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Smart Basics August 1996 IntelliScope

Adrenal Stress Index
SMART Basics and LIFESPAN Institute Introduce New Adrenal Testing and Consulation Service

With the current availability of supplemental DHEA (dehydroepiandrosterone) and PREGNENOLONE, Americans now have access to powerful compounds that can have a profound impact on human health and longevity.

As exciting as these new compounds may be, it is important to recognize that these are not simply vitamins, which can be used in relatively large amounts without fear of imbalance. DHEA and Pregnenolone are known to exert powerful regulatory effects, and unmonitored supplementation with either can be problematic in some individuals.

To address this issue, Smart Basics, in association with THE LIFESPAN INSTITUTE, is now introducing a convenient and affordable testing and counseling program to our clients. To understand the scope of this new service, it is helpful to first review what the program is designed to measure.

The adrenals are two small glands, each weighing approximately 4 grams, that lie attached to the top of the kidneys. The adrenals have one of the highest rates of blood flow of any tissue, and contain the highest amount of vitamin C per gram of any tissue in the body.

Each adrenal gland is composed of two distinctly different zones, the large outer cortex, and the smaller inner medulla. The medulla produces vital catecholamines such as norepinephrine and adrenaline, while the adrenal cortex secretes cortisol, DHEA(s) and Aldosterone. Adrenaline, DHEA and cortisol are are the body's three major stress hormones.

The adrenal glands don't secrete hormones constantly throughout the day, but instead release them in a cycle, called the circadian rhythm, with the highest values being in the morning and the lowest values at night (see chart below). Any abnormality in adrenal rhythm can disturb vital body functions and lead to serious health problems.


While hormone therapy has been around for some time, what is new is the attention centering on DHEA and it's sulfate, DHEA(s). A commonly overlooked aspect when speaking of DHEA is the critical relationship between DHEA and cortisol, an important glucocorticoid hormone synthesized by the adrenal cortex. Cortisols' role in human health ranges from promoting protein synthesis to counter regulating the activity of insulin and glycogen synthesis. Cortisol is also required in the production of prostaglandins, maintaining cellular response to catecholamines, and regulating adrenergic receptor functions.

Under conditions of physiological and psychological stress cortisol can be released in high amounts in response to the stress stimulus. It is this increased cortisol production that is linked with obesity, suppressed thyroid function and a host of other serious health consequences.


  • 1. LOW ENERGY: People who are constantly tired, have difficulty getting up in the morning and suffer from energy slumps often have abnormal adrenal rhythms.

  • 2. MUSCLE DYSFUNCTION: Excess cortisol decreases muscle protein synthesis and reduces muscle mass. Reduced tissue repair and increased tissue breakdown can lead to muscle and joint injury and chronic pain.

  • 3. IMPAIRED BONE REPAIR: Cortisol inhibits hormones required for calcium deposition. If night cortisol levels are elevated and morning levels high, bone growth and repair is suppressed and one may become more prone to the osteoporotic process.

  • 4. THYROID DYSFUNCTION: Hypothyroid symptoms such as fatigue and low body temperature are often due to adrenal maladaption, such as dysfunctional cortisol.

  • 5. DEPRESSED IMMUNE SYSTEM: Several key aspects of immune function follow the cortisol cycle. If this cycle is disrupted, especially evidencing elevated levels at night, then the immune system is adversely effected.

  • 6. IMPAIRED SLEEP QUALITY: Elevated night cortisol can interrupt entry into REM (Rapid Eye Movement) sleep, the body's regenerative sleep mode, reducing mental vitality and vigor, and lead to depression.

  • 7. POOR SKIN REGENERATION: Human skin is regenerated mostly at night. With higher night cortisol levels, less skin regeneration take place.

