PRECONCEPTION

010: Hormone Balance And Fertility w/ Carrie Jones, ND, FABNE, MPH

010

010: Hormone Balance And Fertility w/ Carrie Jones, ND, FABNE, MPH

Welcome to the Hey Mami podcast!

Our guest today is Carrie Jones, ND, FABNE, MPH. Dr. Jones is an internationally recognized speaker, consultant, and educator on the topic of women’s health and hormones.

She graduated from the National University of Natural Medicine (NUNM) in Portland, Oregon, where she also completed a two-year residency in women’s health, hormones, and endocrinology. Later, she graduated from Grand Canyon University’s Maser of Public Health program.

Recently, Dr. Jones became board certified through the American Board of Naturopathic Endocrinology. She was adjunct faculty at NUNM for many years, teaching gynecology and advanced endocrinology/fertility. While in practice, Dr. Jones served as Medical Director for 2 large integrative clinics in Portland. She is currently the Medical Director for Precision Analytical Inc.

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In today’s episode we are talking all about fertility and hormones.

Many people are aware of progesterone, but forget about markers like DHEA, cortisol, and melatonin…not to mention the three different types of estrogen.

 

Highlights:

  • Why does Dr. Jones care about hormones?
  • Common testing patterns that Dr. Jones sees in women who want to get pregnant or thinking about fertility
  • Best ways (and times!) to test for progesterone
  • Symptoms of low progesterone
  • Possible causes of low estrogen
  • Why the term “over-exercise” depends on the person
  • The role of DHEA in fertility
  • The adrenals and thyroid
  • Why melatonin is important for the ovaries

Important Links

Find Dr. Jones online here

Follow Dr. Jones on Instagram

Quotes

“On DUTCH test specifically and just actually any testing, we will often see low progesterone for women who are struggling to get pregnant, or we will see that they do make progesterone, but it declines sooner than we would want.”

“Low estrogen can be a problem with fertility. Low estrogen, believe it or not, can slow or lower ovulation. So we need a real healthy estrogen rise in the first part of our cycle to help with ovulation. We also need estrogen to push out what are called progesterone receptors in our uterus. Basically, make the uterus hospitable when we’re trying to get pregnant.”

010: Hormone Balance And Fertility w/ Carrie Jones, ND, FABNE, MPH TRANSCRIPT

Dr. Maren:                          Hello and welcome back to The Hey Mami Podcast. In today’s episode, we are talking all about fertility and hormones. Many people are aware of progesterone and maybe even low estrogen, but they forget about markers like DHEA, cortisol, and even melatonin, not to mention the three different types of estrogen, which can get complicated. Both Dr. Carrasco and I use a dried urine test for complete hormones. It’s called the DUTCH test. In our clinical practices, we find this test to be super useful, and we love the objective data which helps drive our individualized protocols. So, ladies, today is a very special episode where we get to pick the brain of the medical director for DUTCH test. We’re touching on fertility concerns and common hormone imbalance and trends that she has seen on literally the hundreds of thousands of tests she has reviewed. Our guest today is Dr. Carrie Jones.

Dr. Maren:                          She is an internationally recognized speaker, consultant and educator on the topic of women’s health and hormones. She’s a naturopathic physician and 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. She was adjunct faculty at National University for many years teaching gynecology and advanced endocrinology and fertility. Most recently, Dr. Jones became board certified through the American Board of Naturopathic Endocrinology. While in practice, she served as medical director for two large integrative clinics in Portland. And she is currently, like I said, the medical director of the DUTCH test. So thank you so much, Dr. Carrie Jones, for being here today. When we think about hormone testing, we think about you. So we knew we needed you on this podcast.

Dr. Jones:                            Oh my Goodness. Thank you so much for having me on. Yeah, absolutely, hormones, that’s what I know.

Dr. Maren:                          Your jam. Hormones are your jam. Right.

Dr. Jones:                            Absolutely. Not at all. No. As I said to lots of people. I’m like hormones are like herding cats. It is fun.

Dr. Carrasco:                      And we have two, and that’s a hard nighttime routine for us.

Dr. Maren:                          So we just like to kind of start out with asking our guests about why you do what you do. So give us a little window into why you care so much about hormones?

Dr. Jones:                            Why do I care about hormones? I’ve known since I was a little girl that I wanted to go into women’s health and I thought I wanted to be an OB-GYN or maybe even pediatrics, but focus on the like teenage population. And it’s like got into naturopathic medicine, I just kept doing more women’s health sort of at-large. My mentor was all into hormones, gynecology and so I just loved it. And it just seemed to resonate with me. Those are the studies that I would pick up. Those are the books that I would read. And as a woman, it just made a lot of sense. And as I watched my female friends go through their struggles, their symptoms, their conditions, what have you, my mom, my grandmother at the time, like wow, I can learn a lot about this and I think I can help educate and make a difference. And so that’s why I kept going down that pathway. And like I said, hormones is what I know. So if you do have kid problems, don’t ask me. It’s cute when people are like my three-year-old, I’m like, oh no.

Dr. Maren:                          Yeah, let’s not go there.

Dr. Jones:                            I have no idea. Or oncology or my knee hurts. I’m like, no.

Dr. Maren:                          Yeah. We’ll just stick with hormones. That’s awesome. And I think with hormones, I always say like, what woman doesn’t have some sort of permanent struggle?

Dr. Carrasco:                      I mean, at some point.

Dr. Maren:                          At some point in her life, like everybody you know. From one pattern or another.

