Why Salivary Cortisol Tests Are a Game Changer for Stress Management

If you’re experiencing symptoms related to stress or fatigue, you may benefit from getting a salivary cortisol test. Cortisol regulates your body’s stress response, including anxiety and fatigue. Salivary cortisol measurements are important to detect cortisol levels in your saliva and provide valuable insight into the body’s response to daily stressors.

You can improve your physical and mental health by identifying abnormal cortisol levels. This article will explore the importance of salivary cortisol tests and highlight some popular at-home tests to understand your body’s stress response better.

What exactly is cortisol?

Cortisol is a hormone that regulates the body’s stress response and sleep-wake cycle. It’s at its highest in the morning and gradually decreases throughout the day. It triggers gluconeogenesis [1] – the production of glucose from other sources in the body. Cortisol also initiates various other catabolic or breakdown reactions in the body.

While it’s not inherently harmful, having chronically high cortisol levels can lead to insulin resistance, endothelial dysfunction, and reduced immune function. As a result, it’s essential to regulate cortisol levels and ensure they stay within a healthy range. When you’re feeling stressed, know that cortisol is working hard in your body to help you cope.

Why is it important to know our cortisol levels?

Cortisol levels play a significant role in our physical and mental health. It is commonly known as the “stress hormone,” which regulates our fight or flight response during stressful situations [2].

However, imbalances in cortisol levels can harm our health, such as weight gain, chronic fatigue, and even depression. To ensure proper health, it’s also important to maintain blood pressure levels, which can be assessed through a salivary cortisol measurement. Luckily, with the help of testing, individuals can identify and manage their cortisol imbalances. Understanding our cortisol levels allows us to manage stress more effectively and prevent potential health issues.

What is the salivary cortisol test?

The salivary cortisol test measures the cortisol levels in the saliva, often to evaluate the adrenal and pituitary function. The test measures the levels of cortisol present in the saliva to determine if they are within normal ranges. It involves collecting a saliva sample multiple times a day.

Salivary cortisol testing is a non-invasive and convenient method compared to popular alternatives, such as a urine test, which tests urinary cortisol amounts, or a blood test, which tests cortisol levels in the blood.

To determine the stress hormone rhythm or lack of rhythm, a saliva cortisol test is conducted four times in a single day. Saliva testing provides a more accurate depiction of cellular activity than blood work. Blood work examines the fluid that carries cells, whereas saliva cortisol testing examines the interior of cells.

Having high or low cortisol levels can indicate an adrenal gland disorder [3], a pituitary gland problem, or a tumor that produces cortisol.

Why is the salivary cortisol test done?

When a doctor or functional medicine practitioner orders a salivary cortisol test, there are many reasons why they may be doing so. Firstly, a cortisol imbalance may be suspected as this can cause a range of conditions such as mood disorders, chronic fatigue, or even obesity.

Additionally, the salivary test is 90% accurate at identifying Cushing’s syndrome, a rare condition caused by excess cortisol production. The test can also help to assess HPA-axis dysfunction, which affects the body’s stress response system. This can help healthcare providers determine how to address chronic stress and manage symptoms accordingly.

Furthermore, evaluating the effectiveness of cortisol-lowering medications and monitoring cortisol replacement therapy is essential. For those with anxiety or depression, salivary cortisol levels can help determine the stress level present in the body. For all of these reasons, a salivary cortisol test can provide valuable information to help diagnose and effectively treat a variety of health concerns.

The Best Salivary Cortisol Tests of 2023

Here are some popular salivary cortisol tests on the market and a breakdown of their details:

Canary Club ZRT Diurnal Cortisol 4x Stress – $129

Canary Club’s ZRT diurnal cortisol 4X stress test is an excellent choice for individuals looking to take control of their health and well-being by measuring cortisol levels produced by the adrenal glands due to stress. It checks for chronic fatigue & other health complications that can result from prolonged high cortisol production.

This test measures cortisol levels at four different times during the day, providing a complete picture of the daily cycle. Saliva samples are collected in the morning, afternoon, evening, and again at nighttime.

The test is suggested for individuals experiencing prolonged fatigue and stress, which may indicate an imbalance in the adrenal glands. The cortisol level in the body changes throughout the day, with the levels highest in the morning & lowest at midnight or about three to five hours after falling asleep.

Dutch Cortisol Awakening Response – $299

The Dutch cortisol awakening response (CAR) test requires you to collect five saliva samples in one day. Choose a day when your routine is relatively consistent to ensure accuracy. For example, choosing another day is best if your sleep is disrupted.

