Episode 9 – A Deep Dive into Female Hormones at Every Stage with Dr. Carrie Jones

Evelyne: Me too. So today we’re doing a deep dive into all things female hormones, not necessarily talking about one specific condition, and in fact, at some point during my preparation for the show, I think I had over 50 questions, which I’ve had to narrow down. So we’ll talk about types of testing for hormones, different conditions, common imbalances and patterns you may see, nutritional supplements, bioidentical hormone replacement therapy. So I’m very excited. And if you’d like to hear us talk in more detail on Conversations for Health about one of these topics in particular, you can always drop us a note at conversations@designsforhealth.com. So Dr. Carrie Jones is a naturopathic doctor. She’s board certified in naturopathic endocrinology. She has a master’s in public health. She taught gynecology and advanced endocrinology at the National University of Natural Medicine in Portland. She was the medical director for two large integrative clinics in Portland, then medical director for Precision Analytical, which is the creator of the DUTCH test, which we’ll talk more about, for almost 10 years. Then head of medical education at Rupa Health and she still hosts the Root Cause Medicine Podcast there, and now she’s back to her passion of all things hormones as medical educator at Metabolic Mentor University. Carrie, I’m a fan. I love the information that you share on social media. You always share interesting research, actionable tips, and I frequently share your Instagram page with practitioners who have questions about female hormones. So thank you for everything you do.

Dr. Carrie Jones: Oh, I appreciate that. Definitely hormone education is a passion of mine and I find that not as much anymore with social media, but back when I got started a long time ago, almost 20 years ago, it just wasn’t out there. And so to be able to even come on and hang out with you and do the podcast, I just love to keep getting this information out there.

Evelyne: So how did you get into naturopathic medicine in the first place and then develop a particular interest in women’s hormones?

Dr. Carrie Jones: I was raised in Lexington, Kentucky, which a lot of people are surprised to hear me say. And what’s even funnier is prior to us recording, I was on the phone with my girlfriend who is in the state of Georgia and has a very strong Georgian accent. My parents live in Atlanta, so they just kept going further south and I moved west. I moved to Portland, Oregon. And so on the phone with her, my southern accent came out. When you talk to a Southerner, it’s pretty funny, but I was raised in Lexington and the health, and I guess you would call it sex ed type class, was taught by the football coach. So you can imagine how that went. And from high school, I went to college in Ohio and as much as I like the state of Ohio, there’s not a lot to do there.

And my friends kept saying I was on track to become an MD and go to conventional medical school, but they were like, “I don’t know, I feel like you’re going to own a spa. You’re going to get wellness and spa.” And we didn’t really know what that was in Ohio, right? Spa is all we had. And I actually decided to forego conventional medical school, put a pause on it and move to Portland with a friend of mine, a girlfriend of mine, and that’s where I found naturopathic medicine. And once I figured out what it was and realized that was the medical school I was supposed to be in and that’s the type of medicine I was to practice… Gosh, that was back in 1999 when I found it and 2001 when I started, that’s the only thing that I could foresee myself doing. And I got into hormones because I had so many friends and family and then patients who were like, “You know what? I didn’t know that. I didn’t know that’s how my body functioned. I didn’t know that’s what’s going on with me.”

I would have grown women with multiple kids in their forties or fifties or sixties say to me, “I didn’t actually know how that worked.” I’m like, “How did you not know? You’ve lived your whole life female. You’ve had cycles, you’ve had kids.” And they’re like, “I don’t know. Nobody taught me.” And that was the theme I heard over and over, nobody taught me. And that’s where I thought, all right then I will be part of that movement.

Evelyne: I love it. That’s awesome. So let’s get into the DUTCH test a little bit, the dried urine test for comprehensive hormones, which is made by Precision Analytical. Obviously since you were there for a long time and you’ve read thousands and thousands of test results, I’d love to ask you some more questions about it because it is kind of a complicated test. And I think there’s still confusion, maybe even controversy depending on who you ask about when to use a urinary test for hormones versus a serum or blood test or a saliva test. So my question to you is, when would you recommend that a practitioner use the DUTCH test? And you can go into the cycle mapping versus the single day test. And when do you see that it’s most clinically useful? What are the things it tells us that you cannot get from conventional testing?

Dr. Carrie Jones: I’ll actually start there ’cause I think a lot of people listening are probably pretty familiar with what you can get out of a blood draw. What you can get if you’re looking for estradiol, if you’re looking for total and free testosterone, if you’re looking for progesterone, you can get those things out of a single blood draw. Unfortunately, this is partly where urinary testing became popular. First, it started out with 24-hour urine, so where you pee in a jug all over 24 straight hours and then mail a portion of that back to the lab and then became into the spot testing, which is where DUTCH has made its name as a dried urine test. But what you can’t get out of a blood test is that you can’t get what are called metabolites. And so what I have seen really trend in the literature lately is the study of metabolomics.

And so it’s the study of the breakdown products of hormones, as an example, there are other obviously metabolites out there. And we now know and what we have known for years, but researchers aren’t now realizing and publishing that these breakdown products, these metabolites are really quite potent themself and it is helpful to know what you have, where they’re going and what they’re doing. Because a lot of either genetics and even mostly epigenetics, things we do in our life, things we eat, things we do or don’t take really affect this. And so to answer the very last question first, when you get the DUTCH test, you will get a look into estradiol, estrone, the progesterone, metabolites, testosterone, cortisol, but then you also get those metabolites. And so we find it really helpful, especially in the estrogen section. We’re trying to mitigate risk because we know estrogen detoxing out of the body is really important and quite helpful for men and women.

Men have the same pathways as women do. Testosterone, when you have somebody, let’s say PCOS or even just cystic acne, male, female pattern hair loss, helpful to look at those testosterone metabolites as an example. So the DUTCH test is nice ’cause the word that’s in it is comprehensive as opposed to the snapshot that’s in saliva. Now, like any test, serum, saliva or urine, it is a one-day test. And so people will often ask me, well, what if I collect it accidentally on the wrong day? Or what if I did this or what if I did that? I’m like, well, it’s accurate to what you collect. Just like if you got a blood draw and you collected in the follicular phase instead of the luteal phase, it’s going to tell you the results of that phase. So it is just a one-day test, and that’s where DUTCH realized need to expand and do something like cycle mapping where you can collect almost every day of your cycle and then they graph it out for you.

