Episode 47: Adrenal Fatigue: Part 2 with Christopher Kelly

A New Test and a New Way of Looking at Adrenal Fatigue

Christopher Kelly was the guest on Episode 15 of this podcast, where he gave us an overview of adrenal fatigue, and talked about how he recovered from this condition himself and helped many others do the same through his functional medicine practice, Nourish Balance Thrive. Today, we’re going to talk about a new diagnostic test, called the DUTCH test, and how it has changed the way Chris sees and treats this condition in his practice. Chris is a pro mountain biker and his practice focuses on helping athletes recover their health.

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Show Notes

• Intro (0:00)
• Thank You to our Podcast Sponsor – Paleo on the Go (1:54)
  • A frozen meal delivery service, they have a large menu of items for the paleo autoimmune protocol (AIP).
  • Use the code PHOENIX for 10% off your first order.
• What Is Adrenal Fatigue? (3:10)
  • While many articles online talk about the Stages of Adrenal Fatigue, Chris doesn’t believe this is a useful model.  Instead, he thinks it’s more helpful to look at actual test results to see what’s happening inside your body.
  • When people are feeling the classic symptoms of “adrenal fatigue”, they usually have low free cortisol in the body, which can cause hypoglycemia (low blood sugar), low energy/fatigue, and disruption of circadian rhythms which can cause difficulty sleeping. The key, Chris says, is finding out why the cortisol is low and the DUTCH test provides information that helps determine the root cause. It’s usually not the adrenals themselves that are the problem.
  • Chris recommends the book, Why Zebras Don’t Get Ulcers by Robert Sapolsky, which is a more accurate description of how stress affects our health and has nothing to do with stages.
• DUTCH vs Saliva Testing (8:55)
  • The Saliva test has been the standard for cortisol testing for decades. It takes 4 saliva samples over a one-day period to measure your body’s cortisol levels and circadian rhythm.
  • The DUTCH test is relatively new and was created by Mark Newman of Precision Analytics. It takes 4 urine samples over a one-day period.
  • Both tests measure the circadian rhythm – the levels of cortisol throughout the day and evening. In a healthy person, cortisol peaks in the morning and then tapers off gently throughout the day, reaching its lowest point right before bed. This gives you energy to wake up and complete your daily tasks, while allowing you to rest well at night.
  • How do they differ? Saliva measures free cortisol (the cortisol currently available to the body). The DUTCH test measures both the free cortisol and the total cortisol produced by the adrenal glands. This gives a more complete picture. Sometimes cortisol is low because the adrenals aren’t producing enough, but other times it’s low because the body is clearing it too quickly. These situations need to be treated very differently. With the saliva test, they would look the same.
  • Resource video comparing DUTCH and Saliva test results.
  • There is also a blood test for cortisol, but it’s less useful because it only measures bound cortisol, when free cortisol is what is actively available to your body. Also, the blood test is only taken once, and therefore doesn’t capture the circadian rhythm.
• Since the DUTCH Test is New, How Do We Know It’s Accurate? (16:12)
  • Chris agrees that time and experience will tell, but he has faith in the DUTCH test for the following reasons: (1) It uses tandem mass spectrometry, a tried and true method of chemical analysis that has been proven to be accurate for decades. (2) Mark Newman, the creator of the DUTCH test is an analytical chemist with extensive experience in both urine testing and salivary cortisol testing. This test is built with all of his knowledge and experience. Resource:  Interview with the founder, Mark Newman. (3) Chris believes in this test so much that he has stopped using the saliva test and solely uses the DUTCH test for adrenal testing in his functional medicine practice. That said, Chris doesn’t rely on any one test for all of this information. He usually runs blood, stool and urine organic acids tests as well as the DUTCH test, and looks at all of them to get an accurate picture of his client’s health, alongside the client’s symptoms.
• Examples – DUTCH vs Saliva Testing (21:08)
  • DUTCH Test Result A: Low total cortisol (being produced by adrenals) and high free cortisol (the body is having trouble clearing it) is often a symptom of hypothryoidism, which Chris would then confirm through other testing. The saliva test would only show high free cortisol, and Chris might have prescribed supplements to lower cortisol, which would have compounded the problem.
