DUTCH Plus

Overview:

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.

The DUTCH Plus® takes hormone testing to a whole new level. In addition to sex hormones and their metabolites, the DUTCH CompleteTM 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.

 

How to Collect Saliva

1. Be sure to complete all information on each collection device.
2. Begin collecting right when you wake up, before getting out of bed. Remove the blue cap and place the cotton swab from the collection device in mouth.
3. Leave in mouth until fully saturated but not longer than 5 minutes. Lightly chewing on the swab may help stimulate saliva flow.
4. Once done, place swab back in the same tube, just as you found it. Do not remove the inner tube. You do not need to spit into the tube. Touch the swab as little as possible with your hands.
5. You may freeze all saliva samples until they are ready to ship.

Important Note: For the waking sample, set the saliva collection device, the requisition form, and a pen next to your bed. It is helpful to have a timer nearby to set for 30 and 60 minutes after you have begun your first collection. After collecting the first sample, it is best for you to be in a well-lit place.

How to Collect Dried Urine

1. Complete all information on each collection device.
2. Saturate the filter paper by urinating directly on it OR urinating into a clean cup and dip the filter paper for 5 seconds.
3. Leave the sample open to dry for at least 24 hours.
4. Once dry, close each collection device and place them all in the resealable plastic bag provided.

How to Return

Upon Completion

1. After drying the urine collection devices, make sure each sample is clearly labeled and dry.
2. Place the dried urine collection devices in the resealable plastic bag and back in the test kit box, along with the frozen saliva tubes.
3. Complete the requisition form.

Shipping Information

4. Place the entire test kit box and the completed requisition form inside the return mailer.
5. Affix the prepaid label or postage, if applicable.
6. Return using the appropriate carrier.