And that’s really nice for those women who say, I have all these symptoms that seem tied to my cycle or tied to the ovulation or their ovulation and PMS time where they very specific days in their cycle. I get migraines on these days like, all right, a one-day test is not going to work here no matter what it is, serum saliva or dried urine. We really need to look at cycle mapping and evaluate the whole thing. And so as I said, it’s really helps give you that comprehensive look at a number of hormones including the next layers down. When you’ve got a patient in front of you who’s been struggling a long time, it’s nice to have that info.

Evelyne: And so when you’re doing the cycle mapping over the course of a month, what are the clinical pictures or the symptoms that you see that would warrant doing that longer test?

Dr. Carrie Jones: The cycle mapping is my favorite. If it fits in somebody’s budget and they have the ability or that fits the symptoms they’re having, I really prefer that because I can zoom out and go, okay, here’s the whole map of the city as opposed to looking at just one building and trying to guess around that. So she says something like… Let’s use headaches. I get headaches before ovulation or even I get histamine-like symptoms. I get rashes, I get sick, I get stuffy, I get all these things right before ovulation and then through PMS. Or my anxiety. My anxiety is really bad on these particular days and then it gets better and then it gets worse again as it leads up to my cycle. Fertility is another really popular one. They’ll say, I have had a progesterone drawn in serum. I was told my progesterone on that one day is really healthy, but it feels like I really am struggling with progesterone.

I’d like to know from a zoomed out perspective, does my progesterone go up and down very quickly? Maybe on the day it was drawn, it was at its peak and then it crashes. It just fell off the mountain the next day. Or do you have a nice rounded mountain? Hopefully you should, where your progesterone goes up, stays up a little bit and then gradually comes down. So to get that zoomed out view can really help us make clinical decisions in that example. Yes or no, you need progesterone or yes or no, we need to do something to help support your progesterone production in that part of your cycle.

Evelyne: And regarding testing, timing of day also matters, right? Because estrogen and progesterone fluctuate throughout the day.

Dr. Carrie Jones: That’s what’s nice about the DUTCH test, because everything moves in pulses and we can’t determine when the pulses are going to happen. Our estrogen and progesterone pulses in females don’t necessarily follow a circadian rhythm. We would hope that they would like cortisol, but research has shown that not all women do that. So what I mean by pulses is hormone production is not like a hose. We don’t just turn it on and out comes all this progesterone. The brain pulses down to the ovaries, and then we get a pulse out of progesterone and our next pulse may not be for an hour, it may not be for three hours. So if you go to the lab to get a serum draw at 3:00 in the afternoon because that’s when your doctor’s appointment is, you could be at the dip or the trough and then you get a blood draw and you’re like, oh my gosh, my progesterone’s really quite low.

On a DUTCH test, because it’s collecting four times during the day, they take a weighted average. So believe it or not, your testosterone results, your estrone, estradiol, estriol results, your progesterone metabolite results are actually a weighted average. So that is the weighted average of you through all four of your collections versus going and getting a blood draw as an example, four times in a day just to see on average what is your progesterone? So it does help you weigh out the highs and lows to give you a better picture of what’s going on.

Evelyne: That’s very interesting. You mentioned histamine and estrogen in your answer, and I want to talk about that ’cause I’ve been asked about it and I don’t really know a lot about it. What’s the correlation there?

Dr. Carrie Jones: Yes. So estradiol, we naturally have it in our body, when we have higher levels than maybe anticipated or at certain ports in our cycle, we naturally have high levels. So right before we ovulate as females, our estradiol goes up really high. It’s supposed to help as part of the induction of ovulation. When you have higher levels of estradiol, it slows down the breakdown of histamine. And so I’ve absolutely had women say to me, oh my gosh, right before ovulation, or as I get into the PMS time, I feel allergic, or I have runny nose or I’m itchy, I’m sneezing. Or they get itchy on their skin or they’re like, I get these weird red sort of allergic type rashes and then my period comes and they go away. And maybe some GI stuff, they’re more reactive to foods than were before with histamine. Maybe wine wouldn’t be such a problem, but now they have a glass of wine around ovulation or PMS time and they’re like, oh my gosh, I just feel really swollen and puffy and itchy and all the things.

I don’t understand why sometimes I can have wine or cheese and sometimes I can’t, or why do I have allergies when it’s not allergy season? I’m like, ah, because estrogen, estradiol can slow down that breakdown when it comes to histamine. So by helping support estrogen detoxification. I’ve had a lot of clients and patients over the years say, oh, I feel so much better. This has been really helpful, especially when it’s not so much seasonal allergy related, although that plays in. But all people in the dead of January in North America say, what’s with all these allergies? Nothing’s in bloom. Like, oh, could be hormonal contributing.

Evelyne: And then could taking something like supplemental DAO be helpful also?

Dr. Carrie Jones: One of my favorites. So DAO is really great in the gut. That’s what helps break down histamine in the gut. So if you’re eating something, let’s say leftovers, let’s say foods that have a lot of histamine in them or induce a lot of histamine, DAO is one of my absolute favorites to go ahead and just take. And we lose our ability to produce DAO as we get older like we were when we were younger. And so sometimes people will say, I don’t understand why. Why in my twenties could I, and now in my forties I can’t? And I’m like, unfortunately, we don’t make it like we used to. And that includes the enzyme DAO as well.

Evelyne: Very interesting. So a lot of the issues that we’re going to be talking about today are related to hormone imbalance, and I feel like sometimes we hear that word. I think you just did a post about it recently because in the media it seems like lately I’ve seen some articles saying, oh, hormone imbalance is a made up term. But how would you define hormone imbalance and what are your thoughts on that?

