In episode #134, Dr. Jill Carnahan interviews Dr. Carrie Jones from Rupa on Estrogen’s Exit Plan. Dr. Jones is a leading expert on hormone testing and estrogen therapy, and she has developed a unique and effective exit plan for women who are experiencing estrogen imbalance. If you're struggling with low cortisol levels, estrogen imbalance, or toxic stress, this video is for you. Dr. Jones will explain how her exit plan can help you get your life back on track.
- Best test to request from your doctor for hormone testing
- Why do so many women suffer from estrogen imbalance and what to do about it
- Tips for toxic stress and high or low cortisol and why it matters to the rest of your hormones
The Guest – Dr. Carrie Jones
Carrie Jones, ND, FABNE, MPH is an internationally recognized speaker, consultant, and educator on the topic of women's health and hormones with over 20 years in the industry. Dr. Jones graduated from the National University of Natural Medicine in Portland, Oregon where she also completed a 2-year residency in women's health, hormones, and endocrinology. Later, she graduated with a Master of Public Health program. Dr. Jones was one of the first to became board certified through the American Board of Naturopathic Endocrinology and currently serves on the board. She was the Medical Director for the DUTCH Test for several years and is a Clinical Expert for the Lifestyle Matrix Resource Center and Under Armour. Currently, she is the Head of Medical Education at Rupa Health and host of the Root Cause Medicine Podcast.
Dr. Jill Carnahan is Your Functional Medicine Expert® dually board certified in Family Medicine for ten years and in Integrative Holistic Medicine since 2015. She is the Medical Director of Flatiron Functional Medicine, a widely sought-after practice with a broad range of clinical services including functional medical protocols, nutritional consultations, chiropractic therapy, naturopathic medicine, acupuncture, and massage therapy. As a survivor of breast cancer, Crohn’s disease, and toxic mold illness she brings a unique perspective to treating patients in the midst of complex and chronic illness. Her clinic specializes in searching for the underlying triggers that contribute to illness through cutting-edge lab testing and tailoring the intervention to specific needs.
A popular inspirational speaker and prolific writer, she shares her knowledge of hope, health, and healing live on stage and through newsletters, articles, books, and social media posts! People relate to Dr. Jill’s science-backed opinions delivered with authenticity, love and humor. She is known for inspiring her audience to thrive even in the midst of difficulties.
Featured in Shape Magazine, Parade, Forbes, MindBodyGreen, First for Women, Townsend Newsletter, and The Huffington Post as well as seen on NBC News and Health segments with Joan Lunden, Dr. Jill is a media must-have. Her YouTube channel and podcast features live interviews with the healthcare world’s most respected names.
Dr. Jill 0:12
Okay, hello, everybody. We are live again. Welcome to another episode of Dr. Jill Live. I'm here with my friend, Dr. Carrie Jones, whom I'll introduce in just a moment. We're going to be talking about everything hormones today—one of my favorite topics, and I know [for] Dr. Jones as well. If you've missed any previous episodes, you can find all of them on my YouTube channel, on iTunes, on Stitcher, or anywhere that you listen to podcasts. Please stop in, leave a review, and rate us so that we can reach more people.
Dr. Jill 0:42
Now I want to introduce my guest. Dr. Carrie Jones is an internationally recognized speaker, consultant, and educator on the topic of women's health and hormones. [She has] over 20 years in the industry. Dr. Jones graduated from the National University of Natural Medicine in Portland, Oregon, where she also completed a two-year residency in women's health hormones and endocrinology. Later, she graduated with a Master's of Public Health program. Dr. Jones is one of the first to become board certified through the American Board of Naturopathic Endocrinology and currently serves on the board. She was the medical director of DUTCH [Test] for several years—one of my favorite tests for hormones; we'll talk a little bit about that today—and a clinical expert for the Lifestyle Matrix Resource Center and Under Armour. Currently, she's the head of medical education at Rupa Health and the host of the Root Cause Medicine Podcast. So welcome, Dr. Carrie; I'm so glad to have you here.
Dr. Carrie Jones 1:31
Oh, my goodness! Thank you so much for having me on. I always love talking with you.
Dr. Jill 1:35
I know—we have so much fun! I love to start [with one's] story. I'd love to know: How did you get interested in medicine? Was it something you always knew you wanted to do? What was your path to becoming a naturopathic doctor?
Dr. Carrie Jones 1:47
It is something I've always known I wanted to do. Since I was a little girl, I knew I wanted to be a doctor. I thought I would become an OB-GYN or maybe a pediatrician. I really got into that—women's health love and hormones love—because, I don't know about you, but I got health education, sex education for my football coach. I grew up in the South, and because they were short [of] teachers, a lot of teachers did cross-duty in what they taught. We learned all about health from a southern football coach. It was not great; we did not learn a lot, as you can probably imagine. And moving forward into college, I was getting ready, prepping, taking all the classes, and volunteering to go to medical school. I was working with a hospital that did a lot of community outreach. And I thought, “Man, I really love the outreach aspect, the education aspect,” as opposed to the very stark, harsh clinical surgery, which is very important [and] very needed. I'm not against it at all. It just wasn't lighting me up. I moved to the West Coast from the Midwest, and I found naturopathic medicine. I just kept going in the direction of women's health—hormones in particular. I find that a lot of my friends, family, colleagues, and patients are like, “Gosh, Carrie, I didn't know that.” I didn't know that's what happened with my menstrual cycle. I didn't know that's what happens when you move into perimenopause. I didn't know that's what happens in menopause. Because there were so many “I didn't know,” [and] “I didn't know, nobody taught me,” I just kept going in that direction to really shine a light on that area [and] educate people.
