Beyond Free Cortisol: Balancing the Adrenals and HPA Axis

by Carrie Jones, ND

 

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Lesson Description

Gain confidence by learning from Carrie Jones, ND; a hormone and laboratory testing thought leader who has devoted years helping women restore adrenal and sex hormones and evaluating data on serum, saliva, and urine testing.

In this presentation, Dr. Jones will discusses more about:

  • How evaluate the HPA axis beyond free cortisol
  • The role of 11bHSD in cortisol and cortisone activity
  • Key insights about phase 1 and phase 2 detox for estrogen
  • Understanding patterns in 5a-reductase for hair loss, acne and facial hair
  • Optimal way test and evaluate adrenal and sex hormones

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Show Notes

01:22 What is Adrenal Fatigue? The concept of adrenal fatigue is becoming outdated. The adrenals don’t give out. The ovaries give out and shut down, but not the adrenals. The hypothalamus tells the pituitary what to do. The pituitary tells the adrenals what to do. In response, the adrenals make cortisol. It is a miscommunication issue. Most often it is from the hypothalamus and the pituitary, not the adrenal.

03:10 What Causes this Miscommunication? Long term chronic stress is a big influence. People use glandulars, herbals and vitamins, which are effective short term. If you are not addressing the cause of the fatigue issues, you will dig yourself into a hole. Inflammation and obesity play a big role.  Adipose tissue creates its own inflammatory cytokines and upregulates the enzyme 11 beta HSD (11 beta-hydroxysteroid dehydrogenase). That converts cortisone into cortisol. Being hyperthyroid or taking too much thyroid medication greatly affects the way that your adrenals do or do not work. Hypothyroid will also slow the adrenals. We need to look at how much the gland is producing versus how much is free and available.

04:50 Cortisone and Cortisol: The adrenals make cortisol first. It can convert it to cortisone. This is not what you receive in a shot, which is cortisol. Cortisone is the inactive or dead form of cortisol. They can convert back and for to each other. When the body wants to slow down, as when you are stressed or ill, you will make more cortisone to make you tired so you will rest and heal. On the flip-side, if we need to be anti-inflammatory, or if we need more umpf to recover it will make more cortisol. Some tissues will do it more than others, like adipose tissue and fat tissue.  It takes cortisone and reactivates it as cortisol regardless of the adrenals.

06:66 Cortisol from Fat: Fat tissue makes cortisol, causing it to be amplified in the fat tissue, stimulating the growth of more fat tissue. It is different from cortisol made from the adrenals, which originated in the hypothalamus and then the pituitary.

07:07 Circadian Rhythm: If fat cells are inflamed and there is excess adipose tissue, they may be creating and releasing cortisol all the time. Anxiety is common when this happens. The norepinephrine to epinephrine (adrenaline) conversion happens in the adrenals. It is driven by cortisol.  Those of us with lots of cortisol, report being anxious, jittery, can’t sleep, stressed and tired-but-wired. This is likely due to the adrenaline being produced by the excess cortisol.   The adrenals should fire cortisol in the morning to get us out of bed.  Sometimes we don’t have an adrenal problem, we have a rhythm issue. Maybe we don’t make any in the morning, waking up tired. Maybe the response kicks in later, impacting sleep and the production of melatonin, growth hormone, detox and cellular repair. It becomes a downward spiral.

08:52 Circadian Rhythm Imbalance: Blue light from cell phones at night are a big part of circadian rhythm imbalance. Your brain says that it is daytime.  We wonder why we can’t sleep, can’t heal, can’t recover from our workout, cannot lose weight, or why we have anxiety. Blue light blocking glasses are inexpensive and helpful, but Dr. Jones says “Just ditch the phone”.  Also, bring down the brightness in the room in the evening.

11:25 The Liver and Cortisol/Cortisone Production: When the adrenals make cortisol, the kidneys can deactivate it into cortisone and then flush it out of the body. As it is circulating and the body converts it to cortisone, the liver can reactivate it back to cortisol just like fat cells do. In a healthy person, there is an ebb and flow. Certain glands turn it off.  Certain glands turn it on. Do you need energy at the moment?  Do you need it as an anti-inflammatory? Do you need to calm down and heal? If your liver it toxic, often because you are drinking a lot, you have blood sugar/insulin issues, high cholesterol/triglycerides, you are not going to have a healthy liver, and therefore you probably won’t have a healthy cortisone/cortisol shuttle. Liver health is important for all of your body’s processing.

12:37 Liver Support: Dr. Jones recommends prophylactically taking Milk Thistle and choline,  as well as drinking detox tea. Every little bit helps.

13:28 Caffeine and Adrenals: When we depend upon caffeine to get going, and we consume a lot of caffeine, we are whipping a dead horse. We need to look at why we would need coffee to get going.  A single cup of coffee in the morning as part of your routine is probably not a problem.

15:09 Alcohol and Adrenals: Any more than two glasses of alcohol will raise estrogen because of the effect on the liver. Much of it contains a lot of sugar which raises insulin, and can be detrimental to sex hormones: estrogens, progesterone, testosterone and the adrenals. The occasional glass of alcohol is probably not a problem. Daily consumption is probably a problem, especially when it is used as a means of calming our body.  When we need this, we often have neurotransmitter imbalance and adrenal imbalance.

16:55 Medications and Adrenals: Corticosteroids, whether prescribed or over-the-counter, either injected, oral, topical, inhaled or intranasal, are suppressive to the adrenals, depending upon the length of time they are used and the size of the dose. They can induce full adrenal insufficiency, which can stay with you for 6 months or longer.

