Kelly: Wellness is a practice, not just a word. Welcome to the Synergee Podcast, where myself, Kelly Engelmann and Lori Esarey shed light on powerful tools and topics that nourish your body, and most importantly, feed your soul.
Hey, Synergee listeners, we’re about to dig in with Mark Newman from DUTCH. So excited he joined us today. I will have to give you a little warning. It’s a little nerdy. We’re talking all things hormones. We’re getting into the weeds of how you actually metabolize your hormones and what that means for you as far as keeping hormones safe and effective.
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Welcome Synergee listeners. We are so excited today to have Mark with us. We are gonna dig into all things hormone balancing. Lori and I have known Mark for a long time and he has been responsible for a lot of our education and the backbone of, of many of the things that we do in our practice to help keep you safe with hormone therapy. And so we’re gonna dig into all of that today. So thank you, Mark, for being here.
Mark: Happy to be here.
Lori: Well, it’s the pleasure. I mean, obviously as Kelly shared, we’ve known you for a, a really long time. We won’t date ourselves, but going back to the inception of basically DUTCH. So tell us a little bit about your story. How did you land doing what you’re currently doing and, and why?
Mark: Yeah. For me it was, you know, a season in a few different places. Looking at some of the different tools that you can use to measure hormones and just kind of living with the pros and the cons of different things and, and all the wild sort kind of putting together in my head this sort of puzzle piece of like, okay, like if I wanted to do this better, what am I doing? How am I doing it? That sort of thing. And, and for me, a lot of it centers around just information. Like there, there are a lot of different, if you think about like, what’s in the middle of my house and I get to look in this window and I get to look in that window and I’m trying to figure out what the heck is going on in there, like the- the more vantage points I have, the more confident I am of what’s going on and I- I don’t like to be wrong. Because in the, in these situations, you’re talking about people’s health, right? I mean, if you march confidently in the wrong direction, like that’s something that we can do really easily in medicine if we have the wrong vantage point.
And so our testing is meant to really be comprehensive in terms of looking at a lot of different angles on primarily reproductive and adrenal hormones, but as you all know, we do some, some additional things. But those hormones that make us tick, like they’re, they’re complicated. And so we want to get a broad view of that because there are a lot of different flavors of dysfunction when it comes to your hormones, and that’s always been my goal, is to just get the best look at that we can, figure out what story it tells about you, and then try to put that in a format where, you know, brilliant providers like the two of you can take that and, and make it actionable. So that’s always been the game for us is to just find the best tools to figure out what’s going on.
Lori: So what is your formal education, Mark?
Mark: I’m a chemist, so I’m of that nerd, sort of set of . Like my thing is building the assay itself. Like I’m, I’ve always been. How do I build a better mouse trap for looking at the things that we’re looking at, which happen to be hormones? So I’m an analytical chemist by trade, and I’ve spent my entire career looking at different ways to test hormones in urine, in saliva, in blood, and different modalities that are available to doctors. And then trying to figure out like which one’s best. And the answer is almost always. It depends, right?
Kelly: Right. Yes. I love that. It does depend. Right?
Lori: And that’s why we are so excited to have you here because we have to have a conversation. I think we all know that hormones are disturbed, right? They’re imbalance and it’s a symphony of those hormones that lead to optimal wellness.
Lori: And that is a question. And so many times we get asked the question, you know, our hormone. For me, but it’s not just “Are hormones right for me.” once you are on hormone therapy, how do we manipulate them? How do we dose them? How, what do we use? What types do we use so that we are treating you like you said, right? Safely and effectively? And it depends.
Kelly: It does depend. And I love what DUTCH has brought to the table in the way of a tool that we actually have like a 30,000 foot view of like what is going on with all of the intricacies of hormone balancing what’s, you know, we can extrapolate from that what’s driving some of this dysfunction for patients and really help them understand their hormones in a much different way than just looking at, say, serum testing for a patient. And sometimes serum testing is appropriate. You know, sometimes with my male patients on testosterone, I’ll just use serum testing for a while, but I love having the advantage of having the DUTCH as part of that treatment plan when managing especially female hormones. Yeah.
Lori: So tell us a little bit about appropriateness of testing because I, I love the soap box. Like you, you’ve given it to us a time or two, and I just think it really needs to be shared appropriateness of testing.
Mark: Yeah, I think it, it goes back to the same mantra of, it depends. But you know, serum testing is always gonna be in your toolbox, right? Because you’re not doing CBCs and blood chems. These things you, any doctor you go to wants to know if your thyroid’s outta whack and wants to know if you know these really standard things that everybody does. I sort of call that like commodity lab testing. It doesn’t really matter what lab does it, as long as they’re not crazy, like they, like, they’re really automated procedures and very standardized across the industry, which is really different than what we do. Like we have to go into our lab and go, what do we wanna test for? What methods are available and, and what is the scientific literature have to say about those things? And so it’s a, it’s a completely different category of things that we wanna look at. So serum is always gonna be a staple of what you do.
