The DUTCH Test: What's New & Why It Matters

In this episode, Dr. Carrie Jones and Dr. Jaclyn Smeaton delve into the complexities of hormonal health, focusing on the DUTCH Test and its comprehensive approach to understanding hormones. 

This conversation also covers:

• The importance of clarity in hormone testing
• The DUTCH Test’s new interpretive framework called the DUTCH Dozen 
• How chronic stress can impact metabolic health and the often-misunderstood nature of cortisol
• The significance of the cortisol awakening response and the DUTCH Test’s assessments for understanding hormonal health
• The importance of lifestyle changes in managing stress and hormonal balance

Show Notes

Check out the 5a-androstanediol research mentioned in this episode.

Learn more about the simplified DUTCH Test, the enhancements to the DUTCH Report, and the DUTCH Dozen. And check out our new library of video collection instructions!

Learn more about Dr. Carrie Jones and follow her on Instagram @dr.carriejones!

Become a DUTCH Provider to discover how the DUTCH Test can profoundly change the lives of your patients.

Chapters

• 0:00 Podcast Opening
• 2:07 Introduction to Hormonal Insights
• 5:08 Understanding the Dutch Test Report
• 8:16 The Key to Hormonal Balance
• 11:13 Estrogen Metabolism Explained
• 13:44 The Dutch Dozen: A New Framework
• 16:43 Androgens: Beyond Testosterone
• 23:20 UGT and Its Role in Hormonal Assessment
• 25:46 Cortisol's Impact on Hormonal Health
• 31:50 Updated DUTCH Test Report
• 32:57 Understanding Cortisol: The Good and the Bad
• 40:47 The Importance of the HPA Axis
• 47:15 Cortisol Clearance Rate: What It Means
• 54:32 Key Assessments for Hormonal Health
• 1:00:04 Podcast Ending

Transcript

00:00:00:00 - 00:00:05:09
Dr. Carrie Jones
I always joke that I would name hormones after OPI nail polish, like I'd make them just like really fun, easy to pronounce.

00:00:05:15 - 00:00:30:03
Dr. Jaclyn Smeaton
It would be like bossy in Brazil. Basically, yeah. Rowdy in RIo haha Welcome to the DUTCH podcast, where we dive deep into the science of hormones, wellness and personalized health care. I'm Doctor Jaclyn Smeaton, chief medical officer at DUTCH. Join us every Tuesday as we bring you expert insights, cutting edge research, and practical tips to help you take control of your health from the inside out.

00:00:30:05 - 00:00:54:07
Dr. Jaclyn Smeaton
Whether you're a healthcare professional or simply looking to optimize your own well-being, we've got you covered. The contents of this podcast are for educational and informational purposes only. This information is not to be interpreted or mistaken for medical advice. Consult your health care provider for medical advice, diagnosis and treatment. I'm so glad that you're here with me on today's episode of the Dots podcast.

00:00:54:09 - 00:01:17:15
Dr. Jaclyn Smeaton
It is a fabulous episode, and whether you are an experienced DUTCH provider who's done a lot of tests and you want to get an update on what's happening right now because we just launched a new report, or if you're new to DUTCH testing or you're thinking about doing DUTCH testing, this is an awesome first episode to listen to because we're going to touch upon really every key element of the report in its new format on our new summary page.

00:01:17:18 - 00:01:37:06
Dr. Jaclyn Smeaton
Now, today's guest is a very special guest for DUTCH. Doctor Carrie Jones was the first clinician to work with Mark Newman as he developed and launched the DUTCH test. And I can even sense her excitement when we talk about DUTCH dried urine test for comprehensive hormones. Really, with this release, we've gone from being just comprehensive to also being crystal clear.

00:01:37:12 - 00:01:56:28
Dr. Jaclyn Smeaton
And I think you can sense Doctor Carrie's excitement about that as well. We're going to cover so many topics about the new summary page, about the release and what you can expect, but it's not just reporting to you what's changed. You're going to get to hear Doctor Carrie's description of each of these different assessments and why they're important and really, really dive right in to the science.

00:01:56:28 - 00:02:06:07
Dr. Jaclyn Smeaton
So I'm not going to tease you any longer or keep you waiting. Let's go ahead and dive right in. Well, Doctor Carrie, it's always awesome to have you on the DUTCH podcast. Welcome back.

00:02:06:10 - 00:02:09:11
Dr. Carrie Jones
Oh, thanks for having me. I always love coming back and talking with you.

00:02:09:18 - 00:02:15:21
Dr. Jaclyn Smeaton
But today we're going to get to talk about all, all the things that are happening with hormones and isn't there enough to talk about.

00:02:15:24 - 00:02:17:27
Dr. Carrie Jones
Oh my gosh, so much.

00:02:18:00 - 00:02:33:02
Dr. Jaclyn Smeaton
I want to start by talking about one thing that's huge on our news, which is the new DUTCH report. I know that you had a chance to see it. You even got a little bit of an inside scoop because we ran it by you. Yeah, in the development process. To really get your tips. But what do you think about it?

00:02:33:04 - 00:02:49:02
Dr. Carrie Jones
I'm excited. I think because, you know, there's the sea of comprehensive. And that's what people really feel about the test. And so now with the new report and the new layout, the new questions, I think is really going to help people not feel so overwhelmed and really be able to understand hormones through the lens of the DUTCH test.

00:02:49:05 - 00:03:07:25
Dr. Jaclyn Smeaton
It's funny that you bring up that see in comprehensive, because that's one thing that I had like chimed over and over again is sea has always been, you know, DUTCH we're talking about like the C in DUTCH, DUTCH dried urine tests for comprehensive hormones and the C is stands for comprehensive. But I think the C can sometimes feel like confusing for people.

00:03:07:27 - 00:03:33:12
Dr. Jaclyn Smeaton
And so I'm like with this one, we want it to be clear. We want it to be concise. You know, we're we're changing that C to clarity. And I think we really hit the mark here for people who have maybe taken a look at the DUTCH test before and felt like it took a lot of time to go through, or, it was really hard conceptually to understand, you know, we really want that sea to be confidence this time that like when you take a look at it, you're going to know that you're getting the insights out of it.

00:03:33:14 - 00:03:44:12
Dr. Jaclyn Smeaton
I mean, let's talk about this from the point of view of providers, because you and I both talked to a ton of providers. What are the areas of the DUTCH tests that you think people pick up on right away that are like really easy for them right away?

00:03:44:12 - 00:04:04:11
Dr. Carrie Jones
I honestly, especially based on the first summary page, I think they look right to the cortisol curve because that is familiar. That sort of transcends even other other tests, other methods of collection. And so they're like, oh, I can I can see that. I can see the cortisol pattern. And they recognize the names, they'll see estradiol, they'll see progesterone, they'll see, you know, testosterone, etc..

00:04:04:11 - 00:04:10:20
Dr. Carrie Jones
And so like they recognize those things. And then beyond that, sometimes their eyes roll in the back of their head.

00:04:10:23 - 00:04:35:17
Dr. Jaclyn Smeaton
Well, I can feel overwhelming. Right. And we'll talk a little bit about what we call the DUTCH dozen, which is like a new kind of framework that we provided to provide kind of a way to go through the report. But let's talk about the cortisol more, because I have to share. When I was a student and I learned the diurnal pattern of cortisol, which of course we all learn, I learned it as like, that's kind of all you had to look at when it came to assessing cortisol.

00:04:35:17 - 00:04:57:10
Dr. Jaclyn Smeaton
And I'm actually really surprised still how when I speak with really well trained providers, that's still fundamentally the only tool they use to assess cortisol is like a salivary pattern. Or even if they're running the DUTCH test, they're really only looking at that diurnal curve. And there's so much more to the picture, like talk a little bit more about that.

00:04:57:10 - 00:05:13:15
Dr. Jaclyn Smeaton
Like how impactful is it to kind of maybe if you're a provider who's listening, who's always looked at the diurnal pattern of cortisol and kind of ended your assessment there, especially if you ordered the DUTCH test because you're paying for more, right. What else can you what else is to gain from looking a little bit more comprehensively?

00:05:13:17 - 00:05:30:27
Dr. Carrie Jones
Oh my gosh, so much. And we know just looking just because the free cortisol which we know is less than 5%, you know, free hormones are like children. They can't be unattended at any time. So it's a very small amount of cortisol that's actually active and binding to receptors and creating that circadian rhythm. So I'm like well where's the rest of it.

00:05:30:27 - 00:05:54:10
Dr. Carrie Jones
And that tells a story as well. Like what what what's the metabolize cortisol doing that paints a picture. What's the cortisone pattern doing. That's the inactive kind of dead in the water form of cortisol. Is is the body preferring to deactivate to cortisone. So somebody may have a low diurnal cortisol. And you're thinking immediately as a provider. Oh my gosh they don't make any cortisol.

