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Saliva Cortisol Testing and Adrenal Fatigue

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. 

ASI adrenal test. low cortisol at all times

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.

Cortisol is very high in the morning. The rest of the day it comes back down to normal.

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.

Inverted cortisol pattern on test. it is below normal in the morning and higher at night.

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.

Other pages on cortisol and Adrenal Fatigue

Naturopathic treatment of adrenal fatigue

Adrenal supplements and adaptogens

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Lab Tests For Epstein Barr Virus (EBV)

Epstein Barr Virus and Mononucleosis

Epstein Barr Virus (EBV) is a very common infection. Over 90% of the world’s population tests positive for exposure to it.
In conventional medicine EVB is the cause of infectious mononucleosis. This is commonly called “mono.”
Mono often strikes teenagers and young adults. It causes severe symptoms for weeks to a few months and then goes away.
Common symptoms of mononucleosis include:

  • Fever
  • Sore throat
  • Fatigue
  • Anorexia
  • Myalgia (muscle pain)
  • Lymphadenopathy (enlarged lymph nodes)
  • Splenomegaly (enlarged spleen)

This is an abbreviated list. Mononucleosis can be a severe acute infection.
In conventional medicine once symptoms subside and lab tests return to normal is it assumed that the patient has recovered.

Chronic EBV and Stealth Infections

A “stealth infection” is one that no longer is causing the classical acute symptoms. The patient seems to have recovered. However, the infection stays in the body, causing chronic symptoms.

Over the past few years people in natural health have associated EBV with chronic illnesses such as chronic fatigue and autoimmune disease. One popular author (Anthony Williams) has even written books citing EBV as the cause of autoimmune hypothyroidism. I like to avoid extreme statements. There is not just one cause of all autoimmune disease. However, EBV is more than something which causes mono in teenagers.

The book, The Epstein Barr Virus Solution by Kasia Kines lists many conditions which research shows is associated with EBV. A partial summary is as follows:

  • Autoimmune disease (includes hypothyroidism, hyperthyroidism,  multiple sclerosis, rheumatoid arthriris, scleroderma, sjogren’s, lupus)
  • Brain related illnesses
  • Gastrointestinal (includes H. pylori, inflammatory bowel disease, ulcer and GERD
  • Acute hepatitis
  • Numerous ocular symptoms

Blood Tests for EBV

Complete Blood Cell Count (CBD) with Differential

This the most basic type of blood test for the immune system is the CBD and differential. Doctors run this almost anytime blood worked it ordered.

We have two types of common blood cells. Red blood cells carry oxygen. White blood cell fight off infections. The CBC counts the total number of red and white blood cells. Since we also have several white blood cells, the differential tells how much of each kind we have.

Basic interpretation
The optimal range is where a healthy person should be. Reference range is larger, being outside of it shows there is a condition to treat.

WBC (white blood cell count)
Optimal is 5 to 7.5.
Reference range goes from about 4 to 11.
The WBC increases during acute infections. In case of long term chronic infections is may drop.

Neutrophils
Optimal is 40%  – 60%
These help the body fight off bacterial infections. Just like the WBC, neutrophiles can increase at the start of an infection then over time decrease.

Lymphocytes
Optimal is 24% – 44%
Lymphocytes are more specific for viral infections.
In case of EBV there is an initial increase in lymphocytes, which then comes back down to reference range.

Eosinophils
Optimal is 0% – 3%
Conventional 0% – 8%
These can increase in cases of allergies or parasites. Not typically relevant to viral infections such as EBV.

Although the WBC does not say what specific infection someone has, it does show general information about how the immune system is doing. It can help to guide treatment.

Antibody Tests for EBV

Antibodies are made in response to specific infections. These are proteins which allow the immune system target and destroy specific infections.

There are 4 common EBV antibodies:

VCA IgG: During an acute infection these go up. After the infection subsides there stay positive for life.

EBV nuclear antigen (EBNA) IgG: Just like the VCA IgG these increase after the initial infection and then stay elevated for life.

EA (D): These are elevated later into the acute phase of infection and then go back down to normal.

VCA IgM: These increase during acute infection and then go back down to normal.

