New Organic Acid Markers Will Be Added to the DUTCH Test!
December 13, 2017 by Carrie Jones
by Carrie Jones, ND, MPH
In January of 2018, we will be adding six organic acid tests (OATs) to the DUTCH Complete™ and DUTCH Plus™ tests — at no extra charge! This additional information will give practitioners an even more comprehensive understanding into the hormone and adrenal picture, especially when it comes to commonly reported symptoms such as fatigue, anxiety, insomnia, depression, motivation, sex drive, estrogen dominance, and stress.
The 3 neurotransmitter markers are:
• Homovanillate (HVA) – the primary dopamine metabolite
• Vanilmandelate (VMA) – the primary norepinephrine and epinephrine metabolite
• 5-hydroxyindoleacetate (5HIAA) – the primary serotonin metabolite
The 3 nutritional organic acids are:
• Methylmalonate (MMA) – elevated if patients are vitamin B12 deficient
• Xanthurenate – elevated if patients are vitamin B6 deficient
• Pyroglutamate – elevated if patients are glutathione deficient
As the OATs will be automatically added to all DUTCH Complete™ and DUTCH Plus™ tests in 2018, practitioners do not have to do anything extra to request them! They will be resulted on our new DUTCH Extras (page 6), so be on the lookout.
Considerations and required food restrictions:
There are certain foods, medications, and supplements that can artificially increase the levels of the neurotransmitter metabolites. We suggest avoiding 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. Please consult with your healthcare provider before stopping their use. Medications such as SSRI’s and SNRI’s should not be skipped or stopped suddenly unless under medical direction.
Future DUTCH collection kits will instruct patients to restrict the list of problematic foods (above). If you wish to use an existing collection kit, please print the food restriction handout for your patients.
How do these new markers correlate with the DUTCH Test?
If MMA is elevated, it means there is a deficiency of B12 in the cells. In order to get from methylmalonic acid (also known as methylmalonate) to methylmalonyl-CoA to Succinyl-Co-A, you need cobalamin or B12. If there is a deficiency in vitamin B12, then methylmalonate will instead shunt into the urine and show up on the DUTCH Test. B12 is critically important as common symptoms of deficiency include fatigue, brain fog, memory problems, muscle weakness, unsteady gait, numbness, tingling, depression, migraines/headaches and hypotension. B12 is also important in the Methionine or Methylation cycle in moving homocysteine around to methionine. On the DUTCH test, we evaluate 2-hydroxy-E1 going through methylation and becoming 2-methoxy-E1 for safe excretion. This requires the COMT enzyme that is dependent on the methylation cycle functioning normally.
Another example is 5HIAA or serotonin. The amino acid tryptophan can go down two different pathways. First, it can go down the serotonin pathway to eventually make melatonin. Only about 5% of the tryptophan follows this route. The rest of the tryptophan, or about 95% goes down the kynurenine pathway. Certain factors such as high cortisol or high estrogen can shunt tryptophan AWAY from serotonin and thus melatonin and 5HIAA towards the kynurenine pathway. This will cause the 5HIAA to be low. By looking at the estrogen and cortisol markers on the DUTCH test, you can see if they are elevated causing low 5HIAA. You can also look at the melatonin marker on the DUTCH test to see how it is being affected by this shift and address it all appropriately.
By combining these new organic acid markers with the DUTCH Test, practitioners now have the most comprehensive, easy-to-collect test that allows them to make an even greater impact on their patients at a deeper level.