Cortisol: the emergency responder hormone that when chronically elevated, makes you fat, stupid and unsexy. Nobody wants an excess of cortisol, but like all things in physiology there’s a sweet spot; low cortisol doesn’t feel right either.
Which you have?
Symptoms of high cortisol Symptoms of low cortisol Fatigue Extreme fatigue Muscle weakness Muscle or joint pains Depression, anxiety and irritability Depression, irritability Loss of emotional control Salt craving Cognitive difficulties Abdominal pain New or worsened high blood pressure Low blood pressure, even fainting Glucose intolerance that may lead to diabetes Low blood sugar (hypoglycaemia) Headache Nausea, diarrhea or vomiting Bone loss, leading to fractures over time Weight loss and decreased appetite Source: Mayo ClinicBoth sets of symptoms are very similar, in fact, all of these symptoms could be attributable to half the diseases known to man. The only way to know for sure what’s going on with your cortisol is to do the test.
I tested over 500 endurance athletes
And all but a handful had low free cortisol. Free cortisol is the active fraction of the hormone, but it only accounts for 1% of the total cortisol production and so forms just part of the puzzle. I can’t give you any more information than this because free cortisol is all a saliva test measures.
Luckily the testing has gotten more sophisticated
Mark Newman is an analytical chemist and the founder of Precision Analytical, a lab using GC and LC-tandem mass spectrometry to measure not just free cortisol, but also the metabolites tetrahydrocortisol and tetrahydrocortisone. Their DUTCH test is a game changer. The extra information in this test enables me to be a better detective. Now I can differentiate between problems with cortisol production and cortisol clearance. The two have very different implications.
Not just cortisol
The DUTCH also measures no less than eight androgens, eight oestrogens and two metabolites of progesterone. The results can be overwhelming at first, but as you begin to appreciate the pathways that these hormones take, the picture becomes clear.
Testosterone
Testosterone can metabolise down one of two pathways: the more androgenic alpha pathway that leads to the hormone DHT, thinning scalp hair and prostate problems for older men or a potentially more desirable and less androgenic beta pathway. The good news is that once you understand your metabolism, there are nutritional supplements that you can take to inhibit the alpha pathway.
Oestrogen
Saliva isn’t a very accurate way to measure oestrogen. Not only is urine more precise, but it also enables us to test the metabolites that tell us all about both phase 1 and phase 2 metabolism. Oestradiol is the most abundant oestrogen, and its friend oestrone breaks down in one of two different directions. This can produce two very different, and not always desirable outcomes. The only way to know what’s happening to you is to do the test
Establishing a baseline
During this interview, Mark makes an important point. Let’s say you feel good right now. Wouldn’t it be nice to have the complete picture of your hormone metabolism for future reference? Or perhaps you suspect a problem. Either way, you can order a DUTCH though me and then together we figure out a plan to optimise your hormones. Don’t be that guy guessing using the list of symptoms you found on the Mayo Clinic website.
Here’s the outline of this interview with Mark Newman:0:00:50 Mark Newman is an analytical chemist with a master's degree in forensic science.
0:01:07 Mark started with urine testing then moved onto saliva testing.
0:01:41 DUTCH stands for Dried Urine Test for Comprehensive Hormones.
0:02:11 The DUTCH combines the best of saliva and urine.
0:02:51 Educational videos.
0:03:32 The DUTCH is the culmination of Mark's life work.
0:05:01 My first saliva test showed high cortisol at night, and low cortisol during the day.
0:05:51 We've run over 546 saliva tests now.
0:06:12 All the results look the same.
0:06:31 The question is WHY low cortisol?
0:07:01 Mark has managed data from one million saliva results.
0:07:23 Mark started with the idea that cortisol makes you fat, yet salivary cortisol isn’t higher in fat people.
0:07:40 The free cortisol is just one piece of the puzzle.
0:08:07 With urine testing, you also get to look at the metabolites.
0:08:24 Free cortisol is only about 1% of the total.
0:08:53 40% of patient that have low free cortisol do have elevated production (metabolites).
0:09:45 What drives cortisol production also drives clearance.
0:10:00 In obesity there is high production AND clearance, overall free cortisol is often low.
0:10:33 In hypothyroidism cortisol clearance is sluggish.
0:11:06 The DUTCH is the only way to get all three dimensions.
0:11:51 I get the impression all the tests will look dated in 10 years time.
0:12:32 Mark is skeptical when I say "everybody's low".
0:13:01 Reference ranges can be very problematic.
0:13:38 You cannot easily compare results from different tests.
0:14:13 Not everybody has low cortisol.
0:14:55 Morning serum cortisol is better than nothing.
0:15:08 Saliva is better still and DUTCH better yet.
0:15:27 The term adrenal fatigue needs some work.
0:15:44 Adrenal glands are not like ovaries (they don’t tend to give out with age).
