Episode 2: Adrenal Health and How to Support Your Adrenals ( Dr. Carrie Jones)
Show Summary:
Dr. Carrie Jones, Medical Director for the DUTCH test, joins us to discuss how the adrenals impact our health and what we can do to support the adrenals.
We cover how to identify symptoms of adrenal dysfunction and options for testing. We also discuss how the adrenals impact the immune system, gut health, and autoimmunity. Tune in to find out practical tips and steps to support your adrenal health!
Listen to the full conversation:
Subscribe:
Watch on YouTube:
Full Episode Transcript:
SPEAKERS: Dr. Andrew Wong, Dr. Carrie Jones
Welcome to the Capital Integrative Health podcast, a podcast dedicated to transforming the consciousness around what it means to be healthy and understanding the root causes of both disease and wellness. I am Dr. Andrew Wong, co-founder of Capital Integrative Health, an integrative practice committed to expanding access to holistic root cause medicine to the global community.
We are excited today to be joined by Dr. Carrie Jones, medical director of the DUTCH test. Dr. Jones is an internationally recognized speaker, consultant, and educator on women's health and hormones. We have had Dr. Jones several times over the last year speak on wellness webinars and we always enjoy learning from her. Today we are going to discuss why adrenal health is so important and what you can do now to support your adrenals.
Dr. Wong:
So today we are going to discuss why adrenal health is so important and what you can do to support your adrenals. Welcome, Dr. Jones!
Dr. Jones:
Oh my gosh, thank you so much for having me. I'm thrilled to be here.
Dr. Wong:
Thank you so much for coming on and yes getting started with our podcast here and what better person to bring on than Dr. Jones. Now we can talk about the adrenals, we've talked about this a couple times during bonus webinars but just for our listeners who have come on for the first time here- what are the adrenals, and why are they so important to our health?
Dr. Jones:
We have two of them. They sit well; assuming you have two kidneys, you have two adrenals that sit on top of each of your kidneys and they are tied to a system called the hypothalamic-pituitary-adrenal system or HPA axis which you've probably heard a lot. (And) our adrenals honestly, they produce a number of hormones- cortisol being the most famous and because it produces cortisol it really helps us manage our blood sugar, manage our stress, manage our inflammation. It's kind of our fight or flight system with our whole HPA axis so they're really important. They get a really bad rap because of their production of cortisol but they are literally critical to living. We have to have a healthy HPA access to survive and thrive.
Dr. Wong:
And please remind me I want to take a deeper dive into cortisol later because we always think about cortisol being like the bad guy like “oh too much stress, too much cortisol” but we do know and I’d like to take a deeper dive in this a bit later in this podcast about the relationship between low levels of cortisol and Covid-19 morbidity this idea that we actually need some cortisol to reduce some of that inflammation. So, I would like to hear your thoughts about that but first of all I wanted to also ask you about the DUTCH test, now you're medical director of the DUTCH test and that we could think about DUTCH, of course, being, you know, European designation. What is the DUTCH test? Let's talk about that.
Dr. Jones:
It is an acronym. It stands for Dried Urine Test for Comprehensive Hormones. So, it's an at-home collection test where you basically urinate on these pieces of filter paper, four if not five times throughout the course of the day and into the night and let them dry, mail
them back to the lab and what we get off of these filter papers are hormones. So we get your estrogens, we get your testosterone, we get your DHEA, we get your melatonin, cortisol as we'll talk about, some organic acids like a B12 marker, two B6 markers. A lot of good(y) things on this test and what's it like, I said, it's pretty comprehensive, hence the C in the DUTCH part and it's easy to collect at home so for those who don't like their blood drawn. It's great.
Dr. Wong:
I want to get to the most important question of the DUTCH test, which is in order to send it to the lab and not let it be eaten by your lab, by your dog, just throw that in there. Where do you? Where do you recommend storing it in your house if you're getting a DUTCH test?
Dr. Jones:
So, you can let it dry on your counter, you do need to be careful of animals. We get a fair number of calls about animals and kids who grab the filter paper and take off with it. Something fun or interesting and naturally that's what they gravitate towards. So somewhere up high on the bathroom counter, they can let it dry. Once it's completely dry and if you're waiting to mail it for whatever reason, maybe it's a weekend, toss it in the freezer until you're ready to actually ship it out. Just don't forget it's in the freezer, we have had a number of people collect (it) on maybe a Friday, they put it in the freezer all weekend and completely forget about it, and weeks later they're like “oh my gosh! Can I still send it in?” Yes, as long as it's in the freezer.
Dr. Wong:
Okay, great. And we know that, I know a lot of listeners may know about sort of salivary cortisol testing and salivary adrenal testing. If you could just speak to salivary versus urine hormone testing and kind of the differences or similarities there.
