Testing your Stress Level

Testing your stress level by measuring your cortisol levels

Because cortisol levels are a good predictor of the stress response in most individuals, measuring cortisol levels is a common tool to assess what level and type of stress you are experiencing. When cortisol levels are very low, it is a sign of adrenal exhaustion or burnout. When cortisol levels are very high it may mean there is an uncontrolled acute stressor present (chronic inflammation) or that the feedback loops that should be lowering cortisol are not functioning properly.

Cortisol can be measured from blood, urine or saliva samples. Your doctor may use any or a combination of test to help determine the level of adrenal stress you have.Salivary testing is common and an extremely accurate method of testing function of the hormonal system. The saliva test measures the active hormones only, rather than the inactive hormones. The active hormones can also be measured through a blood test but this test is extremely expensive.In a saliva test, samples are collected 4 times throughout a “normal” day: once upon rising, once in mid-late morning, once in the afternoon and once before bedtime. The lab will evaluate total levels of active cortisol and the proper diurnal rhythm. Most laboratories will also measure additional hormones such as DHEA, melatonin (in the bedtime sample) and sometimes even testosterone and estrogens.These other hormone levels can help define certain related conditions to help your doctor define a better treatment approach.

Three general categories of adrenal stress are typically defined:

Acute Adrenal Stress: Sometimes called “The Alarm Reaction” or being “wired,” this is a response to current demanding stressful situations that are causing high amounts of cortisol production without adequate feedback reduction. These individuals may lack an adequate diurnal rhythm as well. Acute adrenal stress will eventually suppress important immune functions and will often result in increased risk of sickness.

Mild Adrenal Fatigue: This condition can be the result of adjustments to an ongoing acute adrenal stress condition or the accumulation of years of mild stress without adequate relaxation and recuperation. These individuals may have cortisol levels with in the normal range but either lack proper circadian rhythm or have reduced levels of DHEA.

High Adrenal Fatigue: This is often called “burnout” or adrenal exhaustion. This condition typically has low or very low cortisol levels (Addison’s disease is the complete loss of cortisol production). These individuals are easily overwhelmed by any stress and find that even simple tasks become burdensome.

Through a process of physical examination, health history, lifestyle assessment and functional testing, your health care professional can find out what level of stress or fatigue you are currently experiencing and develop recommendations so you can experience renewal and a healthy, balance, more fulfilling life!

Understanding the Science behind the Stress Response

Understanding the rudimentary aspects of the stress response requires knowing a few components of anatomy and hormone physiology. The basic components we will discuss are the adrenal glands and several hormones made in the adrenals, as well as they hypothalamus and pituitary glands and some of the hormones they secrete.

The Adrenal Glands:

The adrenal glands are small (5 grams or about the size of 2-3 pinto beans) glandular tissues lying atop each of the kidneys. The inner portion, called the medulla, secretes epinephrine (adrenaline) and norepinephrine and is an extension of the sympathetic nervous system. The larger outer portion, called the cortex, is responsible for secreting various steroid hormones. We will consider only the cortex and its hormones in this particular discussion.

Of the nearly 30 steroid hormones produced by the adrenal cortex, the principal ones include aldosterone (a mineralocorticoil), cortisol (a gluccorticoid) and various sex hormones and their precursors (DEHA, androstenedione). The ineralocorticoids play an essential role in regulation potassium and sodium levels, water balance and, consequently, blood pressure. DHEA and its metabolites have diverse effects during the lifecycle of the individual. Finally, there is the glucocorticoid, cortisol, a key player in the adrenal glands stress response mechanism.

Cortisol:

Cortisol is tightly regulated by feedback mechanisms in both the hypothalamus and the pituitary glands, where the original hormonal signals trigger its production. As in other systems, the hypothalamus gland, located at the base of the brain, begins the process by secretion corticotropin-releasing factor (CRF0 in response to a variety of “stressors.” CRF then triggers the anterior pituitary to release adrenocoricotrpic hormone (ACTH), which travels through the blood until it reaches the adrenal glands where it induces the adrenal cortex secretion of cortisol. In turn, increasing cortisol levels slow down the production of both CRF and SCTH from their respective glands. This whole circuit is referred to as the hypothalamic-pituitary-adrenal (HPA) axis or system. Similar systems also regulate the thyroid hormones (HPT axis) and ovarian hormone production (HPO axis). Not surprisingly, stress will also cause imbalance in thyroid and female hormone cycles as well.

Normal functioning of the HPA is known to have three attributes. First, when the system is unstressed there is a regular circadian rhythm of activity. The rhythm results in the highest cortisol levels shortly after awakening (7-8 a.m.) and progressively falling until they are lowest during the first several hours of sleeping. A healthy HPA axis should have a circadian rhythm, as well as appropriate total daily secretion of cortisol. The second function of the HPA is proper feedback loops coordination. As mentioned previously, increasing amounts of cortisol should be able to shut down ACTH and CRF production, and hence reduce serum cortisol levels. Clinically appropriate challenges with corticosteroids like dexamethasone can be used to test this feedback loop. Positive tests for pituitary and adrenal cortex functions can also be performed by giving CRF or ACTH and measuring cortisol responses.

Third, and most importantly for us, is the fact that various stressors can stimulate the HPA and many can do so in a way that overrides both the circadian and feedback controls. It is this well-known phenomenon that allows the functional testing of the HPA system to give us a glimpse at the effects of stress (both acute and chronic) on the health of an individual.