Dr. Jill 3:27
It's sad, isn't it? Because even in this decade, we should know about hormones, we should know about sexual health, and we should know about women's health as we age and through our different phases of life. Like you, I went to medical school [was] trained in all this stuff, and even there, some of the really practical stuff… I mean, yes, we know metabolic pathways, we know biochemistry, right? But some of the practical things, like, what do you do [during] menopause [about] vaginal dryness? Unless it's a pharmaceutically-sponsored kind of thing, we are not taught the ins and outs and the details that we as women need to know and that we as doctors need to pass on. You and I have now become hormone experts—thank God for that, for sure! We'll go deep today. But I love that you're talking about this for our listeners. If you're listening, write in questions because we want to go deep and talk about the things you care about. You probably have questions. You either haven't gotten a good answer from your doctor or maybe you're wondering, [but] you're afraid to ask. And this is so common, right? If we look at the historical studies, it was all men, and so much was predominantly male. And we are very different hormonally. It's so, so, so important. One little tidbit is that at 25, I went through breast cancer, so I learned a lot about hormones. Maybe let's start there. That frames the detox pathway so well because if I look back at my history, why would a 25-year-old get cancer?—a hormone-related cancer. Two things I'd love to start with are: What are endocrine disruptors?—because I feel that's a piece of the puzzle. And then we'll go on to: Why would someone maybe have trouble with detox at a young age? So endocrine disruptors—let's just start there.
Dr. Carrie Jones 4:57
Endocrine disruptors are chemicals that look and act like our endocrine system. Our endocrine system is our hormone system; think of our estrogens, progesterone, testosterone, thyroid, etc. When we talk about endocrine disruptors, they're chemicals that literally come in, look like our hormones, and disrupt that system. Now, that system is delicate, [it] does not want to be disrupted, and [it] has a fine pattern or rhythm that it follows most of the time. If you are exposed to endocrine disruptors, you're going to literally disrupt that rhythm [and] the production of those hormones. You're just going to cause a lot of the symptoms that you're likely having. It's so interesting to me [because], having worked for a lab company for a long time, we would see people with completely normal levels of estrogen—estradiol, let's say, on lab work—and they would say: “I have all the symptoms. I'm so estrogenic.” Come to find out, they were really exposed to all these chemicals. These chemicals don't show up in traditional laboratory testing. They look similar to estrogen, but not enough to show up positively on a lab test or to skew or elevate a lab test. It can be really disheartening, because maybe you go see your OB-GYN or your practitioner, who's not hormonally skilled, and they go: “No. everything is fine. You look fine.” And you're like, “No. But I have horrible, heavy periods, and I have terrible PMS,” or “I'm growing fibroids or polyps or breast cancer,” and like, “Where did this come from?” Knowing that these chemicals can play a major role is a huge one.
Dr. Jill 6:37
Yes. So thanks for framing that, because, like you said, it can be very confusing. Let's talk: What is estrogen dominance?—because what you're describing is estrogenic, or estrogen dominance. How might a young woman, a middle-aged woman, or women [of] different ages know? Tell us a little bit about: What does that look like for people with estrogen dominance?
Dr. Carrie Jones 6:56
Estrogen dominance or estrogen excess—we shortened a big, long phrase down to two words: Estrogen excess [and] estrogen dominance. What we mean is, usually in a cycling woman—if you get your period after ovulation in that second half of your cycle called the luteal phase—you [will] not have enough progesterone or too much estrogen compared to where you should. That's a very long sentence. What we've done is shrunk it way down and go, “Well, you're estrogen dominant.” Unless you have zero progesterone, you're not actually dominant in estrogen. In that phase of your cycle, you really shouldn't be making boatloads of progesterone—milligrams worth of progesterone. But what can happen is that it's kept in a careful ratio with estrogen and estradiol. If you don't make those boatloads of progesterone, or you've got an excessive amount of estradiol for whatever reason, there are a few, then your ratio is tipped in the direction of estrogen and you feel it. That's when you feel those [things such as] PMS, heavy periods, bloating, maybe acne, fibroids, polyps, etc., etc., in the cycling woman.
Dr. Carrie Jones 8:00
As we move, as we get older, and as we hit our perimenopausal age, what happens is that we lose the ability to ovulate or release that egg, either regularly or with a lot of oomph behind it. When we can't do that, we don't make a lot of progesterone. By default, we perimenopausal women feel more estrogenic in our everyday lives. The other interesting thing about perimenopause that is not a great design, [a] flaw, is that our estrogen levels, instead of being in a nice, healthy rhythm or what I call a controlled roller coaster, are like an off-the-wall roller coaster; like, estrogen is high; estrogen is low; estrogen is high again; estrogen is over there; estrogen is over there. And people feel that, you know. We have women in their 40s or early 50s who come in and they're like, “What happened to me? I have gone off the rails!” I'm like, “Literally, your estrogen has gone off the rails. It is all over the place.” Because your estrogen is all over the place and [your] progesterone is generally on the low end, you get that estrogen dominant estrogen excess type symptom.
Dr. Jill 9:06
Well, thank you for explaining. For those of you who are listening to the audio only, we're doing these hand signs of a roller coaster because we know, we've been there, and all of that. Like I said, thanks for explaining. Just as a side note, Carrie, one of my favorite things about you is your sense of humor, and it comes across so good on Instagram and stuff. I'm like, “I just love her.” And did I hear—are you a Gemini?
Dr. Carrie Jones 9:28
Heck yes, I'm a Gemini.
