How the Stress Test Works: Results and Insights

Dr. Robert Rountree INTRO

This is The Thorne Podcast, the show that navigates the complex world of wellness and explores the latest science behind diet supplements and lifestyle approaches to good health. I'm Dr. Robert Roundtree, Chief Medical Advisor at Thorne and Functional Medicine Doctor. As a reminder, the recommendations made in this podcast are the recommendations of the individuals who express them and not the recommendations of Thorne. Statements in this podcast have not been evaluated by the Food and Drug Administration. Any products mentioned are not intended to diagnose, treat, cure, or prevent any disease.

Hi everyone, and welcome to The Thorne Podcast. This week we're going to be taking a look at Thorne’s Stress at-home test kit. As always, when we do one of these test kit deep dives, in addition to the audio episode, we're releasing a video version as well, so be sure to check that out on Thorne.com or on our YouTube page so you can follow along as we go over our results and see all the graphics and visuals that come along with the recommendations. Joining me to talk about this test, as always, is my good friend, colleague and returning guest of the pod Thorne's VP of Medical Affairs, Dr. Amanda Frick. Hi, Amanda. How are you doing today?

Dr. Amanda Frick

Hi, Bob. I am well, thank you. How are you?

Dr. Robert Rountree

I'm good. Are you getting plenty of sleep and not working too hard?

Dr. Amanda Frick

I try. I do my best.

Dr. Robert Rountree

Yeah. And how's it going with the espresso? I know you're a fan.

Dr. Amanda Frick

I am. I’m a massive fan.

Dr. Robert Rountree

I have to confess, I had four shots of espresso this morning, and I'm feeling pretty good.

Dr. Amanda Frick

Do you just take them black? Straight?

Dr. Robert Rountree

No. I like a little cream and a little bit of honey. Just enough to cut it. But I seem to be in the 50 percent of the population that can consume caffeine without it destroying my heart rhythm.

Dr. Amanda Frick

Well, that's good. That's good for you. I guess it depends on what you're trying to accomplish. [Laughs]

Dr. Robert Rountree

Yeah, well, yeah, trying to accomplish getting things done.

Dr. Amanda Frick

That's good.

Dr. Robert Rountree

I happen to be, again, I'm in that camp that that seems to benefit from caffeine. Certainly, I have patients that that don't, and maybe we can talk a little bit about that as part of the podcast today. You and I have both taken Thorne’s Stress Test. We're going to walk our listeners through the results in a bit, but we always like to establish, why would anyone take this test? What does it mean? What kind of stress exactly is it measuring?

Dr. Amanda Frick

I think that's kind of a misnomer, actually. It's not really measuring your stress – only you can do that – but I think it's measuring what stress is doing to your body or how you're reacting to it. If I were looking at it, and my patient was doing a stress test, I'd be looking at, “How early are we here we are? Are we in a reactive state? Is your body reacting to what's currently happening or have you already berated it with stress so much that it's like barely keeping up for you?” And really what I think people don't understand is treatment for those two things are really different. So being stressed and how your adrenal glands are responding have two different ways you can approach it based on how they're reacting to you or how longstanding that stress has been on your body.

Dr. Robert Rountree

You know, it's interesting. You can't always tell from the outside what's going on internally with a person. I know they're what's called “hot reactors.” And I don't know if they call them “cold reactors” or maybe “not-hot reactors.” But I remember a study a few years back where they hooked people up to a pinball game, and they wanted to see like what was really going on inside. Certain people who seemed frantic when they were playing the pinball, they were cool as a cucumber inside. Their blood pressure was good, their pulse was fine. Other people who were calmly working the machine had high jumps in their blood pressure, their pulse rate, their sweat. You know, they were they were basically freaking out. But you would never know it from the outside, which I always thought is interesting. So you can’t always tell just by looking at a person, you would say, “Oh, that person is really stressed.” And hence the value of doing a test that's actually measuring how your adrenal glands are responding. So maybe very quickly, tell us what the adrenal glands are. Where are they in the body and what do they do?

Dr. Amanda Frick

Yeah, adrenal glands are located above your kidneys. You have two of them. They release stress hormones and not just cortisol, although that's what we're measuring today, but also certain types of stimulatory things like catecholamines, nor epinephrine, epinephrine. They're your fight or flight response. So if a if a bear is going to chase you, they're helping your body to react to what's happening, that's a good thing. And they're meant to help you respond to stress in a way that either lets you mount a response or get away from, you know, whatever the stressor is. They probably weren't designed for... We were talking about social media earlier. They weren't designed for getting stressed out by social media all day long or CNN or something that's happening at your neighbors and just constant the way that we're stressed now. And so I think they tend to get affected and easily get out of balance just because of what a modern lifestyle looks like. So what they're doing is a good thing, but sometimes they can overreact or they're getting the wrong message because of lifestyle factors or stressors. And then sometimes they get tired. They just they've reacted so much that they're not putting out the same kind of reaction that they should when you need it. It's really nice to be able to measure and take a look at where they're reacting for you.

