In this episode of The Dr. Hedberg Show, I interview DUTCH test founder Mark Newman. We covered a lot of detailed information about hormone testing and why the DUTCH test is superior in many ways to other forms of hormone testing.
Here is a transcript of my interview with Mark Newman on the DUTCH Test
Dr. Hedberg: Okay, well, welcome, everyone. This is Dr. Hedberg and welcome to "The Dr. Hedberg Show." I'm excited today to have Mark Newman on the show, and Mark is the founder of Precision Analytical. This is a lab that I've been using, I think, pretty much since the beginning, but Mark is a recognized expert and international speaker in the field of hormone testing. He has assisted many labs in developing novel tests to create world-class laboratory testing. He's also educated thousands of providers about hormone monitoring best practices. Welcome to the show, Mark, thanks for coming on.
Mark: Yeah, glad to be here. It's good to chat with you.
Dr. Hedberg: Why don't we start with you just filling everybody in on what you've been doing and what you've been working on with your testing?
Mark: Sure. The tests that we do and most people know it by its acronym, which is DUTCH, so it's a Dried Urine Test for Comprehensive Hormones. It's kind of a culmination of everything I've done career-wise vocationally in this world of hormone testing, starting off developing and working on 24-hour urine testing and kind of taking a good look at that in terms of the pros and cons. And then moving on to blood testing and saliva testing and governed over about a million of those tests over a five or six-year period. And what we've been doing the last five or six years is trying to piece together a little bit of a better model for people to get more information when it comes to reproductive and adrenal hormones.
You know, saliva testing has its advantages and blood testing has its advantages, and we've tried to combine all of that into one model that people can use to get a lot of information. So, we've got a uniquely comprehensive look at your adrenal hormones and your reproductive hormones and that's what we did and launched in about 2000, early 2013. I think you were kind of one of the first to jump on with us, which we've, of course, appreciated. And since then, we've been looking at this puzzle and saying "Okay, what else can we add to this to add into the picture?" So, we added a melatonin marker, we added 8-Hydroxydeoxyguanosine for an oxidative stress marker.
And then we've recently added a handful of organic acids so that we can see B12 deficiency, B6 deficiency, glutathione deficiency, a window into the neurotransmitter world. Because those all have a lot of crossover with the hormones and our goal and my goal is really just to give people the best most cost-effective tool they can for when you're dealing with functional medicine, integrative medicine and just some of these tough cases where you've got multiple things going on and we're trying to figure out as much as we can about those patients so that we can treat them well.
Dr. Hedberg: Yeah, I was really looking forward to this interview so we can really delve deep into some of these areas. So, like you said, I think I was one of the first to start using the DUTCH Test and like a lot of practitioners out there, I started with saliva and blood. And then I had done some 24-hour urine, but that always was a little bit difficult to get the patient to do all 24 hours of collection. And then with that, we didn't have the cortisol rhythm that we have with the DUTCH Test. So there were a few disadvantages there, but why don't you give us a general breakdown of the advantages of urine compared to saliva and blood testing?
Mark: Sure. Yeah, I mean, I think historically, if you're trying to use something for its biggest advantage, then you're really better off, if saliva and blood are your options, you're really better off going to saliva to look at cortisol. Because you want to look at not just free cortisol, which you're not typically getting in blood, but you want to look at free cortisol at multiple points throughout the day, right? Blood cortisol is not a useless test, but it really tells you so very little, and we could go into the specifics of that, but it's just well-documented that going to saliva to get free cortisol over time is better. But then when you look at the reproductive hormones, there are very significant advantages to testing the blood over saliva, and I would point mostly to the problems in testing estradiol.
And that is, you know, with no disrespect to the labs that are doing the test, there's just so little hormone in saliva that your ability to differentiate between "sufficient" and "deficient" is really just not done well enough for us to make decisions. So just as an example, I can think of a very prominent lab that does a good job with lab testing, but if you look at their saliva assay, the estradiol range for postmenopausal women and premenopausal women is essentially the same. So what I'm saying is when we test otherwise healthy people who are estrogen-deficient and estrogen-sufficient, we get essentially the same values.