  • DUTCH Test Result B: High total cortisol (being produced by adrenals) and low free cortisol (available to the body). This is common in people who are obese and/or insulin resistant. The saliva test would only show low free cortisol, so Chris might have prescribed supplements to raise it, which again would compound the problem.
  • Sometimes the test results are consistent between total and free cortisol, with both being high or both being low. Yet the root cause can still be elsewhere. For example, when there’s a chronic infection in the body, the brain will lower cortisol to increase inflammation to try to drive out that infection. So, the answer isn’t to raise cortisol but to cure the infection.
• Is Adrenal Fatigue a Real Condition or a Symptom of Another Problem? (27:06)
  • Chris believes it’s more often a symptom, and a good practitioner will try to discover and treat the root cause (i.e gut infection, hypothyroidism, insulin resistance, lifestyle choices interfering with circadian rhythms, etc.) In fact, he thinks we should all stop using this term, because it implies the problem is with the adrenals, when the problem lies elsewhere. The symptoms are very real, however.
  • Resource article: The Truth About Adrenal Fatigue by Dr. Bryan Walsh. Note: it was written before the DUTCH test came on the market. And it does contain a little profanity.
• Other Hormones Measured By the DUTCH Test (38:01)
  • Melatonin, DHEA, Testosterone, Estrogen, Progesterone, and the metabolites of the sex hormones as well as their pathways of use. This can be helpful in showing methylation problems. And for people taking hormone replacement therapy, it can show potential cancer risks. Sample Report.
  • While you can order saliva tests which measure sex hormones in addition to cortisol, they are present in much lower numbers in saliva making those results less accurate. Also they don’t have information on metabolism of the hormones.
• The Best Time to Take the Test (40:44)
  • Both Saliva and DUTCH tests measure just one 24-hour period. Cortisol results will vary greatly on a relaxed vacation day vs. a stressful day. The goal is to take the test on whatever type of day is “normal” for you.
  • Since the DUTCH test includes hormone testing, it is recommended that menstruating women take it between day 19-21 of their cycle.
  • There is also a separate test called DUTCH Cycle Mapping that focuses on sex hormone levels throughout the month. If your cycle is unpredictable, this test might be more helpful than a one-day test.
• Why There Is Sometimes a Delay Receiving the DUTCH Results (45:38)
  • Tests are often run in batches to make the most efficient use of the equipment. Average turnaround time is 2 weeks. But if your sample arrives right after a batch was run, your result might be delayed until enough samples arrive to do the next batch.
• Prednisone Recovery (48:04)
  • You can take the DUTCH test while taking prednisone, or after tapering off it. The DUTCH won’t measure the prednisone itself, but rather the natural cortisol levels of the body that were disrupted by prednisone. Chris believes this testing can be very helpful during recovery.
  • Resource Article: Common Medications May Cause Adrenal Insufficiency.
• Tips For Supporting Healthy Adrenal Function Naturally (53:47)
  • The Paleo Autoimmune Protocol – to figure out your unique food sensitivities.
  • Sleep affects all aspects of health, so it needs to be a priority. If you’re having trouble sleeping, work on circadian rhythm entrainment.
  • Stress Management is essential, but stress tolerance varies from person to person.
  • Social isolation affects immune function, so it’s important to cultivate positive relationships.
  • Healthy movement in a way that’s appropriate for you.
  • These are all easy to say, but difficult to implement. If you need help, it’s worth hiring a health coach.
• Outro (58:45)
  • Christopher’s functional medicine practice is called Nourish Balance Thrive. He works primarily with athletes – both competitive athletes and “weekend warriors”. If you have a complex autoimmune disease, he actually recommends his colleague, Torea Rodriguez who has Hashimoto’s and a functional medicine practice. Both Chris and Torea offer DUTCH testing. Chris also hosts a great podcast, which you can find in iTunes or Stitcher.
  • Eileen (your podcast host) is the author of multiple books, written to help people thrive with autoimmune disease. Learn more on the Books Page.
  • If you like this podcast, follow or subscribe through your favorite podcast app. You can also subscribe to Eileen’s biweekly newsletter.
  • Check out the entire archive of podcast episodes.

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