00:05:54:10 - 00:06:11:21
Dr. Carrie Jones
No wonder they're so tired I need to pump them up. I need to pump their ass up. I need to give them all the stimulatory stuff. Come to find out, they're actually deactivating. They're just activating a cortisone, so they make it fine. But the body's like, throw the e-brake. We're not doing this. We're going to deactivate. And that's a completely different way of treatment.

00:06:11:21 - 00:06:27:16
Dr. Carrie Jones
And so by understanding gathering all this extra information on that page of the DUTCH test, you can make a much, truly a much more personalized precision decision around what you're going to do for them.

00:06:27:18 - 00:06:49:08
Dr. Jaclyn Smeaton
Yeah I think I mean that's really one thing that DUTCH has always excelled at is kind of going deeper or trying to tell the whole story of what's happening hormonally. And I think like maybe it'd be helpful for our listeners today, like, let's go through I know you can't look at a summary page right now, but if you are a provider who's listening, you can go to DUTCHTest.com, and on the homepage you can click on a report type.

00:06:49:08 - 00:07:10:09
Dr. Jaclyn Smeaton
Let's look at the DUTCH Plus for the sake of today. I mean you can download a sample report if you want to kind of look at it as we talk about it. But on the summary page, a couple of things we've tried to do is one, reread books left to right. When you looked at the DUTCH task before, we asked our clinical team, like, kind of draw a picture on the report of what you look at first and second and third.

00:07:10:12 - 00:07:25:18
Dr. Jaclyn Smeaton
And what we found was that one, everybody did it differently. And you it would like start on page one, top right. But then it would go to the left and then it would flip to page three. And then I would go back to the summary page. And it was kind of all over the place. And we said we want to like we call it reduce the cognitive load, make it easier to look at.

00:07:25:24 - 00:07:42:22
Dr. Jaclyn Smeaton
So now the summary page has what we consider everything you need to tell the DUTCH story to your patient. You can really glean from the summary page, especially if you're new to using the DUTCH charts. We do have some advanced insights. We'll talk about after, and you and I can talk more about these because you are expert at every single one of these things.

00:07:42:22 - 00:07:58:18
Dr. Jaclyn Smeaton
You've done so many and taught around all these, these concepts. But if you're just getting started with the DUTCH test, we want to make it easy so it reads left or right. You talk about the hormones are on the right, you talk about the metabolites. So the first section of the summary page is estrogen and progesterone are kind of sex hormones.

00:07:58:20 - 00:08:29:07
Dr. Jaclyn Smeaton
You can see the dials. And then on the right hand side you can see estrogen metabolites which are broken down at the sliders. The 216 and two four sliders which represent phase one. And then methylation slider which represents phase two. What are you talking you go so eloquently into why it's important to look at estrogen metabolites. Let's start with a little bit of that, because I think most people they can look at the dials for estrogen and progesterone and see whether someone is in range or below or above compared to where they should be.

00:08:29:10 - 00:08:50:23
Dr. Jaclyn Smeaton
That's a pretty easy assessment. Are they high? Are they low or are they normal? But metabolism, especially if you're a maybe a conventional provider you're looking to expand upon, even like OB GYNs, you get learn a ton about hormones, but you don't learn as much about metabolites. And they're really important. So give us your little bathtub spiel about estrogen metabolism.

00:08:50:25 - 00:09:06:15
Dr. Carrie Jones
It's important to know where estrogen goes. It's important and helpful to know where any hormone goes when it gets broken down. I was joking, at a lecture that I gave last weekend that I had put a post up on social media. You'll appreciate this. And I said something about like, how long does estrogen live in the body?

00:09:06:18 - 00:09:22:00
Dr. Carrie Jones
And one of my options on the quiz was if Forever Lives Forever and the number of people who click forever, I was like, oh no, no, no, no, it needs to go. It needs to go out with the old and in with the new. So estrogen gets broken down and and as you said, I use a bathtub analogy.

00:09:22:03 - 00:09:38:13
Dr. Carrie Jones
So we think of the water and we think of the drain. And then we think it's attached to a sewer line that takes it away from, you know, your house or your apartment. And the water is what we call phase one. So we can't turn the water off, but we can adjust it. And when we look at phase one detoxification, those are different pathways.

00:09:38:13 - 00:10:03:15
Dr. Carrie Jones
The two pathway, the four pathway and the 16 pathway, which are shown very, very clearly on the DUTCH test. And these are important to know because the four pathway in particular, if it is left unchecked, it can continue on down a pathway we call the quinone pathway with AQ and the quinone pathway, if that's left unchecked, could lead to DNA damage if the DNA repair system doesn't come after it.

00:10:03:15 - 00:10:23:17
Dr. Carrie Jones
So there's a lot of checks and balances, but the end result is potential DNA damage, and we absolutely don't want that. We'd prefer that your estrogen go down the two pathway. That's what we consider like the more stable better pathway. And then once you go through that go through the water phase, you have to go through the drain phase, just like in your bathtub.

00:10:23:17 - 00:10:46:10
Dr. Carrie Jones
And that is part of phase two, which methylation will then neutralize the two in the four pathways. And so if somebody is methylation on the slide or bar is high, then pretty good chance that they're there are two in there. Four are able to get neutralized. Because then the next step is to make them water soluble so we can get them through the sewer line, which is of course your intestinal track or your kidneys.

00:10:46:13 - 00:11:04:24
Dr. Carrie Jones
But if it's not, if your methylation is low, then we think of it like a clogged drain. So the water's coming in, but the drain won't let it out. And so what does it do? It overflows and ruined your bathroom, just like it can overflow and potentially cause problems in the body. So by understanding, yes, your level of estrogen.

00:11:04:24 - 00:11:14:16
Dr. Carrie Jones
But like then where does it go? Because we really want to do what we can to protect the body with those downstream metabolites. If you're going down a direction we don't want.

00:11:14:19 - 00:11:38:03
Dr. Jaclyn Smeaton
Yeah. So thank you for that because it's such a beautiful analogy and I hope that everyone listening, you've never had your sewer back up on, you know, there in your home or with your estrogen because both of them are painful. Now when we look at estrogen, let's say that estrogen levels, estradiol levels are like in range, middle of range.

00:11:38:05 - 00:12:04:08
Dr. Jaclyn Smeaton
Sometimes we see patients who feel like they have too much. They have those estrogen dominant type symptoms, even though their estrogen is in the normal range. And maybe another patient might have that same exact estradiol but feel like estrogen is low. They have like vaginal dryness and hot flashes. Talk a little bit about how that could happen, where someone could have the same as dial on the dial, but actually have completely different symptom pictures.

00:12:04:15 - 00:12:07:10
Dr. Jaclyn Smeaton
And let's weave in the metabolism here for sure.

00:12:07:10 - 00:12:23:08
Dr. Carrie Jones
And I also want to weave in the progesterone part too, because we know that in the second half of the cycle, the luteal phase, the progesterone is the clear winner. It should be. It should be really elevated, similar to a the tippy top of a mountain. So it goes up and then it drops back down if somebody is not pregnant.

00:12:23:08 - 00:12:52:02
Dr. Carrie Jones
And of course we're talking about females here. So relative to progesterone estrogen can feel in the body sort of, you know, high or low kind of depending on that ratio. But then we take it a step further and we look at the estrogen, the bathtub, the metabolites. Because if you also happen to have a lot of metabolites, whether it's two, 4 or 16, in particular 16, they can also be mildly estrogenic as well.

00:12:52:05 - 00:13:12:28
Dr. Carrie Jones
So it's almost like A12 punch. You get the you get the estrogenic effect of estradiol, which is in range and should be great. But then you layer over it all these extra metabolites that are also circulating around the system and binding to receptors and can cause symptoms. And the same goes if those metabolites are really low and slow.

00:13:13:01 - 00:13:32:21
Dr. Carrie Jones
That means you're having a hard time getting estrogen out. If it's if they're high and fast, then we may be clearing the water through the bathtub at a very fast rate. Your drain is completely open. So by understanding the whole system, we look beyond just estrogen itself. I can see how well are you moving it through? Are you stuck?

00:13:32:21 - 00:13:45:02
Dr. Carrie Jones
And it's, for lack of a better phrase, is it building up? Where are you in relation to progesterone. And it just gives a much better again that like personalized story to figure out what's going on.

00:13:45:04 - 00:14:12:10
Dr. Jaclyn Smeaton
So what we've just walked through is the first kind of four assessments. We recommend this thing called the DUTCH Dozen, which is new with this report launch. We've really like I said, we've created this interpretive framework. Really, this comes from the brilliant mind of Mark Newman, our founder, who created the DUTCH test in the first place. And really, what we tried to do was working with the clinical team and Mark really hone in on like the best way to flow through reading a DUTCH test.

00:14:12:10 - 00:14:32:24
Dr. Jaclyn Smeaton
And how can you make a consistent, methodical faster for you if your clinician is doing this with a lot of patients, we know you have limited time to review these before you sit down with patients. And what we've just covered is really that first section, the four questions of the DUTCH doesn't related to that. So the first assessment was assessed estrogen levels given the patient's reproductive status.