When you get into the hormone world, then it’s just somewhat limited. The most obvious place I think serum is limited is with cortisol, is just, you just don’t get a look- a good look at what’s going on inside the house, if you will, in terms of cortisol. So your stress hormone, which is gonna have to do with fatigue and depression and, and things like that. You just don’t get a good look from serum. So you’ve got urine and saliva as options? We do combinations of both. But the reason that we use urine, so DUTCH, for people that don’t know it, is an acronym of dried urine test for comprehensive hormones. So the idea there is the seat is the comprehensiveness, is we can look, you said 30,000 foot.
And what I love it is I can look from 30,000 feet and say, What’s going on. But they can, I can also drill down, you know, into the details and say, okay, the issue seems to be in your, let’s say, male related hormones of testosterone. But then you can drill down and, and also look at the, the sort of the, in the weeds of how’s my testosterone being metabolized?
Is that, you know, sort of part of the issue. So the appropriateness of testing as, as you asked, I think that’s what I want to do is look broad and then also be able to dig down. Because one of the things that’s complex is that there’s so much overlap. You know, say, “Hey doc, I’m tired.” Like, okay, well if you look at a DUTCH test, I’m tired could mean I don’t have enough cortisol. It could mean I don’t have enough testosterone. You know, we have a vitamin B12 marker on our panel, methylmalonic acid, right? Yep. So if you’re low on B12, what are you? You’re fatigued. Right? So you guessing is not very easy. in that area. You look at something like, Hey, I, you know, my, my aunt, my grandma had breast cancer.
Like, I wanna reduce my wrist. Like, okay, well your cortisol patterns, your estrogen matters. Your estrogen metabolites matter. Progesterone matters, me- melatonin. We measure melatonin.
Kelly: Melatonin matters, yes.
Mark: Levels are lower risks of breast cancer are higher, right? And that’s like the fourth layer of the breast cancer question. So, I would say the two prongs for us is, one, making sure that we’re using the right method in the right situation to get the right information. And then two, looking broadly so that we’re asking a lot of questions about where dysfunction might lie so that we’re not, the last thing you wanna do is treat the wrong thing to solve a problem because obviously you’re not you’re not gonna succeed,
Kelly: Right, like putting a bandaid on a symptom, not really having clarity on what’s driving that symptom.
Mark: Yes, exactly. I mean, if you have a, an overt, like really serious issue in a particular area and you’re just not looking in that area and so you’re fine tuning everything else, obviously you’re not gonna find success. So that’s again why comprehensiveness is so big for us is we want it to be accurate, but we want it to tell the broad story about what’s going on. And then again, then the- the right tool sometimes differs depending on, am I on hormones, am I on hormones? So if you’re on hormones, then you have to ask ’em another layer of questions of, well, how are you taking your hormones? Because the right tool sometimes differs. And we’ve built the DUTCH test to be as broadly applicable as it can be. And then one of our core values is transparency, is to say, listen, we are gonna build this as well as we can. We’re gonna tell you where it works well.
But in those few scenarios where a serum test is better or some other type of testing, then we’re gonna lay that out for you as well. Cause our passion is hormone testing, but also education because these are really complex issues that, you know, you all are busy in your practice. So we have a, you know, the nerd in me, like, we spend a lot of time digging into the literature and into scientific research to figure out, you know, in each scenario, What should a doctor be doing? And then, and then trying to sort of work with you, you know, to make sure that you are in that lane of best practices for the particular scenario, for the particular patient, you know, so you’re helping ’em get better.
Lori: So, I’m curious. I have to just ask the question. Would you go so far as to say that a provider of care not using urinary testing as a part of one’s treatment could be potentially dangerous.
Mark: Is it okay if I answer the- every question the same way and say It depends?
Lori: It depends. (laughs) this is good. This is really good though. Yes.
Mark: So I would say there are scenarios where without looking into the hood of the urine test, there can be things going on where your thing you’re doing to help is increasing risk of something you don’t want to have, right?
Lori: Yes, exactly.
Mark: So whether that’s breast cancer, Or those types of things because of some of the things that we’re able to highlight. Now, if you back up from that, and I, and I’m, you know, I wanna make sure my words are very careful, because in this industry it’s easy to get confused, it’s easy to get misled. So, there are scenarios where, yeah, you can do proper tests, you proper care of somebody and maybe you’re okay without an advanced test like ours. But I think in a lot of situations in most situations, I think it highlights things that are really helpful to optimize. And then there are some treatment situations where I think it really is critical is what you’re sort of getting at is, and I think when you start getting into the world of estrogen therapy, so a good, a good probably contrast would be progesterone and estrogen. So progesterone is something you can actually take without monitoring. If you look at the studies and you follow the studies, like, you can do okay with that. And the truth of the matter is, and this gets into like complex layers of lab stuff, The main reason you take progesterone is to counter the action of estrogen.