Dr. Jones:                            Even if they don’t know what the word hormone means or what they are, women will still say it, right? Like I’m feeling really hormonal today. Like, what’s going on? It’s just my hormones. You’re right. You’re 100% right and just let me help narrow that down for you.

Dr. Maren:                          Right. And I think with hormones too, it’s like, well, common is not normal. So many women have these common complaints of really heavy periods and using like ibuprofen or staying home because they have these like crazy pain.

Dr. Carrasco:                      Curling up for three days with their periods.

Dr. Maren:                          Yeah. But like it’s common, but it’s not normal. Whether you know it or not, you probably have a hormone issue.

Dr. Jones:                            Yeah, absolutely. And I remind them all the time and I say this constantly, the ovaries are sisters, not twins. So right. We get taught that the left and right ovary, do the same thing every month. And then you talk to women and they’re like, oh my gosh, that explains why every other month I get a headache or every third month it’s really bad or every third month it’s really good or what have you. And I’ve had more women say to me that I can feel when I ovulate and it’s this month, I get these really intense symptoms. Like yeah, your lefty and righty are not the same. They don’t have to be the same there. You can have a weaker and a dominant. You can have a Cinderella and evil stepsister.

Dr. Carrasco:                      Oh yeah, my lefty is an evil stepsister.

Dr. Jones:                            For sure.

Dr. Carrasco:                      She is a mean lady.

Dr. Jones:                            Yeah. And that goes with fertility, that goes with hormonal issues, that goes with so many things because as I said recently, you’re only as strong as your weakest ovary, which I mean jokingly. Right. But when we’re talking about hormones, I want to know what both ovaries are doing because when we support them, we support them globally so they both can hopefully be two Cinderellas.

Dr. Maren:                          I love this. I have like all these quote cards. They’re already created. I’m good. I’m good. All right. So let’s talk about some of the common testing patterns that you see in women who want to get pregnant or thinking about fertility.

Dr. Jones:                            So on DUTCH test specifically and just actually any testing, we will often see low progesterone for women who are struggling to get pregnant, or we will see that they do make progesterone, but it declines sooner than we would want. So progesterone is supposed to be this nice, healthy mountain of a shape that starts right after ovulation and then rises up, up, up, up. And some women it’s more of like a molehill. They’re more like [inaudible 00:06:22], and then it comes back down. And so when they test their practitioner says, yes, your progesterone’s in range. I’m like that day, but what happens if it falls the next day? So that’s probably the biggest thing that we see overall. Low estrogen can be a problem with fertility. Low estrogen, believe it or not, can slow or lower ovulation.

Dr. Jones:                            So we need a real healthy estrogen rise in the first part of our cycle to help with ovulation. We also need estrogen to push out what are called progesterone receptors in our uterus. Basically, make the uterus hospitable when we’re trying to get pregnant. Make it nice and lush and five-star hotel ish so that implantation can happen and everything can do its thing. But for women who don’t have normal levels of estrogen, if it’s too low, then they often struggle as well. And then really the third thing, kind of like our adrenal hormones, our cortisol, and our DHEA. So when we have issues with our stress access the body says, wow, you have a lot of stress. You seem to be running from the tiger and it’s kind of hard to stop and get pregnant and maybe we’ll hold off this month. Like maybe I’ll put some things into place so that it will be tougher for you to get pregnant because it seems like now is not a good time. And so we will see issues with cortisol. We’ll see issues with DHEA for these women.

Dr. Maren:                          Awesome. I love that. And I think with low estrogen, I mean, one of the things I preach is like, test, don’t guess. Alex and I both talk about this in our practices because sometimes I’ll see women come to me who are convinced that they have estrogen dominance. And so they’ve put themselves on a bunch of DIM and then they’re like estrogen is totally gone. And then they’re not ovulating. And it’s like, well, this is the opposite of what we need. Right.

Dr. Jones:                            Literally, I just got a text message from a practitioner who said, I didn’t know DIM lowers estrogen out of circulation. And I said, yes, everybody gives DIM, diindolylmethane, the supplement, because everyone reads, oh, if you have high estrogen, if you have PMS, take DIM. If you have heavy periods, take DIM. And it may be appropriate, but yes, it can decrease your estrogen out of circulation. And then if you’re on too much or too long, now you’re like, gosh, I’m starting to have hot flashes and night sweats and vaginal dryness and joint pain and I’m kind of moody. Like what’s going on. It’s you’ve reduced your estrogen too much.

Dr. Maren:                          Yeah. Yep. Interesting. Okay. So I want to dive into those specifically. So we’ll talk progesterone and then estrogen. I want to pick your brain about DHEA and cortisol and even melatonin, but let’s just start with progesterone. So tell us, what is the best way to test for it if we don’t have access to a DUTCH test. And then like what you see on DUTCH testing, are you doing mostly cycle mapping or is it just a single DUTCH test, or what do you see? Tell us more.

Dr. Jones:                            For any woman who wants to get their progesterone tested, whether it’s with their primary care doctor in the blood, totally fine or they do DUTCH testing with their functional practitioner. So we as women don’t make progesterone until we ovulate. So you have to figure out when you ovulate. Hopefully, you’re ovulating and then you test your progesterone roughly five to seven days later. So for the average 28-day girl, you’re looking at days 19, 20, 21, somewhere in there. And if you’re a little longer, let’s say you’re like 30 or 35 days, then you just move your collection up. And if you’re a short day girl, you just move your collection down. And you can do it in serum. That’s fine. And some women are like, can I just do it in blood so my insurance can cover it. If you’re just looking for a spot check on progesterone, sure.