Dr. Carrie Jones: When it comes to hormone imbalance, we’re usually referring to estradiol and progesterone. And I understand 100% what maybe the media or more conventionally trained practitioners mean when they say that’s not true, your hormones change as estrogens and progesterone change every day. That is true. If you are cycling or you should be cycling, your estradiol and your progesterone pretty much change a little bit every day depending on what part of your cycle that you are in. So when we say hormone imbalance, what we mean is for the part of the cycle you’re in, your estrogen and progesterone are supposed to be, for lack of a better analogy, unlike a roller coaster track. It’s a very set track of it going up and down through your cycle. But if you are somehow off your track and your body is producing too little progesterone or too much estradiol compared to what it should be, then we call it hormone imbalance because the track…

All these hormones play well together. It’s like a spiderweb. You can’t touch one part of the spiderweb without the whole spiderweb vibrating. So if any of these hormones are maybe off a little bit, you don’t ovulate, so you don’t make a lot of progesterone, leaving you with relative imbalance of estradiol in your system. We call that hormone imbalance. So I understand their frustration, but at the same time, the description is really long and it’s unsexy, and we know what it means in the functional medicine world of when we say somebody with hormone imbalance. However, what I want somebody to realize is that their symptoms are still real. What drives me crazy is when somebody says, I have really bad PMS, I get really bloated, or I have really heavy periods, or I’m struggling with fertility, migraines, insomnia, anxiety, whatever it is, and they say, I think I have hormone imbalance.

What I would hate, what I would hate is they go to their practitioner and their practitioner says, that doesn’t exist. That’s a lie. That’s just something social media has made up. Don’t believe it, when in fact their symptoms are very real, 100% real. It is caused initially by hormones. There are other higher up, more important things we have to address, but hormones are the immediate superficial thing causing those symptoms, and it is due to they’ve gone off the rails essentially. They’re off the rollercoaster rails and there’s an imbalance between them playing together as a family. So we’ve just shortened it way down to hormone imbalance.

Evelyne: I love all the analogies used. They’re very helpful. I know there’ll be more coming. So let’s talk about estrogen dominance, another thing that sometimes is used as a buzzword, but it just means it’s estrogen is high relative to progesterone. So why do we see this so often and what should practitioners know about it? For lab testing but also treatment, what are some of the considerations?

Dr. Carrie Jones: And actually this is a real passionate topic of mine because estrogen dominance, I’m now thankfully starting to see in the literature more healthy estrogen excess. So even researchers, for better or worse, just are picking up on the ideology behind it. And the thing about estrogen dominance is we make estrogen. We make microgram levels of estrogen, estradiol in our body. So in our peak gluteal phase, so after ovulation, in our peak gluteal phase, micrograms of estrogens are made, milligrams of progesterone is made. So unless you don’t ovulate at all, it’s like near zero. Estradiol won’t dominate. It will not be higher than progesterone ’cause we’re making milligrams compared to micrograms. But again, really the estrogen dominance one in the phrase, whoever named the phrase, that’s sort of what stuck when really it’s estrogen related to progesterone.

And you can have normal levels of estradiol, but really, really, really low levels of progesterone and still be considered estrogen dominant because even though your estrogen levels are technically in range, in relation to progesterone, they’re winning when it comes to that ratio. So when we think of estrogen dominance, I don’t want somebody listening, especially if you’re newer or don’t dabble in hormones very often, to think you’re literally making all this estradiol and it’s just overflowing compared to progesterone because it’s micrograms versus milligrams. But with estrogen dominance or progesterone deficiency, however you want to look at it, a lot of it starts in the brain. And a lot of it is because when we think about reproduction, whether you want to reproduce or not, when you think about the reproductive pathways, a lot of it is trying to keep you, are you safe? Are you healthy? Are you in a state where the ability to reproduce is ideal right now?

And if it’s not, then we’re going to mess this up. I’m going to affect the way you detoxify because I’m dealing with all these chemicals and the brain is talking to the liver and talking to the gut, or it’s going to affect the way you do or don’t ovulate. That pulse is going to get changed. It’s going to affect your mitochondria. Most of your steroid hormones start in the mitochondria. Hormone factory is the mitochondria. That’s the first step. The follow-up step is the endoplasmic reticulum, which is getting a lot more press also with endoplasmic reticulum stress. And so the brain is looking around going, ooh, this is a hot mess, whether it’s stress or chemicals or sleep or infection or mold or whatever it is, and going, we’re going to mess this up, that we should not have healthy hormones this month just in case. Whether you want to get pregnant or not, that’s how our brain thinks.

So we have a lot of women walking around with hormonal dysfunction because we just in general, unfortunately, have a lot of dysfunction in our life, in our lifestyle, in our environment, and our brain is constantly going, protect, protect, save, save. And so as a result, we don’t get the progesterone we need to have made and we get a relative estradiol overload, so to speak. Then you overlay on top of that estrogenic type chemicals that act like estrogen but aren’t actually the estrogen in your body and now we have a double whammy. So we are either making too much estrogen or can’t get it out, and then we have the chemicals on top of it. And that feeling of too much estrogen, that estrogen excess, estrogen dominance really prevails.

Evelyne: Very interesting. You’ve given me so many follow-up questions now.

Dr. Carrie Jones: Love it.

Evelyne: Okay. Since just mentioned the xenoestrogens. So I think in our field, we do talk about that quite a lot. Practitioners realize how important it is, how much of a problem it is, and it can be very overwhelming for patients. I feel like it’s overwhelming to me because we really can’t completely avoid everything. Even if you eat fully organic and don’t use personal care products with fragrances and you don’t use candles and you ask your Uber driver to pull out that air freshener every time.

Dr. Carrie Jones: They always have them. So many.

Evelyne: I know. So it is very overwhelming. And even when you do all those things, I feel like when you get tested, things still show up. So it’s unavoidable, but my question to you is what do you think of all the exposures are the top ones to avoid that actually have the most impact?

Dr. Carrie Jones: I was just having a conversation with Dr. Felice Gersh around this and PCOS as an example, because there’s such good supportive literature behind BPA and plastics in PCOS and then other just female-centered symptoms and disorders and conditions. And so the first thing I tell people when they’re listening to you and me, you and I have been doing this a long time. We are into the third or fourth series of the book, whereas somebody may be on the first book, first chapter, freaking out, and I’m like, no, no, no. We’ve been doing this a long, long time. So you are going to take the baby steps. And I would rather meet somebody where their budget is at. So even little things like can you just take your shoes off when you come into your house? Which here in the United States is hit or miss. In other countries, it’s very common and normalized, take your shoes off. Here it’s pretty hit or miss.

Even opening your windows and circulating the air or considering getting air filters, water filters. But let’s say air filter doesn’t fit in your budget. Let’s start with the air quality of where you are. So candles, do you love the pretty glass candles because they’re decorative and they’re on your shelves and you’re going for that aesthetic, but yet they’re off-gassing all that fragrance, all those phthalates? Those are pretty estrogenic and they can really wreak havoc. So let’s get rid of the candles. Let’s address anything synthetically fragrance related. When you run out of your detergent, can we buy a more clean version of detergent? Can you stop using dryer sheets that are scented, like whatever, a flowery field or whatever they call it, spring whatever? Let’s be careful of that.