Dr. Jill 9:30
Dr. Carrie Jones 9:31
Dr. Jill 9:32
This is like this quirky… I saw that, and I was like, “I love that sense of humor.” By the way, if you haven't followed Carrie on Instagram, please do—she's hysterical. I love, love, love your humor because it's a lot about hormones and about [inaudible]. If you're a woman listening, or a man, and you have a woman in your life, you know this. So, you mentioned cystic breasts, fibroids, endometriosis, and having painful periods—PMS. What woman, at some point in her life, hasn't had those things? The sad thing is what you alluded to earlier: Our world is becoming more toxic. This is the norm instead of the exception, right?
Dr. Carrie Jones 10:08
Dr. Jill 10:09
So, what do people do? Maybe they don't have a doctor like you or me, or [maybe] they do. Where would we start? First of all, we talked about symptoms a little bit; is there anything else symptom-wise? And then, [as far as] testing, what do we do to figure out what's going on?
Dr. Carrie Jones 10:21
First of all, what I tell people is to read your book so that they are educated on these chemicals, the idea behind this, what the body is really capable of, and what you can do because you outline that so well. But the second thing too, what I don't like and what I'm trying to combat, is when you go to your doctor, let's say your general practitioner, your primary care [physician], or your OB-GYN, and they go, “Well, that's normal.” “It's normal for you to have super heavy periods.” “That's normal for your breasts to be tender.” Well, ‘common' and ‘normal' are not the same thing. ‘Common' is accepted but not acceptable, right? ‘Normal' is different. So no, it is not.
Dr. Carrie Jones 10:59
The third thing I say is that your primary care [physician], your GP, or what have you—you allude to this in your book too—may not have a lot of a hormonal background. So it may be time for you to branch out and find somebody who actually really understands hormones at a deep level instead of just blowing you off and saying, “No, no, no, that's totally common” or “that's totally normal if somebody is your age,” when really you need a practitioner who's going to really work you up and figure out your hormones. Now, if you're listening to this and you're like, “I don't even know where to start,” “My appointment,” let's say, “is a two-week wait” or “a two-month wait; what can I do in the meantime?” [I'll mention] the biggest things you can do—this is twofold. One is to get your body eliminating—detoxification. But eliminate what you can—[the things] that are filling up your bucket. In your book, you talk about the bucket analogy, where you've got this bucket, and it gets filled up with life and toxins and chemicals and stress and etc., etc., and if it gets too full, when you aren't able to empty it fast enough, it overflows, [and] you feel that in your body.
Dr. Carrie Jones 12:07
If you can work really hard, if you can look around and think: “All right, Carrie and Jill talked about these toxins and chemicals. What am I putting on [for] my skincare? What am I using for my makeup? What am I washing my sheets with? What's my laundry detergent? What am I using to clean my house with?” “Is my house,” because of course we're recording this at the holidays, “covered in scented candles?” And “spice this” and a “fur that,” “cherry this,” and all the holiday scents that are out right now. We know that, unfortunately, fragrance can be a real endocrine disruptor for a lot of us. So, it's [about] taking stock of what's in your home—taking stock of the water that you drink. Can you look at your budget and maybe even just start with a basic water filter or even a better water filter? You talk about air filters—the air that you breathe. I was listening to somebody earlier talking about mold, and they were like, “Even just periodically opening the window and letting that air flow in and out of the house can make a world of difference if maybe an air filter doesn't fit in your budget.” These things, I had been working on. Like you, I've been working on this journey for decades.
Dr. Carrie Jones 13:21
I remember a couple of years ago when I bought a new mattress. I bought one of those mattresses that is healthy—whatever you want to call that—an organic, healthy, all-things mattress. I had many people in my comments say, “Carrie, I can't afford a mattress.” I said: “Oh, no, no, no. I'm in, like, chapter 24 of my journey; you're in chapter 1. When you run out of mascara, change your mascara. When you run out of deodorant, just switch to a—look it up—clean deodorant. When you run out of detergent, go for one that's fragrance-free to start.” [Take] these baby steps. Don't feel like you need to jump in and spend however much on mattresses if that doesn't fit in your budget and you're not there yet. It's these little, tiny steps—I've learned from you—over time that make a huge difference in our hormones. Where you start today is, well, reading your book. But second, start reading labels. As you run out of things, replace them with better options that aren't going to fill up toxic water in your bucket.
Dr. Jill 14:27
Carrie, I love that. And I love that you say it because—I'll tell you—I had breast cancer at 25. At 26 or 27, I was like, “Why did I get this? What happened?” That was the start of my journey to clean health and living. This is 20 years later, and I remember the overwhelm. I was a medical student at the time, and I knew stuff—I knew how to find research. If you're listening and you're like, “Oh, this is overwhelming,” please know that we understand. That's why I love that you say that because I remember being completely overwhelmed when I realized everything I put on my body was toxic. And the cost! Make-up, hair products—so far, they get a fortune of my money, right? I shouldn't say that because there are obviously local [options]—I like to get local [products] and stuff too. All that to say, we hear you; we know it's a struggle.
Dr. Jill 15:11
It's [been] 20 years in the making, both for Carrie and me. At least for me, I'll admit my age, it's been a long time. What you're saying, though, and what I say in the book: Clean air, clean water, and clean food. We can start really simply. And even the “Dirty Dozen on Environmental Working Group” foods; foods that are most likely sprayed with pesticides—buy those organic. And then buy the other ones, like a banana, [which] you can peel, non-organic so you can save money in different places. Cleaning, like you said, is very basic: Open your window. Open your window [and] clean your filters in your furnace; that's not too expensive. Change those every three months. And there are different things you can do, like buy a higher filter rating. And granted, those standalone air filters that we both love are great, but they're expensive. So, start with those little things. And clean water—making sure you're not drinking out of plastic water bottles. I love that you mentioned fragrance because that's listed as a thing. It doesn't have to be named where it's from, but if it's not from a natural source, which it usually is not, it's a phthalate and a definite endocrine disruptor, so this is a big deal. Years ago, I sprayed perfume on my skin, and I love perfume…
Dr. Carrie Jones 16:11
Me too. Oh my gosh, absolutely.
