00:00:00:03 - 00:00:29:04 

Noah Reed 

Welcome back to the DUTCH podcast, where integrative medicine providers can expand their understanding of functional endocrinology and testing. And everyone, no matter who you are, can learn more about their body’s most complex communications system. I'm Noah Reed, vice president of sales and marketing for the DUTCH Test. And coming up on this week's episode, we get to listen to a really unique conversation with the president and founder of the DUTCH Test, Mark Newman, and our director of clinical education, Dr. Debbie Rice. 

 

00:00:29:08 - 00:00:42:02 

Noah Reed 

We're going to talk about the things you'll see on the DUTCH test in clinical practice. Hopefully, this will give you a little bit of understanding as a new provider what to look for when you're reading the DUTCH test. So, onto this week's show. 

 

00:00:42:22 - 00:01:07:14 

Mark Newman 

Thanks, Noah. And thanks to Dr. Debbie Rice for coming back for a second round of questions. I am excited for this set of questions because I think of anyone of anyone I know when my friends have problems, particularly female friends, and we test them and then they're like, what the heck do I do now? Well, actually, one of the bad things about you being so important in our company is you're not available to see patients anymore. 

 

00:01:08:08 - 00:01:33:12 

Mark Newman 

And you were my number one referral of I knew if I sent someone to you with a set of DUTCH test results and whatever else is going on that you could fix them. So, I want you to help other people fix their patients. So, here's my question for you is as patients come to you as a doctor of functional endocrinology and the things that you're really good at, I want you to tell us what some of those really common themes that you see are in your patients. 

 

00:01:33:16 - 00:01:52:17 

Mark Newman 

And then I want you to take a step further and say, OK, when I see these particular things, these are the things I see in the DUTCH test in terms of patterns that I'm going to recognize and that are going to help me in my quest to find health for them. So, what are the what are the what types of patients are coming to see you and what do they look like on the DUTCH test? 

 

00:01:52:21 - 00:02:16:12 

Debbie Rice 

Yeah, the great questions, I think in as a naturopathic physician, we get a lot of hormones that come in, right? Like they have concerns about thyroid, they have concerns about menopause, perimenopause, hot flashes, tired that's the big one. I'm so tired and I'm not where I was before. Like, I just don't feel like myself that that's probably the biggest complaint that walks through my door. 

 

00:02:16:12 - 00:02:28:05 

Mark Newman 

Fatigue. OK, so a fatigue patient, the stereotypical fatigue patient that you see when you then get their DUTCH results back, what do you what are you guessing you're going to see there and how does that help you? 

 

00:02:29:06 - 00:02:51:10 

Debbie Rice 

So that that is an even better question mark because they're as much as I can best guess, right? Like, oh, yeah, there's going to be some stuff going on with your adrenals. Sometimes it's because they are so stressed that their cortisol is like through the roof, right? They're not able to sleep. They're not able to like just calm themselves down to be able to make it through the day and then also be able to sleep again. 

 

00:02:51:18 - 00:03:15:12 

Debbie Rice 

Not happening. Then you have the other people that are so stressed for so long that their adrenal glands are just like puttering to try to get them through the day. And that's with regard to cortisol and stress response. But when we're looking at sex hormones, there's a there's a big range, right? Like there can be estrogen dominant peaks, type presentations, irregular cycles, fertility, those are going to be other bigger ones that come through my door. 

 

00:03:16:04 - 00:03:42:21 

Debbie Rice 

And when we're looking at that on the DUTCH test, you know, I'm not surprised to see somebody, if they have irregular cycles cramping, breast tenderness, you know, heavy cycles that they're probably going to have a lot of imbalance with their estrogen and progesterone, usually meaning they don't have enough progesterone. And that may either lead to true estrogen dominance where they just have blatantly high estrogens, or they have normal estrogen production and even normal estrogen metabolism. 