Dr. Jones:                            But make sure you get it at that window in that second half-year of your cycle, the luteal phase after ovulation because what we want to see is where it peaks. We’re trying to determine does it peak enough that’s helpful for fertility plus all the other symptoms like it’ll help you minimize PMS and it’ll help you make your cycles nice and smooth and help you reduce breast tenderness and reduce water retention? And so that’s when we test progesterone specifically. Now, if you do a DUTCH test, which DUTCH stands for dried urine test for comprehensive hormones, it’s not a blood test. It’s not a saliva test. It’s an at-home urine test. We have two options. We have the one-day test. So you pee on a strip one day. Or we have what’s called the cycle mapping where you basically pee on a strip every morning through most days of your cycle and then we graph out your cycle for you.

Dr. Jones:                            So for women trying to become pregnant, the cycle mapping is my absolute favorite because it gives me this big bird’s eye view of what’s happening from start to finish. I want to know how does your estrogen go up and down and up again? And I want to know how your progesterone goes up and if it can do it at all, period. Or if it’s kind of weak or maybe like your estrogen is a little too robust at certain points. And so that’s what I’m looking for on the cycle mapping.

Dr. Maren:                          Awesome. I have one literally in the mail on the way, so I’m going to do it first and then I can apply it to all of my patients.

Dr. Jones:                            I’ve done several. It’s my favorite for the cycling women. Like I don’t recommend it for menopausal women. Don’t do it if you’re on birth control. Don’t do it if you don’t have a cycle at all. Like for some reason, you’re you have amenorrhea, maybe PCOS or whatever. But if you are cycling, but things just aren’t right, it is my favorite test, which is why I’ve done it so often.

Dr. Maren:                          And what are some of the symptoms when women might be clued in, to having a progesterone deficiency?

Dr. Jones:                            So low progesterone and then higher estrogen kind of have the same symptoms. So these women, they are more prone to PMS, they’re more prone to the moody changes, they may be more prone to anxiety, more prone to sleeplessness, especially as they get closer to their cycle. They’re more prone to heavier periods, clots, maybe even fibroid or polyp development. Those are some of the things that we see. Maybe recurrent miscarriage if progesterone is the reason. So a history of miscarriage. And so those are often what we will tend to see with lower than optimal progesterone.

Dr. Maren:                          Yeah. And for those of you listening, so what will happen sometimes is if a woman has recurrent pregnancy loss, her OB-GYN or midwife might prescribe progesterone and so they can take it or orally or vaginally. You can actually use the pill. Some people will prescribe it to use vaginally just to try to basically boost progesterone, whether or not we know that it’s lower or not. In many practices, they don’t even measure it. So the assumption can sometimes be let’s just assume you have low progesterone and use it. And it’s pretty low risk.

Dr. Carrasco:                      And then I think also in practice a lot of times, for people that have these symptoms, you can do some topical progesterone or even low dose oral progesterone the last two weeks of the cycle, or you can also do chase, Vitex. So we’d love to hear your opinions about that Dr. Jones.

Dr. Jones:                            Yeah, absolutely. So the thing with progesterone is that there is a feedback loop. And so I do tell women if you are trying to ovulate, then maybe don’t do progesterone in the first half of your cycle. So when you get your period up until ovulation like maybe don’t do progesterone then or do a very low dose before you raise the dose in the second half. And sometimes I will see and you probably do too, where people will come on all this progesterone. Maybe they bought it at the store and they’re slathering it on like lotion and they can’t figure out what’s wrong. Well, first of all, high progesterone can have side effects as well, but second, it can reduce your own ovulation. So you missed the point if you’re trying to get pregnant. So there’s that. And then chaste tree, which is also known as Vitex agnus-castus.

Dr. Jones:                            So it is a herb. It is probably my favorite herb for women’s health and fertility. I have long called it an ovarian adaptogen meaning it seems to help both estrogen and progesterone do the right thing. So studies have shown that it can help with the brain communication down to the ovaries in like sort of multiple ways. And therefore it can help improve ovulation, improve estrogen signaling, improve progesterone production. I just read a study, it can shorten long luteal phases. So women who have sort of this like, it just sort of keeps going on and on and on. Like, it can help shorten that. Now with chase tree though, I do tell women, and same with progesterone, whatever you do for your hormonal health, give it at least three months because it takes about three months to go from what’s called a preantral follicle, which basically means like not the chosen one.

Dr. Jones:                            All right. We release one egg every month, but it takes three months to get there. And that’s why somebody who do fertility is like, oh, my fertility program is at least three months. This is why because we know three months ago it was when the egg started developing. So I say give chase tree at least three months to do its thing. It may make your cycle a little weird at first because it’s adjusting itself. It’s adjusting the signaling from the brain. Try to stick with it unless it’s real bad and give it at least three months. And I love it. I love it, chase tree. And this is controversial. I even use it with my PCOS patients. There are practitioners who feel because chase tree can affect LH, luteinizing hormone, and women with PCOS tend to already have elevated LH, but I find that in a lot of cases that chased tree actually helps them. Obviously, I’m addressing a lot of other issues, like other causes. And then for the ones who it doesn’t work, I just explain it to them, look, you’ve PCOS, it’s controversial, you’re going to see it online. I find it works a lot of the time. Let’s try it. If it works for you, fantastic. And if it doesn’t work, not a problem, we will try something else.

Dr. Carrasco:                      What doses do you find useful in your practice because it runs the gamut?

