Salivary Adrenal Testing Part 2

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At the end of our last chat, I teased you with the idea that salivary adrenal testing tells us more about the communication from your brain to the adrenals than it does about your adrenal gland itself. Let me explain that further.

And to do that I need to go back to where this whole idea of measuring your stress responses began and that was in 1950s with a man names Hans Selye

Selye was an interesting character.

 Selye was born in Vienna Austria in 1907.  He was educated in a Benedictine monastery and with private tutors and by the age of four, he spoke four languages and would go on to learn several more. He got his first degree – a medical degree – in Prague, and then a PhD in organic chemistry, which started at Johns Hopkins but which he finished at McGill University in Montreal. By the age of 27 he became an Assistant professor of biochemistry.

The story goes that Selye was the first researcher to recognize that many people who were sick with different conditions shared some symptoms in common – he called it the “syndrome of being sick”. And this was a revolution for the time because up until Selye formulated his stress theory, medical students were taught that they could diagnose diseases strictly by presenting signs and symptoms – which varied from disease to disease. But no one had connected the dots of things they all shared, things like

• looking tired
• having no appetite
• losing weight
• preferring to lie down rather than stand
• and not being in the mood to go to work

Again, Selye called this the Syndrome of Being Sick.

He began to unravel the particulars when during his postdoctoral work at McGill he was tasked with identifying several female hormones that had yet been discovered. He injected various toxins into rats and on autopsy found some common themes

• The adrenal glands were hypertrophied – meaning they had grown larger than glands from rats who hadn’t received the injections
• But they also had atrophy of their thymus gland and lymphatics – which are involved in immune responses
• Plus, they all had ulcers in their stomachs and upper small intestine

And it didn’t matter which toxin he injected – the rats’ core systems all responded the same way.

He then designed experiments where he put rats in stressful situations, and the finds were the same: adrenal hyperactivity, lymphatic atrophy, and peptic ulcers. 

Selye was able to distinguish between adrenal responses to acute and short-lived stress versus chronic and prolonged stress. And he divided the latter, which he called the General Adaptation Syndrome (GAS) into three stages

• Stage 1: Alarm reaction
• Stage 2: Resistance
• Stage 3: Exhaustion

And this is where the concept of adrenal fatigue and adrenal exhaustion comes from. It’s not something that some whackadoodle, fringe dwelling, natural doctor came up with. It is from the work of one of the most celebrated doctors and researchers of all time.

Selye’s work has had such an impact on medical science that his image appears on a Canadian commemorative stamp from 2000 showing him in his lab with a graph of the three phases of the GAS and the molecular structure of cortisol as overlays. But his own life wasn’t a bed of roses.

He was married and divorced 3 times and when he died in 1982 at the age of 75 it was revealed that much of his funding had come from the tobacco industry. Turns out he participated in a lot of tobacco research and was involved in many marketing campaigns promoting smoking as part of a healthy lifestyle. 

I guess nobody is perfect.

But the good side of his story brought us knowledge of the Hypothalamic Pituitary Adrenal Axis, and an introductory understanding of how chronic stress causes the release of neurotransmitters and hormones from the brain and the gland itself - which all work together to mediate the effects of stress. But there is one aspect of the GAS that has turned out to not be correct and that is

this expectation that everyone responds to chronic stress in a predictable manner, which looks like this:

• The initial Alarm Response where Cortisol and DHEA both elevated
• But if stress continues then eventually this gives way to the Resistance stage where the system adapts to the ongoing stress by diverting raw materials to make all steroid based hormones into the pathway that makes cortisol. So, it is characterized by normal Cortisol but lower levels of DHEA and sometimes even reproductive hormones. And this is what is commonly called adrenal fatigue
• And if stress continues – which it does in chronic health complaints – then eventually the system crashes and you’re not just compromising your reproductive hormones, and DHEA, but you can’t make enough cortisol either. Hence the idea that the system simply becomes Exhausted

But we are almost 70 years now from when Selye wrote his seminal book on stress, and we have learned a few things he hadn’t discovered. Like how someone doesn’t have to progress in this predetermined sequence of Alarm Reaction to Resistance to Exhaustion the way Selye laid it out – let’s call them Stage 1-2-3.