 

00:03:43:03 - 00:04:02:00 

Debbie Rice 

They just don't have the progesterone to match it. But we also want to look at that androgen component, because that's another balance with the estrogen and progesterone, right? Like do they have enough androgens to help with energy and sleep and mood muscle mass, or do they have too much because their body is like freaking out because they're running from a saber tooth tiger? 

 

00:04:02:21 - 00:04:27:22 

Mark Newman 

Right. So, for your fatigue patients, cortisol is kind of the place you start. And then the reproductive hormones add in like really important complementary information slightly and of course, most people have multiple things going on. But you mentioned your PCOS patients, so someone walks in your door, PCOS doctor it's like, what do you what are you looking forward to tease out of them and how is that helpful? 

 

00:04:28:01 - 00:04:58:13 

Debbie Rice 

Yeah, so I think there's there's like this sex hormone component of PCOS and then there's this adrenal component of PCOS. So, in your standard PCOS type of presentation, a lot of times it's going to be higher estrogen, higher androgens. I mean, we're talking about androgens, we're talking about testosterone and DHEA. And in this, that usually shows up as low progesterone and so they have, you know, estrogen is the driver, the proliferator. 

00:04:58:13 - 00:05:18:17 

Debbie Rice 

Right. But when you have a lot of estrogen, and you have a lot of testosterone and DHEA like that is irritability to the max. Like nobody is happy with that. And then they can't even sleep. Right. So, they can't even like calm themselves down. And their cycles may be super irregular. Or not, but they still have those symptoms of estrogen dominance that are irritability, breast tenderness. 

 

00:05:18:17 - 00:05:29:08 

Debbie Rice 

Right. Feeling overheated, feeling agitated, irritated, those kinds of things. Acne, hirsutism, right. Like all of that to your skin is a big thing that can happen with PCOS as well. 

 

00:05:29:15 - 00:05:52:03 

Mark Newman 

So, I generally lower progesterone generally higher estrogen. And then I would imagine the estrogen metabolism is sort of a wild card in that it could look like any number of things that's going to play into that story. Yeah. So, then when you get to the androgens, if I've got acne and the like, I'm thinking that could be I make too much DHEA, I make too much testosterone. 

 

00:05:52:03 - 00:06:09:15 

Mark Newman 

That seems like a common pattern you'd see. What about the metabolism? So, we know the most potent androgen is DHT, which is testosterone pushing down that alpha pathway so for your PCOS patients, is that a wild card? Does that consistently tend to be that high five alpha push? Like, what about that piece of it? 

 

00:06:09:20 - 00:06:30:02 

Debbie Rice 

That's in general? I would say that we do see that alpha preference, right? So, we're talking about androgens. They have they have a choice to go down the alpha or the beta pathway, right? The alpha pathway is more antigenic meaning more of those high androgen symptoms, irritability, facial hair, acne, loss of scalp hair, the beta pathway is less and or genic. 

 

00:06:30:02 - 00:06:46:05 

Debbie Rice 

And that one can be balancing for some people that in PCOS patients because a lot of times with PCOS you see insulin dysregulation, blood sugar dysregulation, a common tie with that is the preference down the alpha pathway. So, it's not uncommon to see that on a DUTCH test. 

 

00:06:46:08 - 00:07:05:11 

Mark Newman 

So, we've got this connection between insulin that pushes five alpha right in a serum or saliva test. We can look at DHEA, we can look at testosterone, but you know, urine in DUTCH gives us that unique additional picture of am I pushing down that androgen OK pathway. So, if I am as a woman and it's because insulin is pushing in that you're dealing with the insulin. 

 

00:07:05:16 - 00:07:14:21 

Mark Newman 

So, do you typically just deal with the insulin and watch it, or do you sometimes also use things that that push that five alpha metabolism away from DHT? 

 

00:07:14:23 - 00:07:35:22 

Debbie Rice 

I think it depends on how symptomatic they are, how miserable they are with their symptoms, right? Like some people have that five-alpha push, but they don't have any symptoms. So, we may not need to intervene with, you know, five alpha balancing in that way. We're going to be looking at more of the lifestyle blood sugar regulation. But for those people that are really symptomatic, we're going to do both. 