Dr. Jones:                            Oh my gosh. When you read the research, clinically it’s like 20 milligrams all the way up to 300. I’m like, what the heck. But what I have found is that there are two main constituents of chaste tree and that’s what dictates how potent it is. And so usually I’m using in the like 100 to 300 range. I usually go higher as opposed to lower. I know there’s some research on 40 milligrams and 80 milligrams being effective. I think if memory serves, I think those are in concentrated tinctures, so urban and alcohol, which would make sense if you’re using a highly concentrated standardized dose, you would need less than maybe otherwise.

Dr. Carrasco:                      Like a dried herb.

Dr. Jones:                            Yeah. So my standard is usually in the like 100 to 300 range. 200, 250 is probably my average most of the time. 500 is like when I really need to kick them in the ovaries. I really need to make it happen. I will give 500. Yeah.

Dr. Maren:                          Awesome. Yeah. We also use a lot of chase in our practices. So it is a good one and easier to use than DIM. Like we mentioned earlier where you can deplete all your levels, like chase tree’s one that’s like, yeah, most people can try it.

Dr. Carrasco:                      Even like the progesterone creams, which are kind of a pain.

Dr. Jones:                            Yeah, exactly. And the thing with the creams too is that oftentimes a lot of women, not always, but often, maybe a woman already has a small child at home and she’s trying to become pregnant with her second or third or fourth and she’s putting the cream on and then she doesn’t realize progesterone is extremely fat-loving, meaning you can transfer it to other people very, very easily. And women will say, well, I rub it in really well. And like, I know you do, it’s just progesterone, it’s just this crazy hormone that loves to glom on to other people and other things.

Dr. Maren:                          That little baby.

Dr. Jones:                            Yeah, exactly. So then you hug your kid or you hug your child or you hug your partner and you’re snuggling or you’re whatever. And you can disburse the cream to them. So you have to be careful. It’s the same with men and testosterone cream. It’s the reverse. Men with testosterone cream can absolutely give it to their partner, their kids by accident.

Dr. Maren:                          For sure. Okay. So let’s dive in and talk a little bit about low estrogen. Of course, we’re not talking post-menopausal today. So we all know, of course, women get low estrogen and hot flashes and vaginal dryness when they’re older. But what about that late 20s, early 30s person who wants to get pregnant, why does she have low progesterone. I’m sorry, low estrogen?

Dr. Jones:                            There’s a lot of reasons. And actually, it fits to low progesterone too. So there are a lot of causes, right? It could be everything from they have a thyroid issue, right, hypothyroidism. They might have high prolactin. So they maybe don’t have what’s called a prolactinoma, which is a tumor in the pituitary, but there are reasons to drive your prolactin up. Now prolactin is our prolactation hormone. It’s what helps with breast milk. But having low thyroid and having high stress and a few other reasons can drive prolactin up. And then the body goes, oh gosh, are we breastfeeding, are we not breastfeeding? What are we doing? And then it throws the cycle off. And so these women will have low progesterone, low estrogen. Excessive exercise. So excessive exerc… Oh my gosh. Can’t even talk today.

Dr. Carrasco:                      It’s a tongue twister.

Dr. Maren:                          Working out, excessive working out.

Dr. Jones:                            Thank you. Excessive working out, being underweight, disordered eating, those are very common reasons for having low estrogen as well.

Dr. Carrasco:                      There’s a lot of kind of talk or controversy about what is too much exercise, all these kinds of opinions about, can you do cardio, should you not do cardio? What is your opinion about excessive exercise and what does that really look like? Is that like for someone that runs like 10 miles a day or is that someone that just does cardio 30 minutes a day?

Dr. Jones:                            It’s a great question. And honestly, it depends on the person. So if I have a woman who does 10 miles a day and she doesn’t have a period, everything’s really low and off, I’m like, wow, that’s too much for you. But if I have another woman who does 10 miles a day and she’s like, my periods are great, they’re totally normal, I ovulate, I know I ovulate, then she’s doing fine. It’s not affecting her. I had a patient, years ago, who was desperately trying to get pregnant and she ran marathons for a hobby. Sounds like an awful hobby to me, but God bless her. And so she would run the half or full marathons every single weekend and she couldn’t figure out why she couldn’t get pregnant. And I was like, well, sweetie, you train all week and you run the marathon on the weekend.

Dr. Maren:                          Like the lion chases you on the weekend.

Dr. Jones:                            Constantly. And so by the end of the week, right? Because she’s gearing up for every week weekend. So when she stopped, it took a couple of months for her body to breathe a sigh of air, and then she got pregnant. I had a woman write me on social media to say that she was doing… I believe she was doing like SoulCycle twice a day. And then when she wasn’t doing twice a day SoulCycle, she was doing SoulCycle in the morning and it’s something else in the afternoon like HIIT or CrossFit or something. And she said I don’t have a period. Is this why? And I was like, yes. I mean, possibly, probably. Yeah, that’s excessive. But another woman could be doing twice a day for whatever reason and her period is fine.

Dr. Jones:                            The IOC, the Olympic Committee says that a woman under 15% body fat and this is not agreed upon by a lot of organizations, but they, in particular, and I believe the Collegiate Athlete Association also says under 15% body fat is where a woman starts to really get into trouble for her cycle. Maybe losing her cycle. And the reason is this hormone called leptin. So we hear about leptin like insulin, high leptin and we think of weight gain and obesity and fat cells. But leptin, when it’s too low, leptin is made by the fat cells and it’s a signal to the brain of I’m full, stop eating, and start burning when it talks to the brain. But when you don’t have enough leptin, then the brain perceives that you don’t have enough body fat on you essentially to make a baby and so you can actually stop or disrupt your cycle.