Dr. Jones:
We actually have a combo too. We can combine salivary with urine testing but salivary testing became really popular because nobody wanted to get their blood drawn throughout the day. That's a lot of pokes, and so salivary testing came along where you sort of free spit into a tube, and you get what's known as free cortisol. Free cortisol is the active cortisol that free portion of it is what helps it bind to receptors and do the things. So you just look at free cortisol but that's not the whole picture and what we did at DUTCH is we used urine so that we could find the free cortisol but also something known as metabolized cortisol which is an indicator of total cortisol production and what I mean by that is free cortisol tells you what's free but it doesn't tell you may be the potential of what was available, and so it's nice to know could you even make cortisol in the first part and then how much of it is actually free. We also look at cortisone which is inactive so some people have low cortisol not because they can't make it but because they deactivate it, and so having all this extra information around cortisol can be really really helpful in answering your questions when you're talking about “I'm super tired in the morning” or “I'm super jazzed up and anxious in the morning” and how does that relate to my cortisol results.
Dr. Wong:
(And) we're going to take a little bit of a deeper dive into this in a minute in terms of let's getting more specific into this sort of (the) medical terminology I think we should sort of maybe differentiate a first out difference between what's called adrenal fatigue you know a classically called adrenal fatigue and what is as you said hypothalamic pituitary adrenal axis (HPA) axis dysfunction and I think we should also throw in there the sort of accepted medical diagnosis of adrenal insufficiency. So where that kind of fits in the spectrum? what is the correct terminology for adrenals like how do you decide with the patient someone's coming in you know with adrenal issues that they say “Hey doc my adrenals are off” you know “do I have an adrenal insufficiency, do I have adrenal fatigue you know do I have HPA Axis?” How do you differentiate there?
Dr. Jones:
So adrenal fatigue is sexy, it's easy to say everyone understands what it means and so when adrenal fatigue, the term became popular, it was easily identifiable and I want everyone listening to know the symptoms are super real, 100% real, I'm not arguing that in the slightest. I totally believe you when you're tired and burned out but unless it's Addison's disease, Addison's is the autoimmune inability to produce cortisol. Your adrenal glands are not actually fatiguing out they're not like a menopausal ovary they don't go through menopause, your adrenal glands do not. So then we decided there's the umbrella term HPA axis dysfunction, so somewhere between the brain and down to the teeny tiny mitochondria in your adrenal cell there's something wrong, there's some sort of miscommunication and that's why you're not making cortisol and what has been sort of come along since then is adrenal insufficiency so the sort of the inability to produce cortisol and often somebody's cortisol is low when they do testing. So I reserve HPA axis dysfunction as more of a grander umbrella term because it can be due to a number of things and when they specifically and because dysfunction can be high, dysfunction could be low, dysfunction can be low in the morning, high at night, you know low in the afternoon, it could be a lot of things. Whereas adrenal insufficiency more implies low cortisol across the board why aren't the adrenals producing it?
Dr. Wong:
And I think words do have the sometimes ability to elucidate but words also have the ability to confuse everyone as well you know that's why testing can be really helpful if someone comes in and says I'm fatigued and burned out, you know I'm crashing it
could be totally an Addison's picture, an adrenaline deficiency, it could be HPA axis dysfunction, it's regulated circadian rhythm you know there's a quite a few variety of possibilities here. So doing testing is really helpful kind of this idea of test don't guess you know and we really love that motto here and I think the other thing in functional medicine we know that a lot of times when people come in and maybe someone has told them they're fatigued because their adrenals or maybe they're fatigued because they are told by their doc that they have a mood issue and they have depression you know and the adrenal thing is on their head you know that kind of thing so moving away from the tyranny of the diagnosis so to speak to just say hey what's the data look like what does the data look like clinically in terms of your symptoms how you're feeling your lab work including things like the DUTCH tests can be really really helpful so thank you for that explanation.
And then this is going into HPA access dysfunction a bit more. What are some of the signs and symptoms besides feeling fatigued and burnt down and things what other things do you see you know overall commonly?
