Using 4-Point Cortisol Testing to Achieve Adrenal Balance
Using 4-Point Cortisol Testing to Achieve Adrenal Balance
It’s estimated that up to 80% of us suffer from some degree of adrenal exhaustion (1).
As we begin a new year, many of us focus on what we can do better – this includes setting goals to improve our diet, sleep better or start an exercise routine. These important lifestyle choices help us get more out of life, inspiring greater happiness, prosperity and success.
However, for many of our patients, the ability to follow through may be hampered by a lack of energy and ability to do these basic, but essential, things.
When we look behind the curtain to see what’s going on, many patients report fatigue and exhaustion, sometimes debilitating, at various times throughout the day.
Instead of action, patients may remain glued to the couch, rather than energetically moving forward on their lifestyle and healthcare goals.
“Since I started using this test, it has changed my medical practice and benefited many patients.”
Recognizing Adrenal Exhaustion
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It’s estimated that up to 80% of us suffer from some degree of adrenal exhaustion (1). It’s a modern phenomenon that many have written about, though not all agree on its cause, that keeps our “fight or flight stress response” active at inappropriate times. Dysregulation of the diurnal cortisol rhythm has been associated with greater cardiovascular risk (2), increased risk of diabetes and depression (3), and may be a factor in up to 58% of chronic illnesses (4).
So where do we start to unravel this problem?
Why Use the 4-Point Cortisol Test
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Besides the usual types of assessment we might conduct, one of the most useful and even transformative tests I have ordered is the 4-point cortisol test (DU 4-Point Cortisol and Cortisone, test code 4320). Since I started using this test, it has changed my medical practice and benefited many patients.
This test comes as part of some of the dried urine tests (DU Balance Hormone Profiles) available through Meridian Valley Lab, or as a stand-alone test that can be ordered separately or paired with any of the 24-hour urinary hormone tests.
While most 24-hour urinary hormone profiles and even the dried urine tests report adrenal reserve values, it is the 4-point cortisol that can help you identify specific abnormalities in a patient’s diurnal cortisol rhythm.
Understanding Cortisol Patterns
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Normally, cortisol rises in the morning, helping us wake up, peaks mid-morning to early afternoon, giving us energy to complete daily tasks, and falls gradually in the afternoon and evening, helping us get ready for sleep. This daily pattern can vary considerably when abnormal, making it hard to properly time any type of intervention.
For example, even with good adrenal reserve test values, if the 4-point cortisol/cortisone test shows values below or above expected levels at certain times of the day, it can be a clear sign of adrenal dysregulation and a poor response to stress.
If there is a lack of a discernable peak during the day or it is blunted or flatlined, this also gives you important information about the health status of your patient.
When to Consider Testing
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I consider this test when other causes are ruled out and patients report:
- Fatigue during the day, including the inability to wake up easily or falling asleep during the day, resulting in dysfunction.
- Persistent insomnia and sleeplessness.
- A lack of energy and stamina or loss of interest in doing usual things.
- Anxiety or depression.
- Adrenal supports are not working and not resolving fatigue or exhaustion.
Supporting Adrenal Balance
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When ordering this test, with or without a hormone profile, I usually plan on running it twice – once to see adrenal results and then again in 3-6 months after implementing an adrenal support program. Since it can take many months to improve adrenal fatigue, it can be useful to include it again with annual testing.
This test helps me determine if adrenal supports are most effective when used in the morning upon waking or in the afternoon to best support a patient’s energy and stamina. If cortisol test results are too high at night, thus impairing sleep I could consider using adrenal supports during the day to improve energy and then supplements to reduce cortisol at night, such as phosphatidylserine, to reduce high cortisol and promote sleep, restore balance, and normal diurnal rhythm.
Although having the total adrenal reserve is very useful, I like the further refinement of the 4-point cortisol values to help me decide when to intervene to restore adrenal balance.
This might include dietary and lifestyle recommendations and targeted supplements such as rhodiola, ashwagandha, adrenal glandulars, and CoQ10, with more intensive treatment if needed. With each treatment approach, strategies to relax and reduce stress are usually included.
Understanding adrenal function and restoring imbalances are important keys to overall health and wellness and achieving lifestyle and healthcare goals.
Clinical Research & Evidence (Plain-Language Summary)
Dysregulation of the diurnal cortisol rhythm has been associated with greater cardiovascular risk (2), increased risk of diabetes and depression (3), and may be a factor in up to 58% of chronic illnesses (4). Research suggests that adrenal fatigue may affect a large proportion of adults during their lifetimes, while dysregulated cortisol patterns are linked to cardiovascular mortality and metabolic disorders.
Who Should Consider 4-Point Cortisol Testing?
- Individuals with recurring daytime fatigue or difficulty waking up or staying awake.
- People experiencing persistent insomnia or sleep disruptions.
- Those with low energy, poor stamina, or reduced interest in normal activities.
- Patients dealing with anxiety or depression alongside suspected adrenal issues.
- Anyone whose existing adrenal supports are not alleviating fatigue or exhaustion.
Testing periodically with a licensed provider can help tailor dietary approaches and reduce adrenal stress.
Final Thoughts
Understanding adrenal function and restoring imbalances are important keys to overall health and wellness and achieving lifestyle and healthcare goals.
Ready to Take the Next Step?
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4-Point Cortisol Testing: Turn insight into action.
Patients: Discuss testing options with your licensed provider. Meridian Valley Lab provides laboratory services only and cannot advise patients directly.
Practitioners: Contact Client Services to arrange a consultant call.
References
- In his book, Adrenal Fatigue: the 21st Century Stress Syndrome, Dr. James Wilson (with a forward by Dr. Jonathan Wright) outlines many factors that affect our adrenal response, including the effects of stress that are prolonged, leading to many of the symptoms we see in patients.
- Karl S, Johar H, Ladwig KH, Peters A, Lederbogen F. 2022. Dysregulated diurnal cortisol patterns are associated with cardiovascular mortality: findings from the KORA-F3 study. Psychoneuroendocrinology. 141:105753.
- Joseph JJ, Golden SH. 2017. Cortisol dysregulation: the bidirectional link between stress, depression, and type 2 diabetes mellitus. Ann N Y Acad Sci. 1391(1):20–34.
- Stress in America 2023: A nation recovering from collective trauma. American Psychological Association. Published November 2023.
- https://www.apa.org/news/press/releases/stress/2023/collective-trauma-recovery
Order Your 4-Point Cortisol & Cortisone Test
Track your daily cortisol rhythm and identify adrenal imbalances with a comprehensive four-point profile.