Everything from your dish soap because you run out, let’s just start looking at the fragrance and can we get a cleaner option? You don’t have to jump right to the most expensive, you don’t have to overhaul your mattress in the first go. That’s several thousand dollars. If you’re not in that series of the book yet, it’s totally fine. Start with the things that you can control. Do you eat out of plastic? Do you drink out of plastic? Do you go to the coffee shop every day and you have a plastic line cup with a plastic lid and your hot beverage? At the very least, can you take the lid off when you sip your hot beverage? Maybe it’s time to bring your own cup. Back in the pandemic, we weren’t allowed to do that, but maybe it’s time to bring your own cup and have them use that instead, so stainless steel is an example, to fill that so that you’re not getting the plastic exposure? And taking it one day at a time.

When you run out of deodorant, your antiperspirant, let’s switch to something clean. When you run out of your blush, let’s just switch to something clean. When you run out of your skincare, let’s switch to something clean. Haircare products, et cetera. And you’re right. I love that you said that, even I am not perfect by any stretch. I do the best I can with what I can and what I know. So I would say 80% of the time, honestly, I do the best that I can and a lot of the environment, we can’t control. When I travel, the plane’s overhead, my neighbors and their garden, et cetera. But what I can control is inside my house and what I can control is the function of my body And that’s slowly over the last two decades, what I have been working on. I’ve noticed a huge difference. I’ve even had people comment on social media that just by changing to 100% organic tampons or pads has made a massive difference as opposed to the bleached dioxin, even scented.

I’ve had women who were like, I didn’t know better. I was buying scented ’cause I wanted to smell good down there. Switched to the all organic 100% cotton, and my periods have been so much better. I’m like, man, that’s the easiest switch. Such an easy switch. You’re paying the money for hygiene products anyway and you just switched to organic all cotton and noticed a massive difference. So I think those are my big, what can we do? But the plastics and the fragrance, huge research in women’s health, so let’s at least start there, right?

Evelyne: Yeah, I love that. And I’m still guilty. I’m in the car a lot. And so when I get a coffee, I don’t want to spill it. And so I still drink through that sometimes.

Dr. Carrie Jones: I know. I’m the same. It’s 80% girl.

Evelyne: Yeah, exactly. And I also feel like stressing so much about everything is detrimental too, and maybe even more detrimental than everything. I don’t know, but-

Dr. Carrie Jones: Yeah, it’s true.

Evelyne: Try not to worry about everything.

Dr. Carrie Jones: People will say, I bet you never drink out of a plastic water bottle. I said, of course, everyone’s been in a situation where they’re super thirsty, run into a gas station or they’re at the airport, you forget your water bottle. Of course, I drink out of… I mean, I don’t want to, but I’m dying thirst, so I’m going to. And the great thing is hopefully the rest of my lifestyle choices and the supplements that I take and my liver health, they’re resilient and robust. And if they’re not, I am doing the things to course correct after the fact.

Evelyne: Exactly. Can you talk more about the science of how xenoestrogens actually have their impact on estrogen receptors?

Dr. Carrie Jones: Yes. So xenoestrogens are endocrine disrupting chemicals. As we know, our hormone system is the endocrine system. And I say this to patients all the time. I’m like, your endocrine system is your hormone system and that’s why you’re here, because you’ve come in and said you feel like your hormones are off, so why would we want you to be disrupted anymore? We have to cut these chemicals out. Let’s not disrupt the system anymore. So they look like estrogen. They’re close enough, they’re not actual, but they look close enough. So even if you just take the most basic lock and key analogy, estradiol can bind 100% perfectly to the estradiol receptor, the ER receptor, turn it and unlock it. These xenoestrogens or the chemicals that can look like estrogen, the key is close enough and unfortunately in our body, close enough is good enough and it will unlock the lock.

And so you could be experiencing estrogenic type symptoms, not because of the estrogen in your body, that’s actually doing just fine, but because of all the estrogenic like chemicals, compounds that are around lighting up and activating all those receptors so they’re doing the thing. So now you have breast tenderness or heavy periods or fibroid growth or polyps or whatever it is, headaches, PMS, weight gain, that seems resistant, that can be estrogen related because of these chemicals.

Evelyne: And I love that you actually shared those stories of women feeling a difference when eliminating those. It’s actually doing something when we make those changes.

Dr. Carrie Jones: I mean, thank goodness I was not raised to be a candle person. My mom didn’t love candles and so I didn’t get into candles, but I know some people are very into the candle aesthetic and have candles all over their home, and they get into it in all the seasons. And so through the years, I’ve definitely had a lot of patients or I’ve had a lot of comments on social media where they’re like, okay, I did it. I switched out to either completely clean non-toxic burning candles, or I just got rid of them altogether for a while. I’m going to clean out, clean house. And they’re like, Carrie, you were right. I actually can tell a difference. Even just since asthma symptoms, drippy nose, itchy eyes, scratchy skin. I’ve even had women say, I noticed my animals are scratching less or their insistent scratching has stopped. Kids stuff got improved. And I’m not saying it’s 100%, but I’ve absolutely had those comments back where they’re like, dang it, everybody’s getting better. I’m like, I know, I’m sorry. I’m sorry.

Evelyne: It’s amazing. I don’t think most of those even smell good, especially those plugins.

Dr. Carrie Jones: Oh, the plugins, yes. And I love that you said the Uber drivers too. I mean, I get why they do, but I feel like it’s a requirement. To be an Uber driver, you have to have a valid driver’s license, no felony, and be sure to use plugins. I’m like, it’s so unfair.

Evelyne: Thankfully it doesn’t give me headaches, but I just hate the scent so much. So depending on who it is and how I think they’ll respond, I actually ask them to unplug it for the ride.

Dr. Carrie Jones: Yeah, I’m always cracking the window.

Evelyne: If they think I’m crazy, then whatever.

Dr. Carrie Jones: Yeah.

Evelyne: Since we talked about xenoestrogens, I want to talk about phytoestrogens as well and how they affect estrogen alpha and beta receptors differently. So how do they block or increase it? And can you talk about some of the controversy around soy, for example? Which actually can be very beneficial, and I think there’s a lot of misunderstanding around that. So just clear that up and discuss how you maybe use them in your practice or how you’ve recommended them, like dietary or supplementary phytoestrogens.