Dr. Jones:
So you can be on either side of the spectrum. Meaning you can be fight or flight, stressed out, anxious, panic attacks, can't sleep, insomnia, you wake up in the middle of the night, and then you can be on the opposite end you can be burned out, low energy, require lots of caffeine, don't want to get out of bed. It's really sort of dragging, it's affecting your mood, it's sort of affecting how you handle your blood sugar, how you handle inflammation, all of those things and it may change depending on the day. So for example, a classic sort of pattern that we see are with our new parents, or with our
entrepreneurs, so they get their kids to bed and then they get their second wind and they do all this stuff between you know like 8 and 11 p.m at night they're on their computer, they're finishing this up, they're finishing that up, they're cleaning the house, they're you know finishing laundry, they're opening mail, and or they're watching their tv show, and then they can't fall asleep, and stay asleep so then they wake up tired so they get this dysfunction because you're supposed to have healthy robust levels of cortisol in the morning and instead they have low levels in the morning but high at night they have what we call as a flipped curve and so you may be all day fight or flight, you may be all-day burned out and tired or you may depending on the time of the day feel one or the other depending on how your rhythm is working which again I agree with you about testing because we can guess sometimes you know with what's going on but if you really
want to know that ideally to test on a typical day is the most helpful.
Dr. Wong:
And what i found is that when people are kind of testing on a typical day and they see that result there's actionable items that can occur from that whether it's something like nutraceuticals but also stress management lifestyle nutrition that are really really helpful that they're going to be motivated because they see the result in that test they see what it's doing to the body because they feel it.
They know it's real and then the test is just validating that as well. I think it’s time for me to take another DUTCH test. I have it in my home, it’s sitting and ready to go. I need to get carve out the time to do the DUTCH test you know.
Dr. Jones:
I love that you said that it can be a you know a good reality check for people. I (did my dutch I) do my dutch test every year because perks are the job and I did it in March, March into April and I knew I was tired and burned out. I knew 2020 had been a very trying year I know for everybody but it's also an extremely busy year for me. Everything got moved online and then amplified 10 times over. So to see it on paper of exactly how my body was not dealing well and I was like “oh there it is!” I cannot continue to burn the non-toxic candle at both ends because it's only going to get worse and
that was even though I work for the company and the medical director and people would go well you should know better (I did) but i'm also human who's a pusher and a goer and Type A and I thought I can get through this.
Dr. Wong:
Yes, push through it, use that adrenaline, yes, I’m the same way.
Dr. Jones:
Yes, it's fine, i'm fine, it's fine and then on paper was like you're not fine. I'm like - Okay.
Dr. Wong:
And you knew these test results actually respond to the lifestyle changes of time. If you check it you know in the next few months; if someone had tests like that or you know whatever their test is and they want to make some changes; when would you say to them “hey recheck it” you know when's a good time to recheck it?
Dr. Jones:
The minimum time i'd say is three to four months. I don't generally retest any sooner than that and the most common reason is that it gives you time to make changes whether you're implementing them all at once or over time and for the females who are still cycling it takes about three months for your ovaries to go from like a really tiny what we call a primordial follicle all the way up into the chosen follicle. So even though we're talking cortisol, for cycling females, we kind of we work monthly and we work in three-month spurts as well. So well let's see what happens in three months so we can see like our next baseline healthiest if you will. But beyond that, like I said it takes about 90 days. 90 to 120 days for people to go okay, i'm gonna make these changes, i'm gonna make them stick they're gonna fall off the bandwagon several times, totally fine, they're gonna get back on because if you just give them 30 days, usually it's not long enough.
Dr. Wong:
30 days is enough time to get off and on the bandwagon one time and then you're back to restart and then you have another 60 more days there so I agree with you I think quarterly is very digestible I think people (you know) people can understand that there's four seasons typically a lot of times a lot of places so you know it's quarterly. Well this is a podcast on Integrative Health Naturopathic and Functional Medicine and so what are the root causes of HPA axis dysfunction (you know). What are some of the upstream causes we have? a DUTCH test shows some adrenal dysfunction; what do we look to for possible root causes you know we maybe want to talk about the gut or hormones or other things.
Dr. Jones:
All of those so when it comes to stress, stress is a couple of things; so stress is everything on the outside and everything on the inside. So what I mean by that is it's what's happening in your environment, it's what's happening mentally you know mentally, spiritual, it's what's happening physically to you, but stress is also actual. So the actual stress you're experiencing it's also anticipated. So what I mean by that is it's the stress that it's actually happening but if you're also the type of person who makes mountains out of mole hills, (so you) the stress maybe isn't happening but you're like worst case scenario type of person, your body reacts the same way and so it's explaining to people if you are always in that mindset of gloom and doom, it's going to happen, I know worst case, this is awful then your body's like “oh fight or flight; there must be a tiger; i'm gonna react” and so it's working through that as a person is that how you identify or you more of an in the moment handle the stress type of a person.
