DUTCH Plus®

Sometimes patients do not collect samples correctly or don’t capture the scenario they were hoping to measure. New collection kits are free, with shipping fees applied only to international or next-day delivery (standard shipping is free). Patients can call customer service at 503-687-2050 to receive a new collection kit and try again.

Once sample collection begins, please limit fluid intake to 40 ounces from the first-afternoon sample collection (approx. 5:00 PM) until the first-morning void sample (waking sample). If limiting fluid intake to 40 ounces is challenging, then fluid intake may be increased to no more than 48 ounces. If more fluids are needed (due to heat, exercise, etc.), an individual may drink eight ounces of fluid AFTER collecting the first-morning void. After the second morning collection, fluids do not need to be restricted UNTIL two hours before the dinnertime sample. Between the dinnertime and bedtime samples, fluids need to be limited to no more than eight ounces. Please ensure that patients drink the recommended amounts to ensure yellow (but not dark yellow) urine.

If patients consume too much fluid prior to testing, their urine may become too dilute and DUTCH results may be inaccurate. To assess this (and to calibrate for individual excretion), urine creatinine levels are measured. If creatinine values are too low (<0.15mg/mL in females; <0.20mg/mL in males), accurate creatinine correction may not occur. In this case, interpret the results cautiously because cortisol and cortisol metabolites may be falsely elevated. If creatinine is 0 then there are no detectable urine hormones to test in the sample.

Patients should follow their normal daily routine. If caffeine is regularly consumed, then stopped for testing, caffeine withdrawal may cause cortisol to spike. If the goal is to assess baseline cortisol levels without the influence of caffeine, avoid caffeine until AFTER the second-morning urine collection or after the second (60-minute) saliva sample. Alternately, if caffeine is not regularly consumed but is consumed on the day of testing, higher cortisol levels may be observed.

Alcohol can disrupt sleep and possibly raise levels. It can also affect estrogen metabolism. If alcohol is only consumed occasionally, it is best to avoid alcohol during DUTCH testing so the results reflect typical cortisol and cortisol metabolism patterns. However, if a patient consumes alcohol daily, DUTCH Test results would reflect typical cortisol levels even after they consume alcohol.

As long as urine can be held in the bladder for two hours before each sample collection, the results should be accurate. If the patient needs to urinate during the night, the patient should collect this urine sample on the included “insomnia” collection strip to ensure accurate cortisol and melatonin results. If the patient requires multiple trips to the restroom during the night to urinate, urine should be collected each time using a single, clean, container kept in the refrigerator. The next morning, the patient should dip the overnight strip into the refrigerated container and then set out to dry.

*It is important to note that this method is not validated.

Melatonin is produced throughout the night and metabolized quickly into a water-soluble metabolite that is excreted in the urine. Melatonin production peaks somewhere between 3 AM and 4 AM, depending on sleep and daylight exposure. The first-morning urine sample reflects the overnight melatonin production.

If the patient wakes during the night, they should collect a saliva sample (for DUTCH Plus), or collect a urine sample (for DUTCH Complete). The next first-morning void—regardless of a middle-of-the-night collection—will accurately represent overnight melatonin levels because internal research shows no significant difference with this method.