Dr. Carrie Jones: So when it comes to phytoestrogens, obviously the most common myth out there is that, oh gosh, phytoestrogens are going to increase or worsen my risk for cancer. And the truth of the matter is no, that’s actually a giant myth. In fact, there’s really great articles out there that evaluate phytoestrogens. When we look at phytoestrogens, there’s three subdivisions that they kind of fall into. So there’s the flavonoid family, and so those were things like your genistein, which is from soy, or your apigenin, which is from parsley and a bunch of others. And then we have your lignans, so think of your ground flaxseeds. And then we have your stilbenes, think of your resveratrol as an example. So we have this division of phytoestrogens, but what makes a phytoestrogen a phytoestrogen is that it has a phenolic ring and it has two hydroxyl groups. And so it’s again, very, very, very, very, very, very, very similar to your estradiol and so it can bind to estrogen receptors.

Now, we have two types of estrogen receptors. We have a GPER, G-P-E-R, which is on the outside, and then we have our estrogen receptor alpha and estrogen receptor beta, which are in the inside. And the alpha and beta are divided differently through the body. For example, our breast tissue has a lot more alpha, but our vaginal tissue maybe has more beta. And with our phytoestrogens, what I am finding in the literature is that they are most smart. What I mean by… It’s almost like an adaptogen, I would say, for estrogen receptors. And they read the room depending how much have you given? How much estradiol is in the area, so is it competition or not? What’s the concentration of the actual receptors itself? Do you have one or do you have a billion? And then they can adjust. They can either bind to a receptor and turn it off, an antagonist, or they can bind to a receptor and turn it on, an agonist.

Resveratrol is a really well-studied one for this where it’s classified as a phytoestrogen so people absolutely lose their mind and freak out, especially ’cause they’re like, I heard that causes cancer. It’s a phytoestrogen. I’m like, hold on. It’s very smart and intelligent and depends on what’s going on in your tissue that it’s going to make that decision. And my analogy is this, I am a very nice person generally. I’m nice, I’m friendly, I’m talkative, but it depends on how much sleep I’ve had, how much food I’ve had, who the person is I’m talking with, and if they’re nice to me. And if all of those things haven’t been met, then I’m not a nice person. So your resveratrol is the same way. These phytoestrogens are very similar. They take everything else into account.

Some of your phytoestrogens, like genistein, which is from soy. Genistein has a ton of research and people freak out because it’s from soy except genistein actually predominantly, I believe, binds to the estrogen receptor beta as opposed to the estrogen receptor alpha. And so when people are thinking cancer, it’s the estrogen receptor alpha that seems to get its name dragged through mud as it relates to cancer. I will say, and I will stand on this soapbox for as long as it takes, cancer is complicated and you cannot single-handedly blame one hormone for cancer. Meaning, I understand, and I know it’s frustrating, and trust me, my grandmother died of estrogen related breast cancer, but estrogen by itself is not the single reason for something like breast cancer. And that’s usually what it gets vilified the most for. I mean, we just talked about chemicals and xenoestrogens. We talked about liver health and gut health and what the ecosystem is doing in your receptors.

A lot goes into cancer creation in the body. We can’t single-handedly blame estrogen. But something like genistein or resveratrol or apigenin or a lot of these other neuron engine phytoestrogens or other well-known herbs that are phytoestrogens more often, most of the time, 97% of the time I think, only because we’re still studying them do good. They do really good things in the body. In fact, there’s literature to show that these phytoestrogens can activate mitochondrial power things. It can activate your antioxidant response element. It can increase and induce superoxide dismutase and catalase. It can help your cell do better without necessarily initiating an estrogenic symptom cascade. That’s smart. That’s way smarter than ashwagandha, when we talk about adaptogen stuff. So when it comes to phytoestrogens and people freak out, I’m like, I wouldn’t freak out. I actually think they’re pretty cool.

Now, this is assuming, this is the Designs for Health podcast, you get it from a quality source. If you are getting from an non-quality source, a crap source, a source that has no idea what they’re doing, then all bets are off. I don’t actually know what’s in the capsule, so I can’t talk intelligently about that. But assuming it’s from a super quality source like Designs for Health, then I would stand behind their phytoestrogen, anything, the product like that all day long. I’ll have the literature to back it up.

Evelyne: Yeah, thank you for clearing that up. That was really helpful. And you can also get genistein from non-soy sources.

Dr. Carrie Jones: That’s true. That’s true. But they often are linked together, so I wanted to say that. And I will say, speaking of soy, I don’t love soy personally, but I’m allergic to soy so my vendetta is personal. Soy doesn’t like me. And I don’t see this as much anymore, but back when soy products came out, the early 2000s, everything. You could get tofu and edamame, fantastic, tempe, great, but then everything else. You’d get protein powder, protein bars, soy cookies, soy ice cream, soy milk, soy yogurt, soy, soy, soy, soy, soy, soy, soy. And people were switching to this sort of very engineered soy food that maybe wasn’t the best quality depending on the company you bought it from. But because it had the word soy in front of it, you thought, well, soy is good for me, the more, the merrier. And I was like, woo, that soy bar and soy cookie and soy whatever you just ate maybe for all three meals, maybe quality counts.

Evelyne: Yes, yes. And most of the soy is genetically modified. You just made me remember something. This is so embarrassing, but in high school, I remember reading an article about Katie Holmes, the actress, and she said she was taking soy protein. I asked my dad if we could buy soy protein from Whole Foods.

Dr. Carrie Jones: See? Yes.

Evelyne: Crazy, the things we do.

Dr. Carrie Jones: And I think we’ve come a long way in the education and people who eat soy. Not to say those products aren’t out there. There are, but I feel the pendulum swung all the way one way, which is how I realized I was allergic to soy and then we’ve sort of found more a happier medium. But genistein and soy, because they’re so linked together, people freak out and go, oh, no genistein’s from soy, I don’t do that, or that causes cancer. I’m like, ooh, actually-

Evelyne: Right, right.

Dr. Carrie Jones: No.

Evelyne: Can we make this into an eight hour masterclass?

Dr. Carrie Jones: Yeah, sure.

