Participants of Dr. Jones’ 2018 events (Finding Balance with Hormones full day workshop in Sydney, and Hormonal Dysregulation seminar in Perth) had the opportunity to ask Carrie some follow up questions following these events. These questions and her responses are below.
Click on the question to view Dr. Jones’ response
The DUTCH test provides information on Oestrogens, Progesterones, Androgens and Cortisol within the one test. This test not only reveals the levels of basic hormones, but also their upstream and downstream metabolites which provides information on the root causation of imbalances and therefore helps to target treatment protocols. Although the levels of the various hormones and their metabolites are highly changeable during peri-menopause, as well as different for each individual, the DUTCH test can reveal critical information which can be utilised to specify treatment and manage symptoms.
Testing for the DUTCH test will depend on the regularity and irregularity of the patients cycle. If the patient is somewhat irregular, it is ideal to utilise LH strips to detect ovulation. Once positive, count forward 5-7 days and perform the DUTCH test.
If the patient is highly irregular e.g. menses every 2 weeks, followed by several months without menses etc., further instructions are indicated. Please contact the RN Labs’ technical team to further specify the instructions for such a patient.
The CAR is useful due to its ability to offer a more precise reading of free cortisol. The CAR records waking cortisol, 30 mins post waking cortisol and 60 mins post waking cortisol, to record the overall cortisol patterns in the first hour.
When we open our eyes upon waking, cortisol levels naturally begin to rise by an average of 50%. 30 minutes after waking, cortisol levels will still show this sharp increase. By 60 minutes after waking, cortisol levels have peaked and begin to decline. Measuring this rise and fall of cortisol levels at waking can be used as a “mini stress test”. Research shows that the size of this increase correlates with HPA-axis function, even if the sample measurements are all within range.
A low or blunted Cortisol Awakening Response can be a result of an underactive HPA axis, excessive psychological burnout, seasonal affective disorder (SAD), sleep apnea or poor sleep in general, PTSD, chronic fatigue and/or chronic pain. A decreased CAR has also been associated with systemic hypertension, functional GI diseases, postpartum depression, and autoimmune diseases.
An elevated Cortisol Awakening Response can be a result of an over-reactive HPA axis, ongoing job-related stress (anticipatory stress for the day), glycemic dysregulation, pain (i.e. waking with painful joints or a migraine), and general depression (not SAD).
A recent study showed that neither the waking nor post-waking cortisol results correlated to Major Depressive Disorder, but the CAR calculation (the change between the first two samples) did. This measurement of the response to waking has independent clinical value showing dysfunction that may be hidden by current testing options.
Overall, the Complete test is not the same as the Plus as far as free cortisol is concerned. The Complete test offers a more comprehensive insight into free cortisol and therefore further insights into the HPA Axis.
It is ideal to use both forms of information. The pie chart represents the ratios of the different oestrogens that are approaching detoxification. Therefore if a patient has a high level of oestrogen in their system (E1 and E2 are in the red) coming into Phase 1, then it’s possible for all the phase 1 dials to be in the red range while the pie chart showcases normal percentages due to ideal distribution.
While this means the distribution of 2, 4 and 16-OH is acceptable, the absolute number of 2, 4 and 16-OH may still be too high/low. It is not ideal to see the absolute number of 4 or 16-OH in the high range regardless of the distribution.
Specifically if 4-OH is not methylated, it has a high chance of becoming a Quinone (which is a reactive oxygen species) and then a depurinating adduct (increased cancer risk).
Therefore it is useful to take both the pie chart and the absolute numbers into account. Overall, the pie chart represents the ratio of 2, 4 and 16OH and is a useful indicator to evaluate whether the ratios are in the ideal ranges. However, the absolute numbers offer the actual levels of hormones, which ideally should be within range, regardless of what the ratio may be.
Furthermore, optimum methylation is ideal in either case otherwise there is an increased Cancer risk.
Ideal supplements for supporting methylation would include: choline, methionine, magnesium, liposomal glutathione, sulforaphane. Furthermore, low doses of B vitamins are also useful. Do not use folate initially. There is also a chart by Ben Lynch which further showcases what other factors may be influencing the situation such as infections, inflammations, heavy metals, gut issues, stress…etc.
Furthermore, oestrogen dominance slows down COMT, therefore increasing fibre, supplementing calcium-d-glucarate and other gut supportive nutrients to support oestrogen clearance via various pathways is also useful.
Reducing overall chemical impact is also a necessary aspect of such treatment. Reducing the presence of endocrine disrupting chemicals though avenues such as skincare, household cleaning chemicals, lawn care/gardening, how the patient cooks, the food the patient buys, water filtration, the presence of plastic lids with coffee/tea etc., is also an a major focal point for such patients.
As there are no set guidelines on how to rectify such mechanisms, treating the patient and changing treatment as required is the ideal form of action. This is the same for treating with a blood work or salivary testing.
For example in a patient who had high cortisol during a rheumatoid arthritis flare up, treatment for lowering cortisol levels resulted in worsening of symptoms – clearly the high cortisol was helpful at that time.
Thyroid extract may be an option depending on the individual at hand. If the thyroid extract corrects the thyroid imbalance then it may correct imbalanced cortisol levels as well; if thyroid issues were the only reason for the cortisol imbalance.
However, a patient may shift into another pattern of hormonal imbalance, as the thyroid may start functioning appropriately but other aspects of the HPA that may not be functioning well may come to the forefront.
If the Mirena is inhibiting ovulation, then the progesterone will be low. Please refer to slides for further information.