 

00:07:36:18 - 00:07:42:16 

Mark Newman 

One of the things I've learned about myself, which is interesting, one, I don't methyl eight, I've got a SEAL. I mean. 

 

00:07:42:16 - 00:07:43:00 

Debbie Rice 

Either. 

 

00:07:43:18 - 00:08:07:01 

Mark Newman 

Maybe we're related distantly, I've got a CMT, I'm homologous for the broken CMT and my estrogens, every methyl eight, my androgens and everything on my panel pushes heavy, heavy beta. So, I'm not five alpha, I'm Phi Beta one of the things I found in the literature that's interesting is that correlates to some degree with hypothyroidism, which is kind of a fun little. 

 

00:08:07:01 - 00:08:07:12 

Debbie Rice 

Yes. 

 

00:08:07:22 - 00:08:35:13 

Mark Newman 

Little nugget is five beta metabolism has a correlation with hypothyroidism. I don't know if that's what drives it for me, but for you, when you're dealing with patients with thyroid, we often get asked like, why don't you just thyroid? And our answer is it's best tested in blood. Go do a blood test, make it comprehensive. So, you're looking at Tsai and TPO, but also, you know, T 43, three, two, three, maybe reverse, which is getting, you know, way over my head when you start getting into those things. 

 

00:08:36:12 - 00:08:49:09 

Mark Newman 

But we think that's the best way to look at thyroid and we complement that well in terms of the information that we give, how do you what do you expect to see on a DUTCH test for someone who's got like an overt thyroid issue going on. 

 

00:08:49:22 - 00:09:11:21 

Debbie Rice 

So, and it's interesting because I've even spoken to providers that are like men. I keep doing the blood testing. The test is like it's just in there. The free T three, it's just in there. But their symptom picture is so suggestive of hypothyroid. I'm going to run a DUTCH test and see what happens. And a lot of times the DUTCH test will come back with, oh, yep, it looks like hypothyroid. 

 

00:09:12:02 - 00:09:32:02 

Debbie Rice 

And so, when we're looking at that pattern, right, we're looking at low capacity to make cortisol because if you have low metabolism, right? The thyroid gland manages all of the metabolism of everything, right? So, if your thyroid gland is not able to keep up with its own metabolism, your adrenal glands also can't keep up with that. Right? So, you're going to have a low production of cortisol. 

 

00:09:32:02 - 00:09:33:19 

Mark Newman 

Meaning low what? 

 

00:09:33:20 - 00:09:34:22 

Debbie Rice 

Metabolize. 

 

00:09:34:22 - 00:09:45:10 

Mark Newman 

So, metabolize cortisol tends to be low. And we can see that in the literature pretty clearly. That metabolize cortisol tends to be low with hypothyroid. What else do you see in those patients. 

00:09:45:15 - 00:10:11:08 

Debbie Rice 

In that combination? We also see a high or higher free cortisol because everything has slowed down, right? So, your production is low of cortisol serum metabolize, cortisol is low, and then your capacity to clear free cortisol is also lowest. You end up getting this little pile up of free cortisol. Some people look at that is like, yay, I still have cortisol which may be good, but it's also indicative of something else that needs to be fixed. 

 

00:10:11:08 - 00:10:21:23 

Debbie Rice 

Right. So, just looking at that balance of the metabolize cortisol where your body's making versus the free cortisol, what your body's able to use. And that creates a good picture for hypothyroid too. 

 

00:10:22:01 - 00:10:37:14 

Mark Newman 

And the conditions, the condition singular that comes to mind when you start talking that way, is Hashimoto's. What are the other? Or maybe that's the end of the list. What are the titles of things that you're going to see in practice that that that would be relevant for? 

