Ep. 241 Mitochondria and the Impact of Hormone Imbalances in Perimenopause and Menopause with Dr. Carrie Jones

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Transcript

Cynthia Thurlow: Welcome to Everyday Wellness Podcast. I’m your host, Nurse Practitioner Cynthia Thurlow. This podcast is designed to educate, empower, and inspire you to achieve your health and wellness goals. My goal and intent are to provide you with the best content and conversations from leaders in the health and wellness industry each week and impact over a million lives.
Today I had the great fortune of reconnecting with Dr. Carrie Jones. We last recorded for the podcast episode 106 in July 2020. I like to think of her as the Queen of Hormones. Dr. Carrie Jones is an internationally recognized speaker, consultant, and educator on the topic of women’s health and hormones. She has her master’s in public health and was one of the first to become board certified through the American Board of Naturopathic Endocrinology, and currently serves on the board.
Today, we dove deep into common hormone imbalances that we see in perimenopause and menopause, the impact of healthy versus nonhealthy mitochondria, the impact of toxins on our hormones. We spoke at great length about thyroid function and the four Ps, which she affectionately refers to, as puberty, pregnancy, postpartum, and perimenopause, the impact on our immune system as well as nonthyroidal illnesses, the role of skeletal muscle, things that no longer serve us in middle age, testing, and why we become more weight loss resistant with age. I hope you will enjoy this podcast as much as I did recording it.
Dr. Jones, I’m so excited to have you back. It’s hard to believe it’s been two years, it was July of 2020, episode 106. For those that are interested in checking out that first episode I did with you. Thank you for your contributions to women with humor and memes and a little bit of snark, which is why I love you best. [Dr. Jones laughs] And we really are friends outside of social media, for which I’m very grateful. So, welcome.
Carrie Jones: Well, thank you for having me. Oh, my gosh, I obviously love coming on the podcast to be able to see you and talk to you, so this is fun.
Cynthia Thurlow: Yeah, absolutely. What has changed for you since we last connected? I know that you transition from Precision Analytical to Rupa Health. And obviously, Rupa Health is something that now I know a whole lot more about, but one of the pain points for a lot of women is figuring out what testing they need. And now it’s all in one place, which is really must be a cool thing to learn about different types of testing that women can utilize, and men for that matter.
Carrie Jones: I’ve really expanded my lab repertoire for sure. When you work for one company and you– I mean, hormones is my passion still to this day. So, I know an awful lot about the DUTCH test, having worked there for nine years. But now that I get all this exposure to Lyme testing, autoimmune panels, and just more GI stool testing that the different companies offer, SIBO, it’s been really a lot of fun to expand beyond– and then get to know the company themselves, when you work for a lab company your kind of heads down, you’re familiar with all the other companies because it’s the same industry. But now, I know people there and I am in meetings, and I get to actually learn how those labs run, some of the labs we visited, so I’ve seen them in person, it’s really been pretty cool.
Cynthia Thurlow: It’s nice because I would imagine that it just expands your knowledge base. In fact, last night, I was listening to a thyroid lecture that you gave, and like I’ve said to everyone. [Jones chuckles] I was like “Dr. Jones likes a lot of analogies, which allows people to understand the science at a different level.” I think that, for those of us that were premeds as undergrads or went back and did premeds, that scratching off those cobwebs, you’re like, “Oh, I haven’t thought about that since biochemistry,” but you make the information really accessible, and I think that’s a unique gift that you have.
So, let’s start the conversation about hormones in general because they are chemical messengers. But I think a lot of people hate their hormones in middle age. They don’t understand their hormones. And I like to remind them, it’s all a bit like a seesaw, we’re trying to find balance. Our body is always looking for homeostasis, even if it is not easily available to it.
Carrie Jones: Man, that’s the truth. Especially estrogen, which you talk about a lot, and a lot of women hate their estrogen, they think they hate their estrogen and gets such a bad rap, it’s very much villainized. When in fact, estrogen, our main estrogen is estradiol, E2, and it does so much when it’s up and down like it’s supposed to be. It’s really helpful, we know now for brain health, heart health, bone health, skin health, and all the healths. So, when somebody says to me, or I read it in the comments or the DMS when they’re like, “I just want to suppress all of my estrogens because of my PMS or my endometriosis or whatever,” I understand where they’re coming from, absolutely. But at the same time, I’m like, “I think it’s possible the way you’re being told to go about it to manage your PMS or manage your endo or manage whatever it is,” is maybe not the most ideal, because you do actually need your estrogen. I would hate for you to suppress your estrogen in your 20s and 30s and have an increased risk for cardiovascular disease, dementia, or osteoporosis right as you hit that prime of life because we’re menopausal for, what, like a third of our life depending. So, it’s all of the hormones can if they’re too little or too much, get this really bad rap. And I’m like, “No, no, no, they do. Like a symphony, I just use them all to play together. I need them to go when it’s their turn, and be in tune, and go with the rest-“- Somebody said yesterday, “Get the band back together,” like “I need the band back together doing the hormonal thing.” And then, it feels good in our body as opposed to feeling completely out of whack.
Cynthia Thurlow: Yeah, I think the Women’s Health Initiative, I have now been talking about this with almost every woman’s health expert, because if you followed what happened in the early 2000s when I was finishing my MP program, and hormones were vilified and made a whole generation of individuals that were fearful to prescribe them, patients who are fearful to take them and we’re starting to see the sequelae of what’s happening, and I always said, “There’s something for everyone.” If you desire not to be on hormones, that can be supported. And if you desire to be on hormones, that can be supported as well. And so, when we talk about the sequelae of not enough estradiol, not enough progesterone, and testosterone, it explains a lot of the symptoms that women experience at this time in their lives.
I think so many of us, we live in these sympathetic dominant states throughout our lifetime. And then, we hit the wall, usually in perimenopause, it happened to me too,a nd then we have to reevaluate things. I always say that my high school reunion is always a good reminder of the people that are thriving versus just surviving, and you can’t live like you’re 18 when you’re 40 something. And it’s just this realization that if you want to thrive in the second part of your life, you have to make some changes. Do you find that to be the case? You were in clinical practice for a long time. And then now, working in a broad-based company where you’re exposed to a lot of different biomarkers and testing, you’re probably hearing these common themes of women, they’re like “What in the world happened?” like “I was, well–” and then everything I used to do no longer works.