First, remove the cap from the collection device and put the cotton swab in your mouth. Keep it in your mouth until thoroughly saturated, but no longer than five minutes. You can chew lightly on the swab to help stimulate the flow of saliva.

Once complete, place the swab back into the same tube you found it in, being careful not to touch it any more than necessary. Thoroughly label each device and freeze them until you can ship them. It’s essential to test your levels of cortisol at specific times of day: upon waking, 30 minutes after waking, 60 minutes after waking, 4 pm to 5 pm, and 10 pm to midnight.

To ensure accurate sample collection, refrain from consuming caffeine and alcohol on the day of your collection and the night before. Additionally, it is recommended that you avoid exercising on the day of your collection. Refrain from brushing your teeth until after the third and fifth sample collections. Do not floss on the collection day or until all samples have been collected.

Verisana – $129.95

Verisana Diurnal Cortisol Test measures cortisol levels in saliva at four different times throughout the day. The first test is taken right after waking up, followed by tests after being awake for 4 hours, at 8 hours, and then at 10 hours.

Like the other tests, this option monitors cortisol levels at different times to determine a person’s daily levels because cortisol levels vary throughout the day. To collect samples, it is recommended to take the first sample of the day between waking up and 11 a.m., the second sample between 11 a.m. and 3 p.m., the third sample between 3 p.m. and 7 p.m., and the final sample between 7 p.m. and bedtime.

According to Verisana, customers who are going to collect a sample should refrain from taking any hormonal medications, except for birth control and thyroid medications, 48 hours prior to the collection. For individuals with regular menstruation cycles, collecting samples on days 19 to 21 of their cycle is recommended. Those with irregular cycles should collect samples five days before their anticipated cycle.

According to Verisana, it is recommended that people refrain from consuming milk and soy products, chocolate, wine, and meat for 12 hours before taking the test. After taking the test, it will take three weeks for the results to be ready from a lab certified by CLIA. This test might be more appropriate for individuals not in a hurry to obtain their results and prefer a comprehensive report that tracks cortisol changes over time.

ZRT Laboratory – $86

The ZRT Cortisol Saliva Test is another good option for tracking cortisol fluctuations. This test requires four saliva samples to measure cortisol levels at different times: upon waking up, at noon, in the evening, & at nighttime. If you are taking hormonal medications, the company suggests being cautious. Before collecting samples, you should wait 12-24 hours after your last dose of creams, gels, pills, or sprays.

To ensure accurate results, avoid using anti-aging face creams for three days before sample collection. If you use a patch, wait 1 to 2 days after applying before conducting the test. If you cannot send your samples to the company’s CLIA-certified lab in 24 hours, freeze them until you can. Your results are expected to arrive within 5 to 7 days.

How to prepare for the salivary cortisol test

When preparing for a salivary cortisol test, there are a few essential steps to ensure accurate results. First, it is recommended to fast for at least 30 minutes before the test and avoid certain foods and drinks that could interfere with the results. Additionally, it’s important to avoid strenuous exercise and rest for at least 30 minutes before the test. Make sure also to follow any instructions your doctor gives regarding medications and supplements that may affect the cortisol levels in your body. Lastly, do not eat, drink, brush, or floss your teeth for at least 30 minutes before the test. By following these simple steps, you can ensure your results are as accurate as possible.

How is a salivary cortisol test performed?

To perform a home salivary cortisol test, ensure you have a specialized kit for salivary testing, such as the ones provided above. To collect the sample, use the provided swab to rub the inside of your mouth until it’s saturated with saliva. This should take a few minutes.

Then, swish the swab in the tube to ensure it’s fully coated with saliva. Repeat this step for multiple samples, depending on the recommended frequency of your kit, usually 1-4 times per day. Certain salivary cortisol tests are performed in the evening when cortisol levels are lower.

Label each tube with the time and date of collection, and store them in a cold refrigerator until you can transport them to the lab or doctor’s office. Be sure to follow the guidelines, including washing hands before handling the swab or sample, collecting samples at the recommended times, and avoiding food or drink for at least 30 minutes before testing.

What do the results of the salivary cortisol test mean?

Interpreting the test results involves comparing the person’s cortisol levels with the normal ranges. Generally, normal cortisol levels should be highest in the morning, gradually dropping throughout the day and reaching their lowest point at night. High cortisol levels may indicate a person is experiencing chronic stress or has an illness such as Cushing’s syndrome. It’s important to note that a single high cortisol level can be due to a one-time stressful event and may not necessarily reflect a problem.

Low cortisol levels, on the other hand, can indicate various conditions, including Addison’s disease or hypopituitarism [4]. However, if it’s just a one-time low cortisol level, it may not be a cause for concern. It’s essential to review the test results with your healthcare provider to determine if follow-up tests or treatment is required. With these results, diagnosing the cause of a cortisol imbalance and managing stress levels can help improve the patient’s overall health.