Dr. Robert Rountree

So the hormones that we're measuring in this test, they're coming from the outer “capsule” – I don’t know if “capsule” is really the right word; it’s called the cortex of the adrenal gland. So the middle part of the adrenal gland makes adrenaline. And that’s of people when they think “fight or flight,” running away from a saber tooth tiger, they think adrenaline. Right? You know, well, we needed our glands to be active, so we didn't get eaten by saber tooth tiger so we could pass on our genes that had that high level of reactivity. But as you said, if you're sitting at your desk all day long and the main stress is from your boss, right? Or from the deadlines that you're under, not such a good thing if it's day in, day out. And here's the good news. We can measure how your body's responding. And what exactly are we measuring?

Dr. Amanda Frick

In this Thorne Stress Test, we're measuring cortisol, at four points during the day, and DHEA. And we measure cortisol at four points during the day because a natural cycle has, I call it, like a ski slope. It starts high, sort of comes down and levels off at night. And that's really what it should be doing to help get you awake in the morning and help be able to fall asleep at night. And so by collecting all four points, you can take a look at whether there's points in the day that it's falling apart or overreactive or whether that's why you can't get up in the morning or can't sleep at night. There's so many different ways that that imbalance can affect, you know, how what your experience is.

Dr. Robert Rountree

One thing I would say about that four-point measurement is that this is backed by years of research. This is not alternative medicine or anything like that. I mean, this is considered really valid by mainstream researchers who have been looking at the body’s stress response. So, you know, what we're measuring here are actually fairly standard markers for what's going on in the course of a day. Now, a lot of doctors who are evaluating their patients may say, “Well, all you need is a morning cortisol blood test,” and that's the end of the story. But they're missing a big part of what's going on if they don't know what's happening throughout the day. And I think my results will actually illustrate that very nicely. And perhaps you can give me some advice about what to do about that.

Dr. Amanda Frick

Well, see, I can send I'll send you an invoice later.

Dr. Robert Rountree

You send me an invoice. [Laughs] Now, these are salivary tests, so I don't know if there's a whole lot to say about that. Maybe before the break, you can mention what was involved in getting the kit and what your experience was of doing that. It's a pretty easy collection in my experience.

Dr. Amanda Frick

You're right. It is a pretty easy collection. And this one is saliva. So you don't have to poke your finger. You don't have to do anything untoward. Or if that's something makes you uncomfortable or, you know, blood draws are not your favorite thing. You know, it's not like spitting is particularly, you know, entertaining, but at least it's not a blood collection of any sort. [Laughs] I think you and I had talked about it, though, that you have to collect four times. One is the first thing when you get up and then at three more points during the day, which are essentially before lunch, before dinner, and before bed, and that first one in the morning, multiple hormones are coming out of, whereas the other ones are individualizing a bit. So that first tube is a little bit larger. So it's a little bit harder because you did just wake up. So some tips I would have for that… There are tips included in the booklet. So you'll find your four different tubes, a little a bag to put them in labels for the tubes and then you know, your instruction booklet. And in the booklet are some tips about how to get your saliva flowing. Like think about a food you really like or, you know, some things like that. I find that rinsing with cold water – you're not supposed to brush your teeth or have food or coffee – so even when you first wake up, rinsing with cold water just to like have your mouth feel fresh and clean, it's not so dried out from sleep. And then just be a little patient. That first one can take a minute to collect what you need. And then after that –

Dr. Robert Rountree

That, it's like you're talking to me. Are you talking to me? Because I specifically remember complaining, whining to you, I said, “You know, that’s a lot of spit, that first one in the morning.” And I'm not a big salivator, right? And you reassured me, “OK, well, it's just going to take a little while.” And sure enough, you know, there was no problem analyzing my results. So it may take a bit of patience for that first morning collection. So, yeah, you remember that interaction quite well.

Dr. Amanda Frick

Yeah.

Dr. Robert Rountree

I said, “Yeah, I just don't spit enough.” And you reassured me, “Oh, that's normal.” It just it may take you a while to generate that much spit.

Dr. Amanda Frick

And the good thing is if you're collecting through the day or you have work to get done, the other collections during the day are a lot smaller, and they go really quickly, actually. Once you get through the first one, you’re a rock star at that situation, and so the rest of them seem super easy.