Stress has a lot to do with our lifestyle. The way we eat, infection and inflammation, our cortisol, our norepinephrine and epinephrine i mean they play a huge role in our immune system so if we have chronically upset guts you know, our microbiome is
dysregulated, we have Lyme, we are dealing with molds, we're dealing with viruses, bacteria, whatever it is, cortisol gets involved. It's part of your system to help you survive and thrive and so when it comes to stress, I don't want anyone to downplay it, blow it under the rug, think it's you know normal it's what humans deal with because stress can be it could be a killer I mean it can really worsen quality of life and so when I think of root cause i'm asking just like you are i'm asking all the questions - what's going on in your life? What's going on in your body? How are you sleeping? What are you eating? What are you exposed to? How's your family dynamic? Do you have a friend group? Talk to me about your community. All those things and (I don't think) people think stress as in like “oh I got a bad text message”, or i'm going through a divorce, or there's a pandemic. A hundred percent on top of that it's everything else. They don't realize “oh gosh you mean my gas
and bloating contributes to the way cortisol reacts?” yes. “Oh my gosh you mean when I get hangry or I skip meals or maybe somebody's dealing with diabetes but not well like that affects my cortisol?” yes. And so it's nice to know how to tie that together.
Dr. Wong:
Yes and I was remembering when I was learning about sort of the dichotomy I guess or just in terms of understanding you know physical stress versus psychological stress really it all comes back it does get stored in the body whether it's you know we call it physical or psychological but even you know psychological stress and then also like you said perceived stress is real too. You know that whole idea of running away from a tiger versus imagining running away from a tiger as a result of getting a bad text message or something.
Dr. Jones:
Right! right, where you think there's going to be, you send a message and you expect the message back to be angry and triggering and full of hate and like you stress out over it and then when the text message comes through it's not. You've just put your body through a stress cycle that you didn't need to but your body doesn't know.
Dr. Wong:
I'm just pivoting a little to COVID; i'm wondering what your thoughts are about the inflammatory you know cytokine storm and this idea of M1 versus M2 macrophages you know this idea of like pro-inflammatory versus more anti-inflammatory macrophages. I'm curious if there's any research out there that you come across that shows that stress will induce M1 a bit you know in other words, this idea that yes cortisol goes up does the immune system also get affected with the cortisol imbalances and things like that.
Dr. Jones:
It does! it does. I haven't necessarily seen research specifically on studying cortisol and COVID. We at the lab are trying to look at that as people report they're positive for COVID or had COVID at the time of testing which absolutely happened we're trying to see how that's affecting hormones and cortisol but we do know in general with any immune response your cortisol should go up. It's anti-inflammatory to a point of course the problem is when you have it up and doing its thing all the time that we get sort of in this chronic inflammatory immune response. So yes, cortisol does play an important role in the immune system
Dr. Wong:
Is there a current thought in the ntegrative health space now about HPA axis function? How we're adrenal fatigue? It was kind of like cortisol is “high high high” and after a while, it kind of burns out and goes low. Is it still kind of thought that is what happens?
Dr. Jones:
There's a negative feedback loop which is that is real and so you have high cortisol. (you have high), think this is my analogy. You have a child and your child is trying to get your attention right like constantly tapping on you “dad dad dad dad dad dad” finally you're like, “stop it! we're done here!” right like, “knock it off!”. The brain does the same thing. So cortisol's “up up up up”, the tissues are like, “I don't want to deal with all this cortisol anymore”, the brain says “fine! negative feedback loop we're going to shut it down” and down drops your cortisol.
Dr. Wong:
So the cortisol receptor resistance.
Dr. Jones:
You get that too, you can get that too. They can be two different mechanisms.
Dr. Wong:
Got it! Okay, locally and so gut is a big you know issue of course and many patients, I think many people in the public also maybe are not aware of that stress you know, a lot of people have heard of leaky gut before the idea of impaired intestinal permeability. But I don't know if everyone knows that stress itself can cause intestinal permeability.
Dr. Jones:
It can! yeah.
Dr. Wong:
I wonder about that gut adrenal connection too.
Dr. Jones:
You have that mucous layer that's really healthy in your in your intestines and the mucous layer acts as a buffer between things you eat things you swallow things you breathe in. What have you and your mucous layer relatively speaking is, it's thick, it's to really provide a fortress between inside the tube and the outside of the tube right. And so if you have chronic stress that those that cortisol and adrenaline so epinephrine norepinephrine it can wear down the mucous layer for lack of a better word and now you get a very thin mucous layer and now things can penetrate the fortress.
Dr. Wong:
So we want a strong fortress. Stress management. What are your favorite stress management techniques? I think we can maybe go back to hormones in a second.