Carrie Jones: I got told that in practice so — excuse me when I was younger, I’m 45, when I was a lot younger, my patients who were going into perimenopause were like, “I turned 45, and,” or “I turned 43, and,” or “I turned 47, and.” Like, “I can’t sleep, I put on all this weight. I’m super moody. My face is breaking out again. My sex drive went away. Everything’s dry or wet at night because I’m having night sweats, but then dry all day. What happened? I didn’t change anything.” And I remember sitting across from them, like, “Good God. Who designed this? This is terrible.” And now that I’m in my 40s, it’s the same thing, I absolutely see it. And I’m so happy to see so much education on podcasts and books, in social media, bringing perimenopause and menopause into the forefront and having that education because it’s true. I have said it for decades. It’s reverse puberty. We know what it was like going into puberty in our teenage years. Now imagine we’re backing out of it. The things you used to do in your teens, 20s, and 30s, they quite literally don’t work as well anymore. We have more on us. Somebody says, “Why is it harder for me?” I’m like, “Well, remember, you’re in your fourth decade, your 40s, when this often happens,” so that much more stress.
If you have children, they’re generally maybe in high school or into college, or maybe you if you started children later in life, your children are coming into puberty, as you’re headed into perimenopause. Your parents are generally older, so you’re taking care of aging parents. Career, you’re maybe at the height of your career, a lot of stress in your career. It just adds on as opposed to somebody in their 20s, who was totally fancy-free and can do whatever they want when they’re young like that, and they don’t have the accumulation of life, and the world, and their choices, and toxins and etc., on them.
And so, we hit the 40s and, as you talked about all the time, we become more insulin resistant. And we have, generally all this cortisol, and we’re losing our ability to make progesterone and estrogen has decided to go rogue and it’s up one day and down the next day. And nobody’s communicating like they used to between the brain and the ovaries and the adrenals and the thyroid, and we feel it. Our patients feel it. The people in our DMs, in our comment section are telling us they’re like, “That’s exactly how I feel. Nobody taught me about it. Nobody talks about it. My practitioner told me, ‘Well, welcome to your 40s Good luck.'” No, not good luck. There’s a lot you can do.” [laughter]
Cynthia Thurlow: I so agree with you because the running joke in my house is that– I’d like to think I’m more evolved than the average person and no one prepared me, not my mom, not my GYN, not my girlfriends who are older than me, no one, no one, no one. Although I remember in cardiology, I always had these women in their 40s, and I would like to scratch my heads. I’m like, “Clearly, what they’re experiencing is real. But what in the heck is going on?” And now I’m 51, and so I would definitely say 45ish was when I noticed an increased uptick, and I was like, “Okay, this isn’t working.” The cruel irony is that I have teenagers and as their hormones are all over the place, I always say to my husband, I’m like, “Thankfully, I’m like a very well-adjusted, emotional human being.” But I have one teenager in particular, where it depends on the day, like some days he’s like a cherub, and the next day, he’s a devil, and there’s [Carrie laughs] no in between, and my engineer husband doesn’t understand, “It’s hormones.” I don’t think he willingly wants to be a jerk, but he can be a jerk, I think the hormones are driving some of that, or at least that’s my working hypothesis.
Carrie Jones: I love it. Yeah, I agree, my best friend’s daughter, I call my goddaughter, she’s 14. My best friend is also a doctor and in her 40s, and feels and eats very similar actually, exactly how we do. So, the child was raised, aware of gluten-free, aware of dairy options, lots of physical exercises, well adjusted, good household and still puberty is what puberty is. You can’t run from puberty and as her emotions are up and down and my best friend’s in her 40s, she’s like, “Ha-ha, hormones are real and I’m trying to work through this.”
Cynthia Thurlow: Absolutely. I guess one of the things that differentiates puberty from reverse puberty or Perimenopause or andropause or adrenal pause, there’s all these kinds of catchphrases, is really understanding what’s changing at a cellular level and really talking about mitochondria, which is a topic I love to nerd out in and talk about, but what are some of the things that start to happen to our mitochondria as we’re making this transition? We may feel 30, but we may chronologically be a different age. And so, what is changing with the mitochondria, this dysfunctional mitochondria that’s driving a lot of the symptoms that women are experiencing?
Carrie Jones: First, our hormones are made in our mitochondria. It’s the very first step. All our steroid hormones, estrogen, progesterone, testosterone, DHEA, and it doesn’t matter male or female, first step is in the mitochondria, they do leave and go into next door, the endoplasmic reticulum and finish out except for cortisol. Cortisol comes back to finish out in the mitochondria. My point being is the mitochondria are critical for the creation of your steroid hormones, all of them. And then second, your mitochondria are extremely sensitive. They’re delicate little creatures. They’re your canary in the coalmine. So, if it’s too cold, too hot, too many toxins, viruses, illness, inflammation, infection, they don’t like that. And they’re not going to do that. [laughter] They don’t function well with that.
Cynthia Thurlow: They’re high maintenance.
Carrie Jones: They are high maintenance, and I do joke. As much as I love– I do love Mariah Carey, and it is Mariah Carey season as we record this, but we all know, girl is dramatic and your mitochondria are very similar, and with good reason. We want our mitochondria to not support viruses or bacteria. We don’t want these outside parasites, outside hijackers to hijack our mitochondria for their use. And so, the mitochondria can be like, “I’m not doing this today. I’m not supporting you.”
But when it says that, we lose our ATP, which is our energy, we all learned in school, mitochondria are our cellular powerhouses, they literally are producing our ATP. But on top of that, they also make our hormones. And you can have dysfunction in different glands. So, somebody might say, “Well, my adrenals seem to be working okay, but my ovaries are taking a hit.” It’s not like all the mitochondria talk and decided to unit one day [Cynthia laughs] like, “Hey, you know what, Thursday today, we’re not going to work.” It’s very gland and tissue dependent. So, because we know our mitochondria are so reactive, so dramatic, it’s really important that we work to support our mitochondria, one, for the energy part, which tends to go down as we get older, and then, two, for the hormone production part. If we want to maintain as best we can for our age, our levels of hormones, because some do naturally decline, there’s nothing we can do about it with age, but we want them to be age appropriate, then we do have to help and support our mitochondria. Which thankfully, I wish to back up and say unfortunately, we don’t get a lot of information about it. But thankfully, it’s I think it’s pretty easy to support mitochondria because they are so dramatic when people go, “Where do I start?” I’m like, “Anywhere.” Anything you do, whether it’s your diet, lifestyle, reducing toxins, exercise, going for a walk and getting some sunshine, red light therapy, cold showers, dark chocolate, thank God, green tea, all these things support the mitochondria in the end, intermittent fasting. Just pick one, start somewhere. It’ll help your mitochondria.
