The DUTCH Plus Test: A Comprehensive Overview

Are your patients resting adequately? Do they have all the nutrients needed for healthy function and metabolism? Are they at risk for stress-related illness? These are a few of the questions the DUTCH Plus Test can answer. 

According to research, up to 90% of disease is related to stress. Stress can cause many disruptions in physiological processes, leading to chronic diseases such as cardiovascular disease. Elevated stress can interfere with our lives and continues to increase for Americans, negatively impacting overall health and daily life. 

The DUTCH Plus Test sheds some hope in helping assess for elevated stress levels that contribute to health issues along with factors that influence metabolism, gut health, and neurological imbalances. It can offer insights into strategies to improve your patient's physiological function and overall health and decrease the risk of stress-related illness.

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What is the DUTCH Plus Test?

The Dutch Plus Test is a comprehensive assessment tool that provides valuable insights into sex and adrenal hormone production and metabolism. The DUTCH Plus is this lab's thorough package for an assessment of hormones, metabolism, and overall health that includes all panels from the DUTCH Complete, which are the sex hormones, adrenals, and organic acids, and the DUTCH CAR. 

In times of physical or psychological stress, cortisol and other hormones are elevated, affecting the hypothalamus, pituitary gland, and adrenal glands (HPA-axis). The Dutch Plus Test is designed to evaluate these hormones, providing a thorough assessment of health and stress-associated conditions.

This test is completed through a urine and saliva sample that can be completed conveniently at your patient's home, providing a comprehensive view of hormone activity. A feature of the Dutch Plus Test is the Cortisol Awakening Response (CAR). The CAR measures how cortisol levels naturally rise and fall during the first hour after waking, giving providers crucial information about a patient's stress response. Additionally, the test includes organic acid analysis to assess nutritional deficiencies, oxidative stress, gut health, melatonin levels, and neuroinflammation.

Are There Certain Patients Who Would Benefit From The DUTCH Plus Test?

Patients can greatly benefit from the Dutch Plus Test, especially when experiencing various symptoms and conditions associated with adrenal imbalances. These symptoms and conditions include premenstrual syndrome, perimenopause symptoms, infertility, unexplained abdominal weight gain, irritable bowel syndrome, muscle pain, headaches, heart disease, high blood pressure, blood sugar issues, anxiety, depression, fatigue, insomnia, slow-healing injuries, and hypothyroid symptoms.

Additionally, the Dutch Plus Test can also provide insights into the CAR. Dysregulation of CAR may be linked to seasonal affective disorder, burnout, PTSD, chronic fatigue, sleep disorders, chronic pain, systemic hypertension, postpartum depression, functional GI diseases, autoimmune conditions, and glycemic dysregulation.

This test can offer valuable information about your patient's stress and cortisol response, helping you to tailor effective treatments and interventions to balance these hormonal responses and improve your patient's overall well-being.

What Information Does The DUTCH Plus Test Tell Us?

The Dutch Plus Test is a comprehensive assessment that combines the DUTCH Complete and the DUTCH CAR panels to provide a wealth of information about hormone levels and adrenal function. 

The DUTCH Sex Hormone panel is a part of the DUTCH Complete and is particularly useful for measuring baseline hormone levels and monitoring hormone replacement therapy, especially estrogen metabolites. It also offers practitioners the ability to track vaginal hormones and oral progesterone.

The DUTCH Adrenal panel is another panel that is part of the DUTCH Complete and is a great adjunct to the CAR testing by providing free cortisol patterns and metabolite measurements for a more comprehensive evaluation of total cortisol production. This panel utilizes a technology that is a reliable and accurate method for assessing cortisol and its metabolites. 

Additionally, the inclusion of the Organic Acid Test (OAT) within the DUTCH Complete offers a holistic view of potential nutritional, hormonal, and metabolite imbalances or deficiencies that can impact overall health and vitality. The OAT will also provide insight into neurological imbalances, such as depression, fatigue, and low motivation.

The Organic Acid Test examines dopamine levels and factors affecting its conversion to HVA. Further, it measures VMA to gain insight into norepinephrine and epinephrine production, providing a deeper understanding of adrenal and HPA axis function. Elevated quinoline levels in the test can indicate neuroinflammation and various neurological disorders.

The DUTCH CAR, a saliva test, offers unique insight into adrenal function, as it includes the awakening response measurement. An abnormal CAR can indicate issues such as an underactive HPA axis, psychological burnout, seasonal affective disorder, sleep problems, PTSD, chronic fatigue, and pain. It has also been linked to conditions like systemic hypertension, GI disorders, postpartum depression, and autoimmune diseases. 

How to Use The DUTCH Plus Test in Clinic

To make the most of the Dutch Plus Test and ensure accurate results, it's essential that your patients follow specific guidelines and instructions. The instructions may be difficult to remember. Therefore, let your patients know that all the instructions will be provided in their test kits. 

Be sure to set the expectation that they will need to collect four dried urine samples and five saliva samples throughout the entire day from when they wake up to the time they go to bed. Your patients will also need to do a saliva sample for their CAR panel, which is a quick swab at 30 minutes after they wake up and at 60 minutes.

