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Here we will explain how to use the questionnaire with a key in order to determine whether or not it makes any sense to do the urine testing for HPU. Depending on the outcome, the lab can sometimes advise doing additional testing.

a. Using the explanation and key at the end, you can decide whether or not to do the testing and if the test turns out to be positive, which additional tests could be done. This possibility is especially useful if you have read the book: “HPU and then…?” or have read the patient information.

b. Using the key to the questionnaire you can choose for a simpler but hopefully not less responsible way to judge the answers. You don’t need any further information to use the key.

  • The questions are presented in the present tense, but think for yourself if the past tense applies to any of them. In the case of young people not yet old enough to develop many of these complaints, think about the health of other family members, especially your mother, grandmother and aunts

The online questionnaire that you can start below can help to determine whether you have HPU. We recommend that you only perform the test if you have sufficient points in this questionnaire.

Start the online questionnaire

Check any boxes if the question applies to you. 

When you have less than 6 points, you will presumably have a negative score on a urine test. At 7 to 9 points it is questionable whether a HPU-test will be positive. If you will come to the count of 10-12 points, then it is likely that you have a positive value. At 13-14 points is this even very likely. Depending on your points score, you can decide whether or not a HPU-test.

Explanation of the questionnaire

Hormonal Regulation

HPU patients usually have a decrease in Thyroid Stimulating Hormone (TSH) production by the pituitary (lower than 2 – usually written as <2 on the test results list). This decrease can cause problems with the adrenal glands, pancreas (blood sugar dysregulation, intestinal complaints, such as gas after a meal) and stomach (feeling of fullness, followed by acid stomach). Adrenal dysfunction can be suspected if an individual has low blood pressure and needs to urinate frequently. Initially only TSH will be tested. If an individual has low blood pressure and/or needs to urinate frequently,  then cortisol can also be tested. If blood cortisol is tested, it must be drawn before 10 AM. Because deviation is less likely than in blood cortisol, salivary cortisol levels are tested during the day. Usually there will be a tendency toward a high morning production of cortisol.

Character traits

The character traits listed in the questionnaire are typical for someone with HPU, especially the perfectionist trait, the ability to combine colours well and being somewhat impatient. Even so, not all these traits are necessarily present. The HPU-person usually has a tendency to complete tasks but, being impulsive, sometimes does not always complete study or leaves projects unfinished. In this area there are usually 6 or more traits. 

Problems with the joints

As inability to climb in rings or ropes or to do push-ups indicates a reduced musculature in the arms, which is typical in HPU individuals. Other traits include knee problems (usually the left one), pelvic instability, hernia, hypermobility in joints such as the jaws and suppleness in other joints. These are typical and indicate the possibility of HPU. In some cases, the opposite is true: the joints are especially stiff.

Sunlight sensitivity

The HPU-patient is very sensitive to light, to pain and to sound but this can vary in individuals. The face is usually pale with the rest of the skin becoming golden brown but, as the person ages, the ability to tan decreases. These people can even develop a sun allergy in the spring. In this category there are usually 5 or more traits scored.


Due to the distress syndrome with an eventual decrease in the production of protective IgA antibodies, many allergies are seen despite the absence of atopy, meaning that there is an increase in IgE antibodies. Typical is hay fever during the summer months, mostly without being able to detect IgE specific reactions. Reactions against dust mites are alos seen at the beginning of the central heating season and against sperm in those using the contraceptive pill. Due to the limited production of protective type A antibodies, a relatively large number will be used up in order to neutralise sperm in the vagina. Consequently, there will be a deficiency in other parts of the body, which is why vaginal infections caused by Candida overgrowth are frequently seen (see also under menstrual problems). The reactions to stone fruit like peach, plum etc. are not actual allergies but pseudo allergic reactions. HPU-patients have poor digestion and assimilation of protein and carbohydrates, which is the reason why we see so many allergies with these patients. In the case of many allergic symptoms,  it makes sense to test for IgE to rule out true allergies. However, if total IgE is not elevated, then an IgG4 test for foods/yeast’s and fungus is advisible. In the case of chronic ENT complaints an alfa-1-antitrypsin test is advised.



Fatigue, skin problems, itching, cold hands and feet and extensive hair growth on the body are indications of a decrease in histamine. The other characteristics also belong to this category. Itching can also be caused by elevated levels of histamine, in which case the symptoms are the opposite. In this category there are usually quite a few yes’s scored, five or more.


Menstrual complaints

Skipped periods or reduced blood flow are typical signs of HPU. Minimal blood loss can be an indication for anaemia. A disturbance in hormone regulation can be the cause of increased blood loss. This is usually accompanied with headache just before or during the menstruation. Distress can be the cause of bladder infections or repeated vaginal fungus infections. If there are many symptoms, then it is advised to do testing for testosterone, estrogen, adrenaline and progesterone. In order to measure the extent of distress, prolactin can be tested. If present during pregnancy, then the chance of depression after pregnancy is greater, including discharge from the nipples. .

Problems during pregnancy

Prolonged periods of nausea during pregnancy can be a sign of HPU. Depending on the type of abnormality in the hormone regulation, either you felt much better or much worse during pregnancy. Your babies were probably born a little too early. The babies are usually mostly girls or, if in combination with abnormality in histamine, mostly boys. If progesterone is decreased, then it will not be easy to get pregnant. If you have not been able to conceive, then it is advised to test for FSH (early menopause) and progesterone (inability for the embryo to attach).