 

00:10:37:23 - 00:11:13:11 

Debbie Rice 

So, it's interesting because Hashimoto's is that autoimmune component of thyroid and you may or may not have hypo thyroid with Hashimoto's so there are some people that test positive for Hashimoto's. They have the antibodies there, but it hasn't negatively affected the function of their thyroid. A lot of times though, by the time they've come in to get testing, they have Hashimoto’s, and they have low thyroid, whether it's functional, low thyroid or blatantly low thyroid, I would say it's more you can see something like graves, which is the complete opposite. 

 

00:11:13:11 - 00:11:36:20 

Debbie Rice 

When we look at how the thyroid is functioning, it's more of a hyper or thyroid presentation. But Graves is still an autoimmune presentation for thyroid, and that's going to be flipped, right? Like your body's making tons of cortisol and it's also clearing your cortisol really quickly. So, you have a higher metabolize cortisol with a low free cortisol, and that shows up as a hyper thyroid presentation so I. 

 

00:11:37:04 - 00:11:41:22 

Mark Newman 

Think that we've had some really blatant examples of that which make for really case studies were. 

 

00:11:41:22 - 00:11:42:11 

Debbie Rice 

Absolutely. 

 

00:11:42:11 - 00:11:44:17 

Mark Newman 

Particularly the people that are fun for us. 

 

00:11:46:06 - 00:11:47:23 

Debbie Rice 

Not fun for them for us. 

 

00:11:47:23 - 00:12:06:07 

Mark Newman 

Yeah, but is when you see that pattern, you raise it as a concern, and it is at that point unknown then the provider. I mean, then that's really where the power of, of the testing comes in is when it's suggestive of something that is, is presently unknown and then they go, you know, barking up that tree and they find that oh this patient does have Grave's disease. 

 

00:12:06:07 - 00:12:12:07 

Mark Newman 

And then of course they start treating them and then the follow up testing becomes really interesting and relevant. 

 

00:12:12:16 - 00:12:34:12 

Noah Reed 

And that's what I love when, when one of the providers that we work with. She described our tests as an investigative tool. It's not diagnosing any of these conditions, but it's helping ask that next question and getting to the root cause of what's going on. What do we need to look for next as we're going through it? Because you get more data points, and it gives you the ability to ask the next best question to help the patient feel better. 

 

00:12:34:12 - 00:12:55:05 

Mark Newman 

And one of the reasons it's not diagnostic in a lot of sense is because you can get the same picture from different causes, right? So, like the Grave’s Disease Patient, it looks an awful lot like a stereotypically obese patient. So, let's go there. So, for your patients that are struggling with weight loss, insulin dysregulation, you know, they've been overweight for a while and they're struggling on that front. 

 

00:12:55:07 - 00:12:59:12 

Mark Newman 

What types of things you tend to see fall out of the the DUTCH test for those patients? 

 

00:12:59:14 - 00:13:29:15 

Debbie Rice 

Yeah, it's a pretty standard picture when we see this, right? You have a lot of production of cortisol. And with this, you don't have a lot of availability of free cortisol. So, you have high metabolized cortisol, you have low free cortisol. And we I always try to remind people that the more fat we have on our body, I mean, whether you have a little bit or a lot, we have to remember that fat cells become their own endocrine organ and they will use cortisol to their advantage. 

 

00:13:29:21 - 00:13:49:15 

Debbie Rice 

So, they will kind of steal. The court is also when there's a lot of cortisol being produced, your fat cells are in there using it. Right. But it doesn't mean that it's available to you. It's almost like insulin desensitization, right? Like your body's making a bunch of insulin so you can manage your blood sugar, but you're not able to use that insulin for your advantage, if that makes sense. 

 

00:13:50:00 - 00:13:51:22 

Debbie Rice 

So same thing with cortisol yeah. 

 

00:13:51:22 - 00:14:17:03 

Mark Newman 

We've got a paper that we hope to publish soon that shows that our our correlation between as people get heavier and free cortisol, there's no there's no real trend there. And then when you look at the metabolites, there's a really strong and positive trend of those being the best marker for production of cortisol. It really is this picture of adipose tissue sort of stealing and sequestering that cortisol and it finds its way into the toilet as a metabolite. 

