Topic: Taking Action - Testing and Prescribing
June 6, 2018
Join Labrix clinical staff and special guests on the first Wednesday of every month at 9:30 AM and 12:00 PM PST. This free, live webinar series will cover a variety of neuroendocrine topics that will enhance your knowledge, with clinically applicable testing and treatment considerations.
Hollywood, FL: May 31 - June 2, 2018
Labrix and Doctor's Data will be in Hollywood, FL for the IFM (AIC) conference on May 31 - June 2. Come chat with our company representatives, including Dr. Erin Lommen and Dr. Jay Mead, and learn more about our vast functional testing menu.
Portland, OR: July 12th - 17, 2018
Join the Labrix and Doctor's Data team at the IFM (APM) conference on July 12-17 in Portland, OR. Learn what neuroendocrine testing with Labrix and Doctor's Data can do for your patients and your practice. Dr. Erin Lommen will be presenting a lunch lecture on hormones on Thursday, July 12.
Adrenal Mythbusters Part 2:
Can DHEA Supplementation Increase Cortisol?
Can Dried Urine Accurately Measure
the Cortisol Awakening Response?
Frequently, providers inquire about treatment and collection methods that are outside of what we recommend at Labrix. We welcome these queries as explaining the differences helps to teach important physiologic concepts as well as laboratory science. The following newsletter is an attempt to resolve two common misconceptions.
Myth #1 - DHEA supplementation can increase cortisol levels:
While DHEA and cortisol are both produced in the adrenal gland, they are produced in separate compartments or “zones”: cortisol from the zona fasciculata and DHEA from the zona reticularis. All communication to these zones comes from the brain via the Hypothalamic Pituitary Axis (HPA Axis): starting with the hypothalamus releasing corticotrophin releasing hormone (CRH), which stimulates the pituitary to release ACTH (adrenocorticotropin releasing hormone) , which then stimulates the creation and secretion of DHEA and/or cortisol as needed. In reviewing the steroid hormone cascade one can see that DHEA does not have the ability to influence cortisol, therefore supplementation with DHEA cannot raise cortisol levels. DHEA’s role in the assessment of adrenal function is to serve as a reflection of total adrenal health and should be thought of separately from cortisol. Because DHEA has the ability to increase estradiol and testosterone via conversion from androstenedione, a common intermediate, DHEA supplementation should be thought of as tool for restoring hormone balance and overall function to the adrenal gland itself.
Myth #2 - Dried Urine can accurately measure the cortisol awakening response (CAR) and accurately predicts disease states like Alzheimer’s and Metabolic Syndrome:
In 2016, the International Society of Psychoneuroendocrinology convened an expert panel of researchers charged with summarizing relevant evidence as it relates to CAR assessment, and to create clear consensus guidelines for future research.
The document entitled “Assessment of the cortisol awakening response: Expert consensus guidelines” endorsed saliva over urine as an effective means of CAR measurement for the following reasons.
- there are no known studies supporting the validity of dried urine collection
- urine cannot represent a single point in time as urine measurements are a pooled average of the preceding several hours (or overnight), rendering it incapable of accurately reflecting the cortisol awakening response
- the filter paper used by labs for dried urine testing was developed for blood, not urine
Saliva is a quick, reliable, and painless way to assess HPA axis health including the most important marker for adrenal health, the CAR. As the marketplace for functional medicine increases, it is imperative to question new testing methods as well as the validity of the collection for these methods, protecting both patients and practitioners. For the most reliable understanding of HPA axis health, consider Labrix’ Adrenal Function Profile.
Guilliams, TG. The Role of Stress and the HPA Axis in Chronic Disease Management: Principles and Protocols for Healthcare Professionals. The Standard Roadmap Series.
Stalder T, et al. Assessment of the cortisol awakening response: Expert consensus guidelines. Psychoneuroendocrinology (2016). Vol 63, Pages 414-432.