Cynthia Thurlow: Well, I think it’s really important to understand that we’re all talking about hormesis or hormetic stress. It’s beneficial stress in the right amount at the right time. We’re not saying to do all of those things all at once.
Carrie Jones: Yeah. [Carrie laughs]
Cynthia Thurlow: [crosstalk] may go. The mitochondria may say, “Sorry, not going to happen.”
Carrie Jones: Yeah, that’s a little much.
Cynthia Thurlow: But I think that it’s the cumulative net impact of really poor metabolic health and why there’s now such a small percentage of individuals, without naming what’s occurred over the last two and a half years, I think a lot of people had a wake-up call/hit a wall really hard because their coping mechanisms had to change given the fact that we weren’t able to do or live our lives the way that we wanted to. I guess that’s the most PC way of saying it. I think, certainly for me, one thing that I find for a lot of middle-aged women that doesn’t work very well for them anymore is alcohol.
Carrie Jones: I knew you were going to say that, yes. [laughs]
Cynthia Thurlow: I know, and it’s very sad because I’ve never been a big drinker, I grew up with an alcoholic parent. But I loved a good martini, like an extra dirty martini, which I think was really a conduit to salt because I like salt. But a really good Martini every once in a while was a wonderful thing. But now, the Mariah Carey mitochondria in my body say, “Heck, no. If you want to sleep, then you don’t drink.” It’s gotten that kind of granular.
Carrie Jones: And I would hear that from women too in practice, I would have all these women go “You wait. When you hit 40, you’re not going be able to drink that wine anymore.” Where I practice was wine country. In the state of Oregon, we have our own wine country, it’s Pinot Noir, and so, I saw a lot of winery owners, a lot of winery people through my practice, and they were like, “What happened?” I used to have a glass of wine, or I own a winery or I work for a winery, and now it wrecks me. I feel terrible. I’m tired. I sleep really poorly. I wake up feeling haggard.” And it’s true our enzymes and our liver that process and deal with alcohol really do shift as we head into our 40s. I’ve had so many of my friends, our friends or colleagues who were female, like, “Yes, I’ve actually, either given up alcohol completely, or it’s for the grand occasion of celebration, where I just know what I’m going to feel like the next day.” And while we can do a lot to “bio-hack” our way through alcohol, people go, “Can’t you take liver support? Can’t you take something?”, it’s helpful, but it’s still alcohol and alcohol is a toxin, always wins. So, it can be really hard.
I noticed too, my neighbors, I’ve said this before in the last two years, or recycle day is on Friday, Friday morning. And so, Thursday night, everybody puts their recycling out. I have a dog who requires a lot of walking. So, every night my husband and I walked the dog and we would see our neighbors, glass bins, the recycle bins full to the brim, beer, liquor, wine bottles when it hadn’t been. I mean, not enough that I would notice, and then 2020, 2021, 2022, I’m like, “Well, I’m pretty aware of how my neighbors are coping.” [Cynthia laughs] It’s right there. [laughs]
Cynthia Thurlow: It’s reassuring to know that there’s a physiologic reason why all of a sudden, certain food, substances, etc., are no longer– they’re working against us and not with us.
Carrie Jones: Yeah, it sucks, the good stuff in this world, probably it’s good in theory, but not so good for the body.
Cynthia Thurlow: Yeah, and so it’s interesting, as I was saying last night, it popped into my inbox and I decided I was like, “Serendipitous, we’re going to be talking today,” and you had a lecture talking about thyroid.
[laughter]
Cynthia Thurlow: Thyroid is a hot topic for middle-aged women, largely because so many of them have either subclinical hypothyroidism, many of them have Hashimoto’s. So, a lot of questions that came in for the good doctor were asking about thyroid testing, what to be asking for, I admittedly years ago used to order a TSH and a free T4 and I thought that check the box and now I know better. So, I always like to omit that. But let’s talk a little bit about what starts to happen to thyroid function as we have these fluctuations and progesterone and whether or not, vis-à-vis, we become insulin resistant, all these things that impact thyroid function, and why so many women at middle age are dealing with thyroid issues.
Carrie Jones: We say at sort of the big piece that when thyroid issues, hypothyroidism, so low thyroid, tends to hit women I think like 4X over men when it’s a true thyroid issue. There’s something else called central hypothyroidism which can affect men and women equally. But what we hear about hypothyroidism is generally women that get affected. So, the big P’s puberty, pregnancy, postpartum, perimenopause, and menopause these big, grand hormonal shifts will really affect the thyroid at a variety of levels. So, it’ll affect it from– these shifts in hormones affect our brain, so our brain communicates to the thyroid, it’ll affect the thyroid gland itself and our neck. So, how we do or don’t produce a hormone in our thyroid gland, we predominantly produce a hormone, T4, which you mentioned, and a little bit of T3, but T3 is the active one, that’s the big gun. It’s like 10X stronger than T4. And then, out what we call our periphery, tips of our toes and tips of our fingers, liver, ovaries, testicles, whatever we can convert and make T3 which is the active guy. So, these shifts in hormones, estrogen, progesterone, testosterone can work with or work against the creation, the formation of T3.
As we make these big shifts, hormones also affect our immune system. So, if you were sort of subclinical, maybe you were never really ever positive for an autoimmune thyroid like Hashimoto’s, as we make these shifts and estrogen, particularly which has a grand influence on our immune system, it can actually push you into– now really seen on lab work. Maybe you were always sort of borderline on your Hashimoto’s antibodies. And by borderline, I mean like you were not quite over the edge, but you were pushing close, which I know there are arguments that you probably were there and didn’t catch it. But what I see then in perimenopause is these grand shifts in estrogen, grand shifts in the immune system, the body’s like, “Ah, forget it. Here are the antibodies,” and it will really show up on bloodwork. It’ll make it stupid obvious once we hit into perimenopause, whereas it was a gray area before.
When we couple all this, this is why women in perimenopause– and then you add insulin on top of it, then add cortisol on top of it, then you add years of gut disturbance on top of it, etc., etc., etc., and the risk for autoimmune goes up exponentially.
Cynthia Thurlow: It’s interesting because I did not know that even though I’ve never had positive thyroid antibodies, my acting functional medicine doc said, “Oh, you definitely have Hashimoto’s. You just have been gluten-free for so long that we have never seen positive antibodies.” If you’re listening to this, and you’ve been told you don’t have Hashimoto’s, statistically, if you’re a woman, and you have hypothyroidism, more likely than not, you actually have an autoimmune issue. And so, that really started to make sense to me. But I think for years, I had been told by another provider, “Oh, you don’t have Hashimoto’s, because you never had positive antibodies.” So, if anyone’s listening, and if that provides enlightenment, for me, I took it much more seriously because no, it wasn’t related to mercury. No, it wasn’t related to low iodine. When you were working with patients clinically, how often did you see these rare etiologies for hypothyroidism? Because now I’m understanding that, it really is driven by these hormonal shifts, as you mentioned but also, this immune reaction, leaky gut, and all these other things, it is this piling on of years, and years, and years, of stress, and other things when we haven’t been taken care of ourselves that really impact our susceptibility to Hashimoto’s.
