94: “Your Labs Are Normal” (But You Still Feel Awful)? With Dr. Carrie Jones

So you don't feel well, you're achy, you're not sleeping well, you're anxious, you're depressed, you've gained weight, your hair and skin have changed. Pretty much everything has changed. And you go to the doctor and you say to the doctor, can you just test me for everything? Because I just don't feel well, I don't feel right. I don't have the energy I used to have. I just. I don't feel like myself. So. So the doctor runs the tests and you get the results, and you're told your testing's normal, you're fine, you're put on this line of fine, and you know you're not fine, and you know you're not normal, and you know this isn't what it's supposed to be, but you don't know what to do, and your doctor told you you're fine. I brought the solution for you today. So Today I have Dr. Carrie Jones. This is the queen of hormones, but I actually refer to her as the queen of functional test. She has been the clinical director of RUPA Health, which is kind of the marketplace of all functional testing. And she has spent her career looking deep, looking at what labs to order, at what. At what these labs tell us. And she is this amazing investigator helping women to get their ideal health. And if you don't know the question to ask, this is where you need to be right now. Because not that you should be your own doctor and not that you are expected to be your own doctor, but it is so important in your journey for you to know the questions, know what you should be asking for, know the values that you should be looking for so that you can be an active participant in your health, because it's so important. So sit tight, get ready, get something to write with, get comfortable, because here comes Dr. Carrie Jones. Okay, so I just want to start with. So many women are told that their labs are normal, right? They get put in that line of fine, and so they go to see their doctor, and they know they don't feel well, they know they don't feel right, but they're told their labs are normal. So what does the queen of labs.

Have to say about that? Oh, my goodness. First of all, it's so frustrating. It's so frustrating. And I've been there myself. You know, I have a primary care. Get labs drawn, and I get this email back in the portal that's like, congratulations, you're normal. It's all fine. And I'm looking at it like, no, it's not. It's the whole reason I went to see my primary care. But what's frustrating, I find, is that women often go, I don't feel good, I'm tired, or I feel hormonal, my periods suck, or my hair's falling out. And so they'll go, I would like comprehensive testing. Or women know enough to say, test everything, figure out what's wrong.

You're exactly right. They do say test everything.

Yes.

But unfortunately, the person that they're asking to test everything has no idea what.

That means and what comes back. It always shocks me. And they'll say, okay, I tested everything, your hormones are fine. And then I get a hold of it, or you get a hold of it. What is it? It's a complete blood count, which is red and white blood cells.

Yes.

Okay. You get a metabolic panel. Don't forget about platelets. Platelets, right. You get a metabolic panel, which is fine. Got some glucose in there, your electrolytes, calcium, some liver markers. Okay, cool. Maybe.

Okay. But it doesn't include an insulin, which I don't understand why.

Yeah, an A1C, like something. Something extra. And then maybe, maybe if you're lucky, you'll get a tsh, thyroid stimulating hormone, and that's about it. And then they'll come back and tell you in your portal. Or the nurse will call you and say, your labs are great, your labs look fine. Well, of course they do. My red and white blood cells are not the problem. That's not what I'm worried about. I'm not worried about my liver enzymes. I'm not worried about my electrolytes. Those aren't what's causing me to be exhausted and rageful and my periods and my hair and my skin. That's not the issue.

And not for nothing, but when, like when people get that and they know that it has nothing to. They know that they weren't covered. Right? They know.

Yeah, absolutely. Yeah. Actually, I'd say yes. A lot of women know. And then some women will go, I will ask, have you had lab work yet recently? And they will go, oh, yeah, I got a full workup. My hormones are fine. But that's not what it is. So they've. Because they've been told everything's fine. They've been told they had a comprehensive workup. Like, you believe it? Why wouldn't you believe it?

You don't.

You don't want you to think your practitioner's lying to you. Not that they're lying, it's just their comprehensive and our comprehensive are very Different. Their idea of a full workup and our idea of a full workup is very different.

But they also know that they're not fine. Despite the fact that their labs are normal. They know that they're not fine. Right.

How could you. How could you deny it? If somebody comes in and they're listing all their symptoms as a doctor, immediately I'm like, oof. This poor person. They feel terrible. They're checking all the boxes. I know. The nurse knows, the medical assistant knows. The front desk knows. Like, everyone knows.