Dr. Jones:
Yeah, so if we're looking at lifestyle stuff there is this, there's this theory it's called the polyvagal theory where it's looking at fight or flight fight freeze or fun which is how people react right or rest and digest. And one of the big things that helps keep you in rest and digest are things like community and joy and love and play. And it's hard to be fight flight freeze fun when you are happy and engaged and you know supported and whatnot. So one of the big things that I've been really talking about is is finding joy finding your community and I know lately it's been hard. The last year with all the shutdowns but doing it is the best that you can. And finding that connection and then the other thing our we know, there are a million like self-care things right. Meditation, there's different forms of breath work, you know every exercise there are there's supplements that are stress supportive. It's eliminating foods that you know are triggering to inflammation. If you know you shouldn't eat ice cream because it sets off your go like stop eating ice cream you know like there's food you know as an adult like I shouldn't eat this but I love it i'm gonna eat it anyway turns out it's a gut bomb right like you know. Avoiding those things, reducing toxin exposure all of these little details add up over time in a positive manner. But what I have found is that it's your relationships, it's your community, it's that joy, it's that play for me anyway. It's sort of at the top of my hierarchy of where I start and then I back from there like, “okay, now try breath work super easy it's you can do it a minute or two a day look at 10 minutes of meditation you know look at this, look at your sleep routine.” are you up late on your phone? on your computer? like let's you know, so then I start to peel apart the other parts of the lifestyle.
Dr. Wong:
And it's creating you know that join, that purpose and that higher order meeting is creating that that sense of safety. I think to all of yourselves you know like that is the fertilizer for your immune system to remain strong the fertilizer for your gut to remain you know like healthy mucous fortress you know things like that. And I think you mentioned also in one of our talks together about massage and bodywork and how that can really affect the circulation that goes up to the hypothalamus and pituitary.
Dr. Jones:
Yeah. If we think about it our blood, our arterial system is our hormone superhighway. I mean it's where everybody travels through and around. So if you are listening to this and your shoulders are up at your ears and you're in a weird position and you're sit down desk or you're you know hunched over, you're going to affect how your blood flow your lymphatics flow everything goes up and down from your brain where it's where the signal starts down into the rest of your body. And so it's, first of all posture right. Like pull your head back, stop looking down at your phone and sit up straight. And then second of all, it's evaluating like “gosh you know what maybe I should see a chiropractor, maybe I should get massage, maybe I should get some acupuncture” and really work on the tightness of your the upper traps and the neck and you know the upper back stuff because it could really make a world of difference. One, you'll help with pain, two mobility and three that hormone super highway.
Dr. Wong:
And a lot of times too, in traditional medicine we talk about like take an aspirin three times a day or you know take ex medication or even nutraceutical you know. And it's almost like the, these treatments are external and they're time limited but we don't think of what we do moment to moment, every single moment to support or maybe harm our adrenals you know. So it's like, we might eat that ice cream but if it's a 80 20 rule thing and we feel good about it we feel connected to the family and friends and the rest of time we don't feel guilt about it and it's like okay with that moment versus if someone ate that ice cream and then they felt guilty for the next you know 48 hours what's that doing to their gut you know that's kind of an interesting thing yes kind of thought.
Dr. Jones:
I completely agree with you. I find that people I get this anecdotal feedback a lot from people when I'm on vacation. I feel like I can eat more foods. I was like that is a big trigger. I mean that's a telltale sign right yeah I mean that's the trigger to me to be like.
Dr. Wong:
People are more relaxed and yes.
Dr. Jones:
They're more relaxed, they're generally happy, they're generally around people, they enjoy you know they're doing something they enjoy. It's truly a vacation, it's time off exactly but you're right think and the reason I say if you know a certain food bothers you, what happens is people tend to get in this sort of mechanistic eating like, “it's dinner, must eat” and then like “oh i'm bored i'm watching TV, I'm disengaged I want ice cream” as an example. I don't mean to pick on ice cream and so then they eat the ice cream.
Dr. Wong:
Its a delicious food.
Dr. Jones:
Right and then they're like “oh you know it's a gut bomb but they weren't really savory in the moment. It wasn't in a great environment. It was you know, (it) not they may not even even felt guilty they're just bored and out of habit that's their comfort food and so
that's why i'm like we've got to evaluate some of these relationships.
Dr. Wong:
Now is that going into the food a bit because we know that food is medicine right. So we have someone with hvac dysfunction or adrenal issues, adrenal imbalances. How do we support the adrenals using diet what are your top tips for nutrition there?
Dr. Jones:
Electrolytes are a big one. So I find that you will hear online of people saying you know add a little bit of salt to your water in the morning. Which can really make a big help, a big difference but even just getting unsweetened electrolytes of those people who are into electrolyte powders that can make a big difference in how you feel and how you hydrate and of course dehydration is a stressor as well eating regularly. What I mean by that is when you are in a state of insufficiency and you don't eat, if you don't have the cortisol to get you the blood sugar that the glucose to be made to break down then you become hangry and you become hypoglycemic and you get more stressed out right and then you produce more cortisol as a result and so in that those states I know intermittent fasting is a big deal now. i know long fasting is a big deal now right now it's all the rage right now and I'm not against it but I do think certain people need to dip their toe in the water or maybe work on their adrenals first before they go doing 24-hour fasts and but yet, they can't even make it through their day because they're so tired.