 

00:14:17:08 - 00:14:33:23 

Mark Newman 

Your adrenal glands got to keep up with that. So, that's, as you said, sort of a stereotypical picture. What other things do you investigate heavily for a patient who's obese? When I'm just thinking of, you know, reproductive hormones or organic acids or what other things do you see in those patients? 

 

00:14:34:04 - 00:14:58:22 

Debbie Rice 

Yeah, I mean, we're looking at inflammation. We're looking at oxidative stress with obese patients, estrogen is very similar to cortisol. So, you get a lot of whether this is because inflammation can up regulate that conversion of your androgens to estrogen. Right. So, you have aromatization, too, estrogen. You just convert everything to estrogen. So, you end up having a lot more estrogen. 

00:14:58:22 - 00:15:05:06 

Debbie Rice 

So, you see a lot more estrogen dominance in people that have more fat tissue in adipose tissue as well. 

 

00:15:05:07 - 00:15:16:19 

Mark Newman 

So heavy estrogen. If I'm overweight, if I'm overweight in a man and I have a lot of estrogen and to the degree that my testosterone you're looking at hypogonadism as well could be. 

 

00:15:16:23 - 00:15:20:16 

Debbie Rice 

Absolutely. I think it depends on where you're at in that process. 

 

00:15:21:00 - 00:15:45:19 

Mark Newman 

OK, another topic that comes up a lot is the big C word, cancer. So, let's don't talk as much about what a cancer patient might look like, but let's talk about prevention. So, if I'm thinking I'm going to do a DUTCH test because my aunt has breast cancer, and I'm feeling high at risk, that sort of female patient, what types of things are you investigating on the DUTCH test that may be related? 

 

00:15:47:11 - 00:15:51:18 

Mark Newman 

Everything like every oh, so higher. So, make a hierarchy. Yeah. 

 

00:15:51:19 - 00:16:10:10 

Debbie Rice 

So, I'm looking at how much estrogen are they producing, right? Like if this is an estrogen, if it's breast cancer, estrogen dominant. Right. Or any kind of hormone cancer, I want to know how much hormones are they making? And a lot of times it's going to be about estrogen, right? Like how much estrogen are they making? And how are they processing their estrogen? 

 

00:16:10:12 - 00:16:25:01 

Debbie Rice 

Do they have a lot of 40 h? Are they able to methylated? What does that look like? How much progesterone are they able to balance their estrogen? With? So, I think that that's an important component, not just how much estrogen, but how much progesterone can balance that estrogen production. 

 

00:16:25:11 - 00:16:37:03 

Mark Newman 

Is it my progesterone adequate to balance that? And then phase one, I'm hoping to lean more towards the two and away from the four and the 16. And then I'm hoping to methyl eight those estrogens. OK, what else. 

 

00:16:37:22 - 00:16:55:15 

Debbie Rice 

I also look at cortisol because we want to make sure, you know, if you have a flat cortisol curve, you're not going to have an immune response. Right? So, we see that in research if you have low cortisol in the morning, you have a slower ability to respond with your immune system. So, we're looking at cortisol and how your cortisol is responding. 

 

00:16:55:15 - 00:17:14:05 

Debbie Rice 

Are you having an appropriate cortisol awakening response? What is your diurnal pattern throughout the day? Diurnal and circadian rhythm, right. That up and down pattern of your cortisol makes a big difference in how your immune system responds how you're able to sleep and how you're able to heal. So, those are huge. I look at melatonin. Melatonin is a very powerful antioxidant. 

 

00:17:14:13 - 00:17:42:04 

Debbie Rice 

We look at all of the organic acids because we're looking at do you have the capacity to have the B vitamins that you need to detox? Right. Do you have what is your oxidative stress marker? Look like? Is that eight hydroxy marker high, low? What's going on there? And when we're looking at the neurotransmitter metabolites, we're looking at sympathetic versus parasympathetic the sympathetic is that drive go stress response parasympathetic is the rest digest, you know, reset. 

