Saliva Testing Misses Up to 50% of Your Total Cortisol


For the last decade or so, there has been a trend in the alternative health space to use a saliva test to measure cortisol.

But there is one major flaw in the use and application of this type of test.  It can miss up to 50% of your total cortisol produced throughout the day.

This will often result in being diagnosed with so-called “adrenal fatigue”, but that may not be the case at all.  Here’s a further explanation and better yet, how to appropriately use a saliva test to measure cortisol.

How Saliva Testing is Currently Used

I’d be willing to bet if you’ve been to a functional medicine practitioner, a naturopath, a physician, or any other practitioner that recognizes the importance of healthy adrenal function, they gave you 4 tubes to spit into throughout the run of a day.

Your instructions were probably something along the lines of, “Take a saliva sample at 8 AM, 12 PM, 4 PM and 8 PM.”

You’re a good patient and really want to get to the bottom of your symptoms, so you do exactly as the clinician told you.

A couple weeks later, your results come back and you’re told you have some stage of adrenal fatigue.  Maybe your results looked something like this:

You’re given a list of supplements to start taking and you go spend a bunch of money on these supplements.

But you don’t get better or you don’t get much better.  What gives?

First we have to understand what the saliva test is measuring and how cortisol levels change throughout the day.

Saliva Test Results

Okay, so this part is relatively simple.

These saliva tests are intended to take a measurement in the early morning when your cortisol should be the highest and then 3 more readings throughout the day as your cortisol should be falling.

The lab then takes all 4 of these results and plugs them into their handy dandy calculator and it spits out an estimation of how much free cortisol you are producing throughout the day.

The Cortisol Awakening Response

As far as the rhythm of cortisol is concerned, your cortisol levels should look something like this:

Several hours before we wake up, cortisol begins to increase.

During the first 30-45 minutes after waking, your body produces about 50% of the total cortisol that it’s going to produce all day and what would be reported on the saliva test.  And you’ll notice that cortisol peaks about 45 minutes after waking.

This is known as the cortisol awakening response or CAR.

Then as we go throughout our day, our cortisol levels decrease and they should be at their lowest about bedtime.

Timing Is Everything!

Let’s say you get a saliva test kit with the instructions of “Take a sample at 8 AM, 12 PM, 4 PM, and 8 PM.”

You have a job and have to be at work by 8:30 AM.

So, you wake up at 6:30 AM to be able to get ready for work.  You get ready and as you’re heading out the door, you do your first reading at 8 AM, just like you were told.

Here’s the problem, if you woke at 6:30, your cortisol is peaking at about 7:15 and will begin falling thereafter.

About 50% of your total free cortisol for the day was produced between 6:30 and 7:15!  45 minutes before you took your sample!

No wonder it looks like your adrenals don’t work!  You missed the majority of what you’ve produced.

How to Best Utilize the Saliva Test

I’m sure you’re hating me right now because you feel like I’ve punched you in the gut and took your lunch money but there is a positive that can be taken from this discussion

Missing the cortisol awakening response (CAR) is obviously a big negative when it comes to saliva testing, and I do think there are a couple more issues with saliva testing that I’ll discuss in another blog post, but there are some very good reasons to utilize saliva testing.

First, saliva testing is easy to administer and can be done in the comfort of your home.

Second, saliva testing is relatively cheap and is often covered at least in part by insurances.

samples of saliva in plastic tubes collected at different time of day for laboratory hormone profile analysis

Now there are basically 2 options on how you can make sure to get the most from doing a saliva test.

The first way is very simple.  You just change when you take your samples.

The doctor told you 8 AM, 12 PM, 4 PM and 8 PM, but the important part is that you’re taking measurements throughout the day.

So, you’ll wake up and take your first sample within the first 30 – 45 minutes after you wake up. Keep in mind to follow the labs instructions by not eating or drinking anything immediately prior to collecting the sample.  You just rinse your mouth out with a little water then collect your sample.

Then sometime around midday you take the sample, then again in the late afternoon or early evening, and one more before you go to bed.

Make sure that when you’re doing this, you’re writing down the time that you took each sample.

Now, the other option is to use the saliva test as an adjunct with the DUTCH test to measure the true cortisol awakening response.

This is my preferred method for a few reasons:

  • You get more detailed information about your free cortisol, your metabolized cortisol, all the hormones that feed into the formation of cortisol and the inactivated form of cortisol via the DUTCH test.
  • You still get to see the pattern throughout the day via the DUTCH results.
  • You get to see the CAR in detail, which can reveal a lot of information about how your brain and adrenal system is working via the saliva test.
  • To use the saliva test in this manner, you’ll wake up, rinse your mouth out with water and take your first sample, then you’ll take another sample at 30 minutes after waking, 45 minutes and at 60 minutes.

    This is going to give you a really good picture of what your cortisol production looks like in the CAR.

    Ultimately, it is your decision on which way you want to go.  Doing both tests obviously increasing the financial investment, but can reveal so much more information and make your path to healing a little clearer.

    If you do decide to rely on the saliva test alone, please keep in mind the importance of timing.

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    The post Saliva Testing Misses Up to 50% of Your Total Cortisol appeared first on Dr. Brandon Allen.

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