Dr. Wong:
Yeah certainly step by step.That's something that you know I always kind of learned through my family upbringing was like take things step by step one thing at a time. If you're not used to 24-hour fasting or even 16-8 then you really don't want to go probably past 12 hours on 12 hours off I would say you know. A lot of people may start with not snacking and just eating like three meals a day and then just being hundred body is healing and certainly stress and sleep and all these things can affect even people's menstrual cycles can affect right the ability to be able to tolerate your low carb or intermittent fasting type of diet. So kind of curious too on the the aspect between males and females if you find any differences clinically there about the ability to tolerate intermittent fasting or other nutritional changes like that.
Dr. Jones:
With females, I do tend to see that it affects where they are in their cycle and so as a woman is leading up to her period if she's especially prone to that late luteal PMS time is what we refer to it as usually she's craving more carbs she actually needs maybe more carbs maybe a lot of the experts out there are saying get yourself out of a low carb state don't be in ketosis necessarily right then versus when you are bleeding when you have your period leading up to ovulation when your hormones are lower and then estrogen starts to rise like that's a much better time to do some sort of intermittent fasting or longer fasting. Because those hormone shifts and the hormone demands the hormone signaling does play a role in and how intermittent fasting or fasting will do for you. And so I hear women who go “oh my gosh I'm doing keto or I'm doing low carb or I'm trying fasting but it's right before my period and I'm miserable and I'm hungry and I'm moody and I'm like yes you have to work with your hormones not against them.
Dr. Wong:
I think that is the danger of Dr. Google or the internet is like intermittent fasting is great for this. One group or this case study so it must be good for everything.
Dr. Jones:
For everyone exactly especially because it's a lot of men and I'm not picking on men at all. It meant a lot of many kind of started the conversation originally around ketosis and intermittent fasting. A lot of the studies have been on men and so women were like fantastic I can do this too who are still cycling men in menopausal women are different they can they can handle it wait they're not cycling.
Dr. Wong:
And do you think it's from the boost and estrogen that happens when needing more carbs that it helps or it's a boost in serotonin.
Dr. Jones:
It's for progesterone. It's more to maintain. It's more to maintain progesterone production.
Dr. Wong:
Okay great. And then how to get tested if you think you have adrenal issues? You're the medical director of the DUTCH maybe we're gonna start with that. What are some good tests for the adrenals?
Dr. Jones:
So I'll start with serum and so if let's say somebody got a blood test for their cortisol it's called a total cortisol and the reason it's a total is cortisol is like a child that can't be unattended at any time. So let's say you get a value of 10 when your blood draw what you don't know is how much of that is bound up on a bus in inactive or is free and available. So a 10 tells me nothing. I have no idea if you're 9 free or 9 bound up so then we have saliva which is easy to collect and at home unless you don't like spitting then that's a problem and but it gives me the free cortisol how much is available and then we have dutch testing the dried urine part still easy to collect at home but does give you more information. You get the free cortisol, you get cortisone, you get total cortisol production plus other cool things like melatonin. And so it gives you a bigger package in urine testing. So I being totally biased like the dutch testing but I do know the other you know if you've got to start somewhere then just start you know if you've never done this before if you're brand new if that's what insurance will cover it'll give you a little bit of insight but I do prefer to be if you're going to spend your money spend it on something that's going to give you answers.
Dr. Wong:
The great value. And I think there's another piece of it which I think might have mentioned but this idea of this DNA oxidative stress marker and we know that with different types of estrogen metabolites, if they're inflammatory that can actually damage the DNA and mutant cancer, is that correct?
Dr. Jones:
Yes, yes. Potentially yeah. Because if the DNA is damaged we don't want that because that means that our DNA repair system has to come in and fix it.
Dr. Wong:
So we don't want to not call it a cancer screening test or something?
Dr. Jones:
It is not. No, it is not a cancer screening test.
Dr. Wong:
That marker is high we know there's some inflammation going on and we know we have got to dig in like an archaeologist. So to speak, to find some of the cause or causes that's going on now, why would my regular doctor not know about this type of test you know if someone is kind of come to me like no one told me about this before what what is your answer to that usually?
Dr. Jones:
Honestly they're not taught in school. It's considered a more functional test. I mean you would know this best of all having gotten that route first.
Dr. Wong:
Definitely not. No education on that at all, no education on this at all.
