DUTCH Plus

The DUTCH Plus is a comprehensive dried urine and saliva test that maximizes the available information from sex and adrenal hormone production and metabolism. With easy, at-home sample collection over the course of one day, providers can gain insights into the overall diurnal pattern of free cortisol and cortisone, along with the total distribution of cortisol metabolites. This test offers further insight by including organic acid testing, which evaluates potential nutritional deficiencies, oxidative stress, gut dysbiosis, melatonin levels, and neuroinflammation.  With the DUTCH Plus, providers also get a closer look into adrenal function with details about a patient’s cortisol awakening response (CAR) by showing cortisol’s natural rise and fall within the first hour of waking.

The kit includes:

• Easy-to-follow Directions and Requisition Form

• (4) Urine Collection Strips and (6) Salivette™ Saliva Collection Tubes

• Resealable Plastic Bag

• Sealable Return Envelope

The results include:

• Analysis of 35 different hormones: estrogen, progesterone, testosterone, DHEA-S, and cortisol along with their metabolites, plus the cortisol awakening response (CAR)

• Graphical representation of results and embedded video tutorials to assist in the hormone assessment to share with your medical provider

• DUTCH OATs: Melatonin (6OHMS), 8-Hydroxy-2-deoxyguanosine (8-OHdG), and six organic acid tests (OATs) including markers for vitamin B12 (methylmalonate), vitamin B6 (xanthurenate), kynurenate, glutathione (pyroglutamate), dopamine (homovanillate), norepinephrine/epinephrine (vanilmandelate).

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 jobrelated 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 is included in your purchase

• Comprehensive EndoAxis Report
• Personalized Lifestyle and Supplement Recommendations
• Practitioner Video Explaining Your Results