And the main place that’s really important is in your endometrium, as you all know. What goes on there? Lab testing doesn’t really for, you know, complex reasons, doesn’t really speak that much to that. There are other things about progesterone that our test helps to illuminate and it’s helpful, but, you know, you’re in this space of like, Hey, it’s additive. But if this was the only thing you cared about, like you can live without a test as long as you understand what doses, by what route of administration are actually really effective for your situation? Fine. Then you move to the estrogen. It’s like, okay, now we gotta be a little bit more careful because getting the dosing right, depends on how a person responds. It depends on how you’re actually administering the estrogen. And then once you get that right, then you still have the next layer, which is the metabolites because right, I mean, as you both know, where your estrogen goes matters. So there are pathways that help you prevent breast cancer or let’s- I would say more lower your risk of breast cancer.
And then there are pathways that have a direct mechanism of estrogen to an estrogen metabolite, which can actually grab a piece of your DNA and break it off. And now I’ve got an actual sort of mechanism of cancer risk. Causing cancer, but just shifting that risk profile. And that’s part of your job, right? Is the whole reason you take estrogen is because there are risks associated with not having enough estrogen, right? Right. And you’re trying to balance that. You have no estrogen? Man, you’re more likely to break your hip in a few years, and you’re more likely to have other issues that you wanna optimize as people age.
But then once you enter into the world of taking estrogen, now I’ve got other risks that I wanna mitigate, which we can, which is where the testing really comes in. To be helpful is how does my body process that? And if that’s problematic, the great thing is it doesn’t mean stop reverse course. You know, you guys have nutraceutical things and different options for supporting proper processing of estrogen.
So when you add together your intelligence of knowing how to bring estrogen to the table, whether it’s a cream or a patch or a gel or whatever, and then the testing to say, okay, how is this doing for her specifically in terms of getting this right? And then you have some interventions to, you know, to be able to intervene and make sure that someone’s feeling well, but also as optimal as they can be in terms of their risk for all the things that are associated with not enough estrogen, too much estrogen, and then let’s call it like poor processing of estrogen, like poor detox of estrogen. So, and that’s what you guys do really well and we’re super thrilled to be just a part of that process as a tool that you can lean on. You know, a lot of what I do in my time is get research out into the literature so you can actually go and you know, get on your computer and go, oh, here’s, here’s actual research that shows that the things that the DUTCH test says it does. Like they’ve proven that they’ve put that in the scientific literature. And that’s something that I think functional medicine needs to do better. There’s a lot of tools that are used that don’t really have that substantial. You know, underpinning of validation data that’s been peer reviewed, meaning other scientists have combed through that and said, yeah, this is, this is legit in terms of what we’re saying it does and what it actually does.
Kelly: So let’s dig into estrogen metabolism because I think a lot of our listeners may be a little bit naive to that conversation, right?
Kelly: They just assume that they take their estrogen and go about their way, and they either have side effects or they don’t. It’s either gonna work or it’s not, but they don’t really think about how that estrogen processes through the body and what that means for them in the way of risk factors-
Lori: And what they can do about it lifestyle wise, right? Which he brought up. Yeah. That as well. So yeah, let’s talk about metabolites. Tell us a little bit more about why it’s important to really look at these metabolites rather than just looking at our dosing.
Mark: Yeah. So the first question is getting the dose right? Right? You want enough estrogen that it helps, but not too much, right? That’s, and that, and that can be done in some situations with other testing. But I think the DUTCH test, to me is the best for estrogen in terms of getting the dose right. And then as you said, then we move on to say, okay, how am I processing that? So there are two steps of that. So you take your estrogen and it does its thing, and then your body says, okay, what are we gonna do with this?
And so it gets moved into these other metabolites on its way of like, Hey, I gotta get rid of this stuff eventually. And it’s got, let’s just say three different doors that it can sort of open and, and head towards the exit. You got three different exit signs. There’s a 2OH pathway, a 4OH pathway, and a 16OH pathway. Some people like to call them the good, the bad, and the ugly. They’re all sorts of different ways to sort of describe these things, which is helpful because they are very different in what they do. two hydroxy. This 2OH pathway is this good and protective pathway in that if you, when you load that into a system where, you know, a breast cancer is trying to get going, like it’s actually protective against that process.
Hey, we like that, that’s good. On the other hand, the four hydroxy is the one that’s most thought to be most problematic because as we, as I said before, it can actually damage your DNA and can cause an increased risk of having breast cancer, that would be then in that situation directly tied to the estrogen that you’re taking. Right? Which is why you all are obsessed with getting it right, but also getting it safe. Yes. And then the sixteen hydroxy estrogen is sort of this kind of in between, I guess it goes back to the, it depends sort of group in the, it’s a strong estrogen metabolite and so it depends. If you have not very much estrogen at all and you make a lot of it and you say, well, that’s helping me protect my bone. And there are studies that show that, that if you don’t make any of that and your estrogen levels are low, it’s gonna lead to more bone loss, but it’s a strong estrogen. So now when you get more hefty estrogen levels and and estrogen’s heading down that exit pathway, then it’s getting more estrogenic.