Dr. Robert Rountree

So it helps to practice your spitting technique perhaps, in advance. But I mean, it's saliva, and you will be able to generate enough. And if it takes a few minutes to produce the adequate amount, well, that's OK. Just be patient with it.

All right. Well, with that, let's take a short break. And when we come back, we'll look at our actual results.

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And we're back. So now it's time to see what Thorne’s Stress Test has to say about our individual samples. We've taken our tests. We’ve spit into the tubes, we mailed it in, and then we got emails notifying us that our results were ready. So we logged into Thorne.com. So Amanda is going to go first, and she’s going to explain her results, and then we're going to swap. So, Amanda, what did you what did you see?

Dr. Amanda Frick

Sure. So this is my result here on the screen. I got my little welcome message. You can find your results on that column in the left that says Test Results. And so I have a little bit of imperfection here. Not as clean as the last one, although I will say in honesty, I am not displeased with this. So really what we're showing here is, this is… When we talked about doing four times a day or that's a ski slope pattern that we were talking about. So these are the timeframes. And as you go from left to right here, then it's like morning to night. And so things are supposed to be high in the morning, sort of drop down rapidly midday, and then ease out at night. And I came in the normal level. My morning cortisol is landing here at 5.6, which is considered normal. Same thing for my noon. It's on the little bit of the high side but still considered normal, and then my pre-dinner marking is out, so it's actually a little bit high. They would expect that or we'd want that to be a little bit lower. And then my night time is back into the normal range where it should be before bed. So what I'm OK with is that I'm getting through the day OK, And I'm still falling asleep all right. So I don't have a massive problem with this. I was pretty happy that I had three of four in normal, because after medical school and private practice and so many other things, I've had a sort of a flatline pattern for a long time. So the fact that I even have a bit of curve showing up, or a morning cortisol that's become more normal, I'm pretty excited about it.

Dr. Robert Rountree

So at one point your glands are flat. You said they weren't responding? Oh.

Dr. Amanda Frick

Yeah, just pretty much straight line across the bottom of the board, the whole time. When I got really lucky, I had a little bit more in the morning. And a lot of work and lifestyle adjustments and it takes a long time to recover that, you know, depending on how long it takes you to get there, you know? So this one, this one's the closest thing to normal I've seen in years.

Dr. Robert Rountree

Yeah, this is progress for you. Progress. And I'm curious, so sometimes that pre-meal rise and cortisol can stimulate appetite. Would you say you ever experience that, like a big craving? Because you know I think there's some supplements that are out there that are used specifically to try to curb that that rise before meals.

Dr. Amanda Frick

Yeah, I hadn't thought about it. I don't… I think that in general, I don't know about cravings or big appetite, but I have a lot of like food seeking behavior at that time. It's the end of the day. And then I start thinking about like, what's the fun thing I'm going to eat? Or what's for dinner tonight? So maybe that's it. That's a good point.

Dr. Robert Rountree

Yeah, it could be cortisol-driven.

Dr. Amanda Frick

But I really like food, Bob. [Laughs] So I don't know if I want it to go away.

Dr. Robert Rountree

Oh, it is one of the great pleasures in life, in my opinion.

Dr. Amanda Frick

Yes, it is.

Dr. Robert Rountree

So what did your DHEA show? I'm curious about that.

Dr. Amanda Frick

Yes. DHEA is showing normal, normal range.

Dr. Robert Rountree

And what does that mean?

Dr. Amanda Frick

I wouldn't mind if it were a little higher for the anti-aging benefits there. So that wouldn't hurt my feelings. But I'm glad that it's still in a healthy, normal range when it's when it gets too low, I think then you start it starts affecting other hormones. To me [that] would indicate possible issues with other hormone imbalance or things that could be going on. I'd want to look further into. But this one would be considered normal. And, you know, I don't have a lot of issues with motivation or drive or fatigue or anything like that. So while I would like to have the aging benefits of having a higher level, this one is considered normal for my age and my gender.

Dr. Robert Rountree

So again, these tests were reassuring more than anything else to you. You can say, “Oh, I'm actually doing OK here.”

Dr. Amanda Frick

Yeah, exactly. Especially that cortisol pattern. I felt a little happy for myself.

Dr. Robert Rountree

Terrific. OK, so that was helpful. Why don't we switch over and I will share my results.

Dr. Amanda Frick

Do you want to see what my recommendations were?

Dr. Robert Rountree

Oh, yes! I don't want to bypass that. Yeah, go ahead.

Dr. Amanda Frick

OK. Good. That’s the fun part!

Dr. Robert Rountree  

What did they tell you to do? Get more sleep?