Dr. Jones:
Yeah and in a lot of conventional medicine and endocrinology there's Addison's and then there's Cushing's which is the opposite end of the spectrum. It's very black and white. There's no gray area. There's no sort of functional cortisol issue. It's well, you're not absent, you're not cushing so you're normal. Meanwhile you need eight cups of coffee and you can't get out of bed and you're super exhausted or struggling to get through your day and that's really unfortunate so that's where the sort of creation of these tests have been born.
Dr. Wong:
So again test don't guess because we can use more precision testing to then it then converts to more precision medicine as well.
Dr. Jones:
Yeah really absolutely.
Dr. Wong:
It's got a lot of success with the best tests using it doing a lot of consults with you Dr. Joseph, thank you so much.
Dr. Jones:
Yes of course, yes.
Dr. Wong:
Let's pivot a little to COVID since that is the hot topic right now. What are your thoughts on sort of covid and the adrenals and how to support the adrenals in this time of COVID?
Dr. Jones:
We know with COVID or at least I've been told and done some reading up that COVID can affect the mitochondria. Okay so our mitochondria are cellular powerhouses we learned about that in school they help us make our ATP to power up our cells and everything in our body but the mitochondria are also where you produce hormones such as your sex hormones estrogen progesterone, testosterone also where you produce cortisol. And so if your mitochondria is affected so some of these people who unfortunately have like long COVID as an example. What's a primary complaint fatigue right primarily fatigue and so I'm loving the research that's looking into what's going on with the mitochondria after a COVID infection.
Dr. Wong:
Sounds like a mitochondrial dysfunction post virus. Whether it's COVID or epstein-barr. Even if there's mimickers like microplasma that go inside the cell or lyme that goes inside the cells right here that go inside the cell and act like viruses they're almost like the factory workers have left the building you know like the mitochondria stopped working they stopped kind of producing for us and then we get that fatigue so I know in our practice we've definitely found that you know IV nutrition to be helpful. And you know nutraceuticals that have been helpful and certainly people are often having to modify their work schedule, their life schedule so that they're not having as much demand because if there's too much demand for their ability to actually produce the ATP from the mitochondria then you get basically mitochondrion coupling and you basically get this idea of too much stress limit chondroitin then they just kind of fall apart and not you don't want to work anymore at all.
Dr. Jones:
Yeah and then we get what we call the fancy word is mitochondrial autophagy or mitophagy. But what we say is like well you know the body recognizes the mitochondria aren't doing well and I'm like well then it has to like put it out to pasture right yeah like, “oh you've got to go” which is not good either.
Dr. Wong:
Right. So, and then I think back to the first comment about cortisol. So again cortisol is not all bad and you know we need cortisol. If we didn't have cortisol we would have this Addison or this adrenal deficiency. Too little cortisol can lead to things like hypotension like low blood pressure you know or things like you know certainly extreme blood sugar dysregulation as well and things like that. And then obviously too high of the cortisol which you're going to get with chronic stress you know that's going to be those situations can even affect people's bone health their osteogenesis, osteoporosis. People are on steroids too for a lot of years. I wanted to ask you about pharmaceuticals as well because I've seen a lot of people recently that have come in that have been on Adderall for well, I would just say sort of generally, I'd say ADHD meds not necessarily just Adderall but ADHD meds or SSRIS you know selective serotonin reuptake inhibitors that are used for either anxiety depression for instance. And they have actually signs on their dutch test of basically HPA axis dysfunction with low cortisol very low and my understanding of some of these medications is that while they're really good sometimes it can be life-saving for some people in the short term and they're appropriate at times in the long term if those root causes are not addressed the mitochondria can be affected. I'm curious if you've seen that on the test?
Dr. Jones:
I have. I have seen that, yeah. It's usually with the ADHD medication we will see and then when you start it we will tend to see cortisol go up right because it's a stimulator and so people feel better they feel like they can focus they have more energy they're thrilled. But just as you said, if maybe some of those root causes not necessarily of ADHD but of HPA axis dysfunction it's just like, “oh here try this med do nothing else” which is very common then over time the body's like “I'm pumping out all this cortisol for you and you're not addressing anything” and so gradually cortisol starts to drop down which is different, different than those who are on steroid medications. So think of your prednisone your injections, your topical creams for rashes and eczema and what have you your nasal sprays your inhalers that are steroidal totally different. So that works by taking over so this those steroid medications will take over for the HPA axis. So it will suppress your cortisol production and it will instead you medicate with that and so that can be really challenging too because let's say you choose to go off and you wean yourself off but now you have to get your HPA axis to like open the factory to make cortisol.
Dr. Wong:
Yeah, yes. We talked about cortisol. I think we should just touch on our, I don't know if it's a big sibling or little sibling but DHEA.