Dr. Jill 16:13
Even now, I still have a few perfumes. But you know what? Now if I do wear it, it's on my clothing; it's not on my skin because that's an absorptive surface. So, I just want to encourage those listening because it is everywhere. Why I get so passionate about this topic is because breast cancer at 25 was my rude awakening to life and chemicals. And I go into the farm chemicals—some of those were such massively toxic things that were probably in my well water growing up. Then, if I look back, I actually think that, probably in utero, my mother probably had [inaudible]. And then, of course, I was probably born with some toxic load. So, it's interesting.
Dr. Carrie Jones 16:47
Even now, speaking of farm chemicals, for those who are like, “Well, I didn't grow up on a farm,” you're eating the food that comes off of it. And if you live by it and the wind blows, you're getting all that. If you've ever walked into your local big-box home shop in the spring, the amount of roundup… I don't know how much roundup pays for that display case here where I live. But I thought, “Oh, we're still doing this. We're still doing this in 2022.”
Dr. Jill 17:14
Exactly, right? Me too, Carrie. And the smell is enough to be like, “Ugh!” It blows me away. I'm like, “I can't believe this is still here.” We were both in Vegas last year, and I walked into the lobby—the casinos. Of course, there's still smoking [allowed], and I'm like: “Aah! People still smoke indoors?”
Dr. Carrie Jones 17:28
That's what I think too, all the time.
Dr. Jill 17:30
And every time, I know this, but I'm like, “Ugh, really?”
Dr. Carrie Jones 17:33
Oh, that's right. I know. I heard so many practitioners who said: “Gosh, I'm reacting; I'm reacting. I forgot you can still smoke in the casinos.” Now obviously, of course, there are various levels of casinos. Where our conference is, it generally attracts people who don't smoke, but that doesn't mean nobody smokes. There are people smoking cigars and cigarettes, so as you walk through, you might really get hit, which then actually brings me to alcohol; I didn't even mention alcohol being a toxin for a lot of people. I make this joke all the time that alcohol is a bully. She will push herself to the front of the line to get processed by your liver, and then the act of detoxifying alcohol creates a little toxin there and ruins estrogen. So now estrogen is pissed, and she's going to go back and recirculate through your body. I'm assuming that, probably predominantly, a lot of your listeners are female—but it applies to men; it applies to everybody.
Dr. Carrie Jones 18:28
But a lot of women are like: “But I love my glass of wine. I have my glass of wine at night. I relax. I have a couple on the weekend. I relax.” I'm like, “All right, but then how do you feel? How do you feel the next day? How are your hormones? How's your PMS?” Or the number of women who said to me when I was younger… I'm 45, so when I was younger, I had all these women hit their 40s, and they would go: “You just wait. You just wait. When you hit your 40s, you can't drink alcohol anymore.” I was like: “What? That's crazy.” Then I learned it was true. Your enzymes in your liver, because of the changes in your hormones in menopause and perimenopause, really slow down the way that you process alcohol. So now I have so many perimenopausal people on social media and friends and colleagues and what have you who are like: “It's so not worth it. I can't even do one glass.” And people will argue like, “Well, I only drink tequila, Carrie, because tequila doesn't affect my blood sugar.” I'm like: “That's great. It's still alcohol.” Or “I only drink organic, biodynamic, no added sugar wine.” I'm like: “That's fantastic. Wonderful. It's still alcohol.” So if you're having issues and you're like, “Gosh, I am a hormonal train wreck when I'm listening to this,” then maybe evaluate alcohol if that's a thing for you.
Dr. Jill 19:38
I love that because we're not saying there's anything wrong, but yet it's a choice. I've chosen [not to] over the years since I had breast cancer. Basically, I don't drink alcohol. Like, one sip is my tolerance, literally, just to have the taste, like, “Oh, that was really good wine,” and that's it. There's no judgment, but I have learned that I value my health so much—and detox. Let's talk a little bit for people who don't understand; give us a very basic description of detox and this recirculation.
Dr. Carrie Jones 20:04
Yes. Detoxification is basically your exit plan. Anything you eat, breathe, drink, or swallow that's maybe not natural to your body—or a chemical or fragrance or even a hormone that you make internally—you at one point have to get rid of it. They're not indefinite—well, that's not true; some chemicals, unfortunately, are. But let's say your hormones; your hormones are not indefinite. When you're done with an estrogen, as an example, your body made it, it used it, and now it's like, “Okay, thanks for your time—it's time to retire—go away.” You process it. When you process it, that's the act of detoxification. It is a two-[step], if not three-step, process. The majority of the process happens in your liver—we love our liver; thank you for our liver—and then we excrete it out of the body. So, we go out [through] the kidneys or we go out through the intestines when it comes to hormones.
Dr. Carrie Jones 20:55
We have other excretion ways—the way we breathe, the way we sweat. But hormones particularly go out the kidneys or they go out the intestines. If your liver is not doing well, if you have a fatty liver, if you are missing nutrients, maybe you have a lot of gut issues, and you're not absorbing—the liver requires a lot of B vitamins, a lot of minerals, and stuff to help it do its job—then you're going to be a little slow, a little sluggish, on the uptake genetically. Maybe you were born genetically with some not-so-great detoxification pathways, so you're more prone to feeling bad in the fragrance aisle, or worst-case scenario, going on to develop cancer at a young age—or, again, gut issues or kidney issues. You're trying to excrete, so if you have constipation, if you have small intestinal bacterial overgrowth, if you're dealing with gas, bloating, and GI issues, this all messes up the way estrogen gets out. If it can't get out [and] you can't eliminate it, then the body recirculates it. It just pulls it right back in and goes: “You know what? Let's go back on that ride. Let's pull you back into the system.”
