If you have followed me for any length of time then you will know that one of my particular areas of clinical focus and expertise is in hormone health and hormone dysregulation. In particular, I work holistically to focus on cortisol and stress hormones – using nutritional, lifestyle, psychological and emotional tools to help my clients deal with stress and the neurological hardwiring towards sympathetic overdrive which can affect hormone production, balance and wellbeing.
Because of the interplay between nutrition, stress, trauma and hormones (through various ‘axes’ within the human body) I work with all manner of female and male hormone irregularities. For a client who is experiencing hormonal dysregulation, I often start by using the DUTCH testing to assess where my clients really are when it comes to hormone levels, balance and metabolism.
Given the fact that I already love DUTCH Testing, imagine my delight when I heard at the end of last year that Precision Analytical were about to take their testing (already a leader within the hormonal testing market)… and make it EVEN BETTER in 2018.
A little while back I commented that for a “Complete Health MOT” I would choose 4 tests: 2 different stool tests, an Organic Acids Test and a DUTCH Complete hormone profile…
Well Precision Analytical have just made me revise that statement. As of January 2018 (yup – that means NOW!) they have added 8 whole new markers into the DUTCH Complete or DUTCH Plus testing (the difference between these is explained later). These are 2 more oestrogen metabolites… AND 6 REALLY IMPORTANT ORGANIC ACIDS.
Now, this isn’t going to be a thorough Organic Acids test. There won’t be markers of gut dysbiosis and many of the more niche markers won’t be there. But what Precision Analytical have done is actually rationally looked at the most impactful and important markers on an Organic Acids test and incorporated them – FOR THE SAME PRICE AS THE ORIGINAL TEST – into their already exceptional DUTCH hormone profiles.
This is, quite frankly, genius. But it’s also just damn useful for me as a clinician – and for many patients this means that I would definitely think twice about whether I needed the extra Organic Acids test to complete their clinical picture.
With the new DUTCH testing I get hormones – I get a full insight into cortisol, metabolism of cortisol, DHEA, melatonin, sex hormones and the breakdown of each of these (new and improved for certain oestrogen metabolites) as well as oxidative stress – and I now get an insight into neurotransmitters and various nutrient levels. The testing geek in me is very happy indeed.
But why should you care – and what do you get as a patient?
Why The Added Markers? What Can You See?
Let’s break this down and see what we can now see in the added markers.
Firstly, it is clinically relevant to understand that it’s good to know how much hormone a client is producing. But knowing how a client is then breaking down the hormones produced provides us with a really key insight into how well hormones are being metabolised, processed, methylated and detoxified. There are many reasons why this important, a key one being that it helps us to see how certain liver pathways are functioning. However, beyond that – how (and how effectively) you get rid of your hormones shows us detox pathways as well as a window into the genetics of hormone metabolism. For anyone with hormonal challenges this helps us to pinpoint where within the hormonal cascade problems may be occurring.
When it comes to hormones – fiendishly complicated in their production and the interaction between different hormonal systems – understanding where the problem is highly indicative of what the problem is.
The addition of two new oestrogen metabolites is interesting for two reasons: firstly, more data points provide a more accurate and insightful picture. But secondly, it indicates that the testing methodology and accuracy on behalf of Precision Analytical is improving. Their ability to now reliably report on these highly specific metabolites is reflective of an overall improvement in the mass spectrometry technology they use to obtain all the data points on the DUTCH test. Better accuracy = better tests = more helpful results. This is a win all round.
Beyond oestrogen, DUTCH have reported for a while on 8-OHdG, which is a urinary metabolite which provides a window into the level of oxidative stress a person is under. This can directly affect the adrenal function and therefore shows us where potential hormonal dysregulation may be stemming from.
But now, added onto the 8-OHdG marker are 6 more Organic Acids: Methylmalonate (MMA) which indicates B12 levels, Xanthurenate which indicates B6 levels, Pyroglutamate which provides a Glutathione estimation and then Homovanillate (HVA), Vanilmandelate (VMA) and 5-hydroxyindoleacetate (5-HIAA) which provide us with a proxy for assessing levels of the neurotransmitters Dopamine, Norepinephrine/Epinephrine and Serotonin respectively.
This is clearly a massive boost to the information obtained from a conventional hormonal panel. Understanding the nutrient levels of our patients through Organic Acid metabolites is a science we have used for decades within Functional Medicine. We comprehend that seeing the waste products of certain parts of cellular metabolism can show us the functional presence of certain vitamins and minerals. Having this information can guide supplementation and dietary recommendations, alongside allowing us to comprehend whether nutrient deficiencies themselves are affecting the hormonal health and stress levels of our clients.