18:40 Restoring Suppressed Adrenals: Dr. Jones starts with the reset of the circadian rhythm, bright happy lights in the morning, and no phone, melatonin, as needed, and dim lights at night. Herbs like maca and cordyceps help with communication. As needed, she may give hypothalamic, pituitary or adrenal glandulars.  She has her patients rest.  The energy created should be used for healing.

20:30 Accutane: Accutane (a form of vitamin A that is used to suppress acne) can suppress hormone production, resulting in low progesterone, low testosterone in men, and lower ACTH, which stimulates cortisol production.  It is thought it induces permanent apoptosis (cell death) in the hypothalamus and the hippocampus, where our short term memory resides.  It is permanent.  Many of us do repeated rounds of Accutane for severe acne.

22:01 Anabolism and Catabolism: Anabolic is building.  When people are anabolic, they build lean muscle.  They favor testosterone and DHEA.  Catabolic is the breakdown of muscle and blood sugar. These are cortisol-driven people. In testing, Dr. Jones can see if their metabolized cortisol is higher than their total DHEA. This shows  that they are in a catabolic state. These people often have anxiety, weight loss issues, blood sugar issues, or insulin sensitivity. They cannot build lean muscle mass. They have poor recovery after workouts. Their metabolism is working, but it is breaking down the wrong materials.

23:09 The Importance of Muscle: Diabetes starts in the skeletal muscle of the legs. The muscle tissue in the upper body rarely becomes insulin resistant. Your muscle tissue is where you burn fat.  It is where leptin and insulin attaches. Dr. Jones tests anabolism to catabolism ratio through a metabolized cortisol test, which measures how much cortisol is being made. It is similar to total cortisol output, as opposed to free cortisol. If someone has a lot of metabolized cortisol compared to their androgen markers, DHEA/testosterone, they are catabolic.  To move from catabolic to anabolic, you need to lift weights, do resistance training, do interval training, and avoid long distance cardio.  Walking on a flat surface won’t do it.  If you must walk, do it at an incline and vary your pace. Testosterone may help you build lean muscle.

27:03 Aromatase: Aromatase takes testosterone and turns it into estrogen, especially in fat tissue. Over aromatized men make too much estrogen. They get abdominal weight gain and breast development. They have sullen moods. They feel tired. Their libido wanes. It is driven upward by blood sugar insulin and inflammation.  Taking testosterone makes it worse. It takes expanded metabolite testing to find this.  Get your sugar and insulin under control.  Get your inflammation under control.  Stop eating foods that are inflammatory to you.  Aromatase inhibitor medications have many side effects, so herbal supplements may be a better option.

29:00 Female Pattern Baldness: Stress, low iron, and high cortisol causes women to lose hair. In addition, testosterone converts into DHT along the 5 alpha-reductase enzyme. If someone is more alpha dominant, they are prone to hair loss/thinning on their head, but also increased facial hair. If you are not testing for it, you may not know. It may not show up as testosterone or DHEA.

31:06 Breast Cancer and Hormones: Once estrogen is spent in the body, it goes to the liver where it goes through phase 1 detoxification. It is broken down to one of three things: 2 hydroxy, 4 hydroxy, or 16 hydroxy. The 2 hydroxy is the healthiest. The 4 hydroxy has the most potentially cancer-causing, because it has the greatest risk of damage to DNA. Pieces of DNA can break off. When the body tries to make repairs, mutations can occur, causing breast cancer, cervical cancer, prostate cancer or uterine cancer. Our own hormones can cause cancer by damaging our DNA. Serum testing will not show this. Urine testing will as it catches what is released from the liver.

33:37 The Methylation, Glutathione, and 4 Hydroxy Connection: Once the estrogen goes through phase 1 and becomes, perhaps, 2 hydroxy, it goes through phase 2 detox. Part of phase 2 detox is methylation, where it becomes 2-methoxy. If you have healthy levels of glutathione, it protects against all damage. Most of us do not have healthy levels of glutathione. Like Sulforaphane, DIM, made from broccoli, helps you make more of the healthy 2 hydroxy.  Eat cruciferous vegetables.  Eat real food.

36:04 The DUTCH Test: DUTCH stands for Dried Urine Testing for Comprehensive Hormones. The website is dutchtest.com. To do the test, you urinate on test sticks 4 times during the day.  It records circadian rhythm influences and shows important metabolites, DHT, metabolized and free cortisol, and cortisone.

37:21 Dr. Jones’ Morning Routine:  She has green tea when she awakens. Then she does 20 minutes of fasted cardio on a treadmill at an incline, varying the incline and the pace. She makes more green tea, and while her tea is steeping, she walks her dog. She also has hot lemon water and then a smoothie..

38:10 Dr. Jone’s Favorite Herb, Nutrient or Botanical: Chaste tree berry (vitex) is great for the hypothalamus.  Dr. Jones considers it to be a magic smart herb. It is like an adaptogen.  She uses it for fertility, for PMS, for heavy periods, for overall hormonal health for women who are still getting their period. It is not for menopausal women.  She has her patients take it in the morning when the hypothalamus and pituitary are more active. It tastes terrible.

39:50 Health Tip: On social media these days it is all about hustle, how to keep going strong. Dr. Jones says “No, no, stop hustling. You’re killing your adrenals.”  Hustle and find balance.  Go on vacations. Say no. Set boundaries. Sleep well. Get off your phone. You don’t have to hustle all the time.