00:14:32:24 - 00:14:59:21
Dr. Jaclyn Smeaton
That's the dial for estradiol assessed progesterone levels given the patient's reproductive status. That's the progesterone dial. The third is to assess phase one as metabolism. And the fourth is methylation or phase two. And all of those are in one place on the summary page 1234 left to right thing be moving. So Carrie, you've just like really summarized how you walk through that and why it's so important to not just look at those parent hormone levels but also metabolites.

00:14:59:21 - 00:15:23:25
Dr. Jaclyn Smeaton
Now let's shift gears and talk a little bit about androgens. This is an area that I think a lot of clinicians could develop further understanding and really be able to help their patients more, both females and males, because I think a lot of people are accustomed to looking at testosterone free and total testosterone. That's probably, from my assessment, the highest comfort level, and then maybe DHEA or DHEA sulfate in serum.

00:15:23:28 - 00:15:46:05
Dr. Jaclyn Smeaton
But when it comes to androgen metabolites, it's really kind of a similar story to we're talking about estrogen and progesterone, but a lot of people haven't kind of added that into their assessment yet. Can you talk a little about what you see providers doing? And let's throw a serum in there, too, because I think a lot of people are using serum, which is a great way to assess androgens, especially testosterone.

00:15:46:07 - 00:15:50:24
Dr. Jaclyn Smeaton
But tell me a little bit about like, what you're seeing people do and what you think they could improve on.

00:15:50:26 - 00:16:09:03
Dr. Carrie Jones
I see it's it's really interesting because people will go get a blood draw for testosterone. Let's say let's do a like a lowercase in a high case. So somebody has high levels of symptoms acne, hair growth in places they don't want, maybe hair loss on their head. Maybe they've been told they have PCOS, maybe not. So they go get bloodwork drawn.

00:16:09:03 - 00:16:24:21
Dr. Carrie Jones
And let's say in this instance, testosterone is completely in range. It's not elevated at all. And so the practitioners like, dang, I don't know what's going on. I don't know why it can't be PCOS. And I don't know why you had acne and his hair loss, because the one marker testosterone that I thought would be high is not.

00:16:24:23 - 00:16:45:02
Dr. Carrie Jones
And again, which we'll get to in just a second. Like when you peel back the layer of the onion and you look at the androgen metabolites, you can absolutely find that the androgenic form is quite high. And it's like a it's like a sneaker, like we had to go find it. And that's that's why we that's why the symptoms are, so problematic.

00:16:45:04 - 00:17:05:02
Dr. Carrie Jones
Now, the same also goes for maybe testosterone is low, like outright low. And I've seen practitioners go, oh my gosh, it's low. You need testosterone. Like let's say an a perimenopausal woman. It's very low. I'm going to put you on testosterone. And then she freaks out. She's like, now I have acne. Now I'm angry. Now I've got to hit my chin hair.

00:17:05:10 - 00:17:21:20
Dr. Carrie Jones
Now my hair loss on my head. And then providers like, that's weird because your testosterone so low. I don't know why this would happen. And again, we peel back the layer, we look at the metabolites and I'm like, oh gosh, you favor what's called the alpha side, which we'll get to just a sack. But like you favor that side.

00:17:21:20 - 00:17:37:07
Dr. Carrie Jones
That's one layer under really causing all the problems. So just looking at testosterone could be helpful for sure. In some cases it will match what's going on under the hood. But sometimes it definitely doesn't. And I see that a lot.

00:17:37:09 - 00:18:00:23
Dr. Jaclyn Smeaton
Yeah I mean I think it's interesting because with androgens with all hormones, metabolites are still active. They still partially bind to receptors, but with androgens in particular many metabolites and metabolites are stronger like DHT is multiple times stronger, binding to the testosterone receptor compared to testosterone. It stimulates activity even more. And I think we talk about that sometimes in men.

00:18:00:23 - 00:18:17:15
Dr. Jaclyn Smeaton
We talk about it in serum testing. We know it has connections in male pattern baldness and prostate issues and things like that. And it's also critically important. So we talk about it in a bad way. But it's critically important during puberty to prime testicular function properly. That's when you should really have a surge of it. But men and women make it.

00:18:17:15 - 00:18:35:07
Dr. Jaclyn Smeaton
It's a metabolite that can be super active. And so I think one challenge with that is it's hard to measure because it's an intracellular hormone. But on the DUTCH test we look at five alpha and diol, which is what the form it's in when it leaves a cell, which is easier to measure or more at more accurate to measure.

00:18:35:07 - 00:19:00:21
Dr. Jaclyn Smeaton
And there's a lot of data on that. We published a white paper last year. We'll link to it in the show notes if you want to learn more. But like talk a little bit about that because I think a lot of providers again, we look just at testosterone. Maybe we look at DHEA sulfate if we're looking at things more comprehensively, but like there's other metabolites and the preference is like Ediacaran alone and drops are around like all these imbalances that we should be considering when we think about how people feel or what impacts how they feel.

00:19:00:24 - 00:19:23:03
Dr. Carrie Jones
I mean, we call it androgen because it's a it's an umbrella. It's a family, right? Which means there's multiple forms underneath it. And with DHT in particular, the five alpha DHT being so potently androgenic, but it's a home body. It's an introvert, like it likes to stay in its cell. It doesn't want to necessarily leave its cell. That means you may not find it in bloodwork.

00:19:23:03 - 00:19:46:27
Dr. Carrie Jones
You elevated anyway. You may not find it. And of course, in urine. So you've got all these symptoms on either hair growth or loss or acne or anger, PCOS, prostate issues. And you're like, that's so weird that the DHT is totally normal. Forgetting it's a it's an introvert. It's a homebody. It stays in the cell. But just as you said, what leaves the cell, what it converts into and leaves the cell is that five alpha interesting dial.

00:19:47:04 - 00:20:10:06
Dr. Carrie Jones
So if it's elevated out in the urine, out in the bloodwork, out of the cell, that I'm like, okay, in the cell, it must be really elevated doing its job. So even with a normal testosterone or low testosterone, even, you can have all the symptoms because in the cell DHT is hammering away. And then we see it in five alpha interesting dial, much more clear than DHT itself.

00:20:10:06 - 00:20:14:24
Dr. Carrie Jones
It doesn't mean it can't be high. If that's the case, then you're like, whoa, yeah, if they're all high.

00:20:15:01 - 00:20:36:17
Dr. Jaclyn Smeaton
Whoa whoa whoa, what's the trouble now? I think I have a good analogy for this one. You know, tell you a little bit about my life, what's going on in my life right now. But I'm a parent, you know, five kids at home. This is like, you know, DHT is kind of like the kid who is wild and so loud in your house that you're afraid to send them to school or to other people's houses because you're like God when they see how they behave.

00:20:36:19 - 00:20:53:03
Dr. Jaclyn Smeaton
But then you get reports back from that parent who had them over for dinner, and they're like, they're the most courteous, polite child. That's like DHT keeping in the cell. It's wild activity, you know? But then it's not having that same effect when it leaves the walls of it's comfort. Comfort home, like you talked about.

00:20:53:11 - 00:20:59:17
Dr. Carrie Jones
It turns into this whole other, this five alpha interesting dial. You're like, who is this kid who is alpha dial?

00:20:59:20 - 00:21:16:26
Dr. Jaclyn Smeaton
That's right. Why is it so quiet around here right now? But, you know, five alpha andro is a great marker for that. And there was a really cool study. We didn't do this, this study, but it looked at women with PCOS and women who did not have PCOS. And it measured androgens and androgen metabolites, a whole list of them.

00:21:16:26 - 00:21:44:05
Dr. Jaclyn Smeaton
Many of them we have on the DUTCH test, but not, I think it had even more than we we measure. But what was really interesting is that when you looked at the normal cohort of women and the women with PCOS, most of the androgens and metabolites and normal ranges overlapped. Five alpha andro was the only one that was totally distinct, meaning that if it was high, it was only high in women with PCOS, and if it was in the normal range, it was always in women who with not without PCOS.

00:21:44:07 - 00:21:55:16
Dr. Jaclyn Smeaton
So it's a really interesting marker to take a look at for that androgen activity. It just goes to show you how differentiating and how important it is as a representation for that intracellular androgen activity.

00:21:55:23 - 00:22:11:17
Dr. Carrie Jones
And I'm glad you put it right on the summary page, because it used to be on page two at the bottom. And we'd have to direct people like, I know you don't normally look at page two, but I need you to look at page two, which is a table. That's the total take that like everything listed out. And so then and if and if you're new like you didn't know that.

00:22:11:24 - 00:22:15:05
Dr. Carrie Jones
So that it just became like flipping back and forth and back and forth. And it.

00:22:15:05 - 00:22:15:14
Dr. Jaclyn Smeaton
Was easy.

00:22:15:14 - 00:22:23:03
Dr. Carrie Jones
I mean, yes, and especially because it's a funny name like who names it five Alpha. Interesting. I would name hormone names. So differently, but nobody asked us, so.

