What are the Best Tests for Adrenal Fatigue? My morning cortisol is low, what is wrong?

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What is stress?  Is it the image of someone looking frazzled and out of control?  Or maybe it’s someone getting angry over small but insignificant situations in life?  Or maybe it’s the “fear of missing out” feeling that you get when you can’t access your social media or catch up on emails?  And what about “hidden” stress, such as the stress caused by inflammation and imbalances in the body?

Unfortunately, in today’s lifestyle, stress is something that most people experience daily.  It is mostly associated with emotions, but stress is intended to be a response to a situation that the body finds to be threatening.  The stress that our body was designed to deal with were the short bursts of stress, such as running away from a dangerous animal or dealing with a food shortage that required our bodies to release stored glucose for energy.

One way of evaluating your body’s response to stress is to look at cortisol and blood sugar levels.  Cortisol is a hormone that is like a long-acting adrenaline – it stimulates the heart and muscles, and provides energy to these in the form of glucose.  Because it can provide energy, it is supposed to be highest in the morning and after exercising, and drop down (to prepare for sleep) by the evening.  If you have chronic stress issues, your fasting blood sugar levels will often be elevated over 100 (with normal-appearing HgA1c and insulin levels), and your morning cortisol will be either out of range or suboptimal (under 10).  To address these imbalances, you need to make sure you are getting good quality sleep (sleep apnea is one of the most common causes of cortisol imbalances) and address the potential stressors in your life (including the obvious and the not-so-obvious, such as an inflammatory diet, over-exercising, or doing the wrong exercises for your body).

Stress contributes to almost every visit to the doctor’s office, but since there is no quick pill for this, we tend to ignore it.  Before it causes more damage, determine your stressors, treat these if needed, and create a daily habit that helps your body manage the stresses with which it has to deal.  You can’t often change your stressors, but you can work to control your body’s ability to handle stress!

Genetic risk for heart disease, what your doctor likely isn’t testing… Someone in my family died early from heart disease, is there a test to detect if I’m at risk (Advanced Lipid Panel)

We all know or know of someone who has made it through a heart attack or stroke.  Maybe we have family members who even died of cardiovascular diseases.  We know that there are things that will increase our own personal risks of developing these disease states, such as smoking, little to no exercise, and eating a fast food diet.  But if you are already doing these things, or are considering making changes in your lifestyle habits, it is important to know your risks.  Your lifestyle may not be as “good” as you think it is, or maybe you need that extra push to make the changes. Find out the specifics of your cholesterol before putting your health in the hands of your health care practitioner (who often only orders a basic cholesterol panel).

What is a more “specific” cholesterol panel?  This is known as an advanced lipid panel.  This is a panel that looks at the “quality” of your cholesterol, not just the “calculated quantity”.  Many doctors are unfortunately not well-versed in using this, and many cardiologists may use it but don’t have drugs that can address the “quality”, so they may not put a lot of importance in using this test.  Here are the components of the test:

  • Triglycerides: Triglycerides are how excess blood glucose is stored in the body (glucose attaches to a fat molecule, either because the body needs these for future situations where food is not available, or because the body cannot handle the amount of glucose in the body and has to store it). High levels of this are associated with dietary choices, and less commonly can be from genetics.
  • HDL Cholesterol: This is the “healthy” or protective type of cholesterol. Just as with the LDL-C, it is only a measure of concentration.  These will be more protective if they are larger and lighter.
  • LDL Cholesterol (also known as direct LDL or the LDL-C, aka Calculated/Concentration): The concentration of LDL particles. The best analogy for this versus LDL size and particle numbers is to imagine 2 jars filled with balls.  One jar is filled with marbles, the other with ping pong balls – they both fill the jars, but the size is different, the weight is different – there are many differences!  A ping pong ball and a marble cannot do the same functions, just as cholesterol will act differently when it is a different size or different weight.
  • Lipoprotein(a): This type of “vehicle” is genetically determined. It is the stickiest and most atherogenic cholesterol marker that we know of (next to the Apolipoprotein Bs).  When you hear of people dying young of heart attacks or strokes, this is always something to consider as being a key component of the cardiovascular events.  There is no drug to lower this (yet), but there are important steps you can take to lower your risks.  Although you may have the genes that increase this type of cholesterol marker, your genes do not have to be your destiny.
  • Apolipoprotein B: The “vehicle” that transports non-HDL cholesterol around the body and into the cells. This is the best marker for evaluating the amount of “atherogenic” (clot/plaque forming) cholesterol particles in the blood.
  • LDL Particle Numbers, LDL Small and medium: These tests look at the size of your LDL cholesterol. If it’s too small/dense, LDL will squeeze into your blood vessel walls and build up, leading to blood pressure issues and atherosclerotic plaques.  The more plaque that builds up, the more likely it is to block blood flow and even rupture the blood vessels walls (which is how heart attacks and stroke often happen).  If the LDL is larger and more “bouncy”, it will travel to where it needs to go (such as making the brain stronger and more resilient to stress – most of the brain is made up of fat!).
  • HDL Large: A measure of your best HDL particles – the larger the better!

Checking these labs every 6-12 months can help you determine your next steps.  It can change your future, and even the future of those you love.

 

References

Chronic stress, cortisol dysfunction, and pain: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4263906/

Cortisol, stress, weight, and the brain: https://www.webmd.com/balance/stress-management/news/20151109/cortisol-stress-weight-memory#1

How sleep loss affects hormones and weight: https://www.medscape.org/viewarticle/502825

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About the Author:

Meg McElroy is a PA with over 20 years of experience in the art and practice of functional medicine. She believes the first step in getting better is to embrace your current health situation (rather than dwelling in the past!), and recognize that health is ultimately impacted by our daily habits and choices. Persist and stay patient, give grace to those that are trying to help you on your journey, and remember that health is a journey, not a destination!
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