How much does a salivary cortisol test cost?

The price range for at-home salivary cortisol testing varies, with some kits costing under $50, while others may be priced as high as $150. Factors that affect the cost of these testing kits include the brand, the number of hormones tested, and the type of sample required.

Although salivary cortisol testing can be done at home, it’s essential to know that insurance coverage for these tests may vary. While some insurance plans may cover the cost of testing, others may require patients to pay out of pocket. Individuals who undergo at-home testing will often be responsible for covering these expenses.

While at-home testing may seem more cost-effective, it’s important to remember that lab-based testing may provide more comprehensive results and may be covered by insurance plans. Additionally, lab-based testing may offer a quicker and more reliable turnaround time. Ultimately, choosing at-home testing kits or laboratory testing should be based on your needs, preferences, and budget.

Are there any risks or side effects associated with salivary cortisol tests?

At-home salivary cortisol tests are generally considered safe, and there are no significant risks involved in taking the test. This non-invasive test only requires a small saliva sample, making it a convenient option for individuals who may not want to undergo blood tests. These tests measure cortisol levels in saliva, providing an overall view of the body’s stress levels, and help diagnose conditions such as adrenal insufficiency and Cushing’s syndrome.

However, some limitations associated with these tests can lead to false results. Factors that may affect the accuracy of the test include the time of day of the test, recent meal intake, and alcohol consumption. Additionally, changes in hormone levels due to medication or chronic illness may lead to inaccurate results. It’s crucial to follow the collection guidelines provided with the test to ensure accurate results. The test should not be used to diagnose a medical condition without consulting a healthcare professional. If you are experiencing unusual symptoms or have concerns about your health, it’s best to seek medical advice from a qualified professional.

Conclusion

Understanding our cortisol levels, ranging from stress management to increased energy and better sleep is essential. With the help of a cortisol test, we can better understand our hormonal balance and make better decisions about our actions and lifestyle.

If you feel that a cortisol test could help provide you with answers regarding your overall wellness, please don’t hesitate to speak with your doctor or healthcare practitioner. With the right information, you can find the best course of action to give your body the support it needs. We all deserve to live healthy, balanced lives; understanding our cortisol levels can take us one step closer to achieving that goal. Thanks so much for reading.

REFERENCES

[1] Chung ST, Chacko SK, Sunehag AL, Haymond MW. Measurements of Gluconeogenesis and Glycogenolysis: A Methodological Review. Diabetes. 2015 Dec;64(12):3996-4010. doi: 10.2337/db15-0640. PMID: 26604176; PMCID: PMC4657587.

[2] Cay M, Ucar C, Senol D, Cevirgen F, Ozbag D, Altay Z, Yildiz S. Effect of increase in cortisol level due to stress in healthy young individuals on dynamic and static balance scores. North Clin Istanb. 2018 May 29;5(4):295-301. doi: 10.14744/nci.2017.42103. PMID: 30859159; PMCID: PMC6371989.

[3] Prete A, Taylor AE, Bancos I, Smith DJ, Foster MA, Kohler S, Fazal-Sanderson V, Komninos J, O’Neil DM, Vassiliadi DA, Mowatt CJ, Mihai R, Fallowfield JL, Annane D, Lord JM, Keevil BG, Wass JAH, Karavitaki N, Arlt W. Prevention of Adrenal Crisis: Cortisol Responses to Major Stress Compared to Stress Dose Hydrocortisone Delivery. J Clin Endocrinol Metab. 2020 Jul 1;105(7):2262–74. doi: 10.1210/clinem/dgaa133. PMID: 32170323; PMCID: PMC7241266.

[4] Henry M, Thomas KGF, Ross IL. Sleep, Cognition and Cortisol in Addison’s Disease: A Mechanistic Relationship. Front Endocrinol (Lausanne). 2021 Aug 27;12:694046. doi: 10.3389/fendo.2021.694046. PMID: 34512546; PMCID: PMC8429905.

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Dr. Linnea Passaler

Dr. Linnea Passaler

Dr. Linnea Passaler has dedicated 20+ years to serving patients, first to a small number of individuals as a successful surgeon and then to thousands of people worldwide as the CEO of a digital health startup. After overcoming her own struggles with a dysregulated nervous system, she created Heal Your Nervous System (HYNS) to empower others in their healing journey. Her combination of neuroscience and somatic work helps those struggling with overwhelm, trauma, burnout, and anxiety to heal their dysregulated nervous systems and thrive.