Have you ever left your healthcare provider’s office feeling like no one truly heard what you were trying to say? Have you been given a prescription as your only solution to managing chronic symptoms? Conventional medicine certainly has its strengths, but when it comes to chronic, often complex health issues it does not always have such a great track record. The conventional medicine approach is often to suppress symptoms, rather than investigating and treating their underlying causes.
This is where functional medicine has an important role to play. We take a closer look at the underlying imbalances that may be leading to symptoms and bigger problems, and focus on how we can resolve those underlying issues.
Testing for Adrenal Fatigue
Adrenal fatigue is one of the most common conditions I see in my practice, and women who come to see me have often read a little bit about it online before coming in. Sometimes, a patient comes to see me really eager to know if I have a test for adrenal fatigue.
I do offer a number of testing options that can be really helpful for unlocking what’s going on with your stress response, cortisol and DHEA levels, and hormonal balance, but there isn’t one “yes or no” adrenal fatigue test out there. There are many layers to adrenal fatigue, and it exists on a spectrum.
My role is not just to give you a test for adrenal fatigue and send you on your way with your diagnosis, it’s to gather a detailed understanding of your history, symptoms, and diet and lifestyle factors, and then combine that with the results of specialized tests to come up with a personalized picture of your adrenal fatigue, and what we can do about it.
An example you can compare this to is Celiac Disease (a genetic autoimmune disease that causes an individual to react to gluten). With this test, you either have a positive result, or you don’t. But we’re now learning that there is a huge population of people who test negative for Celiac Disease, but still have reactions and a sensitivity to gluten. To get to the bottom of that, more specialized testing can be very helpful, including for food sensitivities and gut health imbalances.
Conventional medicine will detect only the extremes, when significant damage to the adrenals has already occurred, such as in Cushing’s disease and Addison’s disease. In between those extremes, you can feel miserable and still be told your cortisol levels are normal. But by responding to early-stage symptoms of adrenal fatigue, we can reverse the developing dysfunction.
Cortisol Testing for Adrenal Fatigue
Cortisol, released by the adrenal glands in response to stress, is the primary hormone we test for when looking at adrenal dysfunction.
Conventional practitioners will do hormone testing for some patients, including blood testing for cortisol, but they will disregard the results if they indicate a “normal” level. This sounds right, but the problem is that in the conventional standard of care, the range of cortisol levels that is considered “normal” is very broad! These tests are designed to flag severe problems, but they tend to miss all kinds of imbalances that do matter, especially when someone is suffering with chronic symptoms that get in the way of their day-to-day life.
The other problem with conventional (serum) cortisol testing is that it does not take into consideration the pattern of cortisol levels throughout the day. Understanding an individual’s cortisol pattern over the day is extremely important in order to really get to the bottom of the state of their adrenal function and stress response. The cortisol blood test, as with many conventional blood tests, is a useful tool but just doesn’t tell the whole story!
In our practice, we measure cortisol levels at several points throughout the day to track the adrenals’ day–night pattern (called the “diurnal rhythm”) using a panel of simple saliva tests. We expect to see higher cortisol levels in the morning to help you get going, and lower levels as the day progresses to night, when it drops to its lowest in order to support restful sleep. This is a healthy pattern.
In the early stages of adrenal dysfunction, cortisol levels are too high during the day and continue rising in the evening. I call this the “Race Horse.” In the middle stages, cortisol may rise and fall unevenly as the body struggles to balance itself despite the use of caffeine, carbs and other factors, but levels are not normal and are typically too high at night. This causes increased issues with regards to sleep, which greatly increases exhaustion. In advanced stages, when the adrenals are exhausted from overwork, cortisol will never reach normal levels. I call that my “Flatliner.”
Saliva tests for cortisol, DHEA, and other hormone levels are great because they’re simple, non-invasive, and reliable, and they help us gather more specific information by making it easy to collect multiple samples over the course of the day.
Dried urine testing has also been found to be reliable and helpful when it comes to cortisol and other hormones.
Saliva tests for cortisol and DHEA levels can also be repeated once treatment is underway, in order to help assess progress (combined with your feedback on how you’re feeling!).
Other Tests for Adrenal Fatigue
When you have adrenal fatigue, it’s not just a matter of disrupted cortisol levels. Cortisol testing is a great way to help determine the underlying problem with your stress response, but adrenal fatigue affects the entire body, and low, high, or erratic cortisol levels are generally an indication of a greater hormonal imbalance.
The cortisol/DHEA ratio is very important to look at, as the relationship between these two hormones plays a major role in adrenal function, hormonal balance, and overall health. This ratio can also help to pinpoint how advanced your adrenal fatigue might be.
I often recommend a complete hormone panel as well as cortisol and DHEA testing, in order to really pinpoint what’s going on and what we need to do about it.
You may also want to look at tests for thyroid function, as hypothyroidism is associated with adrenal fatigue. Testing for further imbalances like food sensitivities, gut imbalances, and micronutrient deficiencies can also be useful in order to help you get to the root of what has been contributing to the chronic stress that has caused your adrenal function to falter.
Testing for adrenal fatigue is just one part of the picture: this is a big part of why I recommend doing hormone tests with a functional medicine practitioner, rather than on your own. A knowledgeable practitioner can help to piece together detailed test results and analyses along with your symptoms, history, and lifestyle factors, and develop a protocol that is right for you.
Should You Get Testing for Adrenal Fatigue?
In general, if you feel happy and well, have steady energy and emotions, sleep soundly seven to nine hours a night, wake up feeling rested, recover well from stress, and maintain a healthy weight without dieting, then your adrenals are probably functioning well!
On the other hand, if your energy ebbs and flows more than feels normal during the day, you feel emotionally stretched much of the time, you sleep poorly most nights, you can’t lose excess weight even while dieting, or you use caffeine or carbohydrates as “pick-me-ups”, you are exhibiting many signs that you could have adrenal dysfunction. When women tell me they have these symptoms, I always suggest testing for adrenal fatigue. There’s no need to wait until you can’t function to find out what’s going on. The more information you have, the sooner you can get on the path to wellness once again!
Reviewed by Dr. Mark Menolascino, MD