The DUTCH Test will now include organic acid tests (OATs) at no additional cost

In their continued effort to innovate and improve, DUTCH have now added six organic acid tests (OATs) to the DUTCH Complete™ and DUTCH Plus™ panels.

Three neurotransmitter metabolites will offer insights into symptoms such as mood disorders and fatigue, and will be combined with markers for vitamin B12, vitamin B6 and glutathione deficiency. These changes have come into effect from January, 2018.

These new markers make DUTCH testing the most comprehensive overview of patient-health available in one test.

New Additional Markers

NEUROTRANSMITTER METABOLITES

These organic acids are the primary metabolite of dopamine, norepinephrine and serotonin. Patients with an imbalance in these neurotransmitters may experience symptoms that are also common with an imbalance in hormones. Hormones (cortisol and estrogen are examples) included in DUTCH testing also directly alter some of these metabolites, so their inclusion provides an even more comprehensive picture of your patient’s hormone health.

HOMOVANILLATE (HVA) | PRIMARY METABOLITE OF DOPAMINE

If dopamine in circulation is low, HVA is usually low. People with low dopamine often report fatigue, low motivation, depression and addiction issues. These symptoms are similar to those with low hormones. Conversely, if there are low levels of SAM, Magnesium, FAD and NAD, dopamine cannot be converted to HVA. In these cases, HVA may be low even though circulating dopamine levels may be normal or elevated.

VANILMANDELATE (VMA) | PRIMARY METABOLITE OF NOREPINEPHRINE/EPINEPHRINE

Cortisol, DHEA and norepinephrine/epinephrine are all released from the adrenal gland at different layers. A marker of the “other” major adrenal hormone gives providers more insight into adrenal and HPA axis function. If norepinephrine/epinephrine in circulation are low, VMA will usually be low. Epinephrine production (from norepinephrine) is actually a cortisol-dependent reaction and measuring VMA along with adrenal hormones enhances DUTCH adrenal testing even more.

5-HYDROXYINDOLEACETATE (5HIAA) | PRIMARY METABOLITE OF SEROTONIN

Many people use the DUTCH Test™ to understand symptoms such as fatigue and depression. While low hormone values can cause these symptoms, serotonin deficiency can also contribute significantly. High cortisol or estrogen can influence tryptophan metabolism to move away from the serotonin pathway, so 5HIAA levels may be particularly relevant to DUTCH testing. Low serotonin can also lead to low melatonin, which is a metabolite of serotonin and included in DUTCH testing.

NUTRITIONAL ORGANIC ACIDS

These organic acids act as functional markers of nutrient deficiency. When the body has inadequate cellular levels of vitamin B12, vitamin B6 or glutathione, levels of their corresponding organic acid build up and spill into the urine. In some cases, these markers are more effective than measuring the nutrient directly.

METHYLMALONATE - Marker for VITAMIN B12

OTHER NAMES | Methylmalonic Acid or MMA

RESULTS | High MMA = Low Vitamin B12

SYMPTOMS OF VITAMIN B12 DEFICIENCY
Fatigue, brain fog, memory problems, muscle weakness, unsteady gait, numbness, tingling, depression, migraines/headaches and low blood pressure.

TREATMENT OPTIONS
Common foods high in B12 include beef liver, sardines, lamb, wild salmon, grass-fed beef, nutritional yeast and eggs. Supplementation may be advised.

ADDITIONAL INFORMATION
This marker is considered superior to measuring serum B12 levels directly. A 2012 publication by Miller showed that 20% of those tested had a genetic defect in the protein that transports B12 to cells. These patients may have a functional B12 deficiency, even if serum levels of B12 are normal.

XANTHURENATE - Marker for VITAMIN B6

OTHER NAMES | Xanthurenic Acid

RESULTS | High Xanthurenate = Low Vitamin B6

SYMPTOMS OF VITAMIN B6 DEFICIENCY
Changes in mood, such as irritability, anxiety and depression, confusion, muscle pains, low energy, or fatigue.

TREATMENT OPTIONS
Food high in B6 include turkey breast, grass-fed beef, pinto beans, avocado, pistachios, chicken, sesame and sunflower seeds. Supplementation may be advised.

ADDITIONAL INFORMATION
If levels of estrogen or cortisol are high, it may exacerbate xanthurenate elevations and increase the need for B6. Xanthurenate complexes with insulin and decreases insulin sensitivity. Xanthurenate can also bind to iron and create a complex that increases DNA oxidative damage resulting in higher 8-OHdG levels. If both markers are elevated, there is likely an antioxidant insufficiency.

PYROGLUTAMATE - Marker for GLUTATHIONE

OTHER NAMES | Pryoglutamic Acid

RESULTS | When levels of pyroglutamate are high or low, there may be insufficient glutathione.

SYMPTOMS OF GLUTATHIONE DEFICIENCY
Glutathione is one of the most potent antioxidants in the human body. It is especially important in getting rid of toxins and can protect against cancer, aging, heart problems and brain diseases.

TREATMENT OPTIONS
High-quality lean protein, fresh fruits and vegetables, spices, increase alpha-lipoic acid, increase selenium, or add a multivitamin with glutathione-supporting vitamins.

Considerations and required food restrictions:

There are certain foods, medications, and supplements that can artificially increase the levels of the neurotransmitter metabolites. Precision Analytical suggest patients avoid the following foods the day before and the day of collecting: avocado, bananas, eggplant, kiwi, butternuts, pecans, walnuts (and their associated nut butters), pineapple (and pineapple juice), plantains and plums. Patients should be aware that any medications or supplements that affect neurotransmitters such as antidepressant medication (SSRI’s, SNRI’s), 5-HTP, tryptophan, SAMe, tyrosine, L-dopa, D, L, phenylalanine, macuna, St. John’s Wort and quercetin may also affect the results. Patients should consult with their healthcare practitioner before stopping their use. Medications such as SSRI’s and SNRI’s should not be skipped or stopped suddenly unless under medical direction.

All DUTCH collection kits now include instructions for patients to restrict the list of problematic foods (above). If you have an existing collection kit that is missing this information, please contact the Research Nutrition office to request the food restriction handout for your patients: support@researchnutrition.com.au • Ph 1800 110 158.

Free Webinar presented by Dr. Mark Newman & Dr. Carrie Jones

In this 90 minute recorded webinar, Dr. Mark Newman and Dr. Carrie Jones cover what organic acids can tell you about your patients, and how they integrate with the other information given on the DUTCH reports.

As always, the Research Nutrition technical support team is available to answer questions and make sure you and your patients are getting the most from these tests.