Research published in the Journal of Clinical & Translational Endocrinology in November 2020 demonstrates the value of combining dried urine and salivary profiling for complete assessment of cortisol and cortisol metabolites. This methodology forms the foundation of comprehensive stress hormone testing.
Study Background
The research, conducted by Newman, Curran, and Mayfield, examined how dried urine combined with saliva collection can provide a complete picture of cortisol production, metabolism, and diurnal patterns, information that single-point blood tests cannot capture.
Why Cortisol Patterns Matter
Cortisol follows a natural daily rhythm:
- Morning Peak: Cortisol should be highest within 30-60 minutes of waking (the cortisol awakening response)
- Gradual Decline: Levels should steadily decrease throughout the day
- Evening Low: Cortisol should reach its lowest point in the evening to allow for restful sleep
Disruptions to this pattern, whether flattened curves, inverted patterns, or abnormal peaks, can contribute to fatigue, sleep problems, weight gain, mood disturbances, and other health concerns.
Key Research Findings
The study demonstrated:
- Diurnal Pattern Capture: Multiple collection points accurately reflect the body's natural cortisol rhythm
- Metabolite Analysis: Dried urine provides insight into how cortisol is processed (not just produced)
- Free vs. Total Cortisol: The combination method distinguishes between free cortisol (active) and total cortisol production
- Clinical Utility: The comprehensive data enables more targeted clinical interventions
Beyond Simple Cortisol Testing
Traditional cortisol tests (blood or single-point saliva) only capture a snapshot. This comprehensive methodology reveals:
- Cortisol Production: How much cortisol your adrenal glands produce overall
- Cortisol Metabolism: How efficiently your body processes and clears cortisol
- Cortisol-to-Cortisone Ratio: The balance between active and inactive forms
- Circadian Rhythm: Whether your daily cortisol pattern is healthy or disrupted
Clinical Applications
This research supports using comprehensive cortisol testing for:
- Chronic fatigue and low energy
- Sleep disturbances and insomnia
- Difficulty losing weight despite diet and exercise
- Mood changes, anxiety, and depression
- Difficulty recovering from exercise or illness
- Blood sugar regulation issues
How SomaFleur Uses This Research
The DUTCH Plus test incorporates this validated methodology, measuring cortisol at multiple points throughout the day via both dried urine and saliva. This allows us to see:
- Your cortisol awakening response
- How your cortisol changes throughout the day
- Your total cortisol metabolite output
- How your body processes cortisol through different enzymatic pathways
Combined with our GI-MAP gut testing, we can also assess how gut health and inflammation may be affecting your stress response.
Study Reference: Newman M, Curran D, Mayfield K. Dried urine and salivary profiling for complete assessment of cortisol and cortisol metabolites. J Clin Transl Endocrinol. 2020 Nov;22:100243.