  • 8. IMPAIRED GROWTH HORMONE UPTAKE: Growth hormone production declines rapidly after the age of about 24, correlating directly on the effects of and symptoms of aging. Maintenance of one's natural production of GH is a paramount goal of any anti-aging program. Unfortunately, cortisol is a GH antagonist, and moderate elevations of cortisol after 10:00 pm, as little as 5%, cause an inhibition of GH release.
  • A critical marker of overall hormonal health is the ratio of serum cortisol to DHEA(s). Under normal conditions cortisol is held in balance, or a state of homeostasis, by DHEA. Unfortunately, DHEA production begins to decline after about age 25, dropping by about 80-85% of peak production levels by age 75. Just as our DHEA levels are falling, cortisol levels begin to elevate in response to stress. The effect of this dysfunctional adrenal rhythm, particularly the circadian variation of cortisol levels, can have profoundly negative and serious side effects on our health.

    The recent advance in personal adrenal management has been propelled by the over-the-counter availability of DHEA and pregnenolone, both of which are crucial substances for adrenal balancing. The primary reason most people take DHEA or Pregnenolone is to slow or offset the effects of aging, but when considering their use it is important that one look at the overall picture of adrenal function. As powerful as these substances can be to any anti-aging program, neither substance can correct other aspects of adrenal disfunction that are almost always present in people with low DHEA levels. Specifically, supplemental DHEA will not, by itself, correct aberated cortisol levels.

    If one hopes to have a realistic impact on the aging process, what is desired is a scientifically accurate assessment of one's unique functional biochemistry before the implementation of a personalized program. Average doses for the masses just aren't good enough when one is dealing with such supplements.

    In 22 years as a practicing nutritionist I've dealt with a number of cases of patients suffering from `adrenal exhaustion,' a usually self-assessed condition described as a loss of energy, poor immune function and a host of other maladies.

    In the course of conducting research for the scientific basis of adrenal exhaustion I was surprised by the lack of a clear cut scientific definition for the existence of this condition. In fact I discovered that in situations of high stress, rather than exhausting the adrenals humans actually produce more, not less, of most important adrenal hormones.

    The most common approach to managing adrenal stress was the use of dehydrated bovine adrenal tissue, even though there was a glaring lack of evidence from human trials to support the application of adrenal tissues. My personal experience in using adrenal tissue products produced results so inconsistent that I was forced to conclude that there was just too little known about applying these products for the hypothesized condition of `adrenal exhaustion'.

    Eventually it became clear that what I, and apparently many other people had been unaware of, was that the use of adrenal cortical extract not only increased DHEA output (generally a good thing), but it also increased cortisol output as well. It was this increase in cortisol output that became a problem, especially since cortisol was already too high in people suffering from "adrenal stress."

    Starting 5 years ago a new piece of lab work called the Adrenal Stress Index (ASI) became available to clinicians. ASI made possible, for the first time, the detailed assessment of one's adrenal hormone cycles by measuring both serum cortisol and average DHEA levels and their ratios throughout the day. The ASI test is a simple, non-invasive test that uses four saliva samples to measure the adrenal rhythm and obtain a DHEA to Cortisol correlation. Measurements are gathered from four specimens collected throughout the day (8 am, 12 noon, 4 pm and 11 pm). The results of the ASI test allow for an in-depth analysis of one's adrenal cycle and contribute to the design of more precise and personalized approaches to balancing adrenal functions.

    The ASI test is non-invasive, can be performed wherever you are, saliva is collected under real life conditions, and there are no stressful blood draws or urine samples to carry around. With blood and urine testing, a number of borderline adrenal conditions are missed, which is not the case with the ASI because it is a time-specific, real-life test.

    Saliva is very accurate, and in some situations, more accurately reflects the level of hormones that are active on the cellular level, which is really what we want to know. DHEA levels in saliva reflect the free fraction, bioactive component of the hormone that functions at the cellular level. Measuring the DHEA in saliva is then a functional assessment on active DHEA levels.