Problems with antibody tests

Unless someone comes back with a positive EA (D) or VCA IgM, the results can be inconclusive. False negatives are possible. Most people are positive against VCA and EBNA IgG as it is. Yet, people with inconclusive results may respond well to natural protocols for the immune system.

Total IgG and IgM

They can test blood to see if total amount of IgG and IgM are low. If these are too low, then false negatives are the above test are more likely.

PCR testing

PCR is a measurement for viral particles in the blood. This in another test to run in case the antibodies miss the infection.

Do lab tests for EBV really matter?

Testing may help in that if an infection is confirmed, then we know what needs to be treated. Often testing is inconclusive because the antibodies that show past exposure are elevated, but the ones that show recent activation are normal. However, since EBV can cause so many symptoms and it helps to confirm on labs what the problem is, testing for EBV should be done.

Often medical doctors are hesitant to order lab tests past the basics. Or even if they do, they don’t order complete tests. So you may need to tell your MD what tests to order. If that doesn’t work, a naturopathic doctor would probably be more willing to order such tests. Depending on your insurance and where you live, getting tests through a ND may be covered. There are also options in certain states to order labs directly out of pocket. Lifeextensions is one such option.

Coming from a traditional, naturopathic perspective the goal isn’t not to simply treat the infection. Rather we work on treating the whole person, which means working on the immune system (and overall health) in general.

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Eosinophils, Parasites and Allergies

Eosinophils, Parasites and Allergies

White Blood Cell Count and Differential

There are two types of cells in our blood. Red blood cells which carry oxygen and white blood cells which are part of our immune system. There are five types of white blood cells:

  • Neutrophils
  • Lymphocytes
  • Monocytes
  • Eosinophils
  • Basophils

On blood tests you will typically see the White Blood Cell count or WBC. This should be followed by the “differential.” The differential is a break down of what percent of the total WBC is each type of white blood cell. Seeing some kinds of white blood cells elevated or suppressed can give information about the state of your immune system.

Elevated eosinophils indicate parasites or allergies.

Convention ranges for eosinophils go up to about 7%. This reference range is in reality far to large. Optimally, eosinophils should be no more than 3%.

Why does it matter if eosinophils are above 3%?

When eosinophils go up this indicates a nonspecific inflammatory response by your immune system against something it does not like. Much more may be going on than just an elevated blood test markers. There may very well be other symptoms caused by whatever is triggering the elevation in eosinophils.

How elevated eosinophils are does not necessarily tell you how bad the problem is. For example intestinal parasites can raise eosinophils (or sometime there is no elevation whatsoever). There may be a very mild increase, perhaps from 2.0 to 4.0, yet this slight elevation can signal a problem which can lead to many other symptoms or diseases.

Regardless, very elevated eosinophils (10% or higher) may be best interpreted as positive for parasite unless proven otherwise.

Some conditions which may be associated with elevated eosinophils are:

  • Cancer
  • Polycythemia
  • Hyperthyroidism
  • Anterior pituitary dysfunction
  • Adrenal dysfunction
  • Phlebitis
  • Edema
  • Rhinitis
  • Gastroenteritis
  • Eosinophila myalgia syndrome

Won’t by doctor treat the problem if eosinophils are elevated?

Not necessarily. First you medical doctor may be using the very conservative conventional reference range, which misses everyone in the 3-7% range. Even if you are over 7% the labs may still be ignored.

If eosinophils are elevated then either allergies or parasites should be investigated. Often the conventional tests for these are not adequate. Typically some IgE and maybe IgG tests are run for environmental and food allergies. These tests are not perfect and allergenic reactions to foods are easily missed.

Then there are microscopic exams for parasites. Stool tests for parasites are very unreliable. Just because you submitted a stool sample and it came back negative for parasites that doesn’t mean you don’t have parasites. All it means is that they didn’t see any parasites in that particular sample. A comprehensive functional stool tests for a lab such as diagnostechs is much better and includes markers such as saliva antibodies to catch parasites that may otherwise be missed visually.

My eosinophils are optimally low – does that mean I don’t have allergies or parasites?

This is just one marker. Allergies and parasites do not always cause an increase in eosinophils. If other symptoms/labs indicate allergies or parasites the it’s best to pursue a course of treatment based on that. These problems can not be ruled out based on normal eosinophils.