Evelyne: I actually would like that. We can just go all day. You brought up the antioxidant response element, and so it makes me think of sulforaphane, which is one of my favorite supplements, and I think it’s one of yours too, right?

Dr. Carrie Jones: Yes.

Evelyne: So let’s talk about some popular supplements that are used for hormones, and I’d love for you to give us an overview. I’m going to pick three in particular. DIM, Calcium D-glucarate, and sulforaphane. We know that they all work differently. They can all be useful depending on the person. So how do those work and how and when do you recommend those?

Dr. Carrie Jones: Sulforaphane by far is my most favorite product for me personally. I’m not saying blanket for the whole world, although I could maybe create an argument for that. But yes, sulforaphane is absolutely one of my favorites. And in fact I just posted something today about DIM, Diindolylmethane, versus sulforaphane kind of versus Calcium D-glucarate because people often confuse DIM and sulforaphane and when to use them, and even Calcium D-glucarate for that matter. So if you picture… We’re going to get back to analogies because I love analogies. So this is the one that I use for these three products. You have a house or a condo or an apartment, and while your house, condo, apartment, you have a front door, which is the main door, but you also maybe have other doors. Maybe you have a backslider door, door to your backyard or a patio. You also have windows and you can get out all of these. You can go out the front door, you can go out the back door. If God forbid you needed to, you could climb out your window. It’s not ideal, but you could do that.

So think of that in your body when you’re trying to get rid of estrogen, you have to get rid of estrogen. Ideally, you want your estrogen to walk out the front door. That’s ideally. So that’s like taking the trash out the front door. We don’t throw our trash out the window. We don’t throw our trash maybe out the back door. If we put our trash cans in front of our house on trash day, we want the trash to go out the front door. So DIM, when you swallow DIM, DIM is specific for phase one detoxification. It will take your estrogen as it’s getting broken down and it will line it with the front door. It will align it more with what we call the two pathway, what’s called a 2-hydroxy or 2-OH-pathway, which is the better pathway. You have other pathways. You have a four pathway and you have a 16 pathway. And the four pathway is probably the most potentially unhealthy. It’s the higher risk for DNA damage.

And your 16 pathway can kind of go both ways. It’s estrogenic so it’s been studied in menopausal women to be helpful to prevent against bone loss, but it also is proliferative, so if you have breast cancer. Not something that we necessarily want to have a whole lot of per se. So we take DIM when we’re trying to get our estrogen to move to the front door. We want it to go down the right pathway. But if your front door isn’t open, if nothing is open in your house, now you’re just piling a whole bunch of trash at your front door and the house is still going to stink. So now we have to open up the door, which is phase two. There are a lot of ways that we can open phase two, but sulforaphane is kind of this broad spectrum phase two opener. In fact, the last I read, I think it turns on or activates some 300 enzymes to help move things through phase two. So instead of just opening the front door, sulforaphane is going to open everything.

So it’s going to air out the house if you’ve been building up trash and it is going to open up the front door so you can get that trash out into your front of your house so that the trash trucks can take it away. So then that leaves with Calcium D-glucarate. Just like in your body, you have to get rid of estrogen, you’ve got to clear it through phases one, two, and three, this includes the intestines. So this includes how well the health of your microbiome, the health of your GI tract, are you having regular bowel movements? Et cetera. So Calcium D-glucarate helps in that section. It helps with the take it away part. It helps with your trash truck so that they come and pick it up off the street and get rid of it. It’s the same thing. So Calcium D-glucarate is a phase three mover of literally getting it off the street, getting it out of your intestines so that you can get it all the way out. Technically, how Calcium D-glucarate works is that it stops estrogen from getting pulled back in or recycled back into the body.

Calcium D-glucarate sort of stops the scissors. You have an enzyme called beta-glucuronidase that your microbiome can make. Beta-glucuronidase can act like a pair of scissors and snip off the portion of estrogen that’s tagged it and keeping it for excretion. And when that part’s removed, estrogen can now get reabsorbed back in the body. So in our trash truck analogy, beta-glucuronidase will pull the trash back inside and we don’t want to do that. We want to block that person who’s trying to pull the trash back in so that the truck can take it away. And so DIM is phase one, very specific for pathways. Sulforaphane turns on all the enzymes, opens all the doors and windows, and Calcium D-glucarate ensures that that trash is not coming back inside. We don’t want that estrogen that has been tagged to exit to get recirculated. We want it to go all the way out. Now, can you do all three at once? 100%. 100%. If you need from start to finish that pathway open, cleared, ready to go, for sure. Do all three. Absolutely.

If you maybe budget-wise or you already have a product at home, you would start with the Calcium D-glucarate, move into the sulforaphane or do sulforaphane and Calcium D-glucarate together and wait on the DIM. You have to make sure that front door is open before you can move the rest.

Evelyne: I love that. That was so helpful. Thank you.

Dr. Carrie Jones: Yes, of course.

Evelyne: Well, we haven’t even talked about bioidentical hormones yet. We might have to already do a follow-up.

Dr. Carrie Jones: We can.

Evelyne: We could be here for hours.

Dr. Carrie Jones: This is the foundation.

Evelyne: Okay. If you had to name your top three things that all practitioners should tell their patients to help with hormones during each stage, and maybe they’re the same, but during the reproductive years, during perimenopause where hormones are fluctuating, during post menopause when things are dropping, what are the top things that practitioners can tell patients to focus on?

Dr. Carrie Jones: So the two out of three, you can do at any single phase. And so one is our hormonal rhythm. If you’re still cycling or even with menopause, your hormonal rhythm is in direct communication with your circadian rhythm. So when somebody’s hormones are off, as we talked about, “hormone imbalance,” I’m pretty sure their circadian rhythm is probably off too. So one of the things I tell people is I want you to really focus on that full spectrum light in the morning, getting up in the morning. How do you do in the morning? How are you feeling in the morning? How long does it take you to get ready in the morning and feel awake? When do you take your supplements in the morning? Sometimes we have to move your supplements to as soon as you wake up. We’re trying to encourage what’s called the cortisol awakening response, get you up, get you going, and then what do you do at night? Are you on your phone, your tablet, your TV? Are you snacking at night? Are you watching scary movies at night?