And when you look at those in blood, there's a full tenfold difference between those two groups, so blood is a much more accurate way to test reproductive hormones, typically. So what you're gonna do, you use both, you got to kinda pick and choose. And what we've shown is that our pattern of free cortisol in urine parallels saliva very well, and we just about got in print our correlation data for reproductive hormones, particularly the female ones, between our urine testing and blood testing.
And one of the other things about blood testing is, well, the numbers, I think, are better than what you're gonna get in saliva, I was just reading a paper actually last week where they tracked a woman throughout a day, and her progesterone varied from 5, which is really on the lower end of, you know, in ovulatory number, all the way up to 35 throughout the day, so it's bouncing all over the place throughout the day. With a urine test, you can average that out and get a truer picture of what their production is.
So, our goal is to give you a viable alternative for those reproductive hormones and the cortisol pattern and the reason that that was my angle when we started working on the DUTCH Test is because once you've established that, now you can open up your panel to everything else that you can do in urine, which includes your estrogen metabolites. So not just estradiol, but, you know, phase 1 metabolites, 2-hydroxy, 4-hydroxy, 16-hydroxy, then you can look at methylation, which is a part of phase 2. And the same story for the androgens, you can look at the hormones, but also the metabolites to see if they're pushing down that highly androgenic 5-alpha pathway like you see in PCOS patients and other situations.
And this story continues to unfold for cortisol and other things. As looking at the metabolites, just adds a lot of value to try to figure out what, really, someone's story is as it relates to that hormone and then when you continue on melatonin, 8-hydroxydeoxyguanosine, organic acids, you just got a really, a comprehensive look that just isn't there with those other tests. Although, having said that, you know, if I've got a testosterone injection and my only goal is to get a good testosterone value on a guy, a blood test is a great way to do that. To get a total in a free testosterone, you know, that works well. If you just want to look at that free cortisol pattern, you know, saliva can do that quite effectively. But when you want to get comprehensive and really see what's going on, that's where, for me, urine brings a lot of value because you're getting everything that you had in those other tests, but you just add, you know, so much more.
Dr. Hedberg: Yeah. I always felt the least comfortable with saliva, the most comfortable with blood and urine, blood especially with testosterone and then urine with the adrenal hormones. But like you said, for me, there was, all was...there just always seemed like there was a lot more to look at and then when the estrogen metabolism markers came out and that became an individual test that was available, I started getting interested more and more into that. And that's something that the DUTCH does test for, so can you talk a little bit more about estrogen metabolism and if there's any advantage to adding those metabolites?
Mark: Sure. Yeah, the metabolites, to me, have kind of two or three different angles. One is, and this is another benefit of urine testing, is if I'm gonna call you estrogen-deficient or estrogen-sufficient or whatever, it's sure nice to have more than one marker, right? So, if I'm looking at, now we have 10 estrogen metabolites, right, when they're all tanked in that postmenopausal range, like, I know who you are as it relates to estrogen. And if there are high, like, that's clear, too, but when you get some of these weird cases where they've got some unique patterns, it's sure nice to see a lot more to just confirm where that patient may be as it relates to just not enough or enough or too much.
But then there's another story that we often see and that is what if your, the reason that you have too much estradiol is not because you're making too much, but because you're not getting rid of it properly. I've had a number of friends who, you know, have come to me and they're just not feeling right and it sounds like estrogen dominance. "Okay, we could just put you on a treatment of, you know, calcium-D-glucarate and high fiber diet and try to get rid of inflammation and maybe some DIM and some of those things." But then we test them and we see is, "Okay, your estradiol is high, but all of your phase 1 metabolites are low."
So, here is a picture of a woman who is making just a decent amount of estrogen,