The results of this extensive panel will provide them with a thorough understanding of their hormonal and stress response along with an assessment of their metabolism and neurologic function, allowing you to create a customized intervention strategy to improve any imbalances they may have. It's important to note that, unfortunately, this lab test cannot be ordered for patients under 12 years old.

Here are the guidelines and instructions that you can give to your patients:

Before Collection:

If you're taking supplements like Tyrosine, L-Dopa, DLPA, Mucuna, or Quercetin, these can affect your organic acid results and should be consulted with your provider before taking the test.

Avoid avocado, bananas, and fava beans for 48 hours before collecting.

Do not skip doses of birth control unless instructed.

Avoid collecting samples while traveling for short periods. 

For Hormone Users:

If you're using Patch, Pellet, or Injectable Hormones, collect your sample midway between doses.

Sublingual Hormone users should review these VIDEO INSTRUCTIONS.

For those on Oral Hydrocortisone, review these VIDEO INSTRUCTIONS

For those on Glucocorticoids, consult your healthcare provider regarding the appropriate collection time. 

Collection for Cycling Women: 

NOTE: Men and menopausal women can collect samples at any time.

For cycling women who are on a regular schedule, Start collecting 6-9 days before your cycle ends, based on your cycle length. For example, if you are on a 20-day cycle, collect on days 11 to 14; if you are on a 21-day cycle, collect on days 12 to 15, and so on.

For women who have irregular cycles: WATCH THIS VIDEO 

72 Hours Prior to Collection:

Avoid oral hormones like Estrogen, Pregnenolone, and Testosterone.

48 Hours Prior to Collection:

Steer clear from consuming fava beans, avocados, and bananas.

Do not take DHEA supplementation. 

The Night Before Collection Day:

Refrain from consuming alcohol and caffeine.

Limit your fluid intake.

If you take oral progesterone, take it at bedtime.

On Collection Day: 

Continue to limit your fluid intake to a maximum of 40 oz throughout the day.

Avoid alcohol and caffeine.

Refrain from exercising and flossing.

Do not eat or drink until after collection 3.

Delay brushing your teeth until after collection 6.

Collection Schedule:

Collect your first saliva sample immediately upon waking, within 5 minutes.

Urine samples at 30 and 60 minutes after waking.

Another saliva sample at 60 minutes after waking, after which you can eat and brush your teeth.

Urine sample 2-3 hours after waking.

Saliva and urine samples before dinner (around 4-5 pm).

Saliva and urine samples at bedtime (around 10 pm - 12 am).

An overnight saliva sample at your first waking sleep disturbance. 

Collection Instructions:

For saliva collection, use the provided device, place the swab in your mouth, and ensure it's saturated but not left for more than 5 minutes.

Freeze the saliva samples until ready to ship.

For urine collection, ensure you label the container with your information, collect urine directly on the filter paper or in a clean cup, and allow the filter paper to dry without touching it.

Complete the test requisition form accurately and include all devices in a resealable plastic bag. 

You can retrieve the collection handout by CLICKING HERE.

Labs to Consider for Further Refinement of Treatments

Here are some other functional labs provided by DUTCH to consider for your patients:

Add-On Cortisol Marker

You have the option to include this test as an additional cortisol measurement point alongside the DUTCH Plus, DUTCH CAR, or DUTCH Cycle Mapping Plus tests. It's essential to communicate with your patients when you require them to collect this specific sample. The additional cortisol marker can be helpful to assess for suspected irregular cortisol patterns throughout the entire day.

DUTCH Cycle Mapping

The DUTCH Cycle Mapping test is designed to track the fluctuations of progesterone and estrogen across the menstrual cycle while also evaluating the cortisol awakening response. This comprehensive test also includes the assessment of insomnia-related cortisol levels and can be a great addition to the DUTCH Complete for women who are experiencing month-long symptoms, infertility concerns, or polycystic ovary syndrome as this test can give a comprehensive view of the patient's cycle. It provides a detailed analysis of the follicular, ovulatory, and luteal phases.

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Summary

The Dutch Plus Test is a thorough at-home assessment that combines dried urine and saliva samples to provide a comprehensive overview of sex and adrenal hormone production and metabolism. This test offers insights into irregular cortisol patterns and cortisol metabolites. It also includes organic acid testing to evaluate nutritional deficiencies, oxidative stress, gut health, melatonin levels, and neuroinflammation. 

This test is a valuable tool for healthcare providers to gain a holistic understanding of a patient's hormonal health, adrenal function, and neurological factors, ultimately contributing to a thorough assessment of overall well-being. 

Learn More About The DUTCH Plus Test

• ‍The DUTCH Plus Test Rupa Reference Guide‍
• Watch the Recorded Class: Using DUTCH TEST Plus to help your patients glide into The Other PMS ™️: Perimenopause / Menopause Syndrome‍
• Watch the Recorded Class: Mastering the Menstrual Cycle: a Truly Comprehensive Lab Assessment of Female Reproductive Hormones‍
• Watch the Recorded Class: Infertility: the Top 3 Functional Lab Tests You Should be Using‍
• Watch the Recorded Class: Understanding the Cortisol Awakening Response‍
• Watch the Recorded Class: How to Get Reliable Results Using Functional Labs