00:22:23:03 - 00:22:24:06
Dr. Jaclyn Smeaton
Would you name that one.

00:22:24:09 - 00:22:31:29
Dr. Carrie Jones
Five? Well, I always joke that I would name hormones after I nail polish. Like I'd make them just like really fun, easy to pronounce. You know something? It would.

00:22:31:29 - 00:22:33:09
Dr. Jaclyn Smeaton
Be like, bossy in.

00:22:33:09 - 00:22:39:02
Dr. Carrie Jones
Brazil, basically. Yeah. Rowdy in Rio. Yes. Yeah.

00:22:39:04 - 00:22:40:16
Dr. Jaclyn Smeaton
We need a root. Who would you.

00:22:40:18 - 00:22:44:15
Dr. Carrie Jones
Carry in Hotlanta? Something like that. You know.

00:22:44:17 - 00:22:47:06
Dr. Jaclyn Smeaton
We came up with them. That's a whole nother podcast episode, right?

00:22:47:13 - 00:22:48:08
Dr. Carrie Jones
Where we name them.

00:22:48:08 - 00:23:10:15
Dr. Jaclyn Smeaton
Definitely. So when we look at the summary page to kind of getting back to what we were talking about, the DUTCH does and has four assessments that you complete around androgens, and they're all accessible from the summary page. The first one is to look at, adrenal androgen levels, not your total DHEA. We didn't really specify that, but androgens are made in a couple places.

00:23:10:17 - 00:23:23:27
Dr. Jaclyn Smeaton
And let's talk a little bit about that before we get into kind of the summary there, because that's where we look at total DHEA production. Yeah. That's really looking at the adrenal DHEA. I mean adrenal production of androgens. Do you want to talk a little bit more about that or what would you.

00:23:23:27 - 00:23:43:14
Dr. Carrie Jones
Yeah. So, so and I think this is so funny when you think of men and androgens like they predominantly make it, you know, testosterone comes from the testicles like, big time. But when we think of androgens in women, we have three different places, like you said. So we can make androgens in our ovaries. There's the outer layer of the ovaries called the fecal glands or theca cells.

00:23:43:16 - 00:24:06:17
Dr. Carrie Jones
And they make, about 25% of the testosterone. They make about 80% of DHEA, not ddgs, but DHEA. And then they make, Anderson a diode. And then out of the adrenal glands, women make up 100% of the DHEA as the sulfate form. And so then they make 25% of testosterone and then some Anderson and the rest of the Anderson at iron, then in the periphery.

00:24:06:17 - 00:24:36:25
Dr. Carrie Jones
So think of like in the fat tissue that Anderson, that I own can turn into testosterone. So that's where the other, the missing 50% of testosterone comes from. And then, but and then, you know, it comes from though the ovarian and the adrenal DHEA, which is the pro hormone. So by understanding that we have these three different places that we make androgens, but DHEA s is all made in the adrenal glands, whereas DHEA no s is mostly made in the ovaries but partly made in the adrenals.

00:24:36:27 - 00:25:02:06
Dr. Carrie Jones
And unfortunately none of this is geotagged. But the we when you get a blood draw or a urine test or saliva or anything, it's not like I can tell you where your testosterone comes from or your DHEA, but that's why, when we look at total DHEA production with DUTCH it's the DHEA s plus it's metabolites endorsed Roan and Edo clan alone together.

00:25:02:09 - 00:25:05:08
Dr. Jaclyn Smeaton
And that gives us that summary of the total DHEA.

00:25:05:08 - 00:25:25:29
Dr. Carrie Jones
Yes. Because DUTCH doesn't look at DHEA. No S because DHEA, no s. The body prefers Das, it prefers to convert it. Something like 60 to 70% is converted to the S form. And then DHEA being a pro hormone, it moves downstream very quickly. So it moves down into Anderson and Ionia moves down into Edo, choline alone and interest alone.

00:25:26:02 - 00:25:46:09
Dr. Carrie Jones
So it can be a little hard, even though we can test in blood work. DHEA no s because it's hard to pinpoint. And it also follows a circadian rhythm. DUTCH took a more like methodical way of let's look at what's what makes up DHEA, where DHEA goes so we can catch those N buckets.

00:25:46:16 - 00:25:56:21
Dr. Jaclyn Smeaton
Yeah. And remember we're trying to look at, you know, we're looking at four time points over the course of the four hours or trying to get an assessment of the total. So I think you're right. Like when you look at DHEA you are looking at that snapshot.

00:25:57:15 - 00:26:20:10
Dr. Jaclyn Smeaton
That quick snapshot which may not represent what's happening over the course of the day, or even what's happening in the course of minutes because of the conversion into downstream hormones. So that's why we try to look at all of them together to give you that kind of good assessment. So that first assessment that we recommend in the DUTCH dozen for for androgens is to look at that DHEA levels, are they high, are they low or are they normal.

00:26:20:12 - 00:26:44:00
Dr. Jaclyn Smeaton
And really we look at that based upon age range because age will cause dependency for androgens for males and females. Then the next one is to look at testosterone levels. There's a couple of caveats with that too. We can talk about that in a minute. And then the third is the looking at the five alpha addressing dial like we talked about, because it's such an important marker for the intracellular androgen activity.

00:26:44:03 - 00:27:07:24
Dr. Jaclyn Smeaton
And we're actually we're in the process of like looking at data because I want to go back and look at every woman who's ever submitted a DUTCH test who has reported, because we ask these questions in the way, in either that they have PCOS, they've been diagnosed with it formally, or that they have high androgen type symptoms. Because we have a little bit of a short symptom questionnaire to look at how many had testosterone in the normal range but had five alpha andro elevated.

00:27:08:01 - 00:27:28:24
Dr. Jaclyn Smeaton
Because I think that's a really interesting we have of course, we have tens of thousands of samples that we could take a look at. And to be able to, to show providers just how impactful that particular analyte is, especially for ones where it wasn't on the summary page, they would have had to look at page three. I bet if we went back in time, a lot of us would reassess a patient's.

00:27:28:29 - 00:27:30:03
Dr. Jaclyn Smeaton
Oh yeah, not us.

00:27:30:03 - 00:27:32:06
Dr. Carrie Jones
Yeah, absolutely.

00:27:32:08 - 00:27:50:17
Dr. Jaclyn Smeaton
And then the fourth assessment is a slider bar on the summary page that five alpha metabolism of androgens. This is the androstenedione clan alone ratio. And that looks at five alpha versus five beta metabolism. Do you find that that normally aligns with five alpha andro measurement.

00:27:50:20 - 00:28:13:08
Dr. Carrie Jones
Not always just because I to be honest, I think because, Ido and andro are more DHEA metabolites and they're not as androgenic, they're like, what, a seventh of the potency of testosterone. And so I do tell people to evaluate it independently. Don't automatically assume the five alpha metabolism is going to be the same as the five alpha.

00:28:13:08 - 00:28:18:13
Dr. Carrie Jones
Interesting dial, because just the type of the metabolite it is.

00:28:18:16 - 00:28:42:27
Dr. Jaclyn Smeaton
Great. So when we're looking at androgens you're looking at total DHEA testosterone five alpha andro and then the metabolic preference, those four things together really tell you the full story of what's happening with androgens. I want you to talk a little bit about UT, and I don't want to get too much into the genetics or like too confusing, but this is an important caveat, and I think this podcast is going to be such a great overview for providers.

00:28:42:27 - 00:28:56:24
Dr. Jaclyn Smeaton
It's going to get a lot of lessons. I know it, but I think UT is something that people should be aware of and we will put this on the report under Advanced Insights. But I want you to just talk a little bit about why it's important to think about that.

00:28:56:26 - 00:29:26:07
Dr. Carrie Jones
So UT is part of the glucagon adoption Snip family. And there is a snip that breaks down testosterone specifically in urine. Not how you make it, but how you break it down. So if you have a deletion in this UGA enzyme, then you're not going to have hardly any levels of testosterone in urine. So if you get a DUTCH report back and the testosterone is so freaking low, you were not expecting it to be that low, male or female, it doesn't matter.

00:29:26:07 - 00:29:49:17
Dr. Carrie Jones
You're like, oh my gosh, this is so low. And I think how how are they surviving? It's so low. You're going to look at we I mentioned or Jacqueline mentioned like the list of hormones where it's estrogen and progesterone and androgens. You want to look for the one called epi epi testosterone and epi testosterone and testosterone are cleared at about the same rate out of the urine.

00:29:49:19 - 00:30:10:13
Dr. Carrie Jones
And if epi testosterone is in range, it's looking good and healthy. It's normal. Then we can kind of assume they probably have this deletion. And this particular enzyme. Now, the interesting thing is it's in a high percent of those of Asian descent. But it doesn't stop there. I mean, my own husband, who's a six foot three white guy of European descent, has it.

