94: “Your Labs Are Normal” (But You Still Feel Awful)? Here’s What They’re Missing with Dr. Carrie Jones

Foreign.

Hello and welcome.

I'm Dr. Jen Simmons, a breast cancer surgeon turned integrative oncologist on a groundbreaking mission to transform the conversation around breast health. If you're seeking to redefine the way that you think about breast health, you're in the right place. Breast health isn't just an aspect of well being. It is health, integral and indispensable. Here on the Keeping Abreast podcast, we delve deep into the innovative ways to diagnose, treat, screen for, and prevent breast cancer. But it's more than that. It's about having the crucial conversations that empower, enlighten, and drive us all to a healthier place. As someone who has navigated the front lines of breast cancer treatment and now champions an integrative approach, I bring a unique perspective to these discussions with blending rigorous science with holistic health principles. Health is a journey, not a destination, and I am truly honored to accompany you on this path. Each episode aims to provide you with actionable insights and cutting edge strategies to take charge of your breast health and.

Your overall well being.

So whether you're here to learn about the latest in medical advancements or seeking tips on lifestyle changes that foster real health, they the Keeping Abreast podcast is your go to resource. Let's embark on this journey together, because when we talk health, every conversation matters. And now, stay tuned for this week's episode.

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, you 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 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 testing. 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 questions 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. 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 and 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 is 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. Platelets. Don't forget about platelets. Platelets, Right. You get a metabolic panel, which is fine. Got some glucose, your electrolytes, calcium, some liver markers. Okay, cool. Maybe.

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

Yeah, some. An. An A, one C. 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 their. 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 as a naturopathic doctor? And I said, hormones. I'm in hormones and 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. Yeah, right. So the people who are supposed to be the hormone experts, the endocrinologists, are not hormone experts. And then we go to our gynecologists, who unfortunately are also not hormone experts. They are, 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 uterus eye 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 band aid. 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. 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 gonna 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 gonna. 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 wanna 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, so, 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? Then 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 to ask, as it turns out. 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'm losing my. I'm losing. 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. It 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 am, 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, to man to woman, Viking ships and train dragons, you know, so I. 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, 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, you know, 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. If we 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.

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.

What would be 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 it 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 so 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% of the population. Now, do you want to be within at the same range that 95% of the population is? Because I know, I don't. I.

Right, like, especially because we know a lot of the population is sadly, unfortunately, very unhealthy.

Yes, yes, of course. So I think the statistics now are that over 90% of Americans have metabolic dysfunction. I just read 90%. This is frightening. I don't want to be part of that 90%. I want to be exceptional. Right. I want to set the standard for what is ideal, what is optimal. And that's what we're never talking about. We're never talking about optimal ranges. So even if all your doctor does are those precursory labs that we, that we talked about in the beginning and we said, oh, well, they're normal, even that is not normal. Right.

And what are we waiting for if you're borderline? So a blood sugar, a glucose above a hundred, but. So 100 to 125 is considered pre diabetic. So let's say you're listening to this, you've got your lab work and you're.

Talking about a fasting glucose.

A fasting glucose. You went in the morning to the lab. Fasting 100 to 125 is considered pre diabetic. You look at your own lab work right now, today, listening to this, and you're at 99. Why would you wait?

Right.

Are you okay to get over 100 to do something about it? What if you're 125? What if somebody says to you, you're fine, you're normal, your blood sugar's a little higher than we like, so, you know, work on that. You're 125, 126 and over on a fasting blood sugar is considered diabetic. Why are we waiting? Why are we not intervening? Why are we not being proactive? I mean, again, rhetorical question, but this is what's so frustrating, because you get the phone call, you get the portal email that says you're fine, you're in range, or you're a little up. So we'll check it again in a year, keep an eye on it. What, you don't feel well? This is contributing to it. You don't want to be borderline or at the line. We want to pull you back from the cliff before you fall off.

I know, but they want you to qualify for the drug, and that's what's going on there. That's what's going on there.

And then a lot of people start one, which leads to two, which leads to three. By the time you're 50, 60 years old and you're on multiple medications, cholesterol, mood, blood pressure, blood sugar, et cetera, et cetera, et cetera. It's not fair. It's not fair to the people, because we look at it from the other lens of, like, gosh, there's a lot we can do before we even get that. Before you fall off the cliff into pharmaceuticals. I'm not against pharmaceuticals at all. All. But I am against essentially kind of pushing people over the cliff into them when we could have done a lot of prevention before.