0:16:16 The problem with cortisol is probably often in the brain, not the adrenal gland.
0:17:01 The misinformation has been driven by oversimplification.
0:18:03 How are the reference ranges for the DUTCH defined.
0:18:20 You start with a bunch of healthy people.
0:18:35 The range is then two standard deviations either side of the mean.
0:18:53 This is useful for finding pathology.
0:19:17 Reference ranges require more thought than simple maths.
0:20:00 Some reference ranges are set up so that everyone is low.
0:20:23 The analytes are unique and so are the reference ranges.
0:21:07 People are critical of blood tests, both blood is very well established and standardised.
0:21:35 Saliva testing has some shoddy standards for some tests.
0:22:06 Intranasal ACTH experiment.
0:22:30 If the lab is not curious enough to do that type of experiment you have to wonder.
0:23:16 Everyone should get test to establish a baseline.
0:23:30 Hormonal symptoms overlap a lot.
0:23:51 Then when people read or hear about symptoms, they say gee that's me.
0:24:18 Lots of things can drive cortisol.
0:24:59 Hormones are worth exploring around menopause.
0:25:28 Everybody is tired.
0:26:17 Mark's sister-in-law is healthy in spite of low hormones, should anything happen in the future, having the baseline would be important.
0:27:20 DHEA comparison.
0:27:34 Mark is a skeptic when it comes to labs, he always suspects they could be wrong, even his own…that’s why having multiple markers (as in DUTCH) for hormones can be helpful.
0:28:19 Etiocholanolone and Androsterone.
0:28:43 Inflammation blocks sulfation DHEA à DHEAS.
0:29:24 The DHEA-S can misrepresent what's really going on.
0:29:55 The DUTCH represents 14 hours worth of DHEA production.
0:30:31 The DUTCH paints the big picture of hormones.
0:31:01 Iron overload in master's athletes.
0:31:24 The DUTCH helps me be a better detective.
0:31:36 Inflammation makes prostaglandins that drive aromatase.
0:32:19 Narrowing down a list possibilities to a list of probabilities.
0:32:43 DHEA and women.
0:33:03 DHT is three times as potent as testosterone.
0:33:18 Insulin can push alpha metabolism.
0:33:36 The beta pathway is less androgen.
0:33:42 Saw palmetto, nettles, pygeum, EGCG, progesterone, zinc, finasteride all block the alpha pathway.
0:33:48 DHT can cause acne, thinning scalp hair.
0:34:37 The DUTCH has 4 alpha pathways measured.
0:34:59 PCOS is a leading cause of infertility.
0:35:36 Could we take supplements without doing the tests?
0:35:59 Mark thinks that's a bad idea in some cases.
0:36:50 Pragmatism can work.
0:37:05 Thinning scalp hair can have a number of causes.
0:37:29 If you can afford the test, do it.
0:37:42 Some of the supplements are also expensive.
0:37:51 DIM for oestrogen metabolism.
0:38:03 Pushes oestrogen down the 2-OH pathway.
0:39:11 DIM as a goitrogen.
0:39:39 I3C metabolises to DIM.
0:40:52 Mark's testing matrix.
0:41:18 People take progesterone at night because it helps with sleep.
0:41:27 Oral progesterone is gone four hours later.
0:42:09 Saliva and serum are not good ways to measure oral progesterone supplementation.
0:43:13 Mark has spent 10 years putting the testing matrix together.
0:43:43 What testing oestrogen can tell you about your methylation status.
0:43:47 Oestradiol is the main oestrogen.
0:44:01 Saliva testing for oestrogen is almost useless.
0:44:20 In serum and urine there's a 10 fold difference in oestrogen between pre and postmenopausal women.
0:44:23 In saliva, it's a 2 fold difference at best.
0:44:44 This is one of the main reasons why Mark switched to urine.
0:45:11 DIM acts on phase one metabolism.
0:45:23 Phase two includes methylation.
0:45:34 Genetic defects affect phase two.
0:45:51 Methylation is an important thing to do well.
0:45:56 Mark has two very messed up COMT genes.
0:46:04 Mark's MTHFR genes are fine.
0:46:17 On the DUTCH test, Mark is a poor methylator.
0:47:40 The DUTCH is cheap to ship (filter paper is light).
0:48:07 The test is still expensive, unfortunately.
0:48:33 Precision Analytical uses GC-MS/MS and LC-MS/MS.
0:49:14 Providers should go to dutchtest.com.
0:49:26 Five tests at half price.
0:50:12 Mark will help doctors interpret the results.
0:50:28 Testing (lab testing, not sample collection) is a four day process.
0:50:55 Organic acids tests are run in batches.
0:51:10 Mark developed organic acids testing for BioTech Lab (US BioTek).
0:51:49 You can order a DUTCH though me and then I can connect with you on the phone or Skype to explain what the results mean