00:30:10:20 - 00:30:33:02
Dr. Carrie Jones
And so he has the deletion. It often also shows up in, these people often have Gill Bares. So they're Billy Rubin on Blood Drive, maybe a little high. So you may already have some insight ahead of time to them, but that just means if you see this pattern, then the testosterone, you're going to have to redo the testosterone in a blood draw to see and confirm what's going on.

00:30:33:04 - 00:30:50:09
Dr. Jaclyn Smeaton
Great. Yeah. And this is something that, like I said, we'll have it in the Advanced insights. It'll put a comment about your patient's results, whether we think that you should do a serum draw to confirm the testosterone level will be kind of putting that in there to alert you that, that they could be someone who has a possible deletion.

00:30:50:09 - 00:31:00:06
Dr. Jaclyn Smeaton
And I think it's 8% in the general like American general Caucasian population. But like you've said in Asian populations, I think it's upwards of 80 plus percent.

00:31:00:09 - 00:31:02:06
Dr. Carrie Jones
I remember it being significant. Yeah.

00:31:02:08 - 00:31:19:22
Dr. Jaclyn Smeaton
So I just keep that in mind. It doesn't mean that DUTCH testing is not great for that group of patients. There are so many things that are great, but with testosterone you might want to think about a serum, draw for a patient of Asian descent that free and total testosterone, and then use a DUTCH test to assess metabolism of testosterone.

00:31:19:24 - 00:31:39:06
Dr. Jaclyn Smeaton
And if you get lucky in there in that small percentage or you're getting a good a reading with the DUTCH test with urine measurement, that's great. And I think one thing that's important, they are still clearing testosterone sufficiently. They just clear it through a different pathway not to look at Asian. And we measure the gluconate form. So that don't worry that it's like getting stuck or that their tubs getting too full.

00:31:39:10 - 00:31:42:25
Dr. Jaclyn Smeaton
It's just going down a pathway. That's not what we measure.

00:31:42:27 - 00:31:45:27
Dr. Carrie Jones
It's like going down a side street as opposed to a major highway.

00:31:45:27 - 00:31:48:28
Dr. Jaclyn Smeaton
Right. Just like your Uber. It took a different a different.

00:31:48:28 - 00:31:49:24
Dr. Carrie Jones
Turn, a different route.

00:31:50:01 - 00:31:51:23
Dr. Jaclyn Smeaton
That's right.

00:31:51:26 - 00:31:55:09
DUTCH
We'll be right back.

00:31:55:12 - 00:32:21:17
DUTCH
Here at Precision Analytical, we've launched the biggest update to our report since 2013. The new and enhanced DUTCH report puts the most actionable hormone insights right on page one, making it faster and easier to interpret. You'll see a reimagined summary page, upgraded visuals for estrogen and cortisol metabolism, and an all new about your results section. What we call the DUTCH Dozen a 12 point framework that helps you understand your patient's hormone story in minutes.

00:32:21:19 - 00:32:45:13
DUTCH
It's a smarter, simpler, and more insightful DUTCH experience. From now through December 19th, 2025, all registered DUTCH providers can order five DUTCH Complete or DUTCH Plus kits for 50% off. Give us a call or visit DUTCHtest.com/order now. Must have a registered DUTCH provider ID domestic and Canada only promotion not available through distributors. Prepaid and shipped to facility only.

00:32:45:16 - 00:32:56:26
DUTCH
No drop ships cannot be combined with any other offer. You can mix and match DUTCH Complete or DUTCH Plus must be purchased by December 19th, 2025. Welcome back to the DUTCH podcast.

00:32:56:29 - 00:33:18:01
Dr. Jaclyn Smeaton
Okay, now the third area on the summary page. So there's basically like three rows. If you guys are looking at if you downloaded it. We talked about estrogen and progesterone. We've talked about androgens. The third is cortisol. And let's start first by sharing like why when we're looking at kind of sex hormones estrogen progesterone and androgens testosterone DHEA where does cortisol fit in.

00:33:18:01 - 00:33:38:29
Dr. Jaclyn Smeaton
Why is that on the DUTCH test. And why is it important to look at it in that comprehensive space? Because again, I think a lot of providers are listening today. You might have come from a more conventional background where you learn about especially like perimenopausal menopausal women, men as aging, you want to know estrogen, progesterone and androgens. But you learn about cortisol just with Cushing's and Addison's and that's it.

00:33:39:01 - 00:33:44:02
Dr. Jaclyn Smeaton
So how do we look at it differently? Why is that a meaningful piece of this puzzle.

00:33:44:04 - 00:33:49:23
Dr. Carrie Jones
And I think cortisol gets a really bad rap. I think a lot of people immediately hear the word cortisol and they're like, oh my gosh, it's.

00:33:49:23 - 00:33:49:28
Dr. Jaclyn Smeaton
Like.

00:33:50:05 - 00:34:20:00
Dr. Carrie Jones
Really fat. Yeah, that's that's blood sugar issues that that means you're super stressed. And we have to remember a cortisol. Much like if you if you have Addison's you're not going to survive okay. So we need cortisol. It's critical to be in a human. And it's really important for yes the fight or flight system, but also like supporting our immune system and inflammation and mobilizing resources when we are in that flight, fight or flight situation, our circadian rhythm, cortisol goes up in the morning on waking and then down, down, down.

00:34:20:00 - 00:34:58:15
Dr. Carrie Jones
So it can be down at night. So melatonin can come up and take it position in the whole circadian rhythm. So cortisol is really critical and the rhythm of support. So cortisol is very critical to how humans function in life. So we have it on the DUTCH test for that reason knowing if you are in chronic fight or flight situation then the body's going to prioritize those things over the production of hormones, over reproduction, whether you want to get pregnant or not, whether you're looking to get somebody pregnant or not, that chronic stress, that dysfunctional circadian rhythm, is going to feed back to the brain.

00:34:58:15 - 00:35:27:20
Dr. Carrie Jones
Not safe, not good. This is an A right time. And so it may impact ovulation. So progesterone and estrogen it might impact his testosterone production. It's going to impact inflammation which then directly impacts how hormones are made and how her cycle works. So it really truly is a critical piece in the whole endocrine system because it has such important feedback to the brain and then subsequently the ovaries and the testicles for making these hormones.

00:35:27:22 - 00:35:36:17
Dr. Jaclyn Smeaton
Yeah, it actually it kind of shocks me that it has, let's call it like a soft science reputation also.

00:35:36:23 - 00:35:37:02
Dr. Carrie Jones
Yeah.

00:35:37:03 - 00:35:48:06
Dr. Jaclyn Smeaton
So I don't know, like maybe that's a good way to put it. But like when people think about cortisol, it's like, oh, that's just like, amorphous functional medicine, integrative medicine concept. Like it's really not.

00:35:48:06 - 00:35:50:14
Dr. Carrie Jones
Or like you're just trying to sell me something. I'm like.

00:35:50:16 - 00:36:12:18
Dr. Jaclyn Smeaton
And the truth is, there are so many publications on the impact of that's just call the whole HPA axis on every single system and process in the body. Like if you go into PubMed, you can look at cortisol. You could look at norepinephrine, epinephrine, glucocorticoids. These are the the keywords you want to be searching that are looking at the hormones made through the HPA axis.

00:36:12:18 - 00:36:42:08
Dr. Jaclyn Smeaton
This kind of adrenal system. And look at cardiovascular health. Look at metabolic health. Look at physical healing. Look at reproductive health. All of these things that touch points. There are thousands that have been elucidated and clarified. It's not soft science. It's really very real. Even in cases where it's not cortisol and Addison's and I, I think one thing that's tough for us, or maybe one of the reasons why we don't focus on it as much is because the right solution is not a pill.

00:36:42:10 - 00:36:44:13
Dr. Jaclyn Smeaton
It's like it's like, sleep well.

00:36:44:13 - 00:36:45:27
Dr. Carrie Jones
Not a pharmaceutical per se.

00:36:45:27 - 00:37:06:19
Dr. Jaclyn Smeaton
Yeah. That's right. And so I think in a way, and I think that's even the case for us, like for myself as a provider, it was always easier for me to address nutrition movement. You know, those things that you can like give a prescription for where I think with HPA axis dysfunction, it's like we all deal with stress.

00:37:06:19 - 00:37:25:15
Dr. Jaclyn Smeaton
And I think it's like, how do you give an effective therapy? And of course, there's really great things on top of just adrenal botanicals and nutrients, but lifestyle changes. But my point is really important to look at. It's not soft science. So if you are a cardiologist, look at the data on this because it's it is important to look at.

00:37:25:15 - 00:37:35:21
Dr. Jaclyn Smeaton
And I wish that like traditional endocrinology and endocrinology societies would really look at that a little bit more seriously beyond just the Cushing's and Addison's.

00:37:35:23 - 00:37:56:21
Dr. Carrie Jones
I couldn't agree more. I mean, even just just even in the blood sugar part alone, like the metabolic syndrome part alone or even inflammation, you know, cortisol initially can help, like shut down the inflammatory cascade. And if you have insufficient cortisol, then it can't do that. And so somebody could be really pretty inflamed causing other symptoms for other diagnoses.

