Stress Reduction (Part 2): How To Manage What You Measure
By George Gillson MD PhD CCFP
In the previous post, I introduced Precision Analytical Laboratory’s DUTCH urine steroid hormone assay, an innovative test which can assess the hour-by-hour variation of free cortisol and at the same time gauge the total output across a 24-hour cycle for all steroid hormones including cortisol. This approach, although originated by Precision Analytical, is now being adopted by most of the other laboratories doing urine hormone testing, due to its versatility.
For those of you who didn’t read that post, I used the following metaphors:
”Cortisol is produced in pulses throughout the day. It’s distributed to tissues, delivers its messages and is then rapidly broken down by the liver into inactive cortisol metabolites and excreted mostly in urine. This seems wasteful but it enables the adrenal glands to rapidly adjust cortisol output to changing demand. Measurement of the cortisol metabolites has been shown to reflect production of cortisol. A good analogy would be to look in someone’s blue bin to determine how much stuff they order from Amazon by counting wrappers and cardboard boxes.
The other cortisol measurement that is important in urine is free cortisol, which is thought to reflect what the bodily tissues are exposed to at any given time. It’s the difference between peering into the blue bin every few hours versus peering into it every other day or so. Another analogy might be that the cortisol metabolites are your salary and free cortisol is what’s in your wallet or purse at any given time.”
Recall that I also exercised artistic license by taking the Morning point (A) point from the standard 4-point free cortisol graph and “replaying” it at the right end of the graph as (A*), to help you picture what is going on with your free cortisol while you’re sleeping. (Remember that you can’t feasibly get this information from saliva or serum testing!) Once again, on the actual reports you only see the A,B,C and D points.
Without further ado, let’s take a look at the profiles I introduced last time in more detail.