So it can, you know, in a premenopausal woman who says, man, I don’t feel well, I’m feeling estrogen dominant. And what do you. She’s estrogen dominant, it has high estrogen, but if she also shoves her estrogen towards that exit, it’s gonna make it worse because that’s a, an estrogenic metabolite that has, let’s just say more of an extra kick for estrogen down that pathway.
So you’ve got your three pathways, they each do different things. One of ’em, we would just. Really like to not see very much of. And then the other one’s considered more good and the other one’s kind of got this dual nature that we want to, you know, balance. You guys talk about balance all the time. So that’s sort of like, which door are you going out? And then there’s phase, part of phase two metabolism is called methylation. So that. That bad estrogen metabolite. When it goes down that pathway, it creates this really reactive, intermediate. So it’s sitting there, it’s on fire, and it’s ready to burn something, so to speak.
And then you have an option. It can either go burn something or your body can do what It’s. Supposed to do, which is detox, that thing, and let’s just say instead of burning something, it gets attached to something that puts the flame out and then out it goes, as you know, into the toilet basically.
And so that process of that protective, what we call methylation, that’s the other. thing that we’re looking at. What are your estrogen levels? Which doorway, where are they trying to exit out to hydroxy for hydroxy 16 hydroxy? And then are we methylating those intermediates to make them safer? And so we can look at that as well.
Like for me it’s, it’s super informative because I suck at methylating, estrogen, every single time I test myself. Why? Because I have, I don’t know if you all do genetic testing, but I have a genetic defect. Let’s say variant. There’s nothing wrong with me. I’m just kidding. That’s right. I have a genetic variant for that enzyme that does that thing.
So when my enzyme says, oh, it’s on fire, I’ll get rid of it. Well, it doesn’t work as well as my wife’s, for example. So I’ve got both broken genes. She’s got both good genes so as you. Yes, guests from genetics. My kids are all one of each. And when you look at my wife’s and my estrogen, like methylation, I suck at it. She’s good at it. And so I need to support that. So magnesium and other, you know, methyl sort of things. And, and, and the thing that’s great about the DUTCH test is it doesn’t stop there, right? Knowing that I methylate very well. Guess what else that I don’t do very well is handle stress because I’m, if I’m making a bunch of adrenaline, well, how do you get rid of it?
Ah, the same enzyme is involved, right?
Mark: And there’s like, I can connect those dots in my own life. You know, at 3:00 AM when I’m not dealing very well with some thought that’s bouncing around in my head. I don’t cool off from that as well as other people because I don’t, so that, that’s the multi-layered nature of what we do is there’s just a lot of really good gems to be found in all of this information. And I’m getting us off track a little bit here, but-
Kelly: so you mentioned, you mentioned Mark phase one detox. Yeah. And you mentioned phase two detox, but there’s also phase three when it comes to hormone balancing, and no one likes to talk about it, but I’m just gonna say it’s pooping, right? Pooping out those hormones. If we-
Mark: I have junior high kids, so not everyone doesn’t like to talk about pooping. (laughter)
Kelly: So we wanna make sure, you know, that people understand the way that we excrete our hormones is actually through bio flow and pooping it. So oftentimes we’re working with someone trying to get hormone balance. If we don’t address that factor, they’re just gonna be recycling those hormones and making those hormones more potent and more problematic.
Mark: Yeah, and that. That sounds a really interesting way that the, the body works. You know, you’ve got your estrogen and it’s gonna do its thing and then it’s gonna go through one of these doors and then it’s gonna get methylated or not in my case. And then it’s like, okay, how do I now, now how do I hit the exit? The real exit, right? Out the toilet. And that is, as you say, the things that are going on in your gut. Really impact that. So you take that thing, you make it more water soluble, like the body can add this little sugar molecule on it. So the sugar molecule says, Hey, now I’m, now I’m able to get outta here. And on its way through the gut, there’s a little enzyme that if your gut’s messed up, you can have a lot of this enzyme. And it says, I’ll take that sugar group, and it pulls it right off the estrogen. And now the estrogen is what? It’s just estrogen. It’s ready to go again. Right. So it’ll circle, as you mentioned, circle back through.
And this is something that has been…. let’s say a blind spot for us in that, as I mentioned, like we want all these windows looking in this house, right? And that’s one where it’s like the shade is pulled here. So what we did is we said we, we need a window into this area. And so that’s why recently July, I think we added Incon right to our, because this, this is my quest is get comprehensive so we can look in, you know, to use a, maybe a bad analogy, but as many windows of this house as we can.
So we say, what’s a marker? Where the science has shown that it, it tells you if something’s going on in the gut that might relate to this. Well, indica is such a marker that when your gut has an issue, indican spills over into your urine. So we started measuring that. Is it a hormone? No. Does it add to the hormone story? It does, yes. And then we, what we actually have just found, I, I probably haven’t shared this with you two yet, but we looked at men and women that have low endocrin, high indocin, and guess who has more estro? The high indocin people. right? Because why? Right? This says, ding, ding, ding, there’s a gut problem, and then on the estrogen’s way out it’s getting recirculated.
