Adrenal Stress Panel Explanation Cortisol Rhythm Description: The panel utilizes four saliva samples. Salivary cortisol measurement reflect the free (bioactive) fraction of serum cortisol. The test report shows the awake diurnal cortisol rhythm generated in response to real-life stress. Therapeutic value: The test results facilitate the diagnosis of stress maladaptation and adrenal fatigue. With this data, you can narrow your choices to the most appropriate modalities of treatment. DHEA/DHEA-S Description: The panel measures the average DHEA/DHEA-S* level for the day using multiple samples. Therapeutic value: The cortisol-to-DHEA (cortisol/DHEA) relationship highlights the many facets of stress maladaptation. The cortisol/DHEA ratio helps determine the projected time for recovery, and the substances (hormones, supplements, botanicals) that promote this recovery. The cortisol/DHEA ratio regulates a multitude of functions. *Salivary DHEA-S is found in about 0.1% of its plasma concentration. Serum fluctuations in DHEA-S concentrations are accurately and rapidly reflected in salivary levels. DHEA-S indicates free fractions of both DHEA and DHEA-Sulfate. 17-Hydroxyprogesterone (P17-OH) Description: The panel measures P17-OH levels in order to evaluate the efficiency of the conversion of adrenal precursors into cortisol. Certain adrenal fatigue patients who are genetically predisposed to low production of cortisol will not beneﬁt from exogenous supplementation of pregnenolone or progesterone. Therapeutic value: By identifying the subpopulation of maladapted and adrenal-fatigued individuals who show impaired P17-OH conversion to cortisol, two things are avoided: Treating patients with precursors (when instead they need cortisol supplements to restore adrenal health). Pursuing further pituitary-related tests and treatments (when they are not needed in this subpopulation). Insulin Description: The panel includes fasting and non-fasting insulin measurements. The insulin values are used to diagnose insulin resistance-functional insulin deﬁcit (pre-diabetes), as well as to correlate elevated cortisol with insulin to help explain glycemic dysregulation problems. Therapeutic value: The combined results of insulin and cortisol can help in designing an effective glycemic control treatment plan that may include lifestyle modiﬁcations, nutritional support and botanical supplementation. Secretory IgA (SIgA) Description: The panel evaluates mucosal immunity by using SIgA as a stress impact biomarker. SIgA values are sensitive to increased cortisol/DHEA ratio and sympathetic tone. Therapeutic value: By detecting the depressed mucosal immune function in certain patients, a number of therapeutic modalities may be invoked, ranging from botanical supplementation to the control of heart rhythm variability. Gliadin Antibodies Description: The panel includes a gliadin antibody measurement that allows detection of subclinical grain intolerance in affected individuals, even in the absence of overt celiac disease. Therapeutic value: This test allows objective identiﬁcation of grain-intolerant patients, who should restrict their gluten intake to reduce inﬂammation and adrenal stress. Clinical Applications of the ASI™ Chronic Pain/Fibromyalgia An adequate adrenal response can maintain a higher pain threshold. The ASI™ is used to evaluate the stress impact of chronic pain and inflammation on adrenal adaptation. A proper diagnosis of low cortisol or DHEA with circadian rhythm disruption is imperative. Subsequent hormone replacement and rhythm correction will improve the individual’s pain tolerance. Chronic Fatigue Syndrome (CFS) A common HPA axis defect in CFS is impaired corticotrophin release. As a result, low cortisol and eventual adrenal atrophy may be observed. Depleted adrenals with flat rhythms are often seen on the ASI™ panel. Simultaneous use of several therapies can help improve the debilitating effects of CFS. Glycemic Dysregulation Chronic hypoglycemia can impair normal adrenal function by repetitive overstimulation of cortisol production. Recurring exposure to high cortisol will impair insulin activity, and invariably lead to insulin resistance and beta-cell exhaustion (diabetes). The ASI™ panel investigates the insulin-cortisol relationship under real-life conditions to allow targeted and meaningful interventions. This panel is useful in the following clinical situations: rapid weight gain and obesity, deranged blood lipids, sugar blues, early diabetes and associated emotional disturbances. Allergies/Autoimmune Disorders More than fifty years ago, Dr. W. Jefferies (author of Safe Uses of Cortisol) discovered that patients with environmentally triggered allergies and autoimmune diseases dramatically beneﬁted when given cortisol for other purposes. More recently, German researchers reported that disruption of the adrenal axis and cytokine relationships lead to predisposition and aggravation of autoimmune diseases. The ﬁndings of the ASI™ help identify patients with autoimmune diseases and adrenal problems who can beneﬁt from cortisol supplements. Depression/ADD Several recent publications report a hyperactive HPA axis in depressed patients. Elevated midnight salivary cortisol is now considered one of the best tests in diagnosing endogenous depression. Other anomalies in cortisol rhythm usually accompany the midnight elevation. On the other hand, cortisol elevations and rhythm disruptions throughout the day are typical of attention deﬁcit disorders (ADD). The anomalous cortisol ﬁndings in depression and ADD can be diagnosed successfully with the ASI™. Subsequent interventions to rectify the time-speciﬁc cortisol elevations (during the day or night) are usually effective when applied under proper supervision.