Dr. Amy Nett: Okay. So I think what you’re talking about here is what we talked about this week was DHEA. And on the DUTCH test if you’re just doing the adrenal assessment, you’re going to get a measure of DHEA-S, so sulfated DHEA. And if DHEA sulfate is out of range, there can sometimes be value in knowing DHEA because what Chris said is that in certain disease states, sulfation can be upregulated or downregulated. So that’s why it’s not always a perfect match in terms of telling us what’s going on with DHEA itself.
So in terms of figuring out whether or not sulfation is upregulated or downregulated, ask the patient. We know that causes of upregulated sulfation might be a really high-protein diet, some liver detox supplements can lead to upregulated sulfation because we use sulfation for detox. If you’re trying to upregulate that process, we might see more. So certain botanicals similarly, some methylation supplements might also cause some upregulation of sulfation. You could also see and then you can also ask about factors associated with downregulation.
The primary two factors of downregulation of sulfation are going to be inflammation and glucocorticoid use. So inflammation, unfortunately, that’s like almost all of our patients, so that one’s really hard to rule out, and then glucocorticoid use.
In terms of looking at sulfation a little bit more, there are some markers on the organic acids test of that Genova Urine Organix comprehensive profile. And I know we haven’t gone over that one in detail. We really only went over the Organix dysbiosis, but if you were to get that comprehensive organic acids profile, that has a few markers for sulfation. But again, I think we’ve mentioned that that’s not the most reliable test. So again, I don’t know though if you really need to figure out whether or not sulfation is upregulated or downregulated. Again you might just consider getting the more complete hormone profile and getting a measure.
Remember you get like a total DHEA level on the complete hormone profile because they take the DHEA-S and then they add it to the two metabolites of DHEA and give you a total DHEA level. So just if you are able to get those numbers, total DHEA plus DHEA sulfate, then you can just figure out by looking at it, is there upregulation or downregulation? But if for whatever reason you’re only getting the adrenal assessment, ask about a high-protein diet, supplements, botanicals, methylation support, inflammation glucocorticoid use to figure out upregulation, downregulation and/or think about using the Organix comprehensive. Not the most reliable, but it might hint at sulfation. Okay hopefully that answers that.