Carrie Jones: And in fact, now we know, there are other autoimmune markers that aren’t commonly tested for, TSH receptor, for example. Hashimoto’s is not defined by a positive TSH receptor antibody. It’s defined more by a positive thyroid peroxidase antibody TPO, many of you may know it as. And so, when I was doing all this research into autoimmune thyroid, while Hashimoto’s is definitely the most talked about and what we would call the most common, there are other autoimmune types of thyroids you can have. We just don’t routinely hear about them or get tested further then.
Then on top of that, you can have something called non-thyroidal illness syndrome. The big three reasons are, big inflammation, big infection, and sepsis, sepsis being worst-case scenario. And because you have this infection, inflammation, sepsis happening through the body, the thyroid, the cells themselves are trying to protect them. So, they downregulate the ability of T4 to get into the cell and then convert into the active form of T3. So, it actually has nothing to do with the thyroid gland itself, that you don’t have a gland issue and you may not have an autoimmune issue. But you do have thyroid symptoms and pathology and labs driven by inflammation and infection that you’ve got in, of course, worst-case scenario, sepsis, but by then you’re probably in the hospital.
And you can have both at the same time. You can have developed, caught a major infection and at the same time, you might also have Hashimoto’s. And so, you get this double drive against your thyroid. So, when people say to me, “Oh, yeah, I have thyroid issues. Where do I start? I was put on medication I don’t feel any better,” I’m like, “Well there’s a slew of reasons that the body does or doesn’t make thyroid and so let’s work to figure out why aren’t you making your T3. Why are your cells mad and not letting your T4 inside? What’s going on with your immune system? What’s triggering and worsening the autoimmune system?” So, it is like anything else in the body, the thyroid is not one and done. It’s not “Here, take this medication,” and you’re fixed. It does take everything, some work to backpedal and figure out what pissed it off, and what can we do about it.
Carrie Jones: Well, I think it’s really important, I know Dr. Eric Balcavage, who’s coming on the podcast again in next month to talk about his new book. He talks a lot about cellular hypothyroidism, and I don’t see a lot of clinicians talking about this, because I think to your point, a lot of individuals, they’re told they have an underactive thyroid, they get medication, they’re like, “Okay, checkbox, fixed.” And then they realize that’s the tip of the iceberg. There’s so much more. You can take medication and still feel terrible.
Cynthia Thurlow: If the cell– he has a great example in his book actually, where he talks about– and I found this in the literature. It’s interesting how researchers and what they publish around thyroid and what endocrinologists teach, don’t always line up. It’s literally in the research. Literally, the sentence right here in this study says, “We’ve known for decades.” They know this, it doesn’t get translated. But Eric has an example in his book of, if you are with cellular hypothyroidism, so you can take thyroid, but you’re given T4, let’s say, you’re given thyroxin, and we’re Synthroid. And so, T4 comes into the system, and it’s super excited, and it goes up to a cell and it knocks in the door, and it says, “Okay, I’m here, I’m here, I’m T4, I’m here.” And the cell is like, “Pfft, hah. No, you can’t come inside.” So, now when you test, maybe you test some blood markers, and the T4 looks good, because it’s still hanging out in the blood, but it can’t get in the cell, and it can’t convert into the active form of T3.
Then, somebody says, “All right, we’re going to add T3. I’m going to add T3 to your mix. Either liothyronine or Cytomel. I’m going to compound you some sort of combination,” something. So, now you flood the system with T3, what can happen in some cases is that again, the cell is like, “No, I don’t want you in here. We have inflammation and infection going on. You need to go away. i’m protecting myself.” And so now, you test now you’re like, “Well, I feel anxious when I take T3, I feel nervous. I can’t sleep. I have heart palpitations,” because you’ve all this T3 going other places around floating around your circulation and so, it can’t get in the cell. Or the body goes, “Okay, cool. I’m going to deactivate it. I don’t want all this T3. I’m literally downregulating to protect you, because of whatever, infection, inflammation, etc., etc., etc. So, I’m going to deactivate you to something called reverse T3.” So, you give T3 and then they end up deactivating it. And again, just like you said, they’re like, “My symptoms didn’t go away. Or they felt better for a couple of weeks or maybe a couple of months and then, they come back and go, “I need more. I need more. That didn’t work.
Cynthia Thurlow: Yeah, I think it’s important for people to understand that taking the medication is not the end story. I’m now working with someone who has been making little adjustments every two weeks with compounded T4 and T3, and it’s the best I felt in a really long time. But I think for anyone who’s being treated for thyroid issues, if you don’t feel better, there’s probably something that’s mitigating this. So, when you are recommending to clinicians or talking to clinicians or doing the amazing education that you do across social media and talks, where’s a good starting point? I know that we talk about a full thyroid panel. We also mentioned some of these antibodies. Certainly, TPO, I’m very familiarized with not as familiar as with this TSH receptor antibody. But when would be the time to be advocating for additional testing along with the basic labs? I think actionable advice is really very helpful on this podcast because then people take notes and then they go advocate for themselves, which I think is so important.
Carrie Jones: First of all, if you’re symptomatic, if you’ve done a quiz online, if you’ve listened to past podcasts when you listened to Dr. Eric, and you’re like “Oh, I have all the symptoms, I have all the symptoms of hypo or hyperthyroidism,” then that’s when you need to get more thorough workup. I saw a post on Instagram yesterday where somebody was like, “Doctors who run full thyroids is a red flag.” I’m like, “No, it’s not.” I can understand not running it on absolutely every person who walks through your office if it doesn’t fit at that time. But if somebody comes in and says like “I’m tired. I have weight loss resistance. I’m losing my hair. I dry skin. I’m constipated. I have a family history of thyroid, or I have a subclinical thyroid issue, I was told a couple of years ago and they didn’t do anything about it. I didn’t know what to do.” So, as these boxes are being checked for me, I’m like, “We’re doing a full thyroid panel.” So, I’m looking at the TSH which is what you mentioned earlier thyroid stimulating hormone. I looked at free T3. I look at free T4. So, I do look at both. I look at reverse T3 because I want to see how much is getting deactivated that helps me to understand if it’s more of a cellular issue. And then, I look at the two big antibodies, so TPO thyroid peroxidase antibody, TGAB, thyroglobulin antibodies, I usually start there.