Dr. Amanda Frick

Yeah, well, we'll see. I got a Mediterranean Diet recommendation, which again, is a general recommendation for anti-inflammatory. Lots of data about why to eat a Mediterranean Diet. Mine had prebiotic and probiotic foods, which is really interesting. And I think the aim here is to help optimize the gut microbiome that helps normalize cortisol levels. So if I were more curious about this, I could run some more testing or I could look at my gut microbiome, but without having that information, it's recommending that I just support my microbiome balance. Because I have a high cortisol level at some point, I got recommended sort of relaxing exercises, so I got recommended yoga and meditation, a workout in the morning. I think that's probably because my cortisol, while it was normal, could stand to be a little bit higher, especially in relation to my other ones. And then engaging in affectionate behavior – so this is a really neat one – and so that's about reducing stress and how whether it's low or high, having some touch time or having time with your friends, family, or important people can really help to regulate how your body responds to stress. So that's a really nice one.

Dr. Robert Rountree

I love that one. Actually. I don't think I'd recognize that that was in it.

Dr. Amanda Frick

You not get that one?

Dr. Robert Rountree

I'll look and see. I don't remember if that's in there or not. I wonder if, like, stroking your cat or your dog would be included. Doesn't that raise oxytocin and lower your stress?

Dr. Amanda Frick

And it does, I think there's studies about that, too, like petting your animal or the same thing that's engaging in affectionate behavior. And you can get that same stress relief response for sure. And then I got one product in my recommendation, which makes sense to me: so Iso-Phos [Phosphatidylserine] is in here, which we use a lot to help support when cortisol is high when we don't want it to be, which is exactly what's showing up in my results, which could help. Especially if I was feeling stressed more in the evening, or if my mind is racing closer to bedtime, or if I had any difficulty sleeping, then Iso Phos [Phosphatidylserine] is great to support those things.

Dr. Robert Rountree

OK, so here my results. And we start with “Hi, Robert.” And “We are excited to show you what your body is capable of with Thorne’s multi-omics testing.” So this is the stress panel analysis, and here is my cortisol. So the first thing I would say about this is that I'm grateful that I have cortisol in the morning. I'm not a morning person, you know, after having read Matthew Walker's book, “Why We Sleep,” he talks about chronotypes, and there's there's morning types and evening types, and I'm definitely an evening chronotype. I really wake up in the afternoon and I'm wide awake. Like, you know, the time when everybody else is going to bed. So I suppose I should be working in a restaurant or something like that. And that's reflected really in what my results show is my cortisol. It's OK in the morning, it's not too bad, but it just stays there, right? It doesn't go down. And then by dinner time it really spikes, and that's where my brain really wakes up, etc. So yeah, I do manage to sleep these days, but it takes me some effort to calm down the transition time is really important for me and so this, I can say, beautifully reflects my experience. You know, this is exactly what it's like to be inside of my skin is that morning’s a little slow, evenings get going, and then really hard to slow down once I've got that momentum. So…

Dr. Amanda Frick

I don't think anybody wants to ski off that slope there. That's more like a butte. Or a plateau.

Dr. Robert Rountree

Yeah, it gets up and it stays up. So we'll come back later and talk about what the recommendations are. But first, let's go into what the DHEA shows. Now, I do take DHEA, and the reason that I have been taking it is because I did one of these tests a few years ago and my level was quite low. And so I started taking it and taking it for years. I take 25 milligrams in the morning, and I did the Biological Age test for Thorne. And as you know, DHEA is one of the things that they look at in there. And I think my biological age is about 15. I'm just joking, you know, not that young, but it did seem to help. And I do experience benefits from taking DHEA. You know, that's not always going to be the case. But I think, you know, my results are going to be a little skewed. I didn't take the DHEA the morning of the test, but that's showing me that it is keeping my levels up pretty high and hopefully lowering my biological age, which is a very interesting thing. So here my recommendations, similar to yours: Follow a Mediterranean Diet. I didn't really need to make any dietary changes. Eat prebiotics and probiotics. I got to say, I love sauerkraut. I actually hope, you know, we have this stuff called wild brine, which is fermented green cabbage. And I have a hit of that every day, not even at mealtime. Just I've gotten to where I really crave it. So I think these fermented foods are really good. Practice yoga and meditate. I do meditate every day, but this makes it sound like I need to do more, and maybe I should be working out more in the morning for a good 30 minutes. Instead, what I tend to do is work out in the afternoon when my cortisol is up. You know, I feel more up for doing that, but maybe I could blunt that effect. I think the implication here is it maybe not the healthiest thing in the world to have your cortisol at such a sustained level for so long. I kind of think that's what these interpretations are saying, like, “OK, maybe it feels good, it works for you. You've built a lifestyle around that, but maybe it is the healthiest thing for your blood sugar, blood pressure, etc.” Would you agree with that, Amanda?