    Addressing saliva samples for adrenal assessment, the July 1996 Townsend Newsletter For Doctors states: "Assessment of free cortisol, DHEA and DHEA(s) in saliva is an economical, convenient, non-invasive, and stress-free procedure. Saliva samples may be collected at home or workplace, which avoids the need of repeated visits to clinic/hospital, and costs involved. Free cortisol levels in saliva reflect the free plasma levels. Salivary DHEAS levels correspond to about 0.1% of their concentration in blood plasma."

    By contrast, blood levels show the gross levels of the hormone, both the bound and free fractions, but not activity at the cellular level. The bulk of most hormones are bound to other proteinasous structures in the blood and are not available at the cellular level. It is possible to do a free fraction measurement in blood, although quite costly. Saliva levels are free fraction only and as a bonus directly reflect the tissue levels of the hormone.

    This ability of saliva to show the tissue-active levels of DHEA and Cortisol is why we refer to ASI as a functional test.

    The ASI is an appropriate test for anyone considering the use of DHEA and/or pregnenolone as part of an anti-aging or life-extension program. The ASI is also commonly ordered for individuals experiencing the following:

    Keep in mind that the ASI does not generally diagnose a specific pathology, but rather evaluates fundamental regulation systems of the body. This makes the ASI an extremely useful tool in assessing and designing a precise longevity and health optimizing program. (Next month we will explore in greater detail the implementation of ASI test results along with some examples of adrenal rebalancing programs).

    After placing an order for your Adrenal Stress Index test, Smart Basics will ship you a compact test kit, which includes four salivary collection vials, a set of easy-to-follow instructions, and a Lab Work Authorization Form. This form must be signed and returned, along with your completed ASI kit, in order to authorize the Medical Consultants from Lifespan to order the laboratory analysis on your behalf.

    State and federal laws bar clinical laboratories from accepting and processing specimens from the public. Specimens must be submitted by a licensed physician. Lifespan and Smart Basics are proud to have Scott Anderson, M.D., as our medical consultant and ordering physician for your lab work.


  • 1. Your ASI kit contains four small collection vials, marked Morning, Noon, Afternoon and Midnight. On the day you choose to collect your test samples it is important to avoid eating any onions, garlic, cabbage, cauliflower or broccoli, as these foods can throw off results of your lab report. It is also important to avoid drinking coffee, tea or caffeine drinks on the collection day.
  • 2. 30 to 60 minutes prior to collecting each sample you should avoid eating food and only drink tap or filtered water. Use of antacids, bismuth medications and mouth wash should also be avoided. Do not brush your teeth or smoke.
  • 3. To collect the samples, first rinse your mouth with cold water. Remove the cotton roll from the vial and place in mouth, rolling the cotton under your tongue until it is well soaked (approximately 2-3 minutes).
  • 4. Return the cotton roll to the vial, capping tightly, and place vial in the zip lock bag which is provided in the kit. Be sure to refrigerate each sample as it is collected. When completed, place all four vials in the zip lock bag, seal in the same box your ASI came in, and mail within three (3) days.
  • Please note: Pre-paid postage for the return of your samples is not included in your ASI fee, as postage rates to the laboratory in Seattle, WA, will vary depending upon your location and choice of shipping (ie priority, next day, etc.).

    Approximately 3 weeks after you return you samples you will receive a copy of your lab report via U.S. Mail. Around the same time you will be contacted by phone by Jerry Stine to arrange a convenient time for your personal phone consultation.

    The consulting process usually consists of a short interview to review: the results of the lab work; dietary habits; type and amounts of exercise; degrees of stress from work and/or family; and other lifestyle factors that influence health.

    It should be noted that any discussion of health problems is done as part of the overall process of helping you focus on the interrelated health aspects of lifestyle, nutrition, environment and fitness.

    At the conclusion of the consultation, a list of suggestions will be prepared for you. These recommendations may deal with diet, nutrition, exercise and other factors. If appropriate and desired, dosage regimens for DHEA, Pregnenolone and/or other supplements will be addressed.

    In no way are recommendations of Lifespan to be considered as a substitute for proper and timely medical care. In the event you are ill, you should consult with your physician.

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