Yay – it’s great when a really good test remains the same but is significantly reduced in price. The DUTCH Plus has come down to £336 from £381. The DUTCH Plus is basically the DUTCH Complete plus CAR (Cortisol Awakening Response). It tests adrenals (both free and metabolised as well as the first morning response to find more hidden adrenal issues), hormone levels and importantly how those hormones are being metabolised. It can also give us clues to methylation rate, thyroid function and good/bad oestrogen balance for cancer risk etc, plus info on some really key markers for oxidative stress, melatonin, glutathione and B12 levels to name a few. It’s a really useful test.
The options for DUTCH testing are – Adrenal Advanced (adrenals only), DUTCH Complete (for men and women, on hormones or not), DUTCH Plus (the Complete plus CAR) and DUTCH with Cycle Mapping (measurements throughout the month to track the hormone cycle). I use the Complete mostly but the CAR in the Plus can find early adrenal issues that may be missed with the Complete. I add cycle mapping if we need to see what’s happening to hormones at certain times of the month – although Genova’s Rhythm Plus can do that more cheaply if that’s all you need. Also, the Genova adrenal test is sufficient for most people wanting to test for adrenal function only.
The DUTCH Plus™ takes hormone testing to a whole new level. In addition to sex hormones and their metabolites, the DUTCH Complete™ looks at the overall diurnal pattern of free cortisol, and the total and distribution of cortisol metabolites. The DUTCH Plus™ adds the Cortisol Awakening Response (CAR) to bring another important piece of the HPA axis into focus.
What is the Cortisol Awakening Response and how do we test for it? 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. A quick saturation of saliva swabs upon waking, and at 30 and 60 minutes after waking, provide what is required to assess a patient’s Cortisol Awakening Response.
A low or blunted Cortisol Awakening Response can be a result of an underactive HPA axis, excessive psychological burnout, seasonal affective disorder (SAD), sleep apnea or poor sleep in general, PTSD, chronic fatigue and/or chronic pain. A decreased CAR has also been associated with systemic hypertension, functional GI diseases, postpartum depression, and autoimmune diseases.
An elevated Cortisol Awakening Response can be a result of an over-reactive 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). A recent study1 showed that neither the waking nor post-waking cortisol results correlated to Major Depressive Disorder, but the CAR calculation (the change between the first two samples) did. This measurement of the response to waking has independent clinical value showing dysfunction that may be hidden by current testing options.
What’s Included in the DUTCH Plus™? 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.