00:37:56:21 - 00:38:16:23
Dr. Carrie Jones
Not realizing if we look back at cortisol could be at the start of it. But I had a continuous glucose monitor in and I've heard this several times over. But this is my own story. So I had a continuous glucose monitor in and my, you know, blood sugar was like 84, 87. And then I got a really upsetting text message.

00:38:16:25 - 00:38:31:07
Dr. Carrie Jones
And I was on my way out to run errands, and the errands took like 20, 30 minutes to get there. And the whole time in the car, I hadn't responded to text message, but I was arguing out loud with myself, you know, like, this is what I'm going to say, and this is how I feel. And like, this is what, you know, like, how dare you?

00:38:31:13 - 00:38:32:08
Dr. Carrie Jones
Did they respond.

00:38:32:08 - 00:38:32:21
Dr. Jaclyn Smeaton
Back?

00:38:32:22 - 00:38:36:04
Dr. Carrie Jones
Because I don't know, I didn't text them. I was, I was, I was formulating my.

00:38:36:04 - 00:38:40:12
Dr. Jaclyn Smeaton
Response when you're in your head, no, I'm gonna say this. They're going to say, oh yeah.

00:38:40:15 - 00:38:57:13
Dr. Carrie Jones
Like a whole conversation back and forth. And by the time I got there, my blood sugar had gone up like 30 points. I mean, it's gone up this, like, enough. My body was like, we're fighting a lion, clearly. Like you're you're getting heated and agitated, and you're raising your voice and your your your heart's racing and you see mad.

00:38:57:13 - 00:39:15:18
Dr. Carrie Jones
So let's get let's give you blood sugar to go to your brain and go to your muscles and, and mobilize. You clearly need to mobilize. Let's go. And I was just going to like Michael's, you know, we're like the grocery store. Like I was just going somewhere super basic. And I thought, oh, no. And recently I was telling a girlfriend of mine this, who also has a CGM in, and she security.

00:39:15:18 - 00:39:37:04
Dr. Carrie Jones
I have had the most stressful week with my patients and just just everything going on in my clinic and my blood sugar hasn't been below 100. She goes, I'm normally in the 80s and it just goes to show chronic, ongoing stress absolutely impacts blood sugar. Plus, I mean so many other things. But, she said, now that I see it with my own eyes, I'm like, oh my gosh, might she?

00:39:37:06 - 00:39:50:13
Dr. Carrie Jones
Because she was like, my diet's great. I eat enough protein and veggies and fruit. You know, I do the thing and I don't need ultra processed food. And she's like, I'm a pretty great doctor and I walk the walk, but stress is getting me okay.

00:39:50:21 - 00:40:12:18
Dr. Jaclyn Smeaton
I love that you bring that up. And I've seen that pattern too in patients. And, it's really it's amazing. And that's a really wonderful thing about cortisol. You started by saying cortisol gets a bad rap. Yes. But, cortisol is like our body's fire extinguisher. Like, if we didn't have it in times of need, we'd be in big trouble.

00:40:12:18 - 00:40:31:19
Dr. Jaclyn Smeaton
Like you said, you couldn't survive. It's really important. But the problem is that we also don't want to live in a foam pit, right? That's actually being sprayed. There needs to be an off and and on. And I think that you're right. The downstream effects on things like metabolic health are really clear. And it points to the fact that this needs to be better regulated.

00:40:31:19 - 00:40:48:01
Dr. Jaclyn Smeaton
And it's a really important part of that overall assessment. And, you know, I think I love that it's included on the test. Because when we look at reproductive health, which is kind of the focus of most of the patients that order the test, although you could definitely order for a HPA axis assessment only. And I'll tell you why.

00:40:48:01 - 00:41:01:07
Dr. Jaclyn Smeaton
We can kind of get into that when we look at why it's more comprehensive, just if you're looking at the HPA axis, but it's such an important piece of that picture to really get to that root cause of why hormone imbalances are happening.

00:41:01:09 - 00:41:18:19
Dr. Carrie Jones
Even in the diagonal curve. And again, and like, we don't just look at that, but I have had a lot of amazing feedback in doing consulting through the many years where, let's say somebody night time point goes up or their dinner time point goes up, you know, like they were going down and then boom, it shoots up. And so I would say like what goes what's happening here?

00:41:18:19 - 00:41:34:21
Dr. Carrie Jones
What's, you know, and I would get the most incredible insight. Sometimes people would say things like, oh my gosh, my kids are so busy. We go, we have a million things, a million practices. I barely get dinner on the table. Sometimes we don't to eat on the fly. You know, it's go, go, go, go. One woman, one said, well, that's when my husband gets home and things aren't good.

00:41:34:21 - 00:41:55:12
Dr. Carrie Jones
I've had people say, migraine. My migraines, well, my migraines start every night that time. And I was like, you didn't mention your migraines that come 5:00 every night. So sometimes these these bigger, these four point or five point tests are so helpful because I can point to a point and say, what happened here? And if it's a one off thing like, oh gosh, I got a one off migraine.

00:41:55:13 - 00:42:05:14
Dr. Carrie Jones
You know, I didn't expect it. That's one thing. But when it's something chronic where somebody goes, ooh, that's where I drink coffee and, you know, eat my muffin, I'm like, there we go.

00:42:05:16 - 00:42:06:18
Dr. Jaclyn Smeaton
Yeah, exactly.

00:42:06:18 - 00:42:07:15
Dr. Carrie Jones
Okay, great.

00:42:07:17 - 00:42:29:23
Dr. Jaclyn Smeaton
So when we look at the summary page, you know, we have that diurnal curve on there. And we also look at total salivary cortisol, which is like a free cortisol assessment. This is in the DUTCH plus. Yeah. So let's call it cortisol. Total metabolized cortisol which comes from urine. So if you're doing a salivary only cortisol test you cannot measure metabolize cortisol in saliva.

00:42:29:25 - 00:42:56:01
Dr. Jaclyn Smeaton
And then we look at cortisol clearance rate. And those are four really key elements to getting the full picture of the HPA axis. Now if you order the dust plus which is our saliva and urine test, we also collect extra samples so that we can report what's called the car, the cortisol awakening response. I think just just to share a couple of like, things on their report that we've done with this launch is that you still see the diurnal curve on the summary page.

00:42:56:01 - 00:43:17:09
Dr. Jaclyn Smeaton
The car is a lot more prominent because it's so important to look at that. And when you order that, plus that's usually why you're getting that much. Plus we've made it way more obvious to see that result for your patient. The other thing that we've done on all of our tests is we're able to plot more points. So if you only your patient collects four points, like for that's complete.

00:43:17:09 - 00:43:37:29
Dr. Jaclyn Smeaton
It has four points in the diurnal curve. But let's say they have an insomnia point or they collect a point midday like noon time where you have them collected when they get a migraine, for example. Let's use that as an example, where now we plot those points on their diurnal curve as well. So reflexes with how many points the patient collects which is new, you used to only see the four on the curve, and then you have to look at the table for the extra.

00:43:38:03 - 00:43:55:29
Dr. Jaclyn Smeaton
But now it's all blended into the curve, which is like technically the most challenging thing that we did with this release that the team started with, that the develop poster, because it was like, let's just make sure we can get this right before we think about adding anything else to this release. But that's so huge because everything's there visually for you and your patient.

00:43:55:29 - 00:44:16:28
Dr. Jaclyn Smeaton
And the other thing we did, which is just like the cherry on top of this diurnal curve improvement, is we plot B below the x axis. We actually put the actual collection times. Yeah. So it's not just saying waking waking plus 30. You can see like 4:05 a.m.. 4:28 a.m.. You know, you can actually see the minutes that they collected.

00:44:17:05 - 00:44:34:04
Dr. Jaclyn Smeaton
I hope your patient's not waking up that early, but my point being, you can see that way if things don't look right, you can also check on the time they collected and make sure that they kind of nailed the periodicity of it just gives you that more information. Again, you could see that before in the header. Now it's baked into that curve.

00:44:34:06 - 00:44:51:07
Dr. Jaclyn Smeaton
So those are the improvements there. I want to talk a little bit about why those four assessments are so critical when we look at HPA axis function. So let's talk about that. We talked about diurnal curve a little bit. What about total cortisol metabolize cortisol and cortisol clearance rate.

00:44:51:09 - 00:45:11:14
Dr. Carrie Jones
Yeah. So we have so the total cortisol are basically the points added up. So if you're looking at a DUTCH plus and you're looking at the five points. So cars are three waking 30 minutes later 30 after that around dinner and before bed. So then that is added together and you get the salivary cortisol total for your day and then metabolize cortisol out of urine.

00:45:11:15 - 00:45:40:12
Dr. Carrie Jones
Gives you an idea of how much you make. And metabolize through the body. And then that's urinated out. And that's of course collected also over the four or 4 or 5 points, depending on which tests that you're doing. And it helps to tell, as Mark Newman would say, it would helps to tell a really compelling story. Because if I see somebody with high levels of metabolize cortisol, I'm immediately starting to think of like metabolic syndrome, insulin issues, high inflammation, high stress.