Yeah, yeah.

But it's so frustrating.

The doctors don't know. That's what's so sad, is that we're so. You know. And I came from that conventional medical system. I came from there, so I'm so. I understand where they're coming from, because that's what we were taught. Yeah. That's literally what we were taught to do. And we have so little understanding about how to evaluate someone outside of your little tiny silo that you were trained in.

Yeah. I had to go see my primary care was unavailable. And I saw her physician's assistant, who was the nicest man, and he said, what do you do for a living? Is a naturopathic doctor. And I said, hormones. I'm in hormones in women's health. And he literally sat back on his stool and he said, oof. I don't do hormones. I refer him on. I said, not at all. You don't. You don't even like doing a cursory workup. He said, no, no, that's not what I do. Now, kudos to him for knowing his boundaries and knowing he cannot and does not understand it and do it. But also, I thought, man, I bet a lot of practitioners feel that way in their head. They just. They don't know what to do. They don't know what to order, and they either do nothing or they refer them on.

Yeah, that's totally true. And yet the people that we rely on for hormones are either the endocrinologists, which, I'll tell you, they don't know either. I mean, the endocrinologists are guilty of that TSH alone, too.

Right.

They're not ordering full thyroid panels. They're maybe ordering a free T4. Maybe, maybe. Maybe it's reflex. Yeah, but most of them are still ordering a TSH alone, and they are not female hormone experts. And they don't even get involved. Right. So the people who are supposed to be the hormone experts, the endocrinologists are not hormone experts. And then we go to our gynecologist who unfortunately are also not hormone experts. They are used as hormone experts, but they're not trained as hormone experts. And so what ends up happening is they either do nothing or complicate the problem more. So what happens is when you train to be an OB gyn, this is a surgical specialty.

It really is.

It's not a medical specialty. So they are not really getting trained on how to evaluate female hormones. They're mostly getting trained on delivering babies, which is very important, very important to know how to do that safely and properly. And they're getting trained to be gynecological surgeons. They're getting trained on how to remove tubes and ovaries and uterize safely. Right. That's really what the bulk of their training is. So what happens when someone comes to them with a hormone abnormality? They put them on birth control pills because that's the only thing they were trained to do. Or if you're bleeding too much, they put you on progesterone. So band aid, Band aid, band aid, Bandaid, bandaid. Meanwhile, this person has significant hormonal dysfunction that is not being fixed by putting them on oral contraceptives or by progesterone to stop bleeding. It's not fixing the problem.

Right.

So we rely on people that are totally untrained to do this very important job. Right?

Yeah. So, yes.

What do you think? What, what should we be doing? What should people be doing?

One, arm yourself with education. The that's why you're listening to this podcast, because you have a pen and paper out or your notes open in your phone and you're writing down the lab work we're going to talk about that you should ask for. And two, now that you're educated, once you get to the end of this episode, you're going to. When you go in and ask for a full workup or comprehensive workup, you can present with a list. Here are the things I would actually like to have tested and the reasons why. This is why I feel like it's important. And I want to preface this by saying we're not requesting wild, crazy, you know, rare, hyper expensive testing. No, you mentioned an insulin. I mean, an insulin, I fully agree. Should be a first line test to go especially with glucose. When we're looking this up, we're working this up. When we're looking at thyroid, I absolutely don't think it's wild and crazy to not only do a TSH, thyroid stimulating hormone and a free T4 and what's called a free T3, some insurance groups will Straight up, not cover a free T3. They think it's excessive. And I. And I just think you don't understand physiology. You don't understand that the majority of your T3 creation is out in your cells. It's not in the thyroid itself. And, oh, by the way, the amount of T3 you have doing the work out in your cells doesn't necessarily communicate back to your thyroid or even your brain to impact TSH and then T4. So you can have two totally different thyroid conversations happening. The one in your brain, what's coming out of your thyroid and out in your cells. So there's three. And if you don't understand that physiology, okay, but insurance companies who are like, well, I just don't. We just don't cover free T3. We don't think it's necessary. Like, that's. That's the heavy lifter. That's the power horse out in the cells.

That's the act of form.