And so that’s the connection between estrogen and as you said, phase three. Phase one. Phase two is methylation, and then I gotta get rid of this stuff. And that has to do with gut health, which is why providers like you are so fantastic for patients because you’re not just gonna get narrowly focused and say you have hot flashes, I’m gonna give you estrogen. Have a nice day. Right? Because you know you have to care about how much estrogen and then how am I processing it, and then how am I getting rid of it? And if there’s a gut issue, then gee, if I don’t solve that problem, then I’m really not taking care of the whole patient. And so there is that interconnectedness between all of that.
And that’s what we love about functional medicine is it’s, you know, it’s wonderfully complex and there are just, A lot of layers to sort of dig into so that we can optimize somebody’s health. And I think the really interesting part of being in this in this industry, trying to help people.
Lori: I’m super glad that you mentioned indocin, you also added a neuroinflammation marker. Can we talk about that?
Mark: Sure. We get into the nerdy chemistry stuff. I love it. Yeah, there’s this interesting marker that you make and it’s called quinolinate or quinolinic acid. And it has this really interesting property in that you have this biochemistry, right going on.
A gets turned into B, gets turned into C all the way through whatever letter, and one of those is quinolinic acid. And when you make it, it just gets turned into like almost nothingness. Like it gets turned into this, you know, other biology that’s just like sort of gone, right? And so, well that’s not interesting, except that it’s made and influenced by inflammation.
Well that’s, that’s good to have, you know, a window into inflammation. But the things that process it from that step and beyond are present in your body, but they’re present in your brain. Which means when you make quinolinic acid not in your brain, it just keeps cruising from A to B to C. And you know, it’s one of those intermediates. But when it happens in your brain, it stops like that’s the end of the road. And so it becomes then this indicator of, well, wait a minute, if this is spilling over into my urine, that means I’m pushing things in this direction in my brain specifically. And so it becomes this marker of neuro-inflammation. Now it’s not that simple. There are other reasons that it can be elevated. So, you know, if you ever talk to people about plastics and plasticizers, pthalates which are I think a particular interest of mine, have always found them interesting cause they, they really mess with the chemistry of making hormones. So women who are exposed to a lot of ’em when they’re pregnant, their baby boys are feminized. Like physically feminized because of this. It’s like taking anti-testosterone. And so it’s just something that you don’t wanna be exposed to. And there’s a whole story to that. But if you are exposed to it, quinolinic acid, for whatever reason, I can’t remember the biochemistry around that, but it can be increased for reasons like that. But if it’s high, you want to pay attention to it.
And if you’ve got neuroinflammation going on, obviously that’s not gonna be a good situation for your patient. And you know, you all know how to address those things. So yeah, that’s one of our our newer markers is indocin for the gut, quinolinic acid for neuro inflammation, and then we added one also for biotin deficiency and that Alan tied into the hormones really interesting- interestingly as well in that we have a lot of women who struggle with hair loss.
Mark: So sometimes P C O S sometimes not, but if you, you know, if you’re I mean, I lost my hair. I deal with it. It’s not that big a deal. , I’ve, I’ve gotten over it. This is only audio, so that’s, that’s better everyone, just listen to me.
Imagine I have this nice head of hair, but I don’t. But you know, as a female, like this can be like life changing when you’re struggling with losing your hair. And so I’m not an expert in that per se, but three of the, the things you might think about would be thyroid, which that’s not us. It’s related to our testing. And if you’re doing hormone health, a lot of times you’re doing a thyroid panel, right. And then there’s the whole testosterone metabolism. So we all know testosterone, it’s the boy hormone, but girls have some too. They just have about 10 times less. And then there’s this metabolite, right? Dihydrotestosterone. It’s three times stronger than testosterone. And your testosterone either gets pushed towards that or gets pushed away from it. And that’s something you can see in our testing is am I doing that? Am I making testosterone into dht? And as a man, that plays into prostate health and there’s some interesting storylines there. But as a woman, the main thing that I’m caring about, there are symptoms of high testosterone. If I turn testosterone into super testosterone, Then I might have acne but also might have hair loss. When this stuff gets made in your hair follicles, you lose your hair. And so that’s something you might wanna look at.
And that’s been a thing that people have explored with the DUTCH test since the beginning is I got my thyroid panel, I got my DUTCH test, and then it got us to thinking, well, hmm. What if you have this big biotin deficiency that is silent, like you don’t know about it, that can cause hair loss as well. So that’s why we added that, is because it adds one thing to that story that if you’re missing, that you’re not going to succeed. Right? So it’s not a hormone, it’s not directly related to hormones, but it’s related to your patient’s hormones story. And so those are the things that, that we specialize in adding is, yeah, everyone knows testosterone, everyone knows estrogen, but there are these other things that add to the story in a, in a really substantial way. So again, you’re just more likely to find the right solution for your patients if that happens to be, you know, something that they’re dealing with.
