Why run Functional Adrenal Stress Profiles?

Do you present with one or more of the following symptoms or conditions?
• Exhaustion • Weight Gain/Loss • Food Intolerances
• Alcohol Intolerance • Allergies • Sinus Problems
• Anxiety • Blood Sugar Imbalances • Depression
• Digestive Disorders • Diminished Sex Drive • Dizziness upon Standing
• Dry and Thin Skin • Excessive Hunger • Craving for Sweets
• Hair Loss • Headaches • Immune Deficiency
• Inability to Concentrate • Parasite Infections • Bacterial Infections
• Fungal Infections • General Pain • Inflammation
• Chronic illness • Irritability • Liver Disorders
• Thyroid Disorders • Pancreatic Disorders • Low blood pressure
• Low Body Temperature • Mood Swings • Pain in the Neck
• Pain in the Shoulders • Low Back Pain • Heart Palpitations
• Poor memory • PMS • Sleep Disorders
• Weakness • Difficulty BuildingMuscle

If they do, this is an indication that they may be suffering from adrenal insufficiency typically driven by one or more chronic stressors. There are a number of sources of stress that may become chronic in nature.

The Adrenal Glands

The two, walnut-size adrenal glands are the command post of the endocrine system and the glands are located in the small of the back just above the kidneys and underneath the last (twelfth) rib. These small but powerful glands are strategically located in the body near the aorta and vena cava to quickly receive information from the anterior pituitary via the release of Adrenocorticotropic Hormone (ACTH). The adrenals are also in close proximity to critical organs that the adrenal hormones act upon including the liver, pancreas, kidneys, and others.
The adrenal glands are divided into two parts: the outer cortex, which consists of three main rings and the inner medulla. The very thin outer ring of the cortex is the zona glomerulosa which secretes aldosterone, the middle ring is the zona fasciculate which primarily secretes cortisol, and the inner ring is the zona reticularis which primarily produces androgens, including DHEA and its metabolites. Despite the diminutive size of the adrenal glands, they are involved in regulating virtually every aspect of body function.

Physiological Effects of the Primary Hormones of the Adrenal Cortex
The adrenal hormones cortisol and DHEA have genetic influence on the body, they penetrate cells and enter the nucleus, where DNA is unlocked and transcribed. Cortisol is the main hormone that directs immune function and its levels are tremendously valuable in assessing overall health. Cortisol and DHEA are also involved in carbohydrate, protein and fat metabolism; eicosanoid modulation; detoxification capacity; endocrine function; and the health of muscle, bone and neural tissues, etc.

Effects of Divergence from Normal Levels of Cortisol and DHEA
Maintaining physiological balance is an important aspect of vibrant health, and nowhere is this more evident when it comes to cortisol. The production of too much cortisol can literally burn up the body, and insufficient cortisol production causes the body’s internal machinery to malfunction, especially at the cellular level.

The adrenal glands produce both cortisol and DHEA in the adrenal cortex under the stimulation of adrenocorticotropic hormone (ACTH), which is released by the pituitary gland. ACTH acts like a whip on the adrenals. It is in many ways similar to a jockey whipping a horse to make it run faster. If the jockey ignores the clues that his horse is fatigued and keeps whipping it, the horse will keep running until it collapses in total exhaustion or death. In the case of the human body, if we allow stress levels to become chronic and out of control, we can sooner or later expect the same result.
When cortisol levels are elevated and DHEA is low we are considered to be in a Chronic Stress Response. When this happens we are losing (or have already lost) our ability to modulate bodily functions and are on the road to further hormone, immune, and metabolic breakdown. For example, if cortisol levels are too high at night, rather than getting the rest and recovery necessary to maintain optimal physical repair and psychic regeneration, the body will be in a catabolic state (high nighttime cortisol levels inhibit the release of growth hormone necessary to repair and rebuild body tissues). This high cortisol will also have a negative effect on brain function, memory, learning and mood. This is especially true if this condition is ongoing (chronic in nature).

We all have noticed individuals who have excess fat around their hips, thighs or waist and yet they do not seem to be particularly overweight. In fact, these people may be slender except for those “problem” areas. More than making them uncomfortable wearing a bathing suit in public, this unsightly accumulation of fat is a telltale sign of adrenal dysfunction and hormone imbalance, specifically an elevated ratio of cortisol to DHEA.