Now, if the TSH receptors, there’s like four or five thyroid antibodies, I don’t generally start with yet. I may add them later as we’re working through. For example, if the antibodies are negative, and very symptomatic family history, I’m like, “There’s autoimmune somewhere. Let’s go ahead and check some of these other markers and make sure.” But that’s usually where I start with the panel when somebody comes in like that. And what’s great is that what we’re requesting, I should say, most of those labs are not weird. They’re not hard to find. They’re not rare at all if hopefully your practitioner is willing to order them for you. The one that’s tough to get sometimes is the reverse T3. The RT3, I have had HMO groups, refuse, I have had hospital groups refuse. And I know in some countries, it’s nearly impossible to get. They don’t do or believe in reverse T3. But if you can get it, it’s helpful.
Cynthia Thurlow: Yeah, and I always think about reverse T3 as the brakes. What is driving the brakes? I think when reverse T3 is normal, I don’t worry about it. But when I’m looking at labs, and I’m playing detective we all do, we’re like, “Okay, what is raising a red flag? What is something that we need to lean into?”. I think something else that has certainly been apparent to me, since I’m allopathically trained, I also have functional training, is understanding that both can be like playing in the sandbox, I’m going to use one of your analogy explanations, we can all play in the same sandbox. But understanding that those traditional labs can be helpful as well as the integration of some of these functional integrative medicine labs which give us a different perspective. One of the really great things that I think about is blood labs for estradiol, estrone, progesterone, and free and total testosterone, versus looking at them on a DUTCH. So, let’s pivot a little bit and talk about the sex hormone piece, because this is, in particular, an area that I found it really beneficial to have, to look at both of them. Unfortunately, I hear from many women. “Oh, my doctor said I’m in menopause, we don’t need to check my hormones.” And I’m like, “Oh, we need to get you hooked up with a different doctor,” that is for sure.
Carrie Jones: Yeah, unfortunately, my old boss in DUTCH used to say, “All this different lab work is looking into different windows of the same house.” In some cases, certain types of blood work, or urine look, or saliva or stool is better than others, and in others, you’re getting a different viewpoint. You’re on the first floor as opposed to the second floor. You’re in the front door as opposed to the sliding door. And I always love that analogy, when somebody says, “I have all this lab work back and I hear conflicting things,” I’m like, “It’s all you. You’re at the same house. We’re looking at you from different angles.” Now, it does take somebody maybe a little more skilled, a little more trained to understand the different angles. And as you said, I love that, if your practitioner is against it, doesn’t believe in it, doesn’t want to, but you don’t feel good, it’s totally fine to get another practitioner, request another practitioner, to keep them if you like them for certain things, and add to your clinical team.
So yes, I am totally okay with people running bloodwork for their hormones. I get asked a lot, like “Oh, but my insurance covers estradiol and progesterone and free and total testosterone or sex hormone binding globulin, DHEA, etc., in the blood work. Can I start there?” I’m like, ” Of course, you can.” It’s just one of the windows into your house and we can use that. And then, depending on their goals and budget, we can add on something like the DUTCH test, which is, I think, really helpful as we head into menopause because so many women– this is when breast cancer obviously becomes more at risk. And a lot of women are going, or choosing, or deciding to go on estrogen replacement. And the Dutch test the urine part gives us what are known as metabolites. Metabolites is just a fancy word for when estrogen breaks down because it has to go somewhere, where it breaks down and some of those breakdown pathways are good or better. And some of those break down pathways, not so good. We don’t really want to go down that pathway. And so, it’s helpful for me when I’m like, “You want to go on estrogen. You’re having all the hot flashes, night sweats, the vaginal dryness, the brain fog, etc. Let me make sure your estrogen, should I give it to you, is going to go down the right pathway. If it’s not, let’s course correct, and then start estrogen.” So, I like that extra window into the house of estrogen with a urine test.
Cynthia Thurlow: I think it’s really helpful and insightful because it’s something that you can then track. I know for myself, pre-HRT, during HRT, one of the reasons why I went off of what I was taking was because I went from metabolizing my estrogen down the 2-OH pathway, which is the good pathway, and down the 4-OHh, which is the one that we know can be damaging to DNA, and we want to really avoid that. I always use myself as an example when I’m working with clients to really understand it doesn’t mean it’s forever. For me, it was the type of HRT I was taking, which I’m now no longer on. And now, I’m actually back to a point where I’m able to metabolize my estrogen properly. And so, when people are listening to this, and they’re trying to wrap their heads around some of these differentiators, what can impact our ability to process estrogen properly in our bodies beyond medication? Let’s start with the basic stuff that I think is really helpful.
Cynthia Thurlow: So, a lot of it, first of all, we’re set up genetically to yes or no with a certain pathway. So, sometimes genetically, you are set up, thankfully, to go down the better pathway, and sometimes, unfortunately, you are set up to go down the less-better pathway, the not-so-helpful pathway, the 4 pathway, and in some cases, the 16 pathway. But alcohol, the toxins we’re exposed to– let me clarify, these pathways we’re talking about, we’re talking about with estrogen, estrogen is not the only thing they deal with. They deal with lots of stuff, everything. We’re very focused on estrogen. But if you manipulate these pathways, they also manipulate how you do and don’t process pesticides or herbicides, or fragrances or phthalates, or plastics or medication, alcohol, etc. So, all of these things can affect– Your diet. Some of these pathways are really improved by things, that are your brassica family, your broccoli, your kale, your cauliflower. If you choose not to or don’t eat those things in your diet, then you may be missing out on improving that better pathway, the 2 pathway.
As we move through detoxification, there’s phases. The second phase really relies on magnesium. Magnesium is a big helper. Your B vitamin is a big helper. Choline. Well, if you’re eating those foods, if you can’t absorb those foods, digestion is a big thing. You’ve got heartburn, you have H. pylori, you’ve got small intestinal bacterial overgrowth, SIBO, got parasites, or a lot of GI stuff that’s going to affect, believe it or not, how you absorb all these nutrients that are then good for your liver. And then, how do we get rid of the estrogen? Well, we urinate it out, or we poop it out. So, if you are constipated, that’s going to affect your ability to get estrogen out.
And so, you can see, a lot of gut talk. We’re talking about– a lot of gut talk and a lot of liver talk. The more you can do to support, “Am I pooping every day? Do I have gas bloating, constipation, diarrhea. Am I popping heartburn medications often? Do I have a history of an ulcer? Do I feel like I have an ulcer?” All these questions are helpful for us at large, but in particular to this conversation, estrogen.