Dr. Jones:                            Dr. Felice Gersh, the [inaudible 00:22:36] doctor, right, she’s amazing. Years ago I heard her talk at a lecture and she said, ladies, whether you want to be pregnant or not, your female body gears every single thing around fertility and therefore all your hormones signaling, all your interactions, everything you do is around could you or should you get pregnant this month? Whether you want to or not isn’t the point. The point is that’s what our female body does. And so all this hormone signaling is around, are you safe enough? Are you healthy enough? Do you have enough nutrition? All these things. And so when it comes to low estrogen, some of these, hypothyroidism, high prolactin, excessive working out because I can’t say exercise, disordered eating, there’s a huge list, high stress.

Dr. Maren:                          Yeah. And I wonder just like if you look at the modern-day, mom who’s trying to homeschool while she works and eating her kid’s leftover crust or something on the plate and not getting enough sleep. And once they have another baby, it’s like, well, that’s hard. We’re not getting enough nutrition, we’re not getting enough rest, this isn’t that far-fetched. It might not even be disordered eating. [crosstalk 00:23:50] you don’t have time.

Dr. Jones:                            There is a hilarious Instagram post today. Sarah Blakely, who created Spanx, it’s her and it looks like she’s in a conference room kind of. It’s four kids and she’s got a glass of wine and she’s like this is running a company and homeschooling four kids. And this is where we’re at right now. And it was just so relatable. Obviously, Sarah Blakely has a lot more money than the average woman, but at the same time like this school is starting. Right. The recording of this podcast, school is starting and I have so many female friends who are like, oh my gosh, how do I run my business and homeschool, especially when they’re young, especially when they’re like littles and you’re trying to…

Dr. Maren:                          Totally. So when all of us have low estrogen and…

Dr. Carrasco:                      I think we might need some chase tree water.

Dr. Jones:                            In the water. We need it in the water system.

Dr. Maren:                          But then there’s this whole big group of women who have too much estrogen. Why should a woman suspect low estrogen? And here’s my big question. I want to talk about libido with you, but I’m wondering if that’s like…

Dr. Carrasco:                      Maybe season two.

Dr. Jones:                            Season two.

Dr. Maren:                          I know, season two, we’ll talk libido, but why should someone suspect they have low estrogen?

Dr. Jones:                            So a big one is a lack of ovulation or trouble with ovulation, believe it or not. And subsequently, she’ll have lower progesterone. Estrogen is what makes us women. It’s what gives us full, beautiful skin and full, beautiful hair. And it helps with collagen and it helps our heart and it helps our brain and it helps our bones. It makes our vagina nice and lubricated. Like estrogen does so much. It helps prime the uterus for implantation. It primes so that progesterone can get it ready. Women are listening to this like, well, my skin looks terrible, my hair is falling out. I know I don’t ovulate, PMS from hell. Like, oh my gosh, could this be an imbalance between estrogen and progesterone? Even low estrogen. Yeah, absolutely. These are the symptoms you’re feeling. Hot flashes, I have women in their 20s going, I get night sweats. Like what is happening? I’m not in my menopausal years yet. I’m like, I know. It’s likely a hormone imbalance of some sort. Or even hot flashes, I absolutely have young women who write me and go, oh, when I get really stressed out, I get hot flashes. What is this about? Like, oh yeah, adrenaline does that.

Dr. Maren:                          Yeah. And like always, test because you know what else can do a lot of those things, your thyroid. Right. I mean, as always, ladies, get somebody to walk you through this.

Dr. Jones:                            Yes. And I know this is hard, but this is where self-education is so critical. Find somebody who understands hormones. It drives the three of us nuts when somebody will say, well, I did testing. Here’s my testing. And you’re like, well, what day did you test it on? They’re like, I don’t know, Tuesday at 2:00. Like, oh, like what day of your cycle was that? I don’t know. Maybe four. I have no idea. I was bleeding. Like, oh, it’s the wrong day of your cycle.

Dr. Maren:                          Totally.

Dr. Jones:                            Yeah.

Dr. Maren:                          Back to the lab.

Dr. Jones:                            Back to the lab. Yep.

Dr. Maren:                          Let’s do it again. Okay. So let’s talk about DHEA. Tell us about DHEA, how it plays a role in fertility and why somebody who maybe wants to get pregnant should think about testing it.

Dr. Jones:                            Think about DHEA. So DHEA primarily is made in the adrenal glands and a little bit, 20% ish of the DHEA is made in the ovaries. So here’s what’s really interesting. In order to make progesterone or estrogen, you need DHEA and testosterone for that matter. So we have cells on our follicles, in our ovaries that make our DHEA and testosterone, they’re called theca cells. And then they migrate or diffuse over to a different cell called the granulosa cells and that’s where we make estrogen. And then the theca and the granulosa cells magically, like Cinderella and the fairy godmother, when she transforms her, they turn into the lutein cells when you ovulate. So we actually need all these cells all throughout our cycle. They play well together, they talk to each other, they become one another. And so if we don’t have enough DHEA, one, it’s an adrenal issue, but two, it could really affect the way we as women make estrogen and subsequently progesterone.