Dr. Jill 22:03
It errs on the side of efficiency, right? It's the same thing with mold. But I love that you're saying that because people don't realize, “Oh, if I'm not eliminating, I'm reabsorbing.”
Dr. Carrie Jones 22:11
Yes. And then you think to yourself, “Gosh, why is my period so heavy? Why are my breasts so tender? Why am I having all these symptoms with my cycle?” [Maybe] you're still cycling and not realizing [certain things on time]. [For example], “Oh, my gosh, my constipation has been really bad this month,” or “Oh, my gosh, I hardly drank any water, my stress has been super high, and I have been around a lot of chemicals,” or “[I'm] not eating that great.” This makes sense because the estrogen that I had is not able to get out of the body, essentially, in the route that it needs to go, so it's just hanging out and playing with its other estrogen friends.
Dr. Jill 22:45
It's like a merry-go-round—round, round, round we go. I love that. Talk really quickly about testing. What's available for people? What can they ask for?—from anything from routine labs to specialty labs with you, which you and I [both] prefer. What can we do with testing?—for women who are curious.
Dr. Carrie Jones 23:02
If you've never had any lab testing before, ever, and you've never had your hormones checked, please be aware that when Dr. Jill and I talk about testing your hormones, we are a lot more advanced, a little more functional. Oftentimes, you'll go to your doctor and say, “I'd like my hormones checked, please,” and they will go, “Great, let's do a red blood cell and a white blood cell” [count]—called a complete blood count—CBC. “Let's do a metabolic panel; maybe throw your cholesterol in there because it's been a while.” And maybe, maybe if they're lucky, they'll run a TSH—a thyroid stimulating hormone. And that's it—that's all their testing. Yet here we are talking about estrogen, progesterone, and testosterone. There are so many other hormones we haven't talked about—DHEA, cortisol, and insulin. We have all these hormones. So, when you go to get blood work done, if you've never had it and you need to start somewhere, that's where you get your pen out and you start making a list of all the things you would like to have run. Now, it is really important when you are running estrogen, estradiol, and progesterone that you want them at a specific part of your cycle. Don't just run it on Tuesday at 2 o'clock because that's convenient. You want to make sure you catch it in what's called the second half of your cycle—that luteal phase. Roughly, we say around days 19, 20, or 21 if you have a 28-ish-day cycle.
Dr. Carrie Jones 24:13
Menopausal women, if you're listening to this, you do not have to collect at a certain time. The same hormones still apply to you, even being menopausal—I don't care. But you can collect at any time because you don't have a cycle. Now let's say you've done that or are ready to go into the deeper next step, [which is] more functional; that's where Dr. Jill and I use other tests. Now we've been talking about estrogen detoxification, and if budget is a big issue, what I actually prefer to start with when it comes to hormones is elimination. I often will start with gut testing, GI testing, which is a very fancy word for poop testing. You will have to poop in a cup for science, which mortifies a lot of people. But I want to see what's going on because, just like in your home, if the bathtub is overflowing and clogged, I want to know: Is it because the actual water won't turn off? Is it because the drain is clogged? Is it because the sewer line is clogged? So, we've got to check your sewer line, which is obviously [by] doing a little stool test, and then we get into more of that functional hormone look. I used to work for the company called DUTCH Test, which is the one that Jill mentioned earlier. The reason I liked that one so much, even though I don't work for them anymore, [is that] they give us a better insight into: Where does estrogen go?
Dr. Jill 25:36
It looks at all the pathways, right?
Dr. Carrie Jones 25:37
It looks at a lot of the pathways, and that's really helpful. Male or female doesn't matter. Men make hormones too, especially estrogen. So, it helps us look at those pathways.
Dr. Jill 25:48
Amazing! And thanks for that great overview, because [inaudible]. It's like: “What do I do? How do I test?” Even the timing and everything else are so important. So that's a great place to start if you're curious and you're out there. Many doctors will run blood work. I would say estradiol, progesterone, DHEA-S, testosterone [both] free and total, and cortisol in the morning. Those are the very, very basics. Anything else that you would recommend in a routine lab that they're looking for [when it comes to] metabolic [function]?
Dr. Carrie Jones 26:15
Well, I would definitely add in that thyroid, which I know you've talked about before in other podcasts.
Dr. Jill 26:23
Just say it. TSH, T23, T24, and thyroid antibodies as well.
Dr. Carrie Jones 26:28
Yes, definitely. And you [mentioned] metabolic health. One of the big ones that I find is that a lot of women will get glucose, but they won't get insulin added. As we get older, as we head into perimenopause and our hormones shift, we become more insulin resistant, which is not a good thing. We don't want to become more insulin-resistant. Really, ask your practitioner if you're getting bloodwork like, “Hey, I'm getting a fasting glucose; can you go ahead and add a fasting insulin on there?” Ideally, you want a fasting insulin [level] between 2 and 5. Now, when you get that range back, you're going to see it's going to say 2 to 25, [but] 25 is an absolute no-no. We want it [to be] 2–5—it's a very narrow range. The research and the literature support that—2 to 5. The reason it's up to 25 is that the old, old, old range has not adjusted and caught up with the current literature out there.