Well, there are some pharmaceuticals that I'm against.

Okay, well, yeah, fair.

I want to go back to. You started to talk about. You get an advanced lipid panel, and you talked about the things that they're named there. And I think that there's something that's worth calling out because we're using that cholesterol as a catch. All right? And people have in their head that if you have cholesterol above 200, that you should be on a cholesterol medication. So I want to dive into this a little bit, because according to Dr. Jen Simmons, I think this is all about a statin narrative, Right? This is about how to get people on statins. So I want to talk a little bit about what you are looking for on that lipid panel. And then what you think of statins and this whole cholesterol story, because the cholesterol story ends up being very important in the hormone story. And we know what happens to people when they go on statins. So I would love you to talk about that. Talk about triglycerides, talk about hdl, talk about what the importance of those are.

So with cholesterol, obviously we have different types of cholesterol. And as a very dear friend, a longevity expert, explained to me, think of cholesterol like a bouncy ball in your arteries. It's bouncing along, and what you don't want it to do is bounce so hard against the wall that it sticks. And if it sticks and makes its way through to the other side and it gets inflamed and the immune system comes, this is the progression of plaque. So we have soft plaque initially, because you have a soft bouncy ball, and then eventually it can become a calcified plaque and the calcified plaque can grow. And this is where your arteries narrow and it can put you at risk for a heart event. Stroke, if it's in the brain, heart attack, if it's, you know, below the brain, then we have a problem. Houston, we have a problem. So when we're looking at cholesterol, I'm looking at everything from how many bouncy balls do you have? And there is some people may have heard of a marker. It's called an lp. And as it was described to me, it's like those sticky hands that we were played with with kids. We'd like throw the hand against the wall and it would stick and it was gross and gummy. So the LP is like a sticky hand wrapped around the bouncy ball. And the more you have, the more sticky it is to the wall. So now again, more balls against the wall. Like the rap song We've got problems. So we've got plaque formation and eventually calcified plaque formation. So we can test this. I can test ldl, I can test LDL particle, I can test lp, I can test inflammation. And because we know more than 90% of people have metabolic dysfunction, which includes a lot of these markers, inflammation, cholesterol, et cetera. My vision is long term goal to prevent the cardiometabolic event I'm trying to prevent, reduce your risk for stroke. Same for any kind of heart attack. And we know heart disease, cardiovascular disease is the number one killer of humans, men and women. So when I'm looking at cholesterol, especially we're going to stick to women, especially as women go through the perimenopausal transition. Oftentimes that decline in estrogen increases and changes for the worse all of their lipid panel results. So you'll have women, you may be listening to this right now and think, I've always had low cholesterol. Carrie, Jen. I've always had low cholesterol. And then, then I turned 45, then I turned 50, then I went through menopause, and my blood pressure went up, my glucose went up, my lipids went up. Everything went to heck in a hand basket. And estrogen plays a big role in how we use get rid of function with cholesterol. Now, the other interesting part of cholesterol is that some people genetically make a lot of cholesterol. They're great makers. They're great. They're, they're, they're little factories for cholesterol are turned up really high. And other people are really good at recycling cholesterol. So as cholesterol gets ready to, like, get excreted from the body, it goes through the bile, and then the bile goes through into the intestines, and essentially you poop it out, believe it or not. So some, you have little grabbers in your intestine that can grab the cholesterol back and pull it back in like you thought you were out, and it pulls you back in again. And now you have more cholesterol floating around. And I can test for that, too. I can test to see, are you a factory maker? And I can test to see if you're a recycler, are you pulling it back in? And these, this information can help with treatment ideas on in which way we go. Because statins don't impact all of this. It doesn't help inflammation. It doesn't really help recycling. It doesn't help so much. The lp, I mean, sort of it, like, raises the. Actually the lp, but it lowers the ball count. So there's, like, people, there's arguments pro and con, against. So when I'm looking at this, it's a bigger conversation and it's a lot more lab work than you think, than just like, oh, what's your total cholesterol? Over 200. Okay, let's do something about it.

Yeah.

What if it's pure installation?

So many doctors that, like, my husband's concierge doctor gave him his list of labs for the year, right? And I called him and I said, you need to add on an hscrp. And he said, why? And I'm like, really?

Why?

Really? And they don't know that, you know, high LDL alone, in the absence of an elevated CRP is not an independent risk factor of heart disease.

Right.

