Table Of Contents
This DUTCH hormone test review has just been updated as of the January 2018 to include some exciting new markers that have been added to the DUTCH hormone test.
The new markers to be included on the DUTCH hormone test are Organic Acid markers to assess neurotransmitters, B12, B6 and glutathione, this is in addition to the oxidative stress Organic Acid marker added last year.
In case you are not familiar with the DUTCH hormone test it is the most advanced test available to assess your sex hormones and adrenal function. DUTCH stands for Dried Urine Test for Comprehensive Hormones, this test can easily be done at home from anywhere in the world without the need to go to a pathology lab, once this is done the test is shipped back to the lab for analysis.
With your sex hormones the DUTCH hormone test not only measures your total hormone levels, but also shows how your body is metabolizing the hormones, this is important for assessing risk of breast cancer, prostate cancer and other hormone dominant conditions. Assessing the metabolism of your estrogen and testosterone cannot be done with a blood test which only measures total estrogen, progesterone and testosterone.
In the table below there is a list of all the different sex hormone markers assessed in the DUTCH hormone test, while this comprehensive list may look confusing when you first see it, this gives us valuable information about the sex hormones. During a consultation with Planet Naturopath all these markers will be explained to you in plain English, and you will have an action plan on how to improve them.
The DUTCH test results will also give detailed graphs on how these hormones are interlinked which will help you understand how the process of hormone detoxification and methylation works for you.
The DUTCH test measures total cortisol production as well as the changing rhythm of cortisol throughout the day, as well as how quickly your body is metabolizing cortisol into cortisone. A blood test cannot measure the rhythm of cortisol and a saliva hormone test cannot measure total cortisol production or cortisone levels.
Below is a list of all the adrenal hormone markers on the DUTCH Hormone test, the test results also shows us graphs so you can easily understand the rhythm of cortisol and cortisone, along with DHEA.
In case you are not familiar with the Organic Acids Test (commonly known as OAT) which is one of my favourite tests to assess metabolism, the Organic Acids are urinary metabolites that can measure specific aspects of metabolism.
The 6 new Organic Acid markers on the new DUTCH hormone test don’t replace doing the complete Organic Acids Test which contains over 40 different Organic Acid markers, but the new markers on the DUTCH hormone test do add some valuable information to an already great test.
It is not just the brain that uses the neurotransmitters dopamine, serotonin and noradrenaline, but the whole autonomic nervous system, for example serotonin one of the most important neurotransmitters for mood is also produced and used by the digestive tract (commonly called the second brain). The Organic Acid markers reflect your body’s production of neurotransmitters, and not specifically levels in the brain (there is no perfect test for that), but research shows that these levels are a good reflection of what is happening in the brain also.
Homovanillate (also known as HVA) is the primary metabolite of dopamine, a brain and adrenal neurotransmitter that comes from tyrosine and other co-factors, and goes on to create norepinephrine and epinephrine (adrenaline).
Low levels of HVA can be due to low levels of dopamine and the associated symptoms include addictions, cravings and pleasure seeking (to boost levels) in addition to sleepiness, impulsivity, tremors, less motivation, fatigue and low mood.
Low circulating dopamine may be due to insuﬃcient BH4, iron or tyrosine, SAM-e, Magnesium, FAD and NAD which are needed to metabolize dopamine. It may also be seen when adrenal function is generally low and the DUTCH test is the best way to assess this.
Elevated HVA may be caused by generally increased adrenal hormone output or because of a copper or vitamin C deﬁciency. Elevated dopamine may be associated with loss of memory, insomnia, agitation, hyperactivity, mania, hyper-focus, high stress and anxiety as well as addictions, cravings and pleasure seeking (to maintain high levels).
Vanilmandelate (also known as VMA) is the primary metabolite of norepinephrine and epinephrine (adrenaline). The adrenal gland makes cortisol and DHEA as well as norepinephrine and epinephrine. When adrenal hormone output is generally low, VMA levels may be low.
Low levels of norepinephrine and epinephrine may be associated with addictions, cravings, fatigue, low blood pressure, low muscle tone, intolerance to exercise, depression, loss of alertness. When the body is under physical or psychological stress, VMA levels may increase.
Elevated levels may be associated with feeling stressed, aggression, violence, impatience, anxiety, panic, worry, insomnia, paranoia, increased tingling/burning, loss of memory, pain sensitivity, high blood pressure and heart palpitations.
If HVA levels are signiﬁcantly higher than VMA, there may be a conversion problem from dopamine to norepinephrine. This case can be caused by a copper or vitamin C deﬁciency.
The enzymes COMT (methylation) and MAOA are needed to make VMA from norepinephrine. If these enzymes are not working properly, VMA may be low when circulating norepinephrine and/or epinephrine are not low.
5-Hydroxyindoleacetate (also known as 5HIAA) is the primary metabolite of serotonin. Serotonin is often thought of as the “antidepressant” neurotransmitter, however it is important to note that 90% is made in the gut and just 1% in the brain, in the gut, serotonin is required for gut motility and activates smooth muscle activity.
Low 5HIAA implies decreased serotonin production/turnover. When levels of serotonin are low, mood disorders like depression may be more likely. Serotonin may be low due to a lack of available precursors (tryptophan or 5-HTP) or due to the excessive metabolism of the tryptophan down the kynurenine pathway (lack of B6). High levels of estrogen, cortisol or inﬂammation can also push tryptophan away from serotonin and towards the kynurenine pathway.