00:45:40:15 - 00:46:01:11
Dr. Carrie Jones
Are they on something that is hurting them? Yeah they do increasing cortisol. So cortisol itself for hypothyroidism like I immediately can start thinking versus if it's low then I'm like maybe hypothyroidism. Maybe under eating overtraining again, maybe stress has been going on for a while and it's like shut down the process. They're struggling to make cortisol in the first place.

00:46:01:11 - 00:46:22:22
Dr. Carrie Jones
So it helps me better direct the questions I'm going to ask the patient like, hey, look, I'm like, I'm showing up very clearly for me and your cortisol or let me ask you these questions and like let's figure out which one or ones could be contributing to the reason you have this pattern in your dial, which direction it's facing so that we can get you better help.

00:46:22:24 - 00:46:45:27
Dr. Jaclyn Smeaton
I should totally show my own report from earlier this year, because I would absolutely that representation. I was like intentionally going through kind of like a cut fitness wise, which is when you like, cut your calorie intake a little bit or increase your workouts to try to. I was trying to convert, you know, fat to muscle, not in an unhealthy way, but I could see that on my test when it came to my metabolized cortisol and other markers as well.

00:46:46:04 - 00:47:08:12
Dr. Jaclyn Smeaton
What that looks like, which I actually think would be a great pattern for us to cover. Maybe I will make a little video on this, because I think a lot of perimenopausal women or people on GLP medications that are not eating enough, you could notice this pattern in them and make sure that they're fueling or resting appropriately, because mine definitely showed that it wasn't, although it could have also been stress, a family stress of work.

00:47:08:12 - 00:47:09:05
Dr. Jaclyn Smeaton
All those things.

00:47:09:07 - 00:47:09:21
Dr. Carrie Jones
Travel.

00:47:09:21 - 00:47:17:18
Dr. Jaclyn Smeaton
Combined travel, all that stuff. So that's a separate aside. We'll definitely chat about that. Now, what about cortisol clearance rate?

00:47:17:21 - 00:47:33:28
Dr. Carrie Jones
Cortisol clearance rates. Really fascinating because it's important to know, you know, when you mate, when you make cortisol much like any other hormone, like you can't hang out forever. So you will see now the addition which was which was added earlier this year, but now it's much more prominent and obvious in the big box at the bottom here.

00:47:34:00 - 00:48:00:14
Dr. Carrie Jones
So it's basically cortisone and cortisol, metabolites divided by cortisol plus cortisone like the free version. And so it helps you understand again relative to the total in the metabolized is the cortisol clearance rate high relative to other people okay. Or actually low. Because sometimes I think the dials can seem like a little gray area, a little nebulous.

00:48:00:14 - 00:48:16:09
Dr. Carrie Jones
And people don't realize the importance of like, hey, you're your patient's cortisol clearance rate is actually really high. Like, we should probably figure out why this is going on, like in an extreme situation or the opposite, it's really low. It's like lower than you are giving it credit for. Like we should figure out what's going on.

00:48:16:12 - 00:48:36:08
Dr. Jaclyn Smeaton
Yeah. And there are times where you'd notice that maybe the diurnal diurnal curve, they look very low or they look very high. Let's say the instance where they look very low, but then you can see metabolize cortisol is really, really high. Right. They have that fast clearance which makes that free amount of really low functionally or vice ever.

00:48:36:08 - 00:48:43:24
Dr. Jaclyn Smeaton
So I can tell you a little bit, which is so interesting because can you imagine if you were treating that patient for low cortisol production.

00:48:44:29 - 00:49:05:09
Dr. Jaclyn Smeaton
When really what they have is they're you know they're clearing it or metabolizing it far too quickly. The approach you take clinically is very different. And this is one thing that I think a lot of providers are probably making mistakes in their clinics every day on this, by only looking at a diurnal pattern or only using a lab that measures salivary diurnal pattern.

00:49:05:14 - 00:49:21:26
Dr. Jaclyn Smeaton
This is one of those things where like, if I could wave a magic wand and change the way functional medicines practice, I'd get people to utilize urine and saliva or urine only for the diurnal or for cortisol assessment, because you really could be moving in the wrong direction with your therapeutic plan.

00:49:21:28 - 00:49:36:27
Dr. Carrie Jones
And, you know, it's funny. You know, the providers will say to me like, well, my the plants that I have, they work like what I'm doing works. But I'm like, well, then you wouldn't be consulting with me about their adrenals. Like it works to a point, right? Or at work or or you'll tell me it didn't work. Like, hey, in this particular person, I thought it didn't work.

00:49:36:27 - 00:50:00:13
Dr. Carrie Jones
They got worse. They had these side effects or mean it didn't work at all. They don't feel any better. Like, we've been doing this for three months. And I'm like, well, it's entirely possible you were chasing the wrong rabbit hole because we didn't have the whole information you just had. You know, either they just did a serum cortisol, which is oh, or they did a saliva, which was just the four point and then completely missed the fact that the metabolism really pointed them in this other direction.

00:50:00:13 - 00:50:20:18
Dr. Jaclyn Smeaton
Right. Yeah. So when we get to the dozen, like I said, there's four assessments for estrogen, progesterone for assessments, for androgen, for assessments for cortisol. We've kind of talked through those. The first one is look at the diurnal pattern. The second is look at the free cortisol. The third is to look at the total cortisol produced by the gland which is the metabolize.

00:50:20:18 - 00:50:37:14
Dr. Jaclyn Smeaton
And the fourth is a cortisol clearance rate. So that's really you can look at those four pieces to get a much more complete assessment. And I think the other thing that we haven't really talked in-depth about yet is the car, the cortisol awakening response, which is not on the Dodge complete. You can only measure it in saliva. So that's why we have the DUTCH

00:50:37:14 - 00:50:47:08
Dr. Jaclyn Smeaton
Plus what is the car add to the picture. And how important is that in your like all the tests you've seen, do you wish more people ordered that to get the car?

00:50:47:09 - 00:51:02:17
Dr. Carrie Jones
I do, you know what's funny is I was recently at a lecture and Andrew Huberman was the speaker. And he somebody asked him like, what's what's one of the best things you've learned in the last year? And he said it was the cortisol awakening response. He's like, I just learned in the last year about the cortisol, a weak in response and the importance of it.

00:51:02:20 - 00:51:23:04
Dr. Carrie Jones
And I turned to my friend and I said, I haven't talked about the cortisol a week in response in DUTCH put the DUTCH plus, I think in 2017, I was like, man, I'm talking about the car for a long time. It's that important. Yes. So basically it's an it's an indicator of how your circadian rhythm runs. It's an indicator of your resiliency, an upcoming stress for the day.

00:51:23:06 - 00:51:44:09
Dr. Carrie Jones
It plays a role in all things, you know, pain and inflammation and autoimmunity immune system. But it's the quick rise of cortisol when your eyes open in the morning and you they get get some sort of light in and register like I am conscious you might not feel awake, but you're conscious. And so the body's like, cool, let's go, let's make some cortisol and it should rise.

00:51:44:09 - 00:52:01:28
Dr. Carrie Jones
You know, people freak out and think, oh, I don't want my cortisol to rise. I don't want to be high. No, no. This is a normal, natural, within range rise of cortisol peaks at about the 30 to 45 minute mark and then starts to gradually drop down the rest of the day. And if you don't get that healthy, rise in the morning.

00:52:01:28 - 00:52:24:14
Dr. Carrie Jones
A lot of times you or your patients will say in the morning or on waking I. So on waking I'm exhausted. On waking I have panic. On waking, oh, my joints hurt on waking, my autoimmune symptoms or the worst on waking I just, I can't focus. I, you know, everything is I can't in the morning on waking I and I find a lot of people when you ask specifically how's your morning?

00:52:24:14 - 00:52:43:16
Dr. Carrie Jones
How is it on waking for you? How long does it take you to go from conscious to alert? And a lot of people say hours, you know, an hour or two hours, a couple cups of coffee. I'm like, it should take 30 minutes, 45 minutes, tops, because the car, a healthy car, should rise and then come down the other side very slowly the rest of the day.

00:52:43:18 - 00:53:06:19
Dr. Carrie Jones
And even if you feel symptoms all day, even if you're tired all day or in pain all day, I would imagine in the morning it's definitely pretty concentrated. And so by being able to restore and reset your circadian rhythm, it starts with sleep quality sleep and moves into how your cortisol rises in the morning. That be so helpful for so many things in the body.

00:53:06:21 - 00:53:24:10
Dr. Jaclyn Smeaton
Yeah. And that healthy car response like it almost takes it's I think about it almost like where you measure blood sugar or you measure a1 c m the a1 c is a measure over months of how your blood sugar has been up and down. And I think about car in a really similar way where you can measure blood glucose.