Cynthia Thurlow: Yeah, I think it’s important. The irony is you can still have a bowel movement every day and still not be clearing your estrogen properly. So, don’t assume because you have a bowel movement every day that you are. And I say this with love and reverence. Because last year when I had that DUTCH, I was predominantly processing down the 4-OH pathway. Guess what? I had a bowel movement every day, and I was certainly very surprised when I got my results. Talking about estrogen, talking about gut health, what are your favorite tests for looking at gut health? I obviously have favorites, but I’d love to hear yours. [Carrie laughs].
Carrie Jones: Like an actual favorite company or favorite markers I’m looking at?
Cynthia Thurlow: Why don’t we say both? Because I think that’s both relevant.
Carrie Jones: I’ll be honest. This is the great thing of working at Rupa health is that I don’t believe– I don’t have a favorite gut test since I now work with all the companies. But I can tell you the top companies that practitioners seem to love, Diagnostic Solutions has something called the GI-MAP. There’s another company called Genova, they have the GI Effects. There’s a company called Microbiome, they have Biome Effects. And there’s a company called Doctor’s Data, they have GI360. And then there’s a company called Vibrant, Vibrant does Zoomer markers, which are also popular. But I would say from casual observation, the DSL, GI-MAP, and the Genova are probably what you’re going to see the most in social media and in practitioners because of what they test and how long we’ve been around in education they do. So, those are the big ones that you’ll see.
Now, you can go to your primary care, and they’ll do a quickie stool test. Let’s say you travel out of the country, and you get diarrhea and you go to your primary care or urgent care and they’re going to go, “Okay your poop, put in this vial. Give it to us,” they’re just doing a quickie test for things like giardia. They want to make sure like the top five real bad organisms, parasites, you haven’t picked up. But it’s not a comprehensive inflammation, infection, bacteria, good and bad bacteria, some of these other pHs, these other cool markers calprotectin, they they’re not going to pick that up. So, if you’re thinking to yourself, “Well, I got a stool. I got home from Mexico and I was having diarrhea. I think I had a stool test, it was normal.” We’re talking a much more comprehensive multi-page report in these companies. So, those are probably the top ones.
Cynthia Thurlow: Now, I have familiarity with almost all of them, and I do think when I’m looking at the Diagnostic Solutions, GI-MAP in particular, because that’s the one I use the most, really zeroing in because the beta-glucuronidase is there on that test looking at dysbiosis. Sadly, almost everyone has some degree of dysbiosis. And I think that’s probably a byproduct of our lifestyles and stress and the foods we eat and a multiplicity of things, the estrobolome, which is this goofy name for how our body interacts with estrogen in the gut. But for you, is the beta-glucuronidase, that you’ll really [crosstalk] on?
Carrie Jones: Yeah, in estrogen, the final two steps for estrogen before you either push it to the kidneys, or push it into the colon is called sulfation or glucuronidation. Fancy words, I don’t know who named them, but that’s what they are, sulfation or glucuronidation. So, beta-glucuronidase is an enzyme that you make in your intestines from your microbiome, and it acts like scissors. So, it cuts off the G, the glucuronic acid of your estrogen. When the G is on, your estrogen is neutral. It can’t bind to receptors. It’s also water soluble, so you can get rid of it. When you come in contact with beta-glucuronidase, like scissors, it cuts it off. Now, the G is gone. So, now you can be reabsorbed. It’s like a package where the bow has been undone, the lid has been lifted, and estrogen floats away. So, now it gets reabsorbed. So, beta-glucuronidase is a big one, because the higher it is, the more at risk you are for having estrogen float away and get reabsorbed. And that was estrogen that tagged to go. Your body was like, “We’re done with you. Go away, get out,” and it gets back in the system.
Unfortunately, we know that the sulfation scissors, which is known as sulfatase, we know it exists in the gut, but commercial testing is not there yet to look at it. So, even if somebody has normal levels of beta-glucuronidase, there’s a lot about that microbiome, we don’t know yet. And in the next several months to years, good gracious, we’ve come so far in a short time, we’re going to get a lot more information around that part of the microbiome that deals with estrogen, the estrobolome. And now, they talk about the endobolome, the endocrine microbiome, because we know the microbiome plays a big role in testosterone and DHEA and progesterone and the entire endocrine system.
Cynthia Thurlow: It’s really fascinating, and I think on a lot of different levels, we don’t think about our gut until we started having problems. And then all of a sudden, we’re like, “Oh, all these imbalances– Oh, I was on antibiotics for six weeks to treat Lyme,” which you needed to take, and then it disrupts the entire gut microbiome and you’re suddenly having more anxiety and depression and you’re not making healthy neurotransmitters. I mean, there’s so much to the gut microbiome, and certainly, back in the dark ages when I trained, we didn’t talk about the gut. It was like the gut was talked about is, “Here are these organs. These are the signs your organs are not working properly.” And we never really thought about good or nonbeneficial or beneficial bacteria in the gut. I always talk about dysbiosis as an example of nonbeneficial bacteria in the gut. It’s like having weeds in a garden. There we go. I thought [crosstalk] analogy.
Carrie Jones: Yeah, there you go, I love it, I’m super proud of you.
[laughter]
Cynthia Thurlow: So, a lot of the questions that I got came in around testosterone, I think testosterone is a really poorly understood hormone, vis-à-vis women, we do make testosterone. It is much more potent in our bodies. But unlike estrogen, and correct me if I’m wrong, estrogen, we get pushed off a cliff eventually. We get pushed off the cliff, and then that drop in estrogen precipitates a lot of systems and symptoms. Testosterone is this gradual decline. So, let’s talk about testosterone because there’s a lot of misinformation out there. I promise we won’t touch on pellets because Shawn Tassone and I talked about pellet therapy. We had a whole conversation, a little powwow on that. Let’s talk about testosterone because I think it’s such an important hormone. I think women think about estrogen and they just think about progesterone. And I remind them that testosterone is, I think, also equally important in our longevity and our health.
Carrie Jones: Testosterone is made in a few places. Unlike men who make 95 plus percent of it in the testicles, we make it in three main places. We make 20% to 25% of our testosterone out of the ovaries, 20% to 25% of it out of our adrenal glands, out of a layer of adrenal glands, and then the rest of it, the body can– we have an intermediate hormone called androstenedione and it can convert into testosterone out in the rest of our tissues. So, as we head into perimenopause and menopause, we start to lose ovarian function because of aging and therefore we can lose 20% to 25% of testosterone production. The ovaries shut down, so we lose all that. Unfortunately, nobody tells the periphery and nobody tells the adrenal glands, “Hey, the ovaries are shutting down, they’re menopausal now. You need to pick up the slack.”
