Gut Health and the DUTCH Test

by Kelly Ruef, ND

When seeking health advice, we’ve all heard the recommendation, “start with the gut.” Whether we have high cholesterol or heavy periods, it always somehow comes back to the gut, right? Why is that? Well, it’s probably because the state of our gut affects the health of every organ system in our body, and because of this, a healthier gut tends to improve how we feel and function on a day-to-day basis. Many people only think to use a stool test to evaluate gut health, but the DUTCH Test may also yield valuable insights through its measurement of cortisol, hormone metabolites, and organic acids.

Cortisol and Gut Health

The adrenal hormone cortisol is most famously known as the “stress hormone.” This is because during a stressful event, cortisol rises to help the body prepare to fight off a threat or flee from a real (or perceived) threat. When cortisol rises, heart rate, blood pressure and blood sugar increase and blood is diverted away from the gut and towards the muscles. The body suppresses all non-critical processes, and thus digestion is halted. Although this reaction supports our survival in the short term, if cortisol remains high day after day, it quickly becomes detrimental to our gut health. In fact, stress has been shown to have both short- and long-term effects on gut function that contribute to the development of disorders such as irritable bowel syndrome (IBS), inflammatory bowel disease (IBD), peptic ulcer disease, gastroesophageal reflux disease (GERD), and more.

The DUTCH Test measures cortisol throughout the day and enables a person to evaluate whether elevated cortisol may be contributing to their gut health issues. It also measures cortisol metabolites , which provide additional insight into daily total cortisol production, and the cortisol awakening response (CAR) in the saliva, which provides insight into a person’s individual response to stress. And for all those who assume their cortisol isn’t elevated because they aren’t “stressed,” keep in mind that cortisol can elevate from other factors too, such as pain, low blood sugar, and strenuous exercise. In the end, high cortisol, no matter the cause, may have detrimental effects on the gut.

Estrogen Excess and Gut Health

Excess estrogen is associated with premenstrual syndrome (PMS), breast tenderness, heavy bleeding, acne, weight gain, and conditions such as endometriosis and fibroids. Poor gut health may exacerbate these symptoms and conditions, and it may even increase the risk of developing estrogen-receptor positive breast cancer . This is because the gut participates in the third phase of estrogen detoxification, where it aids in the elimination of estrogen from the body via bile and stool.

Phase 3 estrogen detoxification is mediated by the estrobolome, which is the collection of microbial genes (i.e., in the gut microbiome) that affect estrogen metabolism. If dysbiosis is present, the estrobolome may tend to overproduce an enzyme called beta-glucuronidase. Beta-glucuronidase causes estrogen in the stool to be released from the compounds that it is bound to for excretion, reabsorbed and recirculated back into the body. Thus, if beta-glucuronidase levels get too high, excess estrogen can result.

To exacerbate the problem, conditions that arise from, or are worsened by excess estrogen (PMS, heavy bleeding, endometriosis, fibroids, breast cancer, etc.) can put stress on the body that adversely affects gut function. Many people caught in this downward spiral may find relief through supporting gut health, but also by treating other contributors to high estrogen.

The DUTCH Test measures parent estrogens, such as estradiol (E2) and estrone (E1), but it also measures estrogen metabolites. In effect, people can use the DUTCH Test to look for elevated estrogen, but also to gain more insight into unhealthy estrogen metabolism patterns that may further impair estrogen clearance, increase risk for breast cancer, and worsen estrogen excess symptoms.

The DUTCH Test also measures urinary indican, an organic acid that has been shown to be a reliable marker for intestinal dysbiosis . In-house, unpublished data from Precision Analytical samples in postmenopausal women and in men have shown a small, but statistically significant association between elevated urinary indican levels and estradiol levels, reinforcing the assertion that gut dysbiosis is an important factor in circulating estrogen levels.

Supporting Gut Health

There are many ways to support a healthy gut, from exercise to targeted diets to adequate hydration. When it comes to cortisol, stress, estrogen, and the estrobolome, consider the following:

• Determine what is contributing to high cortisol (psychological stress, anxiety, exercise, blood sugar dysregulation, pain, stimulants, inflammation, illness, etc.) and treat the cause.
• If psychological stress and anxiety are contributing to high cortisol, consider supplements that lower cortisol levels, such as phosphatidylserine, or calming herbal support with holy basil, passionflower, and valerian. Relaxation practices may also be supportive, such as meditation, breathing exercises and spending time in nature.
• Determine what is contributing to excess estrogen in addition to possible poor gut elimination (obesity, PCOS, alcohol consumption, endocrine disrupting chemicals, insulin resistance, etc.) and treat the cause.
• Support healthy phase 1 estrogen detoxification with dietary choices that likely also support healthy gut function: cruciferous vegetables , apiaceae (carrot) family vegetables, rosemary , fish oil , soy , flaxseeds , and avoidance of high sugar diets and alcohol consumption .
• Lower beta-glucuronidase activity, if elevated, with probiotics, prebiotics , fiber, calcium-d-glucurate (CDG), and avoidance of “Western” high fat/high carbohydrate diets that tend to contain more processed and refined foods.

In the end, because the gut impacts how we feel and function on a daily basis, it’s a good idea to spend some time evaluating its state of health. Stool testing can provide many insights; however it may be helpful to do additional testing when assessing and treating the gut due to the multitude of factors that affect gut function. A few of these, including an exaggerated stress response, high cortisol, excess estrogen, and indican can all be evaluated with a DUTCH Test and may provide a clearer and optimized path to better gut health.

To learn more about the DUTCH Test and to gain access to more expert clinical education, comprehensive patient reports, and validated and peer-reviewed research, become a DUTCH Provider . By becoming a provider, you gain access to DUTCH’s Mastering Functional Hormones Testing Course for free!

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