That's the act of form. Like, yeah, free T3 is what makes a lot of cells go round. Like, come on now. TSH is not what does it. That's just a signal communicator that's impacted by so many things, and it's often right in the range you want it to be. It's. It's kind of like sitting pretty, coming out of the brain. It's doing fine. And that's what frustrates me so much. And so when we ask, I definitely have had doctors say, like, ooh, no, we can't run a free T3. I'm like, why not? Let me pay out of pocket. It's not that expensive. Just add it on. It's like an insulin. Just add it on.

Yeah. It's very frustrating. And also, you know, so you're coming from this super duper educated place, but most people don't even know the questions to ask. Most doctors don't even know the questions ask, as it turns out. So. So I know you're the queen of functional testing, and we are going to get to all of that, because I'm not going to waste my opportunity here with the queen. But I do think that there are. So you can get a lot of information before even going to functional testing, right?

Absolutely.

A lot of information. So I want to hear what's on your doc. I don't feel well. I'm exhausted. My skin is dry. My hair is dry. I am losing my. I'm lo. My hair is thinning. I'm losing the outer third of my eyebrow. I've gained weight. I'm. I just don't have the energy that I had before. I don't have the mood that I had before. I don't have the libido that I had before. I just don't feel like myself or recognize myself. I know you're not saying to them, oh, you're getting older. This is normal.

This is what happens when your kids are that age.

Yeah, yeah, yeah. Or you're busy or. Right. Because busyness doesn't cause your eyebrow hair to fall out. Busyness doesn't cause dry skin, thank God, or I would have a lot of issues. So what. What should this initial lab investigation look like for the person that knows they're just not. They just don't feel right. They're just. They're not fine.

Yes. Okay, here we go. I made fun of the red and white blood cell count earlier. It's called a cbc. Complete blood count. We still need to run it. It's still important. I need to know if you're anemic. I need to know if you're fighting some sort of infection or something wrong with your platelets. So I do run a cbc. I do run a metabolic panel. I want the glucose in there. I do look at your liver enzymes. I look at everything. I'm thorough. I am comprehensive. So CBC and what's called a CMP, comprehensive metabolic panel. Then I run your thyroid panel. TSH free T3, free T4. I run both of them. And then if you haven't had it done in a while, and especially if you have all those symptoms. You just said dry skin, outer third of your eyebrows, missing hair loss, weight gain, constipation. I'm running your thyroid antibodies also. So we have. The Main 1 is TPO, Thyroid Peroxidase Antibody, Thyroglobulin Antibody. TgAb is the other one, the other main one. Because if you're positive, that means you have an autoimmune thyroid issue going on, and sometimes those are positive before your thyroid labs are problematic. So I know it's coming, it's building, and we need to do something about it. Depending on your symptoms, I will also run an iron panel. I may just run iron and ferritin as a cursory As a screener. But if you have a history, heavy, heavy, heavy periods, bruising easily. I will run a full thyroid panel and see what's going on. I will run a vitamin D because, well, I live in the Pacific Northwest. We don't get sun, so I need to see what my D is doing.

I Want to say something about that, right? Because I was, I, I had David Letourneau on my podcast not too long ago. I don't know if you know David, but David invented the energy light, the vitamin D light.

Oh yeah.

And he lives in Scottsdale and he exercises outside every single day with his shirt off. He's like one of those JFK, I mean RFK, RFK. Like 60 something, 70 something. I don't know how old he is and I don't want him to get mad at me, but he's one of those very fit, healthy, silver haired guys, right, who exercises outside in Scottsdale every single day. So he goes to have his vitamin D measured, thinking like there's no way I'm going to be vitamin D deficient. Guess what? Vitamin D deficient. Because even if you are in the sunshine in your shorts every day and you live in Phoenix, you actually need exposure to UVB light. And UVB is only a fraction of sunlight and you have to get it at the exact time of the day, which is midday sun, when the sun is like directly above you at the strongest time, which is when most people in Scottsdale incidentally are not out there because it's like unbearable.

Yeah, fair.

And so even if you are living in this ideal climate, it doesn't mean that you're going to have ideal levels of vitamin D. And then there are people like you and I who live in very unideal climates. And my vitamin D, if I'm not supplementing, but I'm getting a light, but my vitamin D, if I'm not supplementing is abysmal. And then Philadelphia, we're hiding most of the year. Like even when it's beautiful, it's 31 degrees outside today. You think I'm taking my clothes off, you got another thing coming.