Dr. Jones:                            And so what they have found in IVF studies is that when they gave DHEA to women going through IVF, that it really made a difference and improved pregnancy outcomes. Now I will caveat here before everyone jumps on DHEA and starts taking it. Physiologically, meaning what does your body normally produce, the average woman normally produces I believe it’s like eight to 15 milligrams of DHEA a day. Somewhere in that range. The IVF studies were on really high doses, 50 to 75 milligrams. That’s what we call a supra-physiologic, way more than the female body makes, but it’s a very controlled environment. IVF for a month or two with a purpose. Get you pregnant while doing IVF. For the average woman who is stressed out, has low cortisol, low DHEA, struggling with her hormones, then you’re going to be looking at more of that physiologic range. Your practitioner will probably say to you, let’s start out with five milligrams.

Dr. Jones:                            Let’s maybe work you up to 10 milligrams. Let’s go low and slow. DHEA is amazing. It’s my favorite hormone. If I had to pick a favorite hormone, it’s DHEA because it’s so good for the brain. It’s so good for our hormones. It’s so good for so many things. But too much DHEA or DHEA, when it gets broken down, it can go down a pathway that causes symptoms. The symptoms are things like acne on the chin and the jawline. And it can cause hair loss like male pattern baldness but on a woman. And it can cause hair growth in places us women don’t want like on the chin and neck. And it can sometimes make us irritated and angry. So we have to be very careful. We have to treat the DHEA very seriously. And much like progesterone, it is a hormone that’s over the counter, but it still comes with its own risks. We do have to be careful with DHEA, but it’s a good one.

Dr. Maren:                          And another one where measure it first because some women actually have high DHEA and they have PCOS and they never knew it. So if you have potentially PCOS don’t [crosstalk 00:30:23].

Dr. Jones:                            And it’s an easy one to test. You can test it and serum, in the blood. You can test it and blood. You can test it in DUTCH testing. Like it’s definitely a straightforward one to test. You can ask your provider for it. You can like I said, do it on DUTCH testing. You can see where you’re at.

Dr. Maren:                          Okay. And one thing I love about DUTCH is that you can see testosterone metabolites. So maybe you have a little bit of a hint as to who’s not going to do so awesome on DHEA.

Dr. Jones:                            Exactly. There’s an enzyme, 5-alpha reductase, so when your 5-alpha reductase is high, upregulated, which is commonly due to stress or insulin, so blood sugar issues, inflammation can do it too, it’ll push it down the 5-alpha pathway. And it’s that 5-alpha pathway that causes the chin hairs and the chin acne and the hair loss on your head. You’ve got to be careful.

Dr. Maren:                          They are things we don’t want.

Dr. Jones:                            Kind of things you don’t want.

Dr. Carrasco:                      [crosstalk 00:31:09] start thinking about the blockers.

Dr. Jones:                            Yes.

Dr. Carrasco:                      And that gets complicated.

Dr. Jones:                            It’s just more supplements. Right. Yeah. So addressing the cause and the [inaudible 00:31:19].

Dr. Maren:                          Yeah. So let’s kind of go down that adrenal cortisol pathway because I want to pick your brain. I mean, one of my favorite things to talk about is thyroid. So I want to know on the DUTCH test, tell us about cortisol, how that four-point cortisol can give you… Well, not even the four-point, but just cortisol metabolized in total, can give you a hint as to underlying thyroid issues. And why does it look like that?

Dr. Jones:                            It’s so cool. So on the DUTCH test, if anyone has ever done cortisol testing, they usually do it in saliva. And it’s usually what’s called free cortisol. So free is what’s active and available that’s what binds to receptors and does the things. But then on DUTCH, we go a step further and we give you what’s called metabolized cortisol. And that was your cortisol potential for the day. So in total, how much did you make versus how much is free and active? Now the metabolized cortisol is really affected by thyroid. So when your thyroid slows down, when you have hypothyroidism, think about it, it slows everything down. It slows your hair growth down; it slows your metabolism down. It slows your digestion down. You get constipation. It slows stuff with your skin. Now you have dry skin. So it’ll also slow down the metabolism or breakdown of cortisol in the liver.

Dr. Jones:                            So on the DUTCH test, you will see low levels of metabolized cortisol. Then what happens is that free cortisol can’t get metabolized so it shows up in urine as higher because the pathway to metabolize is slowed down. So it’s like I’ll just come out as free. And so what happens, on DUTCH our results are listed as diols. So the diols, they sort of face each other. And when we see that, when we see low metabolized and higher free, that pattern, I’m like, ooh, I bet you have a thyroid problem. And it might even be just subclinical. It doesn’t have to be a TSH of 10. I mean, it could be more like low T3. It could be things like that.

Dr. Maren:                          Totally. I love that. I mean, it makes so much sense. It slows down everything, including your metabolism of cortisol. So there’s your hint.

Dr. Jones:                            I have women that are like, well, I’m on thyroid medication. I’m like, ooh, when was the last time you tested because maybe you’re due for a repeat.

Dr. Maren:                          Yeah. And sometimes it’s like your T4 is not high enough. And depending on the medication, sometimes I’ll see patients who don’t have enough T4 and they have too much T3. I mean, that’s obviously the patient who’s treated with more of a natural desiccated thyroid. And then sometimes you see this pattern of way too much T4, but nobody has T3 because they’re not converting it. So yeah, work with a practitioner who gets thyroid.

Dr. Jones:                            For sure. And I get asked, I’m sure you guys do too, especially with fertility, women will say, okay, I don’t want to do medication. I want to go the “natural route”. I want to take the herbs and the vitamins and what have you or maybe I don’t know, glandulars or something. Yeah. Iodine. And I’m like, well, when it comes to fertility… This is what I say. Like when it comes to fertility though, you have to stop a lot of that. You have to stop the herbs and you have to stop the supplement glandular, not the medication when you get pregnant. And now you’ve got a thyroid problem again and we know how bad it is to be hypothyroid and pregnant. It can lead to so many bad things. So I’m like, oh, I’m sorry, it cannot be this one time. This one time, that was the time instead of the medication.