 

00:17:42:12 - 00:17:46:15 

Debbie Rice 

If you are high drive sympathetic, we're going to see part of that too. 

 

00:17:46:17 - 00:18:14:02 

Mark Newman 

So the nice thing about that topic too is I think sometimes there can be maybe a little too much conjecture in the functional medicine world as we get out ahead of research and we're making up, not making out, but following theoretical concepts and connections. The nice thing about like just breast cancer as an example, is lower levels of the specific melatonin marker that we measure, the way that we measure it not in dried urine but meaning a waking urine sample. 

 

00:18:14:06 - 00:18:38:09 

Mark Newman 

And that specific metabolite has been shown to be lower in people who get breast cancer. And the eight hydroxy dioxin guanosine, that's their oxidative stress marker, has been shown to be elevated in people who end up getting breast cancer and the cortisol curves flattening. You're not talking just conjecture there like you can point to the literature, right? And then estrogen lifetime you know, exposure to estrogen is linked to the risk of breast cancer. 

 

00:18:38:09 - 00:19:02:03 

Mark Newman 

So being able to walk through, gosh, I think you just listed two thirds of a really comprehensive panel, the two thirds of those things actually directly have a role in just shifting your risk, maybe ever so slightly, but maybe ever so slightly on three or four different fronts. Which can be a really great way to just put yourself on a better path towards not getting something like breast cancer. 

 

00:19:02:14 - 00:19:21:21 

Noah Reed 

So, we talked about big scary words that are hopefully not a huge percentage of our our population base. When you think you just said a word stress. Yeah. And some of the things that come along with that. What about like anxiety, depression, the things that seem to be a pretty large percentage of the population at this point coming in. 

 

00:19:21:23 - 00:19:22:14 

Debbie Rice 

Especially after. 

 

00:19:22:14 - 00:19:23:09 

Noah Reed 

COVID? Yeah. 

 

00:19:23:18 - 00:19:50:16 

Debbie Rice 

Yeah. Like, how do I see that on the DUTCH test? So that's that's a really great question. And with that either low mood and or depression and anxiety, like they usually come together. Right. I would say in most cases I see imbalances in cortisol. You can certainly see them in sex hormones too. But a lot of times I see it more in cortisol because of that stress response when people have imbalanced stress. 

00:19:50:16 - 00:20:14:21 

Debbie Rice 

And I think it also depends on your capacity for resilience, too. You know, some people have just worn, worn, worn, worn, worn down their resiliency. There are other people that just have like this really wonderful capacity to just kind of bounce back. So, I think it's also taking into account who that person is, what their history is, and how they've been able to either manage their stress or not. 

 

00:20:14:21 - 00:20:40:06 

Debbie Rice 

And that can make a big difference. And we're looking at stress and resiliency, but whether it is cause or affect that's going to be the bigger question, right? Like is this because you have been so stressed out that now you are so stressed out, you're tired, you can't sleep and now you're depressed and anxious? Or have you just been more of, you know, like that's just kind of your set point that you're just a little bit more anxious and you're a worrier that can further drive some of that stress response to it. 

 

00:20:40:06 - 00:20:42:20 

Debbie Rice 

So, it's a snowball that you need to unpack. 

 

00:20:44:09 - 00:21:01:15 

Mark Newman 

And some of those situations that we've mentioned, one of the things that just comes to mind that's commonly concurrent with those things is just not sleeping well and it can exacerbate so many of those things. What does your sort of stereotypical insomnia patient look like on a DUTCH test? 

 

00:21:01:17 - 00:21:22:04 

Debbie Rice 

Or so in? We have to remember that as much as cortisol is important, melatonin is important, right? Cortisol is your daytime hormone. Melatonin is your nighttime hormone. If you are not sleeping, you don't have the capacity to reset, meaning that your cortisol, when it's supposed to do its thing in the morning, right. Like get up and get you ready for your day. 