Moreover, having a window into neurotransmitter production is useful for comprehending the way our clients’ nervous systems and mental states are being affected by and/or are affecting their overall health. Having readings for the metabolites of neurotransmitters can help clients’ rationalise why they feel or think a certain way and really comprehend the integrated nature of their stress, hormonal and neurotransmitter cascades.
And all of this extra information serves to greater assist patients and practitioners in both understanding the patients’ situation and providing them with accurate and useful clinical data to guide treatment recommendations.
To have this included for the SAME price of the original DUTCH Complete and DUTCH Plus is a fabulous service.
The Difference Between DUTCH Complete and DUTCH Plus
For a while now, DUTCH testing has been more complex as they have offered the addition of a couple of salivary markers to their DUTCH Complete test to provide a reading for what is known as the Cortisol Awakening Response (available in DUTCH Plus tests). This is a really interesting, additional set of markers which provides a reading of the free fraction of cortisol immediately upon waking (literally, within minutes) and how that then responds to the metabolic awakening process of morning triggers being sent to our body.
To understand this marker, it is necessary to explain that everyone is designed to have a spike of cortisol within five minutes of these normal ‘morning’ triggers being sent to our body: light to the eyes, being upright and not horizontal in sleep. Our awakening response is really our impetus to jump out of bed and get going. If we measure cortisol levels before our awakening response has kicked in, and then immediately after it has been set in motion, (i.e. the differential between our sleepy cortisol and the level it gets to after our body knows that it’s time to be awake) we can see how much oomph our adrenal glands have to kick into a cortisol release and awakening impetus.
Due to the speed of the way our biology reacts to awaken, and the need for two readings within in 30 minutes, this is best measurable in saliva.
Low differential = not much of a kick of cortisol. Large differential = waking up is an over-stressful experience. Adequate response = adrenal signalling and output is OK to start the day. In the latter situation, if there is cortisol dysregulation later on in the day we know that this isn’t due to impaired signalling between the brain and the adrenal glands themselves.
This isn’t an essential marker, and the DUTCH Plus is almost £100 more than the DUTCH Complete. However, you can probably tell that for those who are trying to grasp what the responsiveness of their brain to the ‘awake’ stimulus – and the receptiveness of their adrenals to this signal – this is a really intriguing piece of data which can add to the understanding of an individual’s hormonal picture.
Do You Need to Do A DUTCH Test?
So, by now you should be sold on the potential data we can glean from the DUTCH Complete and DUTCH Plus testing. I can’t wait until I start getting the results back from my clients which contain all of these added markers.
However, I am still the practitioner who will caution my clients against having a DUTCH test at all if I already know (or could take a fairly accurate guess at) what that test result is going to say. DUTCH Testing is expensive (starting at £260 for Complete, going up to £449 for Cycle Mapping additions to the DUTCH Plus).
If you are living an excessively stressed lifestyle, with poor sleep and poor nutrition – the DUTCH testing will only prove to you just how dysregulated your hormones are as a result of your lifestyle. For some people this is exactly the impetus they need to change and is a worthwhile investment. However, I would probably suggest that for most people the money may be better spent investing in nutrition and up front lifestyle changes first.
From there, the true place I find value with the DUTCH is for those individuals who have already covered the basics but are still struggling with hormonal dysregulation and/or confusion over why they feel the way they feel (in terms of energy levels or mood in particular). Seeing the way your body is using vs. storing cortisol, metabolising oestrogens, preferentially producing certain androgens and neurotransmitters etc. – this is all useful data to provide a map of how your body is responding. This is a first step to self-understanding.
This map – particularly with the added Organic Acids markers – provides me, as a clinician, with an ‘in’ to effective and targeted treatment. Quite often when looking at hormones the reality is that the body has got into a place where we need to support it with added supplementation and hormonal support to bring it back into balance (you can read last week’s article to understand why sometimes treating the symptoms is completely appropriate). Having a complete map of exactly how each body is working hormonally means that treatments can be highly specific, nuanced and deeply therapeutic.
Moreover, this prevents attempting therapies which may force a client’s hormonal pathways in the wrong direction. It shows us just as much about what strategies NOT to implement as which ones are worth trying.
You can clearly tell that – in the right circumstances – I am a real fan of the DUTCH Testing. The year’s additions have taken a test that was outstanding in its field and boosted it to become the global leader in Functional testing at this level. I am delighted to be able to offer this test to my clients.
If you are interested in obtaining a DUTCH Test for yourself, or are unsure of whether this is the right test for you at this time, please don’t hesitate to send me an email directly: firstname.lastname@example.org – I will happily help you to make your decision and then guide you through the process of analysing your test results and starting on the path to improved hormonal health.