Weight Problems

Despite the fact that there are usually no abnormalities in thyroid hormone found, there are normally symptoms of a hypo-functioning of the thyroid. The increase in weight is usually caused by a another function of the thyroid or hyper-insulinism. By overweight, fasting insulin should be determined.


Sugar dysregulation

Although the symptoms seem to suggest a reactive (up and down pattern) or low blood sugar (hypoglycaemia) in the HPU individual, research shows that there is just as often high blood sugar (hyperglycaemia). In both cases, the diet has been the same. The increased blood sugar is caused by incomplete activation and de-activation of insulin in the liver by glutathione. Fructosamine determination should be carried out. A HbAlc can be substituted, but its range is not as broad. In this category there are usually a large number of symptoms scored (five or more).


General Health Problems

Constipation or diarrhoea are reason to determine total IgA total gluten. This is a different type of gluten sensitivity than for Celiac Disease. In addition, secondary magnesium deficiency can cause other problems. Migraine, twitching of muscles or eyelids and tense muscles are indications for a need to determine magnesium levels. HPU causes an “-itis” picture. “Itis” means inflammation which can be anywhere in the body. Some of these symptoms are caused by decreased immunity for bacteria, viruses, yeast’s and fungi.

Key of the questionnaire


With this key you can try, in your own way, to determine whether or not it makes sense to do the HPU-urine® test and in which areas it’s influence is felt. These areas are an indication of which additional testing might be advisable.

Hormonal Regulation

If you scored 4 or more, note in the box mark at page 26 a “1”. If your score was less than 4 but you checked the question on frequent urination and I have/had low blood pressure plus one of the other questions, then place a “1” anyway. The TSH test can be done to get an impression of the regulation of the thyroid. TSH is secreted by the pituitary and regulates the thyroid.

By low blood pressure and/or frequent urination you can also determine cortisol. Blood needs to be drawn before 10 AM. Usually this test will not get abnormalities, but an adrenal stress profile that is done with saliva several times during the day does show abnormalities.

Problems with the joints

If in this area you scored 6 or more items, you certainly should have the HPU-urine test® done. Note a “2” in the proper place at the end. If you scored 4-5 items, note a “1”. Are you younger than 20 and scored 4 or 5 items, note a “2”.

If you scored 4 or more items here, you are a candidate for the HPU-urine test®. Note a “2” in the correct area. If you scored 3 items, note a “1”. If you are younger than 20 years old, mark a “2” in the area if you scored 3 items or more.

Sunlight sensitivity

If you score 5 or more items in this area, you are a candidate for the HPU-urine test®. Note a “2” in the little box at the end. If you score 3 items, note a “1”. If you are younger than 20 years, you may note a “2” just the same.


Because allergy symptoms can be determined by other factors than just distress such as HPU, the implication of the answers in this area not as great. If you have hay-fever, allergy to dust mites or chronic ENT symptoms then you score a “1”. If you are allergic, it makes sense to determine total IgE. If you have chronic ENT symptoms or lung emphysema, then you are advised to test for alfa-1-antitrypsine. If you have a lot of food allergies, then IgG screening for food/yeast’s should be done.

Histamine Sensitivity

If you score 5 or more in this area, consider the HPU-urine test®. Note a “2” in the box. If you score 4 items, note a “1”. If you are younger than 20 years and score 4 items, note a “2”. If the HPU-test turns out to be positive, you should do a histamine whole blood test, especially if you have fatigue.

Menstrual problems

Menstruation problems can have different causes. If you have/had PMS symptoms, use the “pill” because of menstruation complaints and have very little blood loss during your period, then you score a “1”. Even when the menstruation stopped for a long period, you note one point. Young girls who don’t yet menstruate and men score here 1 point.

Problems with Pregnancy

This area has not been included in the guide for obvious reasons. Typical HPU-complaints would be nausea (morning sickness) after 12 weeks, complaints of sour/acid stomach or regurgitating stomach acid toward the end of the pregnancy, anaemia, diabetes during the pregnancy, toxaemia, and problems conceiving. See the explanation for more comments.

Weight Problems

Low weight

Take your length in centimetres, subtract 100. Take the remainder of this and divide by ten. Subtract this remainder from the first number. Subtract another 5. Is your weight (in kilograms) lower than this number, note a “1” in the box. For example: your length is 168 cm (168-100=68). Then divide by 10 (=68 becomes 6.8 or 7 rounded off). Subtract this from the 68, which gives you 61. If your weight is less than 56 kg, note a “1”.

Low weight

If you didn’t score with low weight, then again subtract 100 from your length in centimetres. Take the remainder, divide by 10 and add this to the remainder. Add another 5. Is your weight (in kilograms) higher than this number, note a “1” in the box. A new example: You are 168 cm (168-100=68). Divide this by 10 (=68 becomes 6.8 or 7 rounded off). Add this result. That will be about 75 kg. If your weight is more than 80 kg, note a “1”. In all other cases note a “0”.

Sugar Problems

If you scored five or more items, then you are a candidate for HPU testing. Note a “1”. If you scored four items and you are younger than 20, note a “1” anyway. If you are presently using a Candida, diabetes or hypoglycaemia diet, note a “1”. If your HPU test turns out to be positive, you can determine fructosamine as indicator for your blood sugar level. If fructosamine is low, it means an under activity of the thyroid (hypothyroidism).

General Health Problems

Constipation, diarrhoea, light coloured stools and upper abdominal pain are typical complaints. If you scored at least two of these problems, note a “1”. If you have frequent diarrhoea and constipation, you can have IgA tested for gluten (a different test from celiac disease test).