DUTCH PLUS COMPREHENSIVE HORMONE PANEL
The Dried Urine Test for Comprehensive Hormones (DUTCH) Plus® test offers a comprehensive assessment of sex and adrenal hormones and their metabolites. It also includes the daily, free cortisol pattern, organic acids, melatonin (6-OHMS), and 8-OHdG. The DUTCH Plus test offers an extensive look into identifying symptoms of hormonal imbalances, HPA axis function, and includes the Cortisol Awakening Response (CAR) to bring another important piece of the HPA-axis into focus.
Symptoms of HPA Axis and hormonal imbalance:
— Chronically stressed/anxious or worried
— Feeling exhausted
— Adrenal fatigue
— Depression
— Brain Fog
— Hair Falling out
— Insomnia
— Weight gain or loss
— Temperature dysregulation (always hot or cold)
— Bloat and fluid retention
— Histamine/allergy reactivity
— Food sensitivity
Symptoms of HPA Axis and hormonal imbalance:
— Chronically stressed/anxious or worried
— Feeling exhausted
— Adrenal fatigue
— Depression
— Brain Fog
— Hair Falling out
— Insomnia
— Weight gain or loss
— Temperature dysregulation (always hot or cold)
— Bloat and fluid retention
— Histamine/allergy reactivity
— Food sensitivity
CORTISOL MEASUREMENT
Cortisol measurement can provide us more insight regarding the functional of our HPA axis. If cortisol is low, this can be a result of an under-active HPA axis, excessive psychological burnout, seasonal affective disorder (SAD), sleep apnea or poor sleep in general, PTSD, chronic fatigue, and/or chronic pain and can be associated with systemic hypertension, functional GI diseases, postpartum depression, and autoimmune diseases. If cortisol is high, this can be a result of an over-active HPA axis, ongoing job-related stress (anticipatory stress for the day), glycemic dysregulation, pain (i.e. waking with painful joints or a migraine), and general depression (not SAD).
HOW THE CORTISOL MEASUREMENT WORKS
When we open our eyes upon waking, cortisol levels naturally begin to rise by an average of 50%. 30 minutes after waking, cortisol levels will still show this sharp increase. By 60 minutes after waking, cortisol levels have peaked and begin to decline. Measuring this rise and fall of cortisol levels at waking can be used as a “mini stress test”. Research shows that the size of this increase correlates with HPA-axis function, even if the sample measurements are all within range.
Even though a client may have “normal” free cortisol levels (via previous measurements) throughout the day, that doesn’t always mean everything is functioning properly. The graph below shows two good examples. A blunted or exaggerated Cortisol Awakening Response (CAR) can appear, even when single samples return “normal” results. The HPA axis might not be appropriately responding when faced with a stressor, even when cortisol levels are fluctuating nicely throughout the day. The “stress” of waking allows us to test the HPA axis in a way that has been independently correlated to clinical outcomes and cannot be assessed by other cortisol tests on the market.
The DUTCH Plus® uses four dried urine samples and five saliva samples. These samples are collected over the course of one day, from waking to bed time. The DUTCH Plus® report includes: Metabolites of Estrogens (10, including E1, E2, E3, 2-OHE1, 4-OH-E1, 2-OH-E2, 4-OH-E2, 16-OH-E1, 2-methoxy-E1, 2-methoxy-E2) , Androgens (8, including Testosterone, DHT and DHEA-S), Progesterone (2), Cortisol (3), Melatonin (6OHMS), 8-OHdG, and OATs (6). The diurnal pattern of Free Cortisol and Cortisone are also provided, including the Cortisol Awakening Response.
Even though a client may have “normal” free cortisol levels (via previous measurements) throughout the day, that doesn’t always mean everything is functioning properly. The graph below shows two good examples. A blunted or exaggerated Cortisol Awakening Response (CAR) can appear, even when single samples return “normal” results. The HPA axis might not be appropriately responding when faced with a stressor, even when cortisol levels are fluctuating nicely throughout the day. The “stress” of waking allows us to test the HPA axis in a way that has been independently correlated to clinical outcomes and cannot be assessed by other cortisol tests on the market.
The DUTCH Plus® uses four dried urine samples and five saliva samples. These samples are collected over the course of one day, from waking to bed time. The DUTCH Plus® report includes: Metabolites of Estrogens (10, including E1, E2, E3, 2-OHE1, 4-OH-E1, 2-OH-E2, 4-OH-E2, 16-OH-E1, 2-methoxy-E1, 2-methoxy-E2) , Androgens (8, including Testosterone, DHT and DHEA-S), Progesterone (2), Cortisol (3), Melatonin (6OHMS), 8-OHdG, and OATs (6). The diurnal pattern of Free Cortisol and Cortisone are also provided, including the Cortisol Awakening Response.
HOW DOES DUTCH COMPARE TO OTHER HORMONE TESTS?
DUTCH vs. Saliva Testing - While the free cortisol pattern in saliva has clinical value, there is a significant missing piece to surveying a patient’s HPA-Axis function with saliva testing – measuring cortisol metabolites. To properly characterize a patient’s cortisol status, free and metabolized cortisol should be measured to avoid misleading results when cortisol clearance is abnormally high or low. Likewise with sex hormones, measuring estrogen and androgen metabolites gives a fuller picture for more precise clinical diagnosis of hormonal imbalances and HRT monitoring.
DUTCH vs. Serum Testing - While the most universally accepted testing method (due to the availability of FDA-cleared analyzers that are reliable and inexpensive), serum testing is lacking in some areas. Adrenal hormones cannot be effectively tested in serum because free cortisol cannot be tested throughout the day. There is also a lack of extensive metabolite testing (especially for cortisol and estrogens).
DUTCH vs. 24-Hour Urine Testing - There are two primary drawbacks to 24-hour urine testing of hormones. First, the collection is cumbersome, and as many as 40% of those who collect, do so in error (Tanaka, 2002). Secondly, dysfunction in the diurnal pattern of cortisol cannot be ascertained from a 24-hour collection. Some providers add saliva for daily free cortisol. DUTCH eliminates the need for two tests.
The purchase of this laboratory test alone does not make you an active client of Simply Nourished. To become an active client of Simply Nourished, be sure to also purchase an Initial Consultation.