In this article I am going to explain why you need to do the DUTCH hormone test to identify adrenal and sex hormone imbalances, the different types of adrenal dysfunction that can occur and what you need to do to improve your hormonal health.
For a long time conventional medicine has only recognized two types of adrenal problems, these are Addison’s Disease and Cushing’s Syndrome, which are either extremely low cortisol or extremely high cortisol production. Both of these conditions are very serious and potentially life threatening if left untreated, but if you don’t have these conditions does that mean your adrenal function is “perfect”?
That is like saying that if your car has not crashed, or the engine has not “blown up” then it is working perfectly fine, but we know that there can be many issues with a car that is affecting it’s performance, like old oil, flat tires, leaking radiator or a broken light …. all of these could affect your car’s performance or safety.
While conventional medicine has disregarded “Adrenal Fatigue”, the latest research shows that a third type of adrenal problem can occur, this is called Hypothalamus Pituitary Adrenal Axis Dysfunction or HPA-D for short.
HPA-D is essentially the same as “adrenal fatigue” except that the name adrenal fatigue is a bit misleading, your adrenal glands do not become tired and stop producing cortisol, instead it is the messages from the hypothalamus and pituitary glands in the brain that either get upregulated or down regulated that causes changes in cortisol production by the adrenal glands.
While these symptoms may also have other causes like poor diet, digestion problems or infection, if you have a number of these symptoms there is a good chance that you have some type of HPA-D
There are three ways to test cortisol and DHEA production by the adrenal glands, they are blood testing, saliva testing and urine testing.
Other advantages of the DUTCH test is that it can measure the sex hormones estrogen, progesterone, testosterone and their metabolites, which measures how well your body is detoxifying hormones, and the methylation of hormones. This is important for both men and women.
The DUTCH hormone test kit can be shipped anywhere in the world, and because it only requires 4-5 urine samples it is easily done at home so you don’t have to go to a pathology lab. Each urine sample is collected on a special type of litmus paper which is left to dry before shipping back to the lab for analysis, the dried litmus paper fits easily into an envelope which makes it convenient for easy posting (no messy urine sample jars!)
Once the lab receives the test kit it takes about two weeks for the results to be finalized.
There is not one type of HPA-dysfunction so there is no one treatment plan for this condition, this is why testing is important to know how your body is responding to stress. Equally important is identifying the underlying cause of the adrenal dysfunction, this could be emotional stress, digestion issues, sleep problems, diet, training load or many other things that we can identify through your consultation and possible further testing.
High free cortisol combined with high total cortisol is often associated with obesity, inflammation, insomnia and cognitive issues. Diet and lifestyle changes are going to be a big part of treatment options here and these will vary depending on the underling cause, supplements will also be necessary to reduce the high cortisol levels.
Phosphatydlserine is great for lowering cortisol, if your cortisol is high all day I recommend taking 100mg 3 times a day, or if it is only high at night time which is quite common you can just take it in the evening. The Jarrow PS100 formula is good and is available from Amazon or www.iherb.com
Relora, Ashwagandha and Holy Basil are great for lowering cortisol and I recommend the Now Foods Super Cortisol Support which has a combination of these herbs and other nutrients to help lower cortisol. It is available from Amazon or www.iherb.com
Blood sugar support is important with high cortisol levels, usually high cortisol is going to lead to high blood sugar, nutrients to help support blood sugar include chromium, lipoic acid, bitter melon and the herb gymnema can reduce sugar cravings. I recommend Jarrow Formulas Glucose Optimizer which you can get from Amazon or www.iherb.com
The treatment plan for someone who has high levels of free cortisol, but low levels of total cortisol production are going to be different, once again identifying the driving force behind this pattern is important. Things to consider would be low thyroid (yes you need to look at more than just TSH), chronic inflammation and even licorice supplementation, it is always important to avoid licorice with high free cortisol and a lot of adrenal supplements include it.
Supplements to consider
Inflammation can be one of the drivers of high cortisol and Curcumin is a good option to help reduce inflammation, I recommend the Life Extension Super Bio-Curcumin which you can get from Amazon or www.iherb.com
This test shows low free cortisol throughout the day, and if you did a saliva cortisol test this is the only information that we would have, and most likely you would be given an “adrenal fatigue” diagnosis. However the metabolized cortisol is high normal so plenty of cortisol is still being produced, this type of pattern can occur with hyperthyroid, obesity, glucocorticoid medications, chronic stress or other chronic conditions like CFS.
You would still look at options to address inflammation, blood sugar control and other areas that are driving the chronic stress, but this type of pattern does well with Adaptogenic herbs that also include licorice. The Jarrow Formulas Adrenal Optimizer includes all of the herbs and nutrients to help improve the low cortisol levels and you can get that from Amazon or www.iherb.com
This pattern is less common than the other patterns of cortisol dysfunction, as most people have either normal or high cortisol. Low cortisol is usually seen in chronic long term health problems, extreme trauma or PTSD, and when you take the case history there is usually a particular cause that stands out.
If you have very low cortisol you will need supplements like theJarrow Formulas Adrenal Optimizer and may even need to consider extra licorice. Adrenal glandulars may also be helpful, but the key is going to be addressing the underlying cause, optimizing sleep, diet and exercise to improve adrenal health. It is important to work closely with your practitioner to get back on track, low adrenal function normally takes the longest to recover from and I would allow 6-12 months.
This can be one of the most debilitating types of cortisol dysfunction, when free cortisol levels are very low in the day but continue to rise and are elevated at night time. This is the exact opposite of what the body’s natural diurnal rhythm is supposed to to and can lead to chronic fatigue during the day, but “tired and wired” symptoms at night making it difficult to sleep.
Phosphatydlserine at night and calming adaptogens find in the Now Foods Super Cortisol Support will be helpful here to help lower night time cortisol and improve sleep, you will also need to work with your practitioner to help support morning cortisol production and address the underlying cause.
I also mentioned that the DUTCH test takes a comprehensive look at the sex hormones and how they are metabolized, the test goes into a lot of detail and this image just shows part of the analysis of the sex hormones …. I think I will have to go into more detail about the DUTCH test and sex hormone testing in another article.
If you would like to get started and order the DUTCH test go to the DUTCH test order page, and we can organize a test kit to be sent to you, all DUTCH test orders include a one hour consultation to explain the results to you and help you with a treatment plan.
If your not sure where to start, or if this is the best option for you, I recommend scheduling a short consultation first so I can help to guide you on the best test options and treatment plan for you.
Michael is head consultant at Planet Naturopath - Functional Medicine and Nutrition Solutions.
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