00:53:24:10 - 00:53:43:16
Dr. Jaclyn Smeaton
You can even track it over the course of a day to get an idea of what's happening and what the ups and downs look like. But the car is that kind of analogous, score that looks at it over a broader period of time, that resilience, that's how I like to explain it to my patients, is that car is almost like that hemoglobin A1, C for your HPA axis.

00:53:43:18 - 00:54:03:09
Dr. Carrie Jones
And I don't I'm sure you do too. I tell because people will say like, well, like I've read in papers, like a one time test isn't enough. You need more than one time and I'll see what we do encourage. And I've always encouraged patients do it on a typical day. If if your Monday through Friday looks pretty much the same, your stressors may be different, but the level of stress you're at is usually not.

00:54:03:11 - 00:54:24:20
Dr. Carrie Jones
Sometimes your stressors don't look different at your family, at your job, at your kids. It's it's the news. And so I'm like, in that case, I'm expecting the car to be kind of the same if I did on a Monday, if I did it on Thursday, because humans tend to follow a pattern in their life. Please don't do the DUTCH Plus on vacation unless you're truly trying to see if you get better on vacation and need to go on more vacations.

00:54:24:20 - 00:54:27:02
Dr. Jaclyn Smeaton
It's like how it goes. So it's like, right.

00:54:27:02 - 00:54:32:24
Dr. Carrie Jones
Don't do it when you're sick. Don't do it. You know, like do it on a typical day. And that will tell you your typical car.

00:54:32:26 - 00:54:49:23
Dr. Jaclyn Smeaton
And that's really what you want to look at. And we would get a lot of that. Like do I take it on medication. Do I take it on a Saturday? I take it on a weekday. And ultimately, like you want to take it on the day you're trying to assess, like and probably for most of us, that's an average an average day in an average day, especially when it comes to that HPA axis.

00:54:49:23 - 00:55:10:27
Dr. Jaclyn Smeaton
So, you know, I think this has been really helpful because we've kind of talked through all of those key, like what we call the DUTCH dozen assessments, the 12 key assessments that you should do from the DUTCH test. Like I said, our goal with this release and I know our customers, you guys have been so loyal. You've seen us through a lot of different, report changes that have happened over the last 18 months.

00:55:10:29 - 00:55:29:23
Dr. Jaclyn Smeaton
All of those were to prepare you for this. We had this goal in mind as our North Star, you are going to see only minor, minor changes that probably you won't even notice at this point. But this is really what we were originally calling like that DUTCH 2.0 vision. That took us a long time to get to, because we wanted to teach you about cortisol clearance rate.

00:55:29:25 - 00:55:53:03
Dr. Jaclyn Smeaton
We wanted to teach you about, five alpha and resting dial. We wanted to get those scientific concepts to you on a drip feed. So you didn't feel like you were drinking from a firehose. But this really, I would not think of it as a lot of new information. It's just reorganization. And our goal here, this big change is that when you sit down with your patients now, you can show them just the summary page and tell them what's going on.

00:55:53:03 - 00:56:12:17
Dr. Jaclyn Smeaton
You might flip to the back to look at some of the other kind of more advanced insights. Things like cortisol to cortisone conversion or you know, there's so many others we can talk through, but are like the addition of Astron and Astral and how they impact overall estrogen feeling or symptoms for patients. We can serve those to be more advanced.

00:56:12:17 - 00:56:39:11
Dr. Jaclyn Smeaton
But Carrie and I have talked about today, that is the fundamental assessment with the DUTCH test. And if you can capture those 12 assessments in the DUTCH dozen, you can use a summary page to walk your patient through. You're going to get through the majority of the insights that you can learn from the report for your patients. So this is our way to really streamline that for you, and hopefully take what felt more complex and comprehensive and turn it into clarity, I love that.

00:56:39:13 - 00:57:02:11
Dr. Jaclyn Smeaton
Yeah. I do want to just touch upon the the report we've added and really reconfigured the comment section as well to follow what exactly Doctor Carrie and I did today. So you actually see the summary page, estrogen and progesterone row back in the comment section. And we describe your patients results below that the next page the androgens and metabolites.

00:57:02:11 - 00:57:24:20
Dr. Jaclyn Smeaton
And we describe your patients results below that. So again that's great for your patients. It's great for you as you orient to the results you'll see those results kind of broken down with our assessment below. And then after that as the advanced insights again those are something that if you're an experienced provider, we've tried to like point you to all those extra insights that you're probably flipping from page to page to get right now.

00:57:24:27 - 00:57:41:06
Dr. Jaclyn Smeaton
And if you're new to DUTCH testing, pull those pages off and wait. You know you don't have to learn all of it at once. Focus on the DUTCH dozen, those 12 assessments, and once you get the hang of it, you can start to filter in other concepts. So a couple things. One, I think it's great that we kind of nail down these are the essential 12.

00:57:41:08 - 00:57:51:09
Dr. Jaclyn Smeaton
And now the rest of these are like bonuses on the ice cream sundae versus that overwhelm you can feel because you don't know every single thing when you're learning which.

00:57:51:09 - 00:57:58:14
Dr. Carrie Jones
And again, we just go back to the see and comprehensive I love that you said we're going to change it into clarity. We're going to change it into confidence. I think that's.

00:57:58:14 - 00:58:20:21
Dr. Jaclyn Smeaton
Perfect. Totally. Just in wrapping, I think you've one thing that I, you have a unique perspective on because you've talked with literally thousands, probably tens of thousands of providers who are at different points and learning the DUTCH test. What would be like the a couple of key pieces of advice you might give to someone who's just getting started with DUTCH testing, and then the next group would be someone who's done a few.

00:58:20:21 - 00:58:23:06
Dr. Jaclyn Smeaton
But now they really want to level up their expertise.

00:58:23:09 - 00:58:41:28
Dr. Carrie Jones
One of the things I just say all the time is that hormones and and I say this hormones are like herding cats. And so if you were in a different area of medicine, let's say, and you're getting into hormones, like do not compare your week one to somebody else's year 20, because it does truly take a minute to understand hormones, the entire endocrine system, what's going on.

00:58:42:00 - 00:59:00:12
Dr. Carrie Jones
But just as Jacqueline said, take it one level at a time. You're going to take the estrogen progesterone metabolite level. It's all in one block. And you'll go down, look at the androgen and you'll go down a look at cortisol, like take a sneak peek at the organic acids. And that'll give you 80 to 90% of what you need to know.

00:59:00:12 - 00:59:28:04
Dr. Carrie Jones
Just as she said the other markers are very cool, but the are the extra toppings on the Sunday. And so just starting there, you're still going to be ahead of the curve when it comes to hormone education. If you've been doing this a minute, you've got 5 or 10 DUTCH tests under your belt. You have a much better grasp on hormones like quiz yourself, look at the DUTCH dozen questions and see how you would answer them, and then look and see what the actual answers are to make sure.

00:59:28:05 - 00:59:45:01
Dr. Carrie Jones
Right that you like. You like. Yeah, I've got this. I know how to. I know how to do this. This is what I would have said. This is amazing. And then move into the advanced insights and then start quizzing yourself on that. Once you get more comfortable with those extra sets of information and making sure like, yeah, I would have said that same thing, that's great.

00:59:45:01 - 01:00:01:26
Dr. Carrie Jones
I got this because I know sometimes practitioners, of course, like we're looking for mentors, we're looking for apprenticeships, we're looking for somebody who can tell us what to do. But the questions and answers are there with the DUTCH dozen and the advanced insights. And so use that as an opportunity to like what would you say, how would you describe it?

01:00:01:26 - 01:00:03:28
Dr. Carrie Jones
And then go look and see if you got it right.

01:00:04:00 - 01:00:21:07
Dr. Jaclyn Smeaton
Today has been really valuable. And I think, like I said, this will be one of those podcast episodes people go back to time and time again. And I will also make sure in our show notes, we link to some of the additional learning resources. We've done a lot of recordings walking you through the new report, to help you connect with our clinical team.

01:00:21:07 - 01:00:27:21
Dr. Jaclyn Smeaton
If you need support with a patient's result. Because we want to make sure you are feeling the clarity.

01:00:27:23 - 01:00:28:12
Dr. Carrie Jones
I love it.

01:00:28:15 - 01:00:36:24
Dr. Jaclyn Smeaton
But, doctor Carrie, thank you so much for joining me today. If there is people who want to get in touch with you or learn more about other things you're doing, what are the best ways for them to do that?

01:00:36:27 - 01:00:49:19
Dr. Carrie Jones
Absolutely. My website is probably the best place. It's Doctor Carrie Jones, Dr. C A R R I E jones.com. You can also find me on Instagram at Dr. Carrie Jones and YouTube at Doctor Carrie Jones.

01:00:49:22 - 01:00:55:02
Dr. Jaclyn Smeaton
Wonderful. Well thank you Doctor Carrie Jones always thank you.

01:00:55:05 - 01:01:14:05
DUTCH
Thanks for joining us on the podcast. Join us every Tuesday for new conversations with leading functional health experts. If you like what you've heard, be sure to like, follow, and subscribe wherever you get your podcasts.