Now, interestingly, I have read some research that says Women’s testosterone doesn’t or shouldn’t decline through the years. And I’m like, “How much experience have you had testing women through the years?” Because [Cynthia laughs] you and I’ve had a lot, and I mean, most of the time, I would say it does decline to some degree, and then can be really– and sometimes it’s to a major degree, they just bought them out. The poor testosterone is just like, “Goodbye,” and down it goes. And so, that’s what leads women to– we don’t have a lot of it, but what we do have, it does play a role in our mood, muscle formation, lean body mass, and libido, and focus and drive and things like that. And if we brought them out in our testosterone, I don’t want to forget about it, estrogen gets the most commercial airtime but testosterone plays a role there too.
Cynthia Thurlow: Well, I think a lot of people think about it in conjunction with libido. But when I see women with really low, free testosterone, they lack motivation. They’re wondering why they don’t want to go to the gym. It’s not that they don’t want to go, it’s like really hard intrinsically to get them motivated to do things. And so, understanding that it’s going to make it harder if your testosterone is low to build muscle. There are cognitive functions of testosterone that people don’t understand. Again, they just think, “Oh, I’m going to close through menopause. It doesn’t matter.” And I always say brain health to me is super important, as well as muscle health. You talked about muscle health, so we’re going to go there. Why are muscles so important as we get older?
Carrie Jones: Well, if everyone will listen to Dr. Gabrielle Lyon, she talks about muscle as its own system. Muscle, it’s just muscle. What do we care? Turns out the muscle, the skeletal muscles, are pretty important and do a lot for blood sugar, glucose, insulin, hormones, our longevity, resiliency. I mean, it’s this entire system. If we don’t have muscle which, as we get older, and we lose estrogen and progesterone, we are more prone to becoming insulin resistant, which we don’t want. Once you sort of move into insulin resistance, you’re at higher risk for prediabetes and diabetes and then it spirals from there. Having good healthy amounts of muscle on our body helps prevent that. Because we use our skeletal muscle, then we become more insulin sensitive, which is a good thing, we like being insulin sensitive, so that we don’t have all this glucose floating around when it shouldn’t be. It can be sucked up into the muscle, for lack of a better analogy, and then utilized. So, having muscle keeps you young, keeps you mobile, keeps you healthier.
And again, as we make that transition, a lot of women heading into perimenopause don’t have a lot of muscle on them. I’m not saying you have to be a bodybuilder, competitive-level muscle but they’ve been busy raising children, working their jobs, handling life and then maybe they go to the gym, maybe they don’t. And then, they hit into perimenopause with not a lot of muscle on them. And then, they tell me “Well, what I did have is squishier. Carrie, I’m getting squishier. I’m doughy, Carrie.” I would hear this all the time from women and they’re in their 40s and 50s. Like overnight, “What happened? I had a little bit of tone, and now it’s gone.” I’m like, “I know. It’s so important.” Because we roll into our 40s, and you talk about this all the time, the importance of putting some muscle on, getting strong.
Cynthia Thurlow: And it’s interesting because no one ever told me we have peak bone and muscle mass in our 20s and 30s, and I never understood the interrelationship between maintaining muscle and maintaining insulin sensitivity. There was a recent study that I looked at that was talking about the net impact of lower estrogen levels. So again, in perimenopause, you have wide fluctuations. It might be high one day, low the next, and that impacts your muscle-to-fat ratio in the body. So, it’s not surprising we get fluffy, which is my hateful word for what happens.
Carrie Jones: Yes.
Cynthia Thurlow: Fluffy, squishy. None of us want that. We may want that if we’re talking about Jell-O, but we probably don’t want that. [Cynthia laughs] You probably don’t want that word [crosstalk]
Carrie Jones: My dog.
Cynthia Thurlow: Exactly, and so, it’s interesting, this interrelationship with estrogen and how that plays a role in insulin sensitivity and muscle mass. And so, it’s not all in your head that this starts to happen. And even in men, if they’re insulin resistant, they will aromatize, so they’ll actually make estrogen from testosterone. So, if you see men that look feminized or they have, we used to call it gynecomastia, they have breast tissue that’s forming. Sometimes, that’s medication mediated, but more often than not, it’s this aromatization of testosterone to estrogen, which is really interesting, and leading to more fat and less lean muscle mass at this stage of our lives. Now, I got a couple of random questions.
And so, I’m going to do some random questions because I know these are things, you’re well familiar with. Why are we more prone to histamine and high responses in middle age? And I know this is a direct reflection of estrogen, but I’m sure you’ll state it in a much more eloquent way.
Carrie Jones: [laughs] Well, a couple of things. So, first of all, if you remember back, we talked about by the time you hit middle age, you have all those years of accumulation on you. So, how your liver functions, your gut function, your stress levels, your resilience, etc., etc. And so, those play a role on how you are able to handle histamine, whether histamine foods, the breakdown of histamine, histamine when it’s allergy season, histamine from wine, whatever it is. So, that right there is against us.
Secondly, when we have a lot of estrogens, typically, in perimenopause, as you said, we get these wild fluctuations, because sometimes the ovaries are listening. And sometimes, they’re not, like they used to, they’re not as rhythmic as they used to. When you get these high fluctuations of estrogen, it slows down the breakdown of histamine. So whereas maybe five years prior, you could be in allergy season and do fine, as an example, you maybe have a little snifflies, but you’re pretty good, now you get into allergy season, and you’re like, “Oh, my gosh. Has allergy season gotten worse?” You’re looking around your neighborhood or your friends and you’re like, “Is your allergies just as bad as mine? Has it gotten worse?” When really potentially what happened is that we now have all these wild shifts in estrogen, so we can’t break it down like we used to.
I see that time and time again because histamine also plays a role in our prostaglandin formation. I have a lot of women that are like “My cramps, cramps and allergy season,” or, “Cramps when I eat high histamine foods are worse.” And I’m like, “Oh, because you have all this estrogen, you can’t break down histamine, you push out prostaglandins.” Prostaglandins make our [unintelligible 00:51:46] and they make things squeeze. And so especially as we get close to our cycle, then we’re like, “What the heck? My cramps used to be fine, and now like I’m having all these crazy, weird spasmy things happening down there, it hurts. It’s not fair.” There’s stuff we can do, but it’s still not fair.