Dr. Jill 27:21
This is a good place to say [it]: A lot of the ideals in functional medicine [are that] we want optimal [health and] not just [to fight] disease. It's not like Tuesday, you wake up and you're not diabetic, and then Wednesday, the next day, you're diabetic. There's no crossover line. It's a spectrum, this trajectory, that we're all walking on. What you and I like to do is [say], “Okay, this might be the range of a normal thyroid,” but we're like: “What's best? What's optimal?” There's a much narrower function range that we often use for maybe TSH. I like it below 3, but 2.3 to 3 is kind of my ideal [range]. If I'm treating [someone], sometimes below 2 [is best because] I really want to optimize their thyroid—their TSH. Insulin—I totally love that. Below 5 is ideal. Fasting blood sugar—I'd say below 90 [is ideal]. Would you agree with that?
Dr. Carrie Jones 28:00
I agree. Yes.
Dr. Jill 28:01
Say someone is cycling in their luteal phase; they're on day 20 of their cycle. What kind of ratio between estrogen and progesterone would you like to see there?
Dr. Carrie Jones 28:12
In blood work—now again, these are American numbers, so I apologize for those [people] international[ly] who are listening; you'll do the conversion—for progesterone, we generally like it in the double digits. We want it at 10 or higher. Now, if you are a 3, 4, or 5, that means you did ovulate and you were eking out some progesterone, but it's just not strong enough. So ideally, we're looking at 10 or higher. And then with estradiol, we tend to look for it to be, some people say, above 100; some people say above 150, depending on your history, your age, and what's going on with that. While I talk about a ratio and how it's important, I don't generally do a ratio calculation only because when you get your blood drawn, there are two types of machines that will run the bloodwork: An immunoassay and a mass spectrometry. I know, you're like: “What? I do not care about this.” I know, I get that. Mass spectrometry is more sensitive, but that makes it a little more expensive. Ideally, you don't want a mismatch. You don't want your progesterone on an immunoassay [test] and your estradiol on a mass spectrometry [test], or vice versa. When we get into the weeds of testing, I want the same type of machine, and I want it to be a mass spectrometry. It's the most sensitive. I want the most sensitive for you because you don't feel good, right? Most people are like, “I feel hormonal; something's wrong.” I'm like, “Right. Let's figure it out.”
Dr. Jill 29:41
Carrie, I love that you're saying this because we're talking about nanograms and incredibly tiny amounts. This is actually why the endocrine disruptors are so fascinating—because they act [with] this hormetic effect. [I'll] just take a minute to go off on a slight tangent; I promise to bring it back. But with things that are endocrine disruptors, there's this biphasic curve. Classical toxicology says, “Okay, at this level, 50% of people are toxic.” So, we say, “Okay, above that level”—I'm just randomly saying numbers—”it's toxic to most people.” But what they miss is that sometimes there's this hormetic effect at incredibly tiny levels of synergy when you add chemicals together. So, at these incredibly low levels that are not considered toxic, it has a hormone-like or hormetic effect on the body at an extremely low level that again is not in the toxicology text. When you synergistically add those, they can have profound disruptive effects because it messes with that hormetic [balance]. I say that because what we're measuring is an incredibly tiny amount. In fact, I think for decades you couldn't measure [certain levels]—now we can—because the machinery wasn't accurate enough to actually detect these low levels. So they're very small amounts, which is why the machinery matters.
Dr. Carrie Jones 30:55
It does. I'm sure it was very frustrating for you given your history. They will say… What's a good example? Bleach in tampons as an example—dioxin in tampons. They'll say, “Well, Jill, you would need this much dioxin to be toxic, so one tampon with a teeny tiny amount of dioxin in it to bleach it white is not a problem.” Right. But you probably started your period in your early teens, and then you get your period every single month, barring those listening who are pregnant, so that's a lot of teeny, tiny exposure over and over and over and over and over and over and over and over and over and over and over and over again. I've had so many women say to me, “When I switched from” maybe “a conventional tampon to an organic, non-bleach tampon, my symptoms got better” [and] “my cramps went down.” I mean, it doesn't cure it, but like, “Oh my gosh, my endo actually improved a little bit.” Like, “The cramps were more bearable.” [It's] because they've been using the same tampon since they were 12, 10, 9, 14, [or] whatever it is, and we don't think about that. Yes, a large dioxin dose is toxic. What about when we have these teeny, tiny little micro exposures all the time?
Dr. Jill 32:11
I love that you're saying that. You mentioned a little allusion to these forever chemicals. So the latest thing on the block are these PFAOs, which are Teflon and Gore-Tex materials. They're in any sort of rain-resistant or liquid-resistant [materials]. Your mattress cover might have these, or your furniture [too] if it's stain-resistant. Or your carpets might have them. We can absorb these through the skin. Where I'm at in Colorado, every water supply has contamination levels, and now with the new threshold, they're all considered [toxic] and they're forever [chemicals]. So the scientists, when they try to find the half-life, can't even calculate the half-life of these PFAOs. And that's just one thing.
Dr. Carrie Jones 32:47
Dr. Jill 32:48
I know it's like, ‘Ugh!' These are things [that last] forever in the environment. So, these things do matter. And on a little existential tangent, our environment matters. I'm becoming much more environmentally conscious because the wildfires are affecting our air quality and the PFAOs are affecting our water supply. So, there are really, really lots of things that we have to start taking action [on]. I'm a non-political kind of person, but I realized I have to start being more action-oriented and encouraging others because these things are getting into our environment and affecting our hormones. Our future generations are set up for disaster if we're not careful.
Dr. Carrie Jones 33:18
I totally agree. I totally agree. I know when you see big things like fire, because Colorado, Oregon, and Washington historically have had a lot of fires, you might watch the news or think to yourself if you're listening right now, “Oh, it's a fire, there's nothing I can do,” when in fact in your home, your HVAC system, or your air filters [you can make changes]. Or [you can consume] supplements to support the lungs or antioxidants. There's a lot you can actually do to [prevent the] progression [of] feeling unhealthy when you get these exposures.