Dr. Jones:
Yes, yes.
Dr. Wong:
Would you consider not to put you on the spot? Would you consider that a big siblings little sibling identical twin? What is it?
Dr. Jones:
It's more like its counterpart. DHEA is my favorite hormone if I to choose a favorite it's all, it's DHEA in the brain it acts like a neurosteroid. It's very protective against the damaging effects of cortisol. DHEA gets a bad rep because women think “oh I don't want high DHEA ( acne, chin hair, PCOS) but DHEA is really quite helpful just like everything else when it's in balance. So it is helpful.
Dr. Wong:
Do you recommend for people to talk with their practitioners about sort of supplementing or how would you get the DHEA up if you didn't want to use supplementation if you wanted to use maybe herbals or lifestyle etc?
Dr. Jones:
Well it's made in the adrenals. So whatever you're going to do to support the adrenal glands
Dr. Wong:
Will help that.
Dr. Jones:
Will hopefully have a roundabout effect on your DHEA as well now there is a difference between DHEA and the sulfated form known as DHEA S and genetics gets involved there to put the S on. You have to have an enzyme called sult. s-u-l-t well it comes from the sult snip and sulfur transferase is what puts it on. And so if you have sult issues you may not have adrenal or DHEA issues. What you may have is the snip issue of a mutation variant and so it is more complicated than people like to try to make it like oh your DHEA is low just take it you'll be fine I'm like well actually you make dhea you just can't sulfate it let's address that.
Dr. Wong:
I can't get out of my head soft to say this on on air here but Dr. Sult is a functional medicine doctor actually.
Dr. Jones:
That's true.
Dr. Wong:
I had to say that.
Dr. Jones:
Yes that is true! Different Sult, yes!
Dr. Wong:
And so the other thing I wanted to just touch on is thymic activation you know you talked about one of your webinars. I think at dutch about cortisone and thymus activity so what is the thymus? Why is it so important with the immune system? How is cortisol related to the immune system again? just in this covid era here we're kind of.
Dr. Jones:
Absolutely hot on that. Your thymus gland sits behind your chest bone here. Your breastbone it's different than thyroid. (it's this is thymus we're talking thyroid is neck thymus is down down below the chest plate) so the thymus gland is super critical to your immune system when you have new baby T cells that are entering into baby T cell school.
They have to mature and as they mature one of the classes they take is “are you autoimmune” and so the thymus gland will take your baby T cells and run them across basically every tissue every piece that you have in your body to see if you accidentally react and if you accidentally react and you're autoimmune then you fail T-cell school and you have to be destroyed and one of the big triggers to help get you to destroy that autoimmune. Cell is the rise the healthy rise in cortisol in the morning and so if you don't get that let's say you have low cortisol in the morning then that T cell that is reactive could slip out and go into circulation and so when you have low cortisol issues in the morning. It could worsen your autoimmune symptoms, it could worsen your autoimmune progression and I hear this a lot from men and women who say, “gosh in the morning my joint pain is worse. They have autoimmune immune something or my thyroid symptoms are worse or whatever. They're my crohn's is worse whatever's going on in this, in sort of inflammatory autoimmune state and we find out with that low cortisol. One, they can't temper their inflammation because cortisol is low but two, it's possible that it's related to the fact that their thymus gland the thymus school is like, “hello I'm pulling them aside I'm pulling the failed ones aside come help me destroy them and they're not going.”
Dr. Wong:
To school us out to lunch or even summer break let's say for the thymus does that mean that we're going to lose T regulatory cells in that situation or,
Dr. Jones:
It's possible. iIt's a little different but it's what we don't want are the autoimmune T cells to go out into circulation. So the T cell that's already trained has already been wired to attack something like your thyroid like your intestine, like your joint. We don't want that to go out in circulation, we want clean well-educated T-cells to go out.
Dr. Wong:
So they all need a college degree or at least a college degree,yeah. Graduate degree, all right yes that sounds great. And so you know we know that you know with the root cause of adrenals it's really looking for to the root cause finding practitioners finding amazing functional labs like Dr. Jones's lab the Dutch test here. Thank you so much Dr. Jones for joining us today. And where can listeners find you to learn more?
Dr. Jones:
I hang well, I hang out with you a lot but I hang out on instagram. I am @dr.carriejones and that's where i do most of my education.
Dr. Wong:
Thank you so much Carrie and thank you Dr. Jones. If you enjoyed this conversation please (leave a moment) take a moment to leave us a review because it helps our podcast to reach more listeners and we're just starting out here. So thank you so much for taking the time to be with us today and thank you so much Dr. Jones.
Dr. Jones:
My gosh! Thank you so much!