Kelly: So, Mark, I wanted to dig into and, and just say, first of all, I appreciate the fact that from the time I started doing DUTCH testing, you’ve added a lot of biomarkers to the table. Right? One of my favorite things on the DUTCH Plus is actually the CAR. The cortisol awakening response. I mean, I just feel like that’s been a game changer for insight on how someone is managing their stress, how resilient they are. Talk to us a little bit more about that. You mentioned that in relationship to breast cancer risk earlier you kind of alluded to it, but we really didn’t get into that.
Mark: Yeah, it’s a really interesting marker. And it’s it’s a math marker. It’s a, it’s a change. What I would love to know, if you came into my office and I was a doctor, which I’m not, you know, I’m a chemist, but you know what I’d love to know. I’d like to look your stress hormone, and then I’m gonna open my closet and I’ve got, you know, I keep a bear in there, and the bear chases you around the, the, the room. And then what happens? Well, you just had a stress event, right? So your stress hormone’s gonna go up and then I’ll put the bear back in the closet and I’m gonna, you know, test your cortisol again. And then I can look and see how much did it change. Because when you have. If you respond appropriately? Hey, good job. Now, don’t, don’t spend your whole life being chased by a bear, right? That’s a lesson you probably give your patients. If you’re stressed all the time, you’re gonna have problems, right? If you’re stressed, your cortisol’s gonna go up. That doesn’t mean something’s wrong, necessarily. It means like you’ve got some lifestyle issues to work on now.
If the bear chases you and your cortisol goes up more than the average person, okay, now you have an overactive stress response and there are consequences to that, right? But bears are expensive to feed, obviously, and keeping them in your closet is rather difficult. And so we have a trick, and that is that the event of waking is a stress. Right? So the, the biochemistry, the things that go on in yourself happen when you wake up. They also happen when the bear chases you. So what we’re able to do is we take a saliva sample. So we have these little cotton swabs. You just stick in your mouth and kind of chew on a little bit, and it takes a little bit of saliva.
So what we wanna do is wake up and take one. And what does that tell you? It tells you you’re waking cortisol. And then when you wake up, the eye hits the back of your light. And all this really complex biochemistry goes on that I have a hard time explaining even to myself, let alone somebody else. It’s complex, but it’s the same type of thing that goes on when the bear’s chasing you is it’s the whole like, Hey, get alert for the day.
Right? Let’s go. Because hey, life is, there’s a certain amount of stress in life that you don’t have while you’re sleeping. And that, so that process we can. We take a saliva sample right at waking that says, this is your baseline. Right? And then we take another one 30 minutes later. So both of those points are interesting.
Maybe the first one’s low. Hmm. That means something. Maybe it’s high. That means something. Same thing with the second one. But what the research is really clear on is the gap itself, right? That stress bounce as you get up is itself connected to health, connected to like, if it’s too big. Getting major depressive disorder, you’re more likely to to get depressed.
And if it’s flat, right, so you wake up, the light hits the back of your eyes, I’m distressed and ugh, my response is sluggish. Then you’re more likely to be someone who’s tired and fatigued. and not just tired and fatigued. Tired and fatigued because of what’s going on with your adrenal hormones, Cause that’s the important thing, right? Tired and fatigued is one thing, but we, that’s what functional medicine’s all about, is asking why questions till we figure out the source of it. And that’s a really important tool, the cortisol awakening response. So the car is really important. So we look at cortisol in urine, we look at it in saliva. We have our sort of a two different tests.
DUTCH complete is urine, DUTCH plus is saliva. And then we combo that with the urine and that gives you a lot of information. So in either test, I can see this up and down pattern. I wake up, my cortisol goes up when I go to bed. It sure better be a whole lot lower, right? This up and down pattern throughout the day is really important. Now with the breast cancer angle is flatness. Flatness with cortisol is bad for people who have. In terms of their survival, like it, it points to some dysfunction that correlates, and I couldn’t really speak that intelligently to the cause, per se, of why your risk is then increased of not doing well. But the flatness of cortisone is bad, right?
You have this dynamic pattern of sleep, wake, sleep, wake. And your cortisol, your stress hormone goes with that up in the morning, down at night. And when that is dysfunctional, you have an issue. You can see that in urine, you can see it in saliva. The car is an additional variable on top of that. That is like really zooming in on that first 30 minutes of the day as you transition. When you wake up, you’re awake. But are you alert? Right? Not really. Like that’s a process. Right? And that’s what that speaks to. And the word that people really like to use with that is, and you mentioned. Is resilience, right? If I’m, you know, some of our docs like to talk about a, a trampoline in terms of like, if you think about a trampoline and a stress event and your body responding and a stress event and your body responding, how bouncy is your stress response in terms of resilience?
Cause we’re, we’re not meant, I mean like is stress, right? We’re meant to be stressed, to respond and then come back to baseline and life goes on, right? It’s. Repeated hits of stress or constant stress that is never relieved, that can really wreak havoc on how your body just manages all of that and how all of that works.
And the testing can be really, really informative in terms of, you know, sort of what flavor of dysfunction you might have. As it relates to those hormones, and that’s, that’s our game, that’s what we’re trying to do is paint that picture for you, the provider so that you can help the patient as best as possible.