An elevated cortisol to DHEA ratio will also interfere with the surface integrity of the body’s mucosal linings that act as its first-line immune defense. This mucosal barrier is primarily under the direction of the adrenal glands, specifically cortisol and DHEA. Cortisol and DHEA systemically modulate the production and turnover of specialized immune cells called immunocytes (also known as plasmacytes), that produce the secretory antibodies that protect us. The primary antibody of defense is secretory IgA (sIgA). When cortisol is elevated and DHEA is low, suppression of these mucosal immune cells occurs, compromising our first-line immune defense, resulting in low sIgA output.
The longer a person is in a state of chronic stress (high ratio of cortisol to DHEA), the more compromised his or her first line of immune defense will be and the greater the risk for opportunistic infections and allergic reactions to foods. This could ultimately lead to cancer, cardiovascular disease as well as autoimmune disease, a variety of degenerative diseases and accelerated ageing.

In a Chronic Stress Response all body functions have become compromised due to prolonged hormone, immune and metabolic breakdown that can lead like falling dominoes to a cascade of chronic degenerative diseases from which the weakened body has a reduced chance to recover.

Stages of Adrenal Exhaustion
Adrenal exhaustion progresses in three stages. Stage I is distinguished by an increase in output of ACTH by the anterior pituitary gland, increased adrenocortical stimulation, increased cortisol output and an increased probability of pregnenolone steal and decreased DHEA. When in a Chronic Stress Response, pregnenolone, the common precursor to cortisol, DHEA and other hormones is preferentially diverted to cortisol production at the expense of the rest of the steroidal hormones. Generally in Stage I cortisol increases and DHEA and its metabolites decrease or an imbalance occurs especially between testosterone and oestrogen.

Stage II Adrenal Exhaustion is marked by the transition from increased to decreased cortisol output. This stage is characterized by continuing high levels of ACTH and thus: adrenocortical stimulation, normal total cortisol output, low or borderline low morning, noon or afternoon cortisol levels, normal nighttime cortisol level, and an increased probability of pregnenolone steal and a further decrease in DHEA. This is a transitional phase in which although ACTH stimulation remains high or even increases, the adrenal output of cortisol declines due to the adrenal fatigue associated with continued hyper stimulation.

Stage III Adrenal Exhaustion is an advanced stage of adrenal exhaustion characterized by decreased total cortisol output. This stage is characterized by continuing high levels of ACTH and thus adrenocortical stimulation, low total cortisol output, and increased probability of a low nighttime cortisol level and pregnenolone steal and even further decrease in DHEA. The adrenal glands are now exhausted to the point that even though there is ongoing hyperstimulation (high ACTH); they continue to lose their capacity and reserve to produce enough cortisol. The eventual result is a crash of the hypothalamic-pituitary-adrenal axis (HPAA) in which essential neuroendocrine feedback loops are unable to return the system to homeostasis.
Testing Adrenal Function
Adrenal Stress Profile is a test that has been specifically developed to assess the level of your patients’ adrenal function. Since cortisol levels ideally fluctuate according to a daily circadian, peaking in the morning and decrementing to a low at bedtime only to rise again over night, four time-specific saliva samples are collected during a “normal” day (morning, noon, afternoon and nighttime).
Chronic Stress: The #1 Source of Illness

Why should chronic stress concern me?
Chronic stress can cause the breakdown of the body’s hormone, immune, digestive and detoxification metabolic systems. The key to discovering the cause of illness is an accurate diagnosis of the sources and impact of chronic stress. There is a difference between occasional stresses that we may be exposed to and those stresses that become chronic in nature and repeat over and over and over again, day in and day out.

Seen versus Unseen Stressors
There are two general categories of stressors, “seen” or clinical stressors and “unseen” or sub-clinical stressors. Seen stressors are typically associated with lifestyle factors and have to do with internalisation of mental/emotional stress, blood sugar control, exercise, rest and recovery. These lifestyle factors can become sources of chronic stress. Usually they are easily identifiable by observing a person’s habits.
Unseen or sub-clinical physiological stressors represent the rest of the sources for chronic stress. There is some overlap between clinical and sub-clinical physiological/biochemical stressors. The following list of potential sources of chronic stress will give you a good overview of the areas to consider relative to diagnosing the underlying cause or causes of health problems including chronic degenerative diseases such as autoimmune, cancer and cardiovascular disease, as well as depression, insomnia, allergies, fatigue, etc. Regardless of the clinical conditions and/or symptoms, this list will help you to understand where to look to investigate the stress or stressor that could be chronic in nature thus resulting in an ongoing chronic stress response that ultimately results in hormone, immune and metabolic breakdown.