Dr. Maren:                          100%. I agree. I mean, so many people struggle with low thyroid function and it takes years to naturally correct that. I mean, and if it’s possible.

Dr. Carrasco:                      If it’s correctable.

Dr. Jones:                            If it’s correctable. And let’s be honest, pregnancy is not going to make it easier.

Dr. Maren:                          No. Pregnancy is going to make it a lot worse.

Dr. Jones:                            It’s not going to make it easier.

Dr. Maren:                          And it’s going to increase your thyroid hormone needs by at least 30% right off the bat. So I think it [crosstalk 00:35:07] your thyroid.

Dr. Carrasco:                      I think if women are going into pregnancy wanting to do the natural thing because they think that that’s going to be better for their baby, a suboptimal thyroid or hypothyroid state, that’s not the biomarker you want to play with to try and do a natural resolution. Really, you have to take the medication.

Dr. Jones:                            I agree, with fertility. Now, if you’re not trying to get pregnant and you’re like, can we try another route to start. Totally different. Totally different. [crosstalk 00:35:38] maybe being hypothyroid. No bueno.

Dr. Maren:                          Yeah, totally. All right. So one of the other things I love about DUTCH test is that we get this measure for melatonin. Let’s talk tryptophan pathway and tell us why melatonin is important for the ovaries.

Dr. Jones:                            Oh my gosh. So melatonin, as we know is like, it comes out from our pineal gland when we sleep, but it’s actually made the most in our gut. It’s made in our intestines, which is very, very cool. It’s a very potent antioxidant. And so when the ovaries are doing, its thing and making all these hormones, this whole creation of hormones releases what are called free radicals. And so we need melatonin in the ovaries to help sort of mop them up, clean them up so damage isn’t done. And there’ve been great research on melatonin, especially melatonin in women with PCOS, and improving pregnancy outcomes, improving ovulation, improving follicle development and growth. And so we love melatonin, but to make melatonin, melatonin comes from what’s called the tryptophan pathway. So you have tryptophan and then that makes 5-HTP, which makes serotonin, and then melatonin.

Dr. Jones:                            And that whole pathway, the tryptophan pathway is greatly affected by things like estrogen. Too low or too high of estrogen will affect the way that pathway works. Stress, high stress will decrease or lower the way that pathway works. Having inflammation in your gut, there’s a kind of bacteria called a gram-negative bacteria and those nasty little gram-negative bacteria release this thing called LPS lipopolysaccharide and lipopolysaccharide is very, very inflammatory. It causes a lot of inflammation in the body. It will also mess with your melatonin and serotonin production. So by knowing our melatonin by testing on DUTCH test, it can be really helpful, one, if you have insomnia. It gives us a good insight into what’s going with your melatonin. Two, it can give us some sort of back insight like, oh, I wonder if your high or low estrogen is the cause.

Dr. Jones:                            I wonder if that inflammation, I wonder if all your stomach issues is a problem here. I wonder if that high stress, that high cortisol is the problem here because not only does it affect melatonin, but serotonin. And we know serotonin, such a big role in mood and our moodiness that we can look at these causes and sort of backtrack to go, oh. So instead of just saying, oh, she has low melatonin, let’s give her melatonin, which is an option, we also can then address the cause. Like, go right from where the issue is.

Dr. Maren:                          Yeah, it’s so helpful because now you know, when you look at the DUTCH, you can see like, oh, there’s a sign. There might be thyroid issues, just like with DHEA, the DHEA sulfate conversion. If that person’s under converting and they’re not sulfating, it’s like, oh, well, there we go, we’ve got some other hints. We need to look at inflammation and sulfation and all of this. So that is another test.

Dr. Jones:                            There’s a lot of little like clues for sure on DUTCH so that we can sort of backtrack and look under other rocks.

Dr. Maren:                          Super cool. Okay. So we’re almost out of time, but just one other little piece of Dutch that we love is the organic acid markers that look for some of the B-vitamins. Tell us why testing organic acid markers are better than serum sometimes.

Dr. Jones:                            So well, one of them is a big one, it’s called methylmalonate. Other labs call it methylmalonic acid, which is a B12 marker. And what happens is when the body is trying to make B12 and specifically it’s the adenosyl B12 that starts with an A, adenosyl. And that’s the B12 of your mitochondria. And what we didn’t talk about only because we’re out of time, is that all your sex hormones, so your cortisol, your estrogen, your progesterone, your testosterone, it all starts in the mitochondria. The production starts there. Most of them finish in the endoplasmic reticulum, but cortisol actually starts and finishes in the mitochondria. So mitochondrial health is so important to hormone production and specifically adenosyl B12 is important for mitochondrial health. So when you have high levels in urine, high levels of MMA, methylmalonate, what that means is that the body couldn’t go forward to make B12 so it had to pivot, become methylmalonate, and get urinated out.

Dr. Jones:                            And so we’re like, oh, it seems like you need more adenosyl B12 to be helpful there. And B12 in general, not adenosyl, but just B12 in general, like methyl B12, helps with estrogen detoxification. Methyl B12 helps with your brain, your nerves. It helps with so many things in the body. So just B12 health, in general, is critical. We do have two B6 markers, one is called xanthurenate and the other is kynurenate. I don’t know who names these things. I would like to have a word with them. But those are B6 indicators. And vitamin B6 is so important for brain hormone production, neurotransmitters. I think B6 is involved in hundreds of enzymatic reactions, much like zinc and magnesium.