Kelly: Yeah. So from a consumer standpoint, I think the question would be why not just do a salivary cortisol over a 24 hour period looking at four points versus doing the urinary, where we can see the metabolized cortisol versus the free Right. That’s, so what insight do we gain from that perspective.
Mark: That’s the story we started with, with you all. I mean there’s the H R T thing. The other big thing we do is cortisol. And that, that was the single variable that really led me to develop this testing method is everyone’s looking at cortisol patterns, and rightly so, right? They’re important, but the cortisol that we measure, while it’s the most important thing to measure cortisol itself, it’s only about one or 2% of the total that you make throughout the day.
And so what we discovered from looking in the scientific literature and just playing around in the lab with all kinds of measurements over, you know, years and years and years, is that there are downstream metabolites of cortisol. And if you want to think about it as just a bucket that catches all your cortisol you make, and at the end of the day you go look in the bucket and say, Hey, how how’d . I do and. . Sometimes that can be really informative, particularly in cases where patients are really clearing their cortisol at a rate that’s sort of abnormal. So the way I discovered that was looking at the cortisol metabolites and cortisol patterns. So you have cortisol. That’s cortisol itself. That’s free cortisol, the thing that does the action, right?
We’re measuring that. And then we also measure the metabolites. That’s the bucket at the end of the day that says, here’s how much you actually made. And what we noticed is that in people who were obese, just as an example, they had like contradictory stories. A lot of ’em had low levels of this cortisol.
And so then what do then, what all our providers have been saying for years and years and years is a statement like this, you don’t make very much cortis. And then you look at the metabolites and if the metabolites are also low, you say, yep, that’s what I said. That confirms the story. I already told myself. And what we found in these obese patients is, we’re wrong almost every time. And that you look at item and the metabolites are really high and you say, hold on, like, what is going on here? And then as you dig into the, into the research that’s been done, you find that as a person gets bigger, The cortisol doesn’t really move in terms of just looking at a whole bunch of skinny people and a whole bunch of bigger people.
You know, as individuals they’re very different, but as a group of people, they’re pretty much the same. And then when you look at their metabolites, very, very different. The heavier people have all these metabolites. And so that’s, there’s a story there that they’re making a lot of cortisol, fat loves cortisol, and so it sucks the cortisol, your adrenal gland makes the cortisol and says, Hey, I did my job. And then those fat cells say, you know what? I’ll just hold onto that. And it ends up in the toilet as a metabolite, and this is going on all day long. So these people, they’re adrenal glands are pumping out more and more cortisol so that what’s in your brain and your elbow and your wherever is at. Like an appropriate level, but you’re just cranking it out.
And so that has added a lot of insight for us, for the doctor to know what’s going on with a patient. And I could give you a, a quick example of a case where that was really, really helpful and that is that obesity. gives you this sort of look of lots of metabolites and maybe not that much cortisol. And the other thing that will give you that same look is jacking up someone’s thyroid, right?
So, oh, your thyroid’s low here. Take some of this, actually take a whole bunch of it. So if you put someone on too much thyroid medication, it just tells your body like, go like mad. And so your, your liver’s gonna take all your cortisol and metabolize the heck out of it and turn it. These metabolites and they end up in the toilet and you end up in this really imbalanced situation where you’re making lots of cortisol, but you’re just cranking through it.
So we had a patient a while back that tested and she had really low cortisol and really high metabolites, and I said, what the heck is going on? She said, well, you know what makes it look like that? I’m like, well, obesity. But she was super skinny. And I said, you know, if you have really high thyroid, that’ll do it. And she said, well, that’s not me because I’m low thyroid, and I’m like, oh, well now I don’t look very smart. And then she called me back that night and she said, you know what? I do have low thyroid. And so my doctor put me on thyroid and said, here’s your thyroid. Take it once a day. And I heard, here’s your thyroid take it twice a day. And so she had been doubling up on her thyroid medication. She had induced hyperthyroidism, right? And so what’s her body doing? It’s going, oh crap, I’ve got all this thyroid. I better get rid of it. Just turned your cortisol burning, if you will, into overdrive. And so the looking at the DUTCH test was really insightful to say, here’s what can cause this look. And as they, they dug into that with the provider and the patient, it was super insightful. They fixed her thyroid, we retested her. And what do you know? Not only did she no longer have these low cortisol levels because she was burning through ’em, they came back. Even more than that, they were high. It was like, okay, here’s someone who, who has identified as, gee, you don’t make enough cortisol with like old school testing that we would’ve done, but with the DUTCH test, we’re able to say, hold on. This is a more complex story. You’re burning through your cortisol. Let’s investigate that. They investigated it and then when they retested her, she’s actually like on fire as far as her adrenal. She needed to get her cortisol down and her stress response down and do some lifestyle maintenance, but they couldn’t even like get to that point because of this little issue. Really was a big issue in terms of getting her medication right with her hormones. So those are the types of insights that we love to see in people in terms of like having the testing being profoundly, you know, differentiating in terms of specifically what’s going on, you know, with a patient so they can get to the bottom of their issue and, and get back on track towards wellness
Lori: And what you just said. There was such a mouthful, but I have to go back and say it’s taking the right test and pairing that with the right provider of care. Taking the right history and the time listening to understand, to then be able to make the changes. And you know, I think sometimes in traditional medicine, we lean just to diagnostic testing, right? We say the 80/20 rule, 80% diagnostics, 20% history. We’re in functional medicine that’s switched back. 80% history, 20% diagnostic testing, choosing that right test to get the right outcome. And I just, I, I wanna say that again, is, there’s a lot to unpack in that test. And I love, I love, love, love. I’m, I’m a scientist too.