Common Sources of Chronic Stress
• Anger • Fear • Worry
• Anxiety • Depression • Guilt
• Overwork • Excessive Exercise • Sleep Deprivation
• Lifecycle Disruption • Late hours • Surgery
• Gluten Intolerance • Injury • Whiplash
• Inflammation • Pain • Temperature Extremes
• Toxic Exposures • Infections (chronic/acute ) • Chemicals
• Heavy Metals • Electromagnetic Fields • Radiation
• Geo-Physical Stressors • Mal-absorption • Low Blood Sugar
• Poor Diet • Nutritional Deficiencies • Sucrose Intolerance
• Food Allergies • Inhalant Allergies • Molds
• Noise Pollution • Mal-digestion • Lactose Intolerance
• Traumas

As you can see, many potential chronic stressors (especially those highlighted) can occur sub-clinically (without noticeable symptoms). If the source(s) of chronic stress are not diagnosed and treated, optimal health cannot be restored. It is crucial to do appropriate functional diagnostic testing to rule in/out sub-clinical physiological processes as potential sources of chronic stress.
Highlighted Laboratory Tests to Assess Specific Categories of Chronic Stress
Gastrointestinal Infections can be detected using microbiology (stool samples) and serology (measuring serum antibody production to various infectious agents). Microbiology and serology are often used together and then correlated with symptoms to maximize detection of infections.

Gluten Intolerance whether clinical (manifesting as coeliac sprue disease) or sub-clinical, is a significant source of chronic stress for many people. Sub-clinical gluten intolerance is of particular concern because of the destruction done to the topography of the small intestine and resultant maldigestion and malabsorption, with no overt GI symptoms.

Toxic Heavy Metals can be extremely damaging to health and a significant source of chronic stress. They act by displacing important minerals in critical metabolic processes within the body. They wreak havoc on the body’s defenses against free radicals and the body’s detoxification systems, setting the stage for a variety of degenerative diseases including cancer, autoimmune and cardiovascular disease. Identifying elevated levels of a metal qualifies that metal as a potential source of chronic stress.
Viruses can be extremely damaging to health and a significant source of chronic stress. They are infectious particles that use the machinery of a host’s cells to reproduce. Often held in check by the immune system until the host is weaken by another infection or toxic exposure, opportunistic viruses can become a significant source of chronic stress as a secondary pathology.

Molds and Mycotoxins can be extremely damaging to health and a significant source of chronic stress. Molds can be immunosuppressive, mitogenic and pro-inflammatory in humans. Under certain metabolic conditions, many molds produce particular mycotoxins, natural organic compounds that initiate a toxic response in humans.
Oral Infections can be extremely damaging to health and a significant source of chronic stress. They are often a “hidden” cause of chronic stress and can occur for a variety of reasons including root canals and improperly completed dental work. Elevated antibody levels to any or all oral bacteria warrant further investigation by a biological dentist as active oral infections have been correlated with cardiovascular disease, autoimmune conditions, gum disease both clinical and sub-clinical, mucosal barrier breakdown and excessive dental plaque.
Hormone Response to Chronic Stress
Pregnenolone steal (AKA cortisol escape) is the body’s hormone response to stress and is the preferential pathway when the body is in a state of chronic stress. Pregnenolone, the precursor to all the steroidal hormones, is diverted to the stress hormones, cortisol and cortisone, when the body is under chronic stress. Pregnenolone is diverted from other down line hormones resulting in imbalances and deficiencies of all of the other steroidal hormones.
The length of time that a person has been in a chronic stress response will determine their risk for serious illness and degenerative disease. Any number of health problems can develop if this condition persists, including: cancer, cardiovascular disease, autoimmune disease and many other conditions and/or symptoms.


David Crisci


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