Testing the Organic Acid metabolites for B vitamins is more accurate than assessing blood levels of B12 and B6, a blood test represents the amount of a vitamin in the blood while the Organic Acid marker represents how the cells are using B12 and B6. It is possible due to genetic snps to have high levels of B12 in the blood but have low B12 at the cellular level.
Methylmalonate (also known as methylmalonic acid or MMA) is a functional marker of vitamin B12 deﬁciency. When cellular levels of B12 are low either from deﬁciency or due to a B12 transporter gene mutation, levels of MMA increase. This marker is considered superior to measuring serum B12 levels directly. A 2012 publication by Miller showed that 20% of those tested had a genetic defect in the protein that transports B12 to cells. These patients may have a functional B12 deﬁciency even if serum levels of B12 are normal.
Symptoms of a vitamin B12 deﬁciency include: fatigue, brain fog, memory problems, muscle weakness, unsteady gait, numbness, tingling, depression, migraines/headaches and low blood pressure.
If levels of MMA are elevated, it may be advisable to increase B12 consumption. Common foods high in B12 include beef liver, sardines, lamb, wild caught salmon, grass-fed beef, nutritional yeast and eggs.
Vitamin B12 levels can also be increased through supplementation of B12 (taken as methylcobalamin, hydroxycobalamin, or adenosylcobalamin), many B12 supplements contain cyanocobalamin which is a poorly absorbed form of B12 and should be avoided, I prefer a B12 lozenge if low in B12.
Xanthurenate (also known as xanthurenic acid) is a functional marker of vitamin B6 deficiency. Vitamin B6 is a critical co-factor to over 100 important reactions that occur in the human body and is stored in the highest concentrations in muscle tissue.
Not only is xanthurenate an indicator of a lack of B6, it is also harmful to the human body. It complexes with insulin and decreases insulin sensitivity. In fact, rats fed xanthurenate will actually develop diabetes because of the eﬀects on insulin. If xanthurenate levels are elevated, B6 supplementation may be considered. Food high in B6 include turkey breast, grass-fed beef, pinto beans, avocado, pistachios, chicken, sesame and sunﬂower seeds.
While there is always some tryptophan going down the kynurenine pathway towards NAD (and possibly xanthurenate), this process is up-regulated by inﬂammation, estrogen and cortisol. If levels of estrogen or cortisol are high, it may exacerbate xanthurenate elevations and increase the need for B6.
Xanthurenate can also bind to iron and create a complex that increases DNA oxidative damage resulting in higher 8-OHdG levels. If both markers are elevated, there is likely an antioxidant insuﬃciency.
Pyroglutamate (also known as pryoglutamic acid) is a functional marker of glutathione deﬁciency. Pyroglutamate is a step in the production/recycling of glutathione. If the body cannot convert pyroglutamate forward, it will show up elevated in the urine. Alternatively, if there is little glutathione available to be recycled, pyroglutamate will be low, so when levels of pyroglutamate are high or low, there may be insuﬃcient glutathione levels.
Glutathione is one of the most potent anti-oxidants in the human body. It is especially important in getting rid of toxins, including the harmful metabolites of estrogen detoxification 4-OH-E1 and 4-OH-E2. This markers are assessed in the DUTCH test and if eleveated can damage DNA if not detoxiﬁed by either methylation or glutathione, this is an increased risk of cancer.
8-OHdG (8-hydroxy-2-deoxyguanosine) is a marker for estimating DNA damage due to oxidative stress (ROS creation). 8-OHdG is considered pro-mutagenic as it is a biomarker for various cancer and degenerative disease initiation and promotion. It can be increased by chronic inﬂammation, increased cell turnover, chronic stress, hypertension, hyperglycemia/pre-diabetes/diabetes, kidney disease, IBD, chronic skin conditions (psoriasis/eczema), depression, atherosclerosis, chronic liver disease, Parkinson’s (increasing levels with worsening stages), Diabetic neuropathy, COPD, bladder cancer, or insomnia. Studies have shown higher levels in patients with breast and prostate cancers.
Elevated levels of this oxidative stress marker means that you need to address the underlying cause, other markers on the DUTCH test can help to identify this.
Melatonin is not technically an adrenal or sex hormone however it is highly involved in the entire endocrine system. It is made in small amounts in the pineal gland in response to darkness and stimulated by Melanocyte Stimulating Hormone (MSH). A low MSH is associated with insomnia, an increased perception of pain, and mold exposure. Pineal melatonin (melatonin is also made in signiﬁcant quantities in the gut) is associated with the circadian rhythm of all hormones (including female hormone release). It is also made in small amounts in the bone marrow, lymphocytes, epithelial cells and mast cells. Studies have shown that a urine sample collected upon waking has levels of 6-Hydroxymelatonin-sulfate (6-OHMS) that correlate well to the total levels of melatonin in blood samples taken continuously throughout the night. The DUTCH test uses the waking sample only to test levels of melatonin production.
Low melatonin levels may be associated with insomnia, poor immune response, constipation, weight gain or increased appetite. Elevated melatonin is usually caused by ingestion of melatonin through melatonin supplementation or eating melatonin-containing foods.
The DUTCH Hormone test uses dried urine samples which are easily collected on the special litmus paper strips that come with the test kit, this makes the samples easy to collect and easy to post back to the pathology lab in the U.S from anywhere in the world.
The DUTCH Hormone test can be ordered from Planet Naturopath from the DUTCH Test Order Page
If your not sure if this is the best test for you and you would like more information, or if you have already done the DUTCH test and would like help with the interpretation of the results you can schedule a consultation
If you have any general questions about the DUTCH test leave a comment below.
Michael is head consultant at Planet Naturopath - Functional Medicine and Nutrition Solutions.
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