Dr. Jones:                            And so B6 is really, really important. And we test an organic acid on the DUTCH test. And then we look at like glutathione, we look at a glutathione marker, which is the biggest… I mean, depending which paper you read, some papers say melatonin is the most important antioxidant, others say glutathione is the most important antioxidant, but glutathione is a big one. So again, that antioxidant support in the body, helping to reduce estrogen risk, helping to improve outcomes especially when it comes to fertility, helping the liver, helping things detoxify, glutathione is a big one.

Dr. Maren:                          Yeah. That’s awesome.

Dr. Carrasco:                      Can we ask one more thing since you mentioned mitochondria and that’s really emerging kind evidence of how really mitochondrial medicine is the future of medicine because I mean the genesis of everything? So can you give us and our listeners like tips to support mitochondrial health which will then in turn support so many other systems?

Dr. Jones:                            Absolutely. So we all learned in high school that mitochondria are our organelles, our cellular powerhouses. Right. And then we left it at that. We were like yeah; they make us energy. Yay, mitochondria. And then it turns out all our sex hormones start there at least. A lot of them start there. So our mitochondria are sensitive little beans too. So they’re very sensitive to things like chemicals. And therefore, when we’re looking at our ingredients, whether we put it on our body or spray it in our house or our detergent or the foods we eat, or the chemicals we’re around in our hobbies or the farms or gardening, all of that will affect our mitochondria. So trying to go as natural as possible, super helpful for mitochondria. Other things that are mitochondrial supportive, now they require certain nutrients to work. CoQ10 is a big one.

Dr. Jones:                            Copper, manganese, magnesium, zinc, oxygen, believe it or not. So how do you breathe? Are you a shallow breather? Do you have sleep apnea? Do you snore at night? Are you a mouth breather? All these things can affect your mitochondria. Cold will improve your mitochondrial function. So for the last, I think I’m at two months now, maybe going on three, I’ve been doing cold showers every morning. You see people online like Wim Hof, right? Cold plunges and cold baths and jumping into cold lakes and cold oceans. And so I have a cold shower. So that’s what I do. Every morning is I take a three to four-minute cold shower. And I’ve had people say to me, is that the research, is the research on three to four minutes? I’m like, no, that’s how long a song is. I do one song and I get out.

Dr. Jones:                            So for cold showers. Weight training, HIIT training, so the high-intensity interval training, but weight training is great for mitochondria as opposed to cardio. Intermittent fasting, fasting-mimicking diets. I’m actually doing the five-day fasting-mimicking. I’m on day four as we talk of the fasting-mimicking diet. And in the fasting-mimicking diet, I’m also doing a 16:8, so I don’t eat for 16 hours. And then my eating window is eight hours, which eating is in quotes because it’s the fasting-mimicking diet. So it’s mostly soups and a few olives and a lot of tea in that eight hours. And so just trying to improve my mitochondria, try and improve my autophagy, which is getting rid of the debris and the cells that just don’t need to be there anymore. Improving my longevity. So with mitochondria, the great thing is there’s a lot we can do as humans to make them better. We can avoid the bad stuff. We can do the good stuff and we can supplement with the coenzymes that help them do their job to make energy and make hormones.

Dr. Maren:                          Yeah, for sure. Like CoQ10 is such a big supplement in fertility. If somebody has seen a doctor, OB-GYN, they usually recommend high dose CoQ10 and we do too. So that is an important one with mitochondrial health. So that is super interesting. I love everything you just ran through. And just like clinically and I’m sure Alex has seen the same thing, it’s like when we do organic acid testing, we see all these problems with mitochondria. I immediately think like, oh, what are the chemicals? Right. Like there’s like heavy metals, well, totally. [crosstalk 00:45:05]. I know it well. Yeah, totally. So still more stuff to dig, but find the right practitioner who can help you do that. So, Alex, do you have any other questions?

Dr. Carrasco:                      I don’t think so. This has been just such a great interview. Thank you so, so much. We so appreciate your wisdom and what you do for the world of women’s medicine. Tell our listeners where they can find you and connect with you online.

Dr. Jones:                            Absolutely. So Instagram is where I hang out. So I’m @dr.carriejones. I do all education all the time. I may work for DUTCH, but I’m not trying to sell anything so you can find me there. And then I am at DUTCH. So if you are interested in learning about just hormones in general, like this podcast, we post everything on DUTCH for free. So it’s dutchtest.com. All our videos, all our webinars, all our podcasts, you can go through and learn for yourself all about hormonal health.

Dr. Maren:                          Yeah. They’re such great resources and your Instagram page is legit. So much information.

Dr. Jones:                            Thanks.

Dr. Maren:                          Yeah. Thank you. All right. Awesome. Well, until next time when we can get you on to talk about libido.

Dr. Jones:                            Libido, yes.

Dr. Carrasco:                      You’ll be back in a couple of seasons.

Dr. Maren:                          All right.

Dr. Jones:                            Awesome.

Dr. Carrasco:                      Thank you so much.

Dr. Maren:                          Thank you.

Dr. Jones:                            Thank you both.

Alejandra Carrasco M.D. and Christine Maren D.O.

Hello! We are Alejandra Carrasco M.D. and Christine Maren D.O. We founded Hey Mami because we felt a lack of support for fellow mamis. As physicians, we see women every day who struggle with fertility, are forgotten about postpartum, and have put their health on hold for years while they raise a family. We’re here to change that.

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