And you’re in good company because I’m a meth- I’m a poor methylator too, by the way. So yeah, you’re in good company, but I just wanna say that I really appreciate and value what your. I feel like your test allows me to be the clinician that I can be because I have access to it and I feel like my patients hands down. They’re lucky to have access to both of those. The good testing and the history, you know, that we have as well as we’re thankful for the education that you give us too, over time, right. You know, that we’ve, we’ve been able to take advantage of.
Kelly: It really allows us to leverage what lifestyle can do to change, change the landscape for that patient. Metabolically speaking, hormonally speaking.
Kelly: To be able to point it. This is where the challenge is. Mm-hmm. . And these are the things that we can do to improve that challenge. Whereas before that same patient you were talking about that had low cortisol, but high metabolites, that patient would’ve gone on perhaps adrenal glandulars. And we would’ve just been fueling the problem. instead of correcting the problem, right? Because we weren’t looking through the right lens.
Mark: Yeah. And that’s, I mean, the, the care that you all take of like addressing lifestyle where you can and starting with that and then, you know, moving through those sort of different variables that you’re looking at with the breadth of knowledge that you have is, you know, your patients are, I think, really blessed to have providers that care that much, but also have that expansive knowledge in, in those things because, you know, ultimately, I, I think you’re always sort of guessing, right? Like you never get comprehensive information about whatever, you know, you don’t get to walk around in the house, right? You get to look and make observations and ask questions and all of that. And ultimately, we’re always like our, our certainty increases with all of the information that we have, but it’s never complete. And I think that’s what we are really trying to do with people is just increase the certainty with which they’re making the conclusions that they are, which leads to the treatment that they take.
And sometimes it’s a major shift from the initial guess of like, oh, you’re tired, it’s probably this. And then as we dig into these things, it’s, oh, this is, this is not only more complex, but it’s this nuanced issue that you all have solutions for. But if you don’t know specifically what the problem is then obviously it’s not easy to find the right solution for that patient because, you know, hormones are complex, life is complex, but the more information that we can give and the better that we can train the people out there in the, the specialty that we have, then we just love that aspect of what we do. And we, we wish we could hear more and more about the end stories that you all get to experience when people come back and say, “Hey, the intervention that you gave me is, is making a huge difference and impact in my life.” And that honestly, those stories are really the primary thing that fuels our entire company.
I mean, we loved hearing about, you know, people’s lives change because of what we’re doing. So it’s great to, to hear what, what you guys are doing, how far you’ve come and, you know, in your practice with using all of these tools, one of which just happens to be what we do. And we, we love doing it.
Well, thank you so much for dedicating your work to just, you know, what you bring
Lori: about at DUTCH. We really appreciate it. We know it’s blood, sweat, and tears, I’m sure. Right? Blood, sweat and tears, years.
Mark: There’s a whole lot of urine around here. Yeah. (laughter)
Kelly: So, yep. So, so tell us a little bit about, as we close, what way in which, if, if consumers are, are looking at people listening to this that don’t know Kelly or myself, but are listening to this podcast, how do they hear more about the DUTCH test?
Mark: You can go to DUTCHtest.com. We have a lot of information on there. We’re a little bit unique I think, in that we’ve put a lot of information out there, just generally that’s not behind a curtain for providers. So patients can do a lot of just nerding out and digging into some of these different topics and things that are, that are really interesting to learn.
And in some of those you’ve learned about yourself, there’s a lot of information there. And then we have a find a provider function, so people that aren’t in your neck of the woods that are looking for someone to work with. I, I do. Honestly, I love our test. I think it’s super important for people to get all that information, but the number one variable, honestly, is to find a competent provider who knows what to do with the tools that are available to walk through that journey with a patient towards wellness.
Because there are a million different paths that you can take to move from your whatever dysfunction you might. You know, towards wellness, and I think using the right tools and, and having the right training, partnering with someone like that is, I think can be the biggest like game changer for people who are struggling with things that may have to do with things like hormone health.
Kelly: All right, Mark, thank you so much.
Lori: Thanks so much for listening to today’s episode. You can find more information about Synergee at Synergee4Life. That’s S-Y-N-E-R-G-E-E, the number four life.com. (synergee4life.com)
Kelly: And then Synergee Connect is our Facebook. And then please make sure to follow us on your favorite podcast app so that you make sure you get future notifications of episodes.