Functional Medicine – Adrenal Stress Test:

Functional Medicine Overview 

Functional Medicine is a lab-based system of medicine that uses ‘metabolomics’ to guide it’s decision making process. Metabolomics is the study of low molecular weight molecules or metabolites found within cells and biological systems. These metabolites are either ingredients or products of different biochemical reactions within the body. They are measured and compared to healthy populations in order to assess the the functionality of various systems that run these metabolomic processes. 

We focus on 3 key types of labs tests, including the adrenal stress test, digestive stool analysis, and organic acids test, to diagnose and assess the health of your body. These labs can be done at home and sent directly to the labs via 1 day courier service. They involve the collection of saliva, urine, or digestive stool, which often provide more extended time-period collection of metabolites (ie overnight urine has been collecting for 6-8 hours, stool for 24-48 hours).

The 3 basic types of labs that we use are:

1. Adrenal Stress Test, to assess HPA Axis functionality (Hypothalamus, Pituitary, and Adrenals) by measuring the pattern of change in cortisol levels over the course of a day, along with DHEA levels.

When you’re under stress to get things done, your body secretes cortisol, which helps to increase energy and focus the mind. If however this goes on for too long and you aren’t getting the sleep and rest that you need, cortisol and DHEA levels drop and you begin to feel tired or burned out. We use the following two labs:
Adrenocortex Stress Hormone Test (Genova)
DUTCH Complete (Precision Analytics)

2. Digestive Stool Analysis, to assesses GI organ function, microbiome status, and the presence of parasites and other pathogens. Many inflammatory conditions originate in the gut. As the gut loses its structural integrity, these conditions can spread to the rest of the body and manifest in myriad symptoms. We use the following 2 labs:
GI Effects Comprehensive Stool Test (Genova)
GI Map (Diagnostic Solutions)

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3. Organic Acids Test, to assess the status of various body systems by measuring organic acid metabolites collected overnight in the urine that are associated with key biochemical processes. These systems include fat, carbohydrate, and amino acid metabolism, Kreb’s Cycle /ATP energy production, neurotransmitter and brain function, liver detoxification phases, and oxidation & methylation processes.

Altogether, data from the 46 different organic acids measured provide a comprehensive view of how well your body’s systems are working. It’s a complex test, and the use of an Organic Acids Test is what differentiates my approach from that of many other functional medicine providers.
Organix Comprehensive (Genova)

Adrenal Stress Tests
The first of these labs, the Adrenal Stress Test, usually offers the most value in terms of cost and benefit, as many people suffer symptoms of what is commonly termed ‘adrenal fatigue’, and experience conditions such as these:
– Chronic fatigue
– Persistent pain
– Neurodegenerative disease and decline
– Depression
– Diabetes and metabolic syndrome
– Gastrointestinal issues
– Autoimmune disease

Case Study:
Here is an example of an adrenal cortex stress lab of a patient who has a low functioning HPA Axis:

Functional Medicine Adrenal Stress Test

This lab reveals:
1. Patient cortisol levels start at waking in the mid-range but immediately drop below normal. This means the patient is not producing enough cortisol to adequately respond to stressful challenges for the rest of the day.

This corresponds with their symptoms that included low energy after waking up, poor endurance, and poor sleep quality, especially in the early morning, along with a slow steady increase in weight over the years.

2. Low DHEA levels that result from the body’s focus on cortisol production at the expense of DHEA, testosterone, and the estrogens. Symptoms included fatigue, weak immune system, low libido, and depression. The low DHEA levels indicate that the patient has been stressed out for a while, possibly decades, and this is significantly affecting their hormonal balance.

Normal levels of Cortisol keep us focused and energetic so that we can be productive when we need to get work done and deal efficiently with stressful situations.

Treatment Program
As part of a comprehensive treatment program, this patient implemented the following lifestyle changes:

Dietary – no gluten, sugar, soy, or dairy.
Regular exercise – including both cardio and strength training,
Daily meditation – starting at just 5 minutes/day,
Better sleep hygiene – resulting in an increase to 7-7.5 hours/night of sleep

They also started a custom-designed supplement program that helped to regulate the HPA Axis and get the adrenals to produce higher levels of Cortisol and DHEA.

While the lifestyle changes were definitely helpful, the patient started feeling a dramatic increase in energy one week after starting the supplement program. The patient continued to improve for the next 4 months. After 6 months, the patient was able to stop their supplement program without a reduction in energy and vitality.

In terms of bang for the buck, the adrenal stress test provides the best return, given its low cost and life enhancing health benefits. While it doesn’t work for everyone, and there can be other factors that require doing the other 2 lab tests to assess as there may be other complexities involved, it’s a good first step for those with budgetary considerations that can’t get the other 2 types of labs done right away.