 

00:21:22:22 - 00:21:44:23 

Debbie Rice 

You may not be able to have that punch because you haven't been able to reset everything. So, the signaling in your brain is not ready for that. So, you start to see this poor response in the morning. So, lower cortisol in the morning and or throughout the day. And in some people, it'll just be flat, right. But other people, you'll have this low low, slow build and then like, oh, you have your second wind at like 8:00 at night. 

 

00:21:45:15 - 00:21:59:09 

Debbie Rice 

So, it kind of depends on where you're at in that pattern. But you can see poor cortisol response in the morning leading to poor circadian rhythm, poor diurnal pattern. And so, it's really, you know, trying to work on resetting that to help. 

 

00:21:59:20 - 00:22:21:13 

Mark Newman 

You and I think that's where being comprehensive with the cortisol is nice. And that with the particularly with the DUTCH plus you can grab that insomnia sample and look at, you know, 237 when you're not sleeping, we can see whether the cortisol is sort of causative. So, yes or no. But then the pattern that's happening in the morning, whether your cortisol tied to 37 or not is still very relevant to that. 

 

00:22:21:23 - 00:22:49:05 

Mark Newman 

So, as we hit menopause not, we as much as post-menopausal women at menopause they don't tend to sleep very well for various reasons. And oral progesterone can help with that because oral progesterone in particular makes aloe pregnant alone, which is a nice little sleepy hormone. Right. So, that in the absence of that someone not taking progesterone, do you see a connection and correlation between just how much progesterone you make and sleep issues yes. 

 

00:22:49:17 - 00:22:50:14 

Debbie Rice 

100%. 

 

00:22:50:21 - 00:23:00:05 

Mark Newman 

So, for your 35-year-old female that's got otherwise normal hormones but isn't making enough progesterone that might be an issue in terms of insomnia as well. 

 

00:23:00:09 - 00:23:15:23 

Debbie Rice 

Even if they're making some progesterone, if they're not making a good balance of progesterone for them and everybody's a little bit different where there, you know, that point is right, but it can make a huge difference for sleep anxiety mood. Absolutely. 

 

00:23:17:05 - 00:23:37:12 

Mark Newman 

Well, that is a lot of really, I think, good, really relevant and common things that people struggle with. And I hope our providers really get a lot out of just us being able to pick your brain on those, because I know you've dealt with so many different types of cases and in people I know personally successfully. So, I think that's helpful. 

 

00:23:37:12 - 00:23:40:18 

Mark Newman 

And thank you for illuminating those cases for us today. 

 

00:23:41:02 - 00:23:42:14 

Debbie Rice 

I couldn't have done it without you. Mark. 

00:23:44:02 - 00:24:03:10 

Noah Reed 

Thank you so much for joining us. Debbie and Mark, this has been a wonderful conversation where we've got new nuggets on what we should look at when reading the DUTCH test. If you're a patient and you were listening, make sure you go to DUTCH test WSJ.com, slash find a provider, you want to find an experienced DUTCH provider in your area to help you read the DUTCH test. 

 

00:24:03:15 - 00:24:29:02 

Noah Reed 

You learned that this is a very comprehensive and complex test that is not worth guessing on. So, find somebody in your area that can help you out. If you're not signed up with DUTCH yet and you're a new provider, go to DUTCH, test dot com, slash become a provider, fill out that form. One of our onboarding specialists will reach out to you and help you get signed up so that you can start profoundly changing the lives of your patients through hormone testing. 

 

00:24:29:09 - 00:24:53:16 

Noah Reed 

I'm Noah Reed, vice president of sales and marketing. Thank you so much for joining us on this first inaugural season. Of the DUTCH podcast. We hope that you've gleaned some information that's going to help you change the lives of your patients. We're going to take a little bit of break through the summer and then bring him back in season two in the fall, bringing you more information than you know what to do with. 

 

00:24:53:16 - 00:25:06:07 

Noah Reed 

It's going to be great. So, join us next fall and sign up for the DUTCH Digest so that you don't miss any announcements. You can find that on the DUTCH Tesco, come and go. Sign up for the DUTCH Digest. Again, thanks for joining us. And have a great summer.