Dr. Amanda Frick

I would. I would.

Dr. Robert Rountree

If I was your patient. Yeah.

Dr. Amanda Frick

I think some people who struggle with high cortisol may have weight management issues, too. And so, you know, that's not an issue for you, but for some people it may be, especially if it's combined with other sort of metabolic issues or lifestyle factors.

Dr. Robert Rountree

Maybe if I didn't exercise as much as I do and didn't do my best to stay in shape, it would be more of a problem. I also should be engaging in affectionate behavior. I had to shut the door so my cat wouldn't come in and jump on my lap during this, but he does have a tendency to do that right in the middle of webinars. And now I have an excuse for doing that. I need to engage in affectionate behavior. So interestingly, the main recommendation for me is Moducare®. Can you tell me a little bit about what that is?

Dr. Amanda Frick

Moducare is plant sterols. So they're helping to sort of realign the immune system, is normally what I think of them for.

Dr. Robert Rountree

OK, well, that makes perfect sense. And this tells me a little bit more about Moducare. I do use that that supplement in my practice, but this gives me a little more insight into what it may be for.

Dr. Amanda Frick

So do you use it for adrenal support in your practice or use it for other things?

Dr. Robert Rountree

You know, I hadn’t thought about doing that, to be perfectly honest, until seeing this. Now it makes more sense. I mostly use it for autoimmune conditions or for general immune support.

Dr. Amanda Frick

Yeah. That makes sense.

Dr. Robert Rountree

So this is one more thing to add to the repertoire. So I learned something from doing this. It was not a big surprise. In fact, when I've done these adrenal tests in the past, they were even worse than this, right? You talk about being flatline low, I've been flatline high where I was just high cortisol all the time. All cortisol all the time. So this is actually a little bit better pattern for me, and it suggests that I'm improving. The reason for phrasing it that way is because I think that these tests can be really utilized well as a serial measurement. And by that I mean doing it maybe every three months or every six months to see if the interventions you're doing are working or not. Would you agree with that?

Dr. Amanda Frick

Absolutely. I think three months is a great timeline for most tests, if not all tests that we have. I think three months is a great retest timeline. I mean, even if there's only a bit of nutritional supplementation that goes in there, you can start to look at what your lifestyle factors are doing, maybe shifting your workout schedule. Like you said, if you didn't change anything, but just shifted some of those schedules around, you can… You know, it's basically like that biohacking or life adjustment. You can see the changes that you make and measure what it's doing on the inside as well as, you know, how you feel and what works well for you.

Dr. Robert Rountree

Well, I have to say that I'm in the camp, that the more information we have, the more data we have, the better. Having just read the book by Dr. Nathan Price and Leroy Hood, which I highly recommend, you know, the book is all about, you know, “The Age of Scientific Wellness,” which is based on data. So the more, as you said, biohacking that we do, the more we know how our body is responding to the lifestyle that we're currently living, the more we have the opportunity to adjust. “We can manage what we can measure,” I think, is how the saying goes. If you measure it, you manage it.

Dr. Amanda Frick

Be careful what you wish for.

Dr. Robert Rountree

Yeah be careful what you wish for because, you know, what are you going to do with that? You're going to have to think a little bit.

Dr. Amanda Frick

And act a lot.

Dr. Robert Rountree

Act a lot. It's going to make you more responsible. But I think that's a good thing. All right. Well, that's all the time we have for this week. So, Amanda, thank you so much for coming on the podcast. I know I always ask this, but if people want to keep track of you, where's the best place for them to find what you're writing about or blogging about, etc.

Dr. Amanda Frick

You can find things I'm blogging about on our Take 5 Daily at Thorne.com, and then other contributions that I make outside of our website. You can find those on LinkedIn, on my profile.

Dr. Robert Rountree

All right. That was excellent. Dr. Amanda Frick, Thorne's VP of Medical Affairs, speaking about Thorne's Stress Test. As always, thank you all for listening.

OUTRO

Thanks for listening to The Thorne Podcast. Make sure to never miss an episode by subscribing to the show on your podcast app of choice. If you've got a health or wellness question you'd like answered, simply follow our Instagram and shoot a message to @thornehealth. You can also learn more about the topics we discussed by visiting Thorne.com and checking out the latest news, videos, and stories on Thorne’s Take 5 Daily blog. Once again, thanks for tuning in and don't forget to join us next time for another episode of The Thorne Podcast.