You can get stuck in Stage 1 and never progress to Stage 2 and simply have ongoing increased production of Cortisol and DHEA without ever fatiguing. And those chronically elevated levels of stress hormones can wreak havoc on other systems and health in general.

Or you can go from an acute Stage 1 reaction to full blow Stage 3 exhaustion without ever passing through Resistance as a transitional Stage 2. So, the progression through stages is not as neat and orderly as Selye laid it out.

Additionally, the amount of cortisol you produce in any given situation is dictated by the activity of neurons in the hypothalamus of your brain not your adrenal gland. If that part of your brain perceives more, or less, stress or is otherwise more or less stimulated, it will send stronger or weaker signals to the adrenal gland to make more, or less, cortisol.

 So, instead of seeing someone who has low total cortisol as being in the Exhaustion stage, we now understand that this means that the control center of the brain that initiates stress responses is being under-stimulated or perhaps inhibited. Which can happen with chronic stress, chronic inflammation and even changes in hormones and neurotransmitters, as well as patterns of blood sugar dysregulation. It turns out that the quantity of cortisol production is a matter of brain health, and not adrenal gland status.

And its similar for the circadian rhythm. Remember that cortisol is naturally higher in the morning and tapers to nighttime to facilitate waking up and having energy and focus in the morning but reversing that at night so we can go to sleep and recover from our day.

 And this circadian rhythm is also not generated by your adrenal gland but by another part of your brain called the Hippocampus. And it turns out that this Hippocampus, which determines the quality of your circadian rhythm, is damaged under conditions of severe or chronic stress. And it is sensitive to chronic and systemic inflammation.

It also turns out that this Hippocampus structure is also response for memory formation. Which is why some many people who are chronically stress, inflamed and otherwise not healthy complain of poor short-term memory and worry that they’re getting an early form of dementia. It’s usually not – it’s usually the effects of chronic stress on how you brain forms memory and is usually completely reversible.

Now there are a couple of other aspects of the adrenal system that are worth mentioning but which are too complex in their operation that it’s not worth the time to go into details. Suffice it to say that other aspects of this adrenal system of yours control how easy it is to trigger a stress response and dictate how long that lasts.

So, people who frighten easily, who are stressed out by sounds and lights and general commotion, tends to be on the worse end of this adrenal spectrum than someone who handles lights and sound and commotion, especially if it takes them a long time to calm down after they get stressed out.

 Here is an example. Pretty much everyone will get a fright if they turn a corner, and a prankster is waiting there to yell BOO. But while one person will react almost imperceptibly someone else might scream and jump out of their skin and get palpitations. The person who barely jumps at all may be perfectly fine two minutes later, while the other person is still a little freaked out hours later.

Say you go to a busy shopping mall at Christmas time and can only stay there a short while because the lights and sounds and commotion of the crowd bother you – then you are further down this stress spectrum than someone who can go Christmas shopping for hours on end and go home without any undue effect.

 The difficulty is that when you get to the point where your stress system is so jacked up and the least little bit of stress creates a large response that takes forever to calm down, is that this often means you have developed plasticity in your stress system, and you have become very good at it. In other words, because of how your stress system adapts and behaves over time while under chronic stress and inflammation is that you become very good at being stressed and inflamed.

 And the only way to get a handle on what that looks like physiologically, and what that means in terms of how to unwind it all, is to have the right blood labs to look for the core underlying mechanisms, and then to look at your salivary adrenal profile to see where you are in the scope of adrenal dysfunction.

Letting go of the more simplistic idea of adrenal fatigue and to focus on the broader system, including what these tests means for brain health.

So that’s wraps number 2 on my list of labs that I would spend my own money on. Next time we meet we’ll talk about number 3 on my list – stool testing.