Cynthia Thurlow: No, absolutely not. And I know there have been so many people asking about that in particular. Last question before I respectfully let you go, because I know that you’ve got a busy workday. What are your thoughts on weight loss resistance? So obviously, big topic, lots of things that impact it. But why are women– a lot of things that we talked about, a lot of things, the loss of muscle mass, insulin sensitivity, etc. But what would be your top three surprising weight loss resistance issues that most people aren’t thinking about?
Cynthia Thurlow: I mean, number one, stress is a big one. When we have a lot of cortisol, cortisol’s main job is to increase our glucose. Cortisol does a lot of things for stress, but increase our glucose is a big one. And then we’re middle-aged, so we’re already getting more insulin resistant than we were in our 30s. So, you’ve high cortisol, more glucose, more insulin resistant, and therefore weight loss resistance. And the cells in our fat tissue, they’re called adipocytes, they actually have a little enzyme in them, God bless them, that activates cortisol, it keeps cortisol active. And so, we have all this extra cortisol in our actual fat tissue that’s amplifying and so our fat tissue can expand, which again, is not fair, and we then tend to see that like spare tire weight gain. Or if you already have the spare tire, it tends to get bigger as you move into your 40s because it already has that enzyme, unfortunately, cortisol, you’re already stressed out. Or maybe you’re doing things you think that used to be helpful for you, like my runners, my cardio buddies, my Peloton riders and they do it every day or twice a day or the long runs are what clear their head, but now they’ve moved into their 40s and that is actually stressing them out. Too much cortisol, too much glucose, so more balanced. So, I’m like, “Hey, we need to flip into more weights. Let’s build some lean muscle to help with that lean weight loss resistance. Let’s slip into some stretching. Let’s do walking. Let’s not be cardio buddies all the time as we hit into our 40s. I totally get it to help clear your head, but it may not be working for you right now. Let’s switch it up because we have to, and go from there.” So, that’s probably the number one, we don’t think about a lot with cortisol.
Number two. We’ve talked a lot about blood sugar and insulin, but I feel like people get their blood sugar checked, you get a fasting blood sugar, and 100, the upper end of the range is generally 100 and then if you get above 126, you’re into the diabetes range. Anything in between is considered prediabetic. And I had a lot of patients that floated in that upper 90s, 99, 98, 101, and their doctor’s like, “Well, you’re not 126, you’re not diabetic. So, we’ll keep an eye on it,” knowing their glucose is already starting to creep up there, knowing they’re already headed into insulin resistance. And especially insulin is a big one, not a lot of practitioners run insulin, functional practitioners do, but a fasting insulin, the reference range is massive. It’s like 2 to 25, which is way, way, way too big. In fact, I was reading a research article the other day that said the higher our insulin is, the more we are susceptible to developing metabolic syndrome. It was a human study, and they said that your risk for metabolic syndrome went up as your insulin got well above– like single digits, 7 or above. So, you will often hear functional integrative practitioners talk about fasting insulin needing to be between 2 and 5. And then, if you get up to 7 and 9, like, “Oh, you’re starting to really–” according to the study,” and then imagine if you’re in the double digits. So, I would have these patients say, “No, no, I got glucose and insulin tested totally normal,” but their glucose was 99, their insulin was 21, and they totally fall in the range. But I know that’s really contributing to their weight loss resistance. Just because the lab range is there, it doesn’t mean it’s going to help them achieve their goals. I know you see that. [laughs] I know you do.
Cynthia Thurlow: I do. The unfortunate thing is I get so much pushback from primaries about drawing a fasting insulin. It’s like a $12 test, it’s not expensive, and that range that I look for is 2 to 5. Yeah, so when someone’s 7, 8, 9, they start to creep or I’ve worked with women who would swear their A1C’s are normal, their fasting, glucose is normal, and then their fasting insulin is 20, and I’m like, “Well, we know why you are insulin resistant, and we know your weight loss resistant, and we have to address this.” Ironically enough, that is such a common discussion that I have with people, helping them understand that I don’t care what your fasting glucose is. This is usually the first biomarker that will start to dysregulate way before your A1C becomes abnormal or your fasting glucose.
Carrie Jones: Yeah, absolutely. And then, I would say the third thing is the water retention that comes with inflammation. I actually just read– I had a practitioner friend of mine post the other day, she has been working on Lyme disease and mold, and she’s been working on it. She said, “I lost 10 pounds just like that off the scale.” Doesn’t mean it was 10 pounds of fat. She’s like, “I just felt puffy. I just felt rings were tighter, socks were tighter, face looked puffier.” And as she continued to work on this inflammation, and a lot of the commenters under her were like, “Yep, same. Once I addressed whatever, my gut health, I was having gas and bloating, my SIBO my, chronic,” whatever it was, a virus, Epstein–Barr, the mold in my house, I mean, it really could be anything like, “I noticed that too. I was not trying to intentionally lose weight because I was so focused on getting healthy. And in the process, the inflammatory weight, so to speak, came off.”
Like histamine makes people puffy. When you have histamine issues, if you’ve ever been in allergy season, which is me, I’m allergic to grass, pollen, mold, trees, dust, all the things, and my face is puffy, my undereyes, you can barely see my eyes, they puff up so much. So, imagine the rest of my body, and then if I’m not careful or don’t take care of myself. And people live with this all day long and think this is their normal and they don’t feel well. And so, that’s the other thing. So, it’s not so much weight loss resistance as it is, “Let’s work on what’s making you inflamed and retain all that water that’s not helping the cause.”
Cynthia Thurlow: No, that’s such a great point. And obviously, I could talk to you forever. [Carrie laughs] Let my listeners know how to connect with you and how to find you on social media. I love Dr. Carrie because she makes everything very clear with lots of analogies, a little bit of snark, and a lot of good memes. I call her affectionally the Queen of Hormones.
Carrie Jones: I love it.
Cynthia Thurlow: So, you have to go check her out. But how do we connect with you outside of the podcast?
Carrie Jones: So, no Instagram I’m @dr.carriejones. I am dipping my toe into TikTok, which is a whole new world and I’m @drcarriejones there. And my website is drcarriejones.com.
Cynthia Thurlow: Awesome, well, it’s always a pleasure connecting with you. I know there’ll be a third and probably a fourth on the agenda-
Carrie Jones: I hope.
Cynthia Thurlow: -in the coming years.
Carrie Jones: Amazing, thank you so much, Cynthia. It’s always fun.
Cynthia Thurlow: Absolutely.
Cynthia Thurlow: If you love this podcast episode, please leave a rating and review, subscribe and tell a friend.