– I found salivary, salivary cortisol testing to be incredibly accurate in comparison to say a morning cortisol test via the blood.
– Because with the salivary, what we could do is we can look at the cortisol rhythm so rather than just seeing where it is in the morning, we could actually have the patient collect their saliva four times throughout the day.
– Right. And we could get a read of the rhythm of the cortisol which is really important ’cause it is a rhythmical hormone. So somebody could have say normal cortisol levels in the morning in the blood, but they might have a rhythm disruption where in the afternoon when it’s supposed to be going down it starts to go up.
– You know, that’s really, brings me to an important thought, and the point is that, I had a patient recently normal cortisol in the morning so waking cortisol was appropriate, right? It was high in the morning, and the cortisol pattern is high in the morning and then it kind of decreases throughout the day and then tapers off in the evening, and you become tired and ready for bed. Her normal, her levels in the morning were normal, but the afternoon cratered, so went really, way down to midnight levels, and then at midnight began to rise again,
– Mm, yeah.
– So the pattern was it felt okay in the morning, relatively, after lunch I’d feel miserable, I’m so tired I could take a nap, I want to fall asleep at my desk at work, and then get home from work, you know struggle through dinner and then all of a sudden the wake, and I can’t sleep, and my mind just races all night long and I don’t get any sleep and I wake up and I do the whole thing again. So, while serum is, is useful as a screen tool sometimes for cortisol, a.m. cortisol, it’s not giving you the rhythm like you’ve talked about, but it’s also a snapshot. So even with sex hormones, even with testosterone it’s giving you what was happening at 10:03 or 8:05 when you tested. It doesn’t say anything about what’s going on at noon or two in the afternoon or seven p.m. or bedtime. So, I like the cortisol in that, I like the saliva in that you could look over a period of time.
– Right, and that, in addition to being able to see the rhythm of the cortisol which one, that’s just such, boy it’s like getting the big picture,
– It’s like getting the big picture and I can see what’s really happening, and it allows me to craft my protocol accordingly…
– for that individual, so if we have somebody like you’re saying has normal morning cortisol but then it crashes in the afternoon and then it spikes again or it starts to go up again at midnight, well then we know exactly what to use to bring to bring the cortisol up in the afternoon and down in the evening.
– There’s no more guess work.
– Right we can really dial in the treatment and then we can easily retest when it’s appropriate.