Dr. Jill 33:51
And [I'll give] just a quick tidbit on wildfires. Almost a year ago today, we had a massive wildfire in my community. [We] lost a thousand homes—all that happened. It was literally in the middle of winter. I did not realize until then how massively that toxic air quality [was affecting people]. It was worse than mold for many people. Literally, I started seeing some lab values like TGF beta and random things that would typically signify other toxicity just from the wildfires. So even if you're like, “Oh, it's not affecting me,” but you know that your air quality is down because there's a fire 100 miles away or 50 miles away, it really is affecting all of us.
Dr. Carrie Jones 34:24
And I don't know why I didn't think of this as a grown, educated woman, but somebody said to me, “Well, Carrie, you think of wildfire and you often think of forest land,” [which includes] woods, trees, soil, [or] whatever. But they're like, “Wildfires burn everything: Cars, homes, buildings, paints, plastic—everything.”
Dr. Jill 34:43
And nowadays, the back porches or the benches in your yard are made of plastic a lot of times. Or you have chemicals in your garage like gasoline, roundup, or whatever. All these things, like you said, burn and then make a huge toxic load.
Dr. Carrie Jones 34:55
Right up into the air. We need to live in a bubble, but a fun bubble. I want a fun bubble.
Dr. Jill 35:00
I know. Environmental toxicity can be pretty depressing. So, we'll end on some positive notes. Let's talk about two things. First of all, say a 32-year-old woman has had a couple of kids. She may or may not want to have more children but is really struggling with the classical estrogen dominance. Let's talk about her. What should she do? And then let's talk about the menopausal woman—I'm going there too. What do we do when hormones do the roller coaster? So, first of all, this 20 to 30-something [year-old] woman who's cycling is maybe struggling with infertility, maybe struggling with breast tenderness. What do we do with this woman? How do they start?—besides elimination, which is what you mentioned first.
Dr. Carrie Jones 35:39
The really nice thing is that it has kind of the same suggestions for everything and everybody. If you and I had a magic pill, and we say this all the time, we would not gatekeep; we would give it to people. I would airdrop it across the world if we had a magic pill. Especially that 32-year-old, if you're cycling and you identify with what Dr. Jill just said as women, our brain is the big hub for: Do we or do we not make hormones? Our brain is constantly scanning our environment. Do we have enough food? Is it too toxic? Is it too stressful? Have you not had enough sleep? Have you skipped time zones? Have you… have you… have you… If… If… And… And… And… Then what can happen if you check yes to all those boxes? It says, [in essence]: “You know what? This is not a good month to ovulate. I'm not going to release an egg this month,” and therefore, your progesterone is going to be low and you're going to feel very estrogenic. What we have found, although it's sometimes hard to hear, is taking an evaluation of what's been going on the last couple of months and course correcting. Have you been getting enough sleep? How has your stress been? Are you feeling happy, safe, and joyful? What does your nutrition look like? Have you had movement [and] exercise? Do you have joy in your life? Do you experience nature? Is it pitch black where you are because it's winter? Do you get any sunlight at all, or do you sit at your desk all day and completely miss out on the outside? As you're evaluating this, these basics, I kid you not, can be really helpful at getting you back on track. If you were on track and got off track, these can help you get back on track.
Dr. Carrie Jones 37:19
Of course, there are other instances such as: Maybe we need to look at your thyroid; maybe nobody's ever diagnosed you or figured out that you have PCOS. There's definitely other stuff that could be going on metabolically or hormonally that we need to look at. As you're listening to this, have you lit every candle in your house? Maybe you should evaluate that. Maybe as you've got the lavender detergent going in your washing machine, the lemon scent all over your dishes, and you've got your perfume on and your candles lit, maybe we should reevaluate that and alcohol to really help. As you're listening to this, baby steps, one thing at a time, will really help get you back on track. Now, for the menopausal woman, the same absolute things apply. I'm sure you might agree, but I tend to find that the women who go through menopause [more] easily have done an audit of those things. They're focusing on their sleep; they're focusing on their joy, their happiness, and their safety. They are focusing on their nutrition, their movement, their exercise, their community, their blood sugar, etc., and menopause tends to be easier for them. Now, could they still have thyroid issues? Yes. Could they still need to go on hormone replacement therapy? Absolutely, yes. But hormone replacement therapy is not going to solve the fact that you choose to stay up late at night, you're always on your phone or tablet, you live on potato chips and bagels and coffee and energy drinks, and you haven't seen the outside in months because it's dark and cold outside. Hormone replacement therapy is just not going to save that, so you do have to get back to the basics. And then we add in and support the other stuff for the menopausal woman as well.
Dr. Jill 39:05
I love that because it's so important to go back to the [basics]—we forget. Honestly, I always say hormones are like sledgehammers; they're very powerful, and they're appropriate at some times. But you don't want to start with a sledgehammer; you start with a little tool that's precise, like sleep, the air, the water, and all those things. So I love that. We didn't talk a lot, but before we end, I want to talk a little bit about cortisol and stress because that plays into this massively too, right? What happens when we are either under massive stress and have a really high cortisol [level] or when that starts to deplete and we're—like I have been in the last year—much more flatline cortisol? Tell us about those two scenarios and how that affects the hormones or just the body in general as well—the cortisol curves.