Do you have your second wind because your kids are in bed so now you’re going through emails, answering stuff, computer stuff, trying to just check off the list, but it’s got you all spun up again? Are you winding down with a glass of wine? All these questions, and I’m like, we need to course correct and go back to darkness at night, wind with a D, wind down at night. However that looks. Sleep in a cool room if you can. Wear a sleep mask if you need to be in complete darkness. And then in the morning is the opposite, full spectrum light, get up, get going, hydrate, and consider taking your supplements close to waking so that you can encourage… A lot of people, if they’re struggling with circadian rhythm, they may be on some sort of adrenal support, HPA Axis support, adaptogens, vitamin C, B5, et cetera. Just take those earlier, take those close to wake up so we can really encourage that whole axis to work. So by improving your circadian rhythm, it helps the communication down to your reproductive rhythm. And I feel like-

Evelyne: Carrie, I just-

Dr. Carrie Jones: Yeah?

Evelyne: I just want to say I’m laughing because I was up late last night. I always get a second wind and I don’t have kids. I’m always up on my computer thinking about work. I’m not a morning person, so…

Dr. Carrie Jones: Dang it.

Evelyne: But the world is not built for us night owls. It’s hard.

Dr. Carrie Jones: Yes.

Evelyne: I also saw on your Instagram that you were talking about light exposure early in the morning before Andrew Huberman made it popular and now everybody’s talking about it.

Dr. Carrie Jones: Yes. Well, and I can’t credit it. My mentor is Dr. Tom Williams, and gosh, 2017 I think is when he taught me. He came out with an HPA Axis book, and I read it front to back, took a ton of notes, tabbed the whole thing, got to know him, and he taught me all about the cortisol awakening response. From there, I dug through all the literature on the cortisol awakening response and Precision Analytical came out with the DUTCH Plus, which is the plus is they added in the cortisol awakening response. And so I’m not nearly as popular as Huberman, but I am beyond grateful that Dr. Huberman is getting that information out there because I think it’s so important. So baseline foundational.

Evelyne: Yeah. And sorry, what were the other two things?

Dr. Carrie Jones: The second thing that I have a lot of people, and I have it somewhere behind me in one of my oats, I don’t think you can see in the thing, but it says, healing happens at joy. And what I find is a lot of people, especially as we maybe get older, is that we are working on our stress response or we’re working on our cortisol. Life is stressful. We have a lot going on, and we kind of lose our joy. And joy, community, family, friends that we truly enjoy, not the ones that we’re just stuck with, makes a big difference in our parasympathetic response. So we have our fight or flight, freeze, and then we have our rest, digest, repair and heal side to us. And doing things that bring us joy, which is an internal thing as opposed to happiness, but true joy, really helps push us into that parasympathetic rest, digest, repair, and heal.

And a lot of us struggle with that. We’re not repairing fast like we used to. We’re not healing like we used to. It’s taking us a long time to get over infections. We’ve been dealing things a long time. And so I tell people, especially as we get older, we lose contact with friends, we stop doing hobbies, we don’t do the things that we truly enjoy. So I say every day, I want you to find something, even if it’s laughing at funny memes, even if it’s reading 10 pages in a book, even if it’s picking up the hobby again that you gave up occasionally, whatever it looks like. And it can be at a grand scale. It can be finally planning that trip you’ve been really wanting to go on. Whatever brings you joy, do it routinely because it’s going to help the rest, digest, heal and repair. And that’s only going to help your hormones, and you can do that at any age.

And I have found, and you probably have too, in all your discussions with people that we can have hormonal imbalance at any age. I mean, I had women in their twenties with hot flashes. Doesn’t mean they’re menopausal, but it does mean they have a lot of hormonal issues. And so by working with the circadian rhythm and then by finding your joy, however that looks, I find that can be really, really helpful. The third thing I will advocate for, since we haven’t had time to talk about it, but I will say when we get into menopause, there is so much stigma and myth around hormone replacement therapy. There’s a lot of fear, and I know we don’t have time to talk, but the third thing is to encourage people as you get close to menopause or you’re newly in menopause, find a hormone savvy practitioner who understands hormone replacement therapy and have a full conversation with them. Because what we learned out of the Women’s Health Initiative that ruined it for all of us and the full circle we’ve come since then, that information is not getting out there like it should.

That research is not being shouted from the rooftops like it should unfortunately. And the loss of estradiol as we get older as women really screws us up. It changes our brain, it changes our hearts, cardiovascular system. It changes our immune system. Almost all of our immune cells have estrogen receptors on them. It changes our microbiome. The loss of estradiol changes our microbiome for the worse. We are way higher risk for developing non-alcoholic fatty liver disease simply because we’ve lost estradiol. It may have nothing to do with our shift in our diet. It puts us at higher risk for insulin resistance, metabolic syndrome. Our weight shifts up usually into an apple shape. Neurologically, brain inflammation. So I’m not saying everybody should or needs estradiol, but if you are a candidate and you have a lot of fear around it, I strongly recommend meeting with somebody and reconsidering, because I would hate for you to miss out on decades of quality life thriving if estrogen and other hormones can make a difference for you. We are going to spend a lot of our life in menopause. Don’t do it suffering.

Evelyne: I’m so glad you brought this up. And since we are talking to practitioners, what do you think is one of the best sources where if they want to be really knowledgeable in bioidentical hormone replacement, what do you think are some good sources?

Dr. Carrie Jones: Locally for practitioners, one of my favorites is to call your local compounding pharmacy and one, pick their brain. That’s what they’re there for. Two, see if they’re putting on trainings. I live in Portland. Our compounding pharmacies are great and they’ve been educating for a while. And then there are obviously big organizations like A4M and IFM that put on hormone trainings and HRT trainings, which can be helpful if you’re already involved in those organizations. Just to get an idea of estrogen in general, there’s a really great book called Estrogen Matters, and that might help you reevaluate estrogen as the authors go through… Up until the point of publishing of that book, they went through the literature around estrogen and menopause.

And even recently and as you and I are talking, I have it pulled up, here it is right here. The title of the study is called, it came out in May of 2023 so it’s very recent, Reappraising 21 years of the WHI study: Putting the findings in context for clinical practice. So Reappraising 21 years of the WHI study: Putting the findings in context for clinical practice, for those who are super nerdy, the PMID is 37209498, and it is written by I believe it’s four of the original WHI authors. And that is a good one to go back where they realize oops.

