
DUTCH CAR™ (Cortisol Awakening Response)
The DUTCH CAR™ "Cortisol Awakening Response" looks at the overall diurnal pattern of free cortisol, and the total and distribution of cortisol metabolites.
When we open our eyes upon waking, cortisol levels naturally begin to rise by an average of 50%. 30 minutes after waking, cortisol levels will still show this sharp increase. By 60 minutes after waking, cortisol levels have peaked and begin to decline. Measuring this rise and fall of cortisol levels at waking can be used as a “mini stress test”. Research shows that the size of this increase correlates with HPA-axis function, even if the sample measurements are all within range. A quick saturation of saliva swabs upon waking, and at 30 and 60 minutes after waking, provide what is required to assess a patient’s Cortisol Awakening Response. A low or blunted Cortisol Awakening Response can be a result of an underactive HPA axis, excessive psychological burnout, seasonal affective disorder (SAD), sleep apnea or poor sleep in general, PTSD, chronic fatigue and/or chronic pain. A decreased CAR has also been associated with systemic hypertension, functional GI diseases, postpartum depression, and autoimmune diseases.
An elevated Cortisol Awakening Response can be a result of an over-reactive HPA axis, ongoing jobrelated stress (anticipatory stress for the day), glycemic dysregulation, pain (i.e. waking with painful joints or a migraine), and general depression (not SAD). A recent study showed that neither the waking nor post-waking cortisol results correlated to Major Depressive Disorder, but the CAR calculation (the change between the first two samples) did. This measurement of the response to waking has independent clinical value showing dysfunction that may be hidden by current testing options.
This test does not provide any Sex Hormone information.
- Over-reactive HPA axis
- Ongoing job-related stress (anticipatory stress for the day)
- Glycemic dysregulation
- Pain (e.g., waking with painful joints or a migraine)
- General depression (not Seasonal Affective Disorder, SAD)
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Your questions answered
Certain tests may ask you to remove certain foods from your diet for a short period, or discontinue some supplements before taking your sample. All details of any adjustments required can be found on the individual test pages under ‘Collection Instructions’. These will also be sent to you in full with your test kit.
If the test you are taking would be impacted by medication then this will be noted on the sample form when you receive the test kit. You would just need to state the medication you are taking, the dose and when you take it. Not all tests will require this information. You must not discontinue any medication without consulting your prescribing physician.
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