Dr. Carrie Jones 39:47
Yes. Actually, what I will say is that cortisol gets villainized just like estrogen [does]. I should have said this in the beginning. I apologize. Estrogen—she's not bad. We need her for our heart, our brain, our skin, and our joints—our vagina likes estrogen. We need our estrogen. It's just out of balance, out of ratio, where she becomes dramatic and, [in essence] says, “This isn't working for me; I'm going to cause symptoms.” I do hear that a lot: “I wish I didn't have any estrogen.” I'm like, “No, trust me, that's not true because of your poor brain, your poor heart, your poor joints, etc.” Cortisol is the same way. We have cortisol for a reason. People villainize it: “Oh, I hate cortisol because it makes me put on weight around the middle. It makes me puffy.” I'm like, “Well, it's elevated for a reason.” Cortisol is one of the stress hormones that help us. It goes up to protect us; it goes up to change systems in our body so that we can fight, flee, or freeze if there is a threat around us—a tiger, a lion, or a bear. The problem is, of course, that a lot of our threats are over texts or are [from people] that we live with, work with, or are in front of our computer, and they're not actually a tiger, a lion, or a bear. They happen every day, and there are small threats and there are big threats. It's a lot of stress—little stressors that happen all day long. You ask your partner, “How was your day?” and they go: “Oh my gosh, it's never-ending. My day was never-ending. I had this meeting, that meeting, this fight, that fight, then I got this email.” Everything is little, but it all adds up.
Dr. Carrie Jones 41:17
Or maybe you had one big stressor. God forbid you had a car accident or [were] going through a divorce. Or [there are] even “good” stresses [like] babies. New babies are very stressful, but you probably wanted it, so it's good stress. Weddings—you hopefully wanted to get married. Weddings are stressful. Cortisol affects our blood sugar, cortisol affects our immune system, and cortisol affects inflammation. And 100%, cortisol talks to, communicates [with], and plays with our hormones—all of them. In fact, your whole body talks as a unit. Nobody is siloed; nobody is individual or independent. Everybody is extroverted, and everybody talks to each other. So when it comes to cortisol, we want it elevated in the morning within reason; there is a range, and it drops at night. Cortisol is like your sun; it comes out in the day. And then at night, you want melatonin to come out; melatonin is like your moon. If you have a flipped curve, you tend to be tired in the morning and wired at night; you get that second wind and you can't fall asleep. Or maybe you crash in the afternoon. You do okay in the morning but then crash in the afternoon. Or maybe your cortisol is way too high in the morning, so you go right into stress, anxiety, and panic, and you can't come down. What happens over time is that we have what's called a negative feedback loop, so you had high cortisol, high cortisol, high cortisol. The Brain goes [in essence]: “Yes, this is annoying. I don't like this. I'm going to slow down the production of cortisol.” Then you drop, drop, drop, drop until you get low cortisol production. Now you generally feel kind of wiped out, burned out, and tired all the time. So, when I see low cortisol in people, I usually ask them: “Hey, what's been going on the last three months to a year or more?—because I bet you had high cortisol and this is the end result.” It's sort of burning out, if you will.
Dr. Jill 43:09
Yes, like a case in point: Some people try to do a documentary and a book all in one year.
Dr. Carrie Jones 43:14
Some people. I wonder who that could be.
Dr. Jill 43:19
So yes, I totally get that. [And some people] then get mold exposure. Anyways. I totally get it. Carrie, you are so fun to talk to and so full of great analogies. Even just listening to you, [like with the] ‘sun' and ‘moon' [analogies], you're so good at making this very applicable to the listener. It's always such a pleasure. Let's leave with one takeaway. What [advice] would you give a listener who's maybe struggling with hormones? We've talked about a lot. What's your takeaway?
Dr. Carrie Jones 43:43
I'll be honest; everyone's going to laugh. I actually have it written on the board behind me. It says, “Healing happens at joy.” That is not my quote. Honestly, I feel terrible. I can't remember whose quote it is. But she was talking about different levels of emotion, whereas [things] like anger and fear are at the bottom of an emotional list, and then as you move up, joy is where true healing starts to happen. When we talk about stress, I tell people to find their joy. When you find a little joy, whether it's the funny memes your friends send you, the cute little thing your cat just did, or that funny TV show you watch for 30 minutes to check out. It doesn't have to be big joy all day long, but it's the little joys that are where we start to lower our cortisol. That's where we start to feel safe. When we can find our joy, that base can really be helpful for our hormones, for our sleep, and for our cortisol. So that's the easy takeaway that I like to tell people. Do you have joy in your life? If you don't, let's start finding it in the little ways every single day so that it can add up in a big way.
Dr. Jill 44:52
I love that! Amazing! Thank you again. And I know you're with Rupa now; do you want to just say a little plug for Rupa? And tell us where else to find you.
Dr. Carrie Jones 45:03
Yes. Rupa Health, for those practitioners who are listening, is the one-stop shopping lab portal. So, if you are listening to us today and we're talking about blood work labs, urine labs, saliva labs, mold labs, or stool labs. Instead of having to go in and out of multiple portals to order it, you can create one portal on Rupa and then order all of those labs for your patients. So, it's very, very easy to organize.
Dr. Jill 45:29
And I just want to say something really quick: I love Rupa. A PA who came and worked with me was like, “Oh, we use Rupa.” I was like, “What's Rupa?” It's changed our lives at the office, so thank you. Then you. Tell me about you.
Dr. Carrie Jones 45:42
Yes. I am on Instagram quite a bit. I am @drcarriejones. My website is www.drcarryjones.com. And I'm dipping my baby toe into TikTok, which is very scary, and trying to get more videos out there—although everybody's on TikTok now; it used to be “the younger generation”—for hormone education and to have a lot more fun around hormones and female health. But again, @drcarriejones.
Dr. Jill 46:10
If anyone's fun, it's you. I love your sense of humor. Carrie, thank you so much. It's been so fun to talk to you today!
Dr. Carrie Jones 46:19
Oh, Dr. Jill, I appreciate it! Thank you.
Dr. Jill 46:20
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