Evelyne: Thank you for sharing. We’ll definitely include that in the show notes. I saw you post about it so I actually had it pulled up and I read the abstract, but I’d like to read the whole thing and we could probably do a show just on that. There’s so many questions around when to replace with hormones versus maybe support herbally and when to start, and is it too late when you’re at a certain point? And those are definitely questions that I have. And we could talk so much more about gut health and all that stuff. And we didn’t even talk about cortisol and higher up hypothalamus pituitary and how that affects GRH and then FSH and LH and then estrogen. And so, gosh, this is why I want to talk to you all day. I do have some questions-

Dr. Carrie Jones: That’s the point of the podcast, so you can involve all these other experts on it to talk about this too, which is great.

Evelyne: Yes, yes. And we are doing more women’s health topics for sure. There are some questions that we like to ask everybody on Conversations for Health, and I think one of them you kind of already answered, but what are your favorite health practices that keep you healthy? Is it the ones that you just mentioned for everybody?

Dr. Carrie Jones: So yes, definitely. And again, remember as I said, if you’re new to this, Evelyne and I have been doing this a while, so I have a lot of health practices that I’m relatively disciplined in, everything from I’m 100% gluten and soy-free. I’ve been relatively dairy free for a really long time. The food choices that I make, I try to eat predominantly organic and free-range and things like that. Movement, I am usually doing exercise. I have a dog, so I’m walking every day. He’s very high maintenance. But my movement, and especially as I get older and I’m working on building muscle. My sleep routine, even things like mouth taping, important for oxygenation. Finding joy and getting back into hobbies. Therapy, got to deal with those big T’s and little T’s. The supplements that I take. I mean, I would say 90 some percent of my products that I use in the house on my skin, makeup, et cetera, are definitely a pretty clean version.

It’s been a journey, but I’m about 90% there. Not everything I can find. I’ll be honest, this black eyeliner I have on is not clean, but you can’t get really sharp clean wings, but that’s about the only thing that it’s not clean. So I mean, I feel like it’s pretty well-rounded at this point, thankfully. But again, it’s a couple decades in the making.

Evelyne: It’s a journey. And I think throughout our lives, depending on what is going on, there are periods when we’re more on top of it and less so on top of it. And that’s just part of being human.

Dr. Carrie Jones: 100%. I’m not perfect.

Evelyne: What are your top three favorite supplements for yourself?

Dr. Carrie Jones: Sulforaphane, absolutely hands down. I take it every day. I feel better when I take it every day, even though you don’t necessarily have to, I do. Magnesium, I take absolutely every single day. I take some sort of magnesium, either glycinate or a mix. I take it at night before bed, absolutely can notice a difference. And then the third one I probably rarely miss, it’s a toss up. No, that’s not true. I would say three is B complex. I seem to, just like everybody else, burn through my Bs. And I have celiac and didn’t know it for a while so I think just absorption in general, as much gut work as I’ve done, is not great. I mean, as best as I can get it to, but B vitamins seem to make a big impact for the better on me when I take a B complex. So that’s probably number three. Number four was going to be omegas, but I do forget omegas. I never forget Sulforaphane, magnesium or B complex.

Evelyne: Love it. And then my final question to you is what is something that you’ve changed your mind about through all your years of practice?

Dr. Carrie Jones: Honestly, estrogen is probably the big one since we’re talking hormones. I recall in the early days of practice, I had a woman, she came in for a consultation. She’d already had breast cancer twice, and she was looking for me to refill her estrogen HRT. No, no, I’m sorry. She’d had breast cancer once, and she said, “I’m looking for you to refill my estrogen HRT.” And I was like, “You are absolutely crazy. You’ve already had breast cancer.” And I realize the contraindication, but at the time, I was so much younger. I did not realize the systemic effect that estradiol has. She said, “You don’t understand. My quality of life is horrible when I don’t take my estradiol.” She had a patch and she said, “If I don’t wear the patch, everything, my anxiety, my depression, my cognition, my heart palpitations, my libido, my vaginal dryness…” Just every aspect of her quality of life plummeted.

And she said, “I’m not willing to give that up to even the risk of developing breast cancer again. I’m doing everything I can to mitigate a secondary risk, but I’m not giving up my quality of life. What if I never get breast cancer again, but I spend the rest of my life anxious or depressed or all these things?” And at the time, I was way too scared, rightfully so, of a lawsuit, but since that time and going through all the literature, I thought, wow, she’s not wrong. And now that I’m in my forties, I think to myself, if I were to get breast cancer and then just quality of life, what would I do? What would I do? And so just learning as much as I can about hormones and what they do, and options women might have, alternatives they might have. Now they allow, if you’ve had breast cancer, you can do vaginal DHEA, thank goodness.

There’s some workarounds now that they’re realizing are okay. I have some more functional oncologists who are okay, depending on the type of cancer or other things that they’re doing, some of the hormones, not all the hormones, but some of the hormones. And I’ve even had oncologists who were like, absolutely no adrenal supports. We do nothing with them other than aromatase inhibitors. And I thought, yeah, but they’re going to live 40 or 50 more years, or 30 or 40 more years, and they are suffering. So now my mind has changed on what can we do? What can we get away with to not increase any risk, in fact, reduce risk as much as possible through all the other things we’ve now learned, but also support their quality of life in menopause because they are going to spend a couple decades in it? And I think that’s probably a big one that I’ve changed my mind on that instead of black and white hard no to wow, there’s a big gray area there, and I don’t want you to succumb to a horrible quality of life.

Evelyne: There’s so much nuance in medicine, right?

Dr. Carrie Jones: Yes. Yes.

Evelyne: And then it’s going to vary from person to person. So thank you so much for sharing that story. Very, very valuable. Well, Carrie, this was so much fun. I’m serious.

Dr. Carrie Jones: Thanks. I agree.

Evelyne: I heard so much. This was a great time, so thank you for being here. And I would suggest that practitioners listening can check out your Instagram to learn more about where and how you’re teaching and watch your videos and all of that. So thank you.

Dr. Carrie Jones: Thank you. I really appreciate it.

Evelyne: Thank you so much for tuning into Conversations for Health today. Check out the show notes for any resources from our conversation, and please share this podcast with your colleagues. Follow, rate or leave a review wherever you listen. And thank you for designing a well world with us. Thank you, Carrie. Have a great day.

Dr. Carrie Jones: Thank you.

Voiceover: This is Conversations for Health with Evelyne Lambrecht, dedicated to engaging discussions with industry experts, exploring evidence-based, cutting edge research and practical tips.