diabetic. Cortisol may be one reason why.
Anxiety and fatigue may also be present with this pattern.
Inverted cortisol pattern
This person will be tired during the day and have a hard time waking up. Later on at night they may get a “second wind” finally have energy to do things and stay up late. Insomnia is possible with this pattern. I have often had people collect saliva cortisol late at night (or even if they wake up in the middle of the night) to see if there is a cortisol issue causing insomnia.
Getting cortisol tested
The lab I have always used for cortisol tests is diagnostechs. I like them because they are affordable and have lab panels which make sense and are clinically relevant.
Typically, cortisol is tested as part of the ASI test (Adrenal Stress Index). This panel includes the following markers:
- 4 cortisol samples
- DHEA: another adrenal hormone which helps to interpret cortisol levles and degree of adrenal fatigue)
- 2 insulin samples: high cortisol can raise blood sugar and insuline
- 17-OH progesterone: A progesterone made by the adrenal glands. This aids in overall interpretation.
- Gluten IgA: a good screen test for gluten allergy and sensitivity. Can contribute to adrenal fatigue.
- Secretory IgA: marker of immune system function. Greatly effect by stress and cortisol.
Small panels are also available is all of the above is not needed.