That and when you and I go to ideal climates, I was just in Palm Springs last week where it was 80 and sunny. I am the color of a cell phone flashlight. Like I was designed to man to woman, Viking ships and train dragons, you know, so I'm covered in zinc oxide, at least part of it, because I don't exactly. My melanin doesn't agree with the sun and I have a very long history of basal cell unfortunately. And so I get sun, I definitely do. But it, you know, I burn very easily and I have to be very careful. So even when I am in the sun, it's not for long periods of time. It's usually under an umbrella. I have to be careful and I don't get the Vitamin D. Yeah.

So sunshine is very important. Right. And it's important for our eyes because that is the signal to our brain to actually release antioxidants into the skin and to tie us with circadian rhythm, which is important for sleep and all kinds of processes in our body. So I am not telling anyone to avoid the sun, but I'm telling you that the likelihood that the sun alone can provide you with the vitamin D level that you need in this day and age is nearly zero.

Not great. Not great. Which is why I test it. Let's see what's going on. I do also often test a vitamin B12, because oddly enough, I have found it low a number of times in people. And B12 is an easy fix. And low B12, mental neurological energy. B12 does a lot of things in the body. So I check a B12 depending on your age. While this doesn't necessarily contribute to the fatigue and everything, if you are especially 40 and over headed in that direction with hormones, I do immediately start looking at your lipids. So I do what's called an advanced lipid panel. I will. Which is your cholesterol is what I mean, talk about your cholesterol. Triglycerides. I will look at something called an APO lipoprotein B, depending on your symptoms. Have a lot of inflammation going on. I will do what's called an hscrp, High sensitive C reactive protein. And I may add on other lipids panel information, depending on your family history, your personal history, what's going on. But we're talking some screening stuff. Then I can run hormones. You can do hormones in the blood work. And what frustrates me more than anything is when I hear back from people who say, oh, I don't test women's hormones because they change a little bit every day. I know. So let's time it appropriately for where they are in their cycle. Or then if they're postmenopausal, they can test anytime. You can absolutely run a progesterone, an estradiol, a testosterone, a total testosterone, a free testosterone. You can run a dheas. S stands for sulfate in the blood work. I can do a morning cortisol on you. It's not the best marker for cortisol. We have way better markers out there. But if I have to start somewhere, maybe, you know, budget is a huge thing. I can use it as a screener. I'll do a morning cortisol on you.

I. I almost universally do a morning cortisol. Yeah. And it's a pretty good Indicator of who is walking around white knuckling life.

Yes. Oh, my gosh.

I'll tell you that. I, I can. It is a very good indicator of who's walking around white knuckling life. You may not pick up everyone, but it's pretty good.

Yeah, yeah, I agree completely. And it at least gives me an idea of, do I, do we need to do more advanced testing? Do I look, look at this harder?

Yeah.

Or am I referring you for some pretty significant nervous system help for that? And then of course, insulin. We've mentioned it a few times. Insulin, I think is a huge. Especially that I can't lose weight, I'm hungry all the time, or I'm hungry after meals, I'm constantly craving sugar. History or current of pcos? You know, definitely. I think insulin should be standard. The issue with insulin, which I know you agree and talk about, the reference range is much too large for insulin. So even if somebody does manage to get an insulin done, the reference range is often up to 20 or 25.

Yeah.

So like 2 to 25, 2 to 28 and you'll be 20.

Wrong. With a circulating insulin of 20.

Oh my gosh. But it's in a reference range. I was reading this article that said if he was talking about high, you know, high insulin, higher levels of insulin, and it said if you have higher levels of insulin, you have a 3 times 3x chance of developing metabolic syndrome. And I thought, gosh, high insulin. I wonder what the authors think high insulin is. It must be over 20, 25, 30, 50. And it was something like over 6.8, over 7.2. I was like, what? Why is the research not caught up with our reference ranges? Why are we giving this huge grace period when we should be catching people much sooner when they develop high insulin, insulin resistance? I mean, that's a big problem.

Well, you know the answer to that question.

I do know the answer. It's rhetorical.

But still, it's still frustrating, unfortunately, the way that our system is set up. Doctors cannot make money unless you're sick. Yeah. Hospitals cannot make money unless you're sick. Pharmaceutical companies who control the narrative and control medical education cannot make money unless you're sick. So the system is set up to promote failure. Right. And so we have these enormous reference ranges that literally include 95%.