Like, they have to be together. He didn't know that. Which is just not.

Not uncommon. Yeah.

Sadly crazy to me that. That these people that are in charge of people's general health and wellness, they don't know. Right, Right.

And if they don't know, how is everyone listening supposed to know?

I know.

How is the general public supposed to understand it?

I know.

It's the same with just hormones. You know, if the majority of practitioners don't know, other than here's the birth control pill or here's the Mirena iud, then how is everybody else supposed to know?

Yeah. No, it's so true. And I think about. So the other part of the cholesterol story that we're not talking about enough is that cholesterol is a very, very, very important molecule. Right. This is the base molecule for our hormones. This is the base molecule for our neurotransmitters. And you cannot be healthy without healthy levels of cholesterol. And when we put people on statins and just lower cholesterol, lower the ldl, which is the building block of our. Our steroid hormones, we are not serving people, and we're actually decreasing their metabolic health. And people who go on statins have a 63% increase in diabetes. This is a problem. And this we're not talking about.

These are the conversations. I see this a lot more, quite honestly, in men. So when I was in practice full time, I had a small handful of men, you know, often husbands of wives who were like, just go see Carrie, even though she's women's health, like, go see her. And they would be on very large doses of statins for whatever reason, and their cholesterol would be very, very low. So if. If. If the range is up to 200, they'd be at 100, they'd be at 110 for a total cholesterol. Yeah. And as a result, their testosterone was super low. They felt a lot of brain fog, they felt fatigue. They have all the things, right? Erectile dysfunction. So these were always the conversations I would have with their cardiologist. I would call and say, hey, I get. You want their cholesterol, their bouncy balls to be super low because you're worried about heart event, maybe their history, family history, whatever it is. However, their daily living sucks. He's tired all the time. He has brain fog. He's Gaining weight. He can't get an erection. He. He's feeling pretty depressed. Can we negotiate this? Because it is literally the LDL droplet. LDL being the cholesterol. A droplet, as you said, is the backbone to all our steroid hormones. So testosterone, progesterone, estrogen, cortisol. And I, you know, cardiologists are thinking one thing. Don't die of a heart attack. And I. That's great. However, I also, I want them to enjoy the rest of their life. Yeah, it was. Can we. So I'm always negotiating. So can we. How can we. We need them. I need them to feel better, but, like, not die of a heart attack at the same time.

Yeah. Well, also, not for nothing, but cholesterol is not really part of the heart attack story in that when you evaluate these people that turn up in the ER with an active MI, a myocardial infarction, a heart attack, 50% of them have normal cholesterol, which is wild.

Think of the sports, right? We've all heard of the high schooler who sadly. Or the college student or the football player, the NFL or whatever, they're at training camp and sadly, you know, had a heart attack and had perfectly normal, allegedly perfectly normal levels of cholesterol.

Before we leave this, I just want to hear what you, what you use as a metabolic screen to know about metabolic health. Because I. We were just at a 4M, the American Academy of Anti Aging Medicine. The entire, the entire focus of this past conference was metabolic health. And what my talk was about was that metabolic health is. And loss of metabolic health. This is a major precursor to breast cancer. And if we would screen for metabolic health with the same vigor that we screen for breast cancer and we worked collectively to improve metabolic health, breast cancer would be reduced significantly. Like 80% of breast cancers are preventable. 80%, right. So, wild, what do you use to evaluate people's metabolic health?

So I look at glucose, insulin, triglycerides. Triglycerides are often in the lipid panel, your cholesterol panel. They're a part of metabolic health. I will do a hemoglobin A1C as part of the lab screening, if we can do so. I do a cgm, a continuous glucose monitor, because I can use the lab work for that particular day, what's going on? But I can use the CGM as more over, depending how often we use it, over two weeks, they're good for about 10 to 14 days. So I may have to do it a month. Like, let's get like a Full month and see what's going on. Combining that in is what my screening is for metabolic health. I know there are other markers out there, but at the minimum. We talked about this earlier. The minimum. If we can get someone to do an insulin, add an insulin to their fasting blood work. Oh, my gosh, that gives us so much information right off the bat. How about you?

Yeah, I do the same thing. And then I'm also making sure that we're measuring blood pressure, that we're measuring waist to hip circumference, because we know that visceral fat, that fat that's around the abdomen, we know that that is a risk factor in and of itself for metabolic disease. Now, there are going to be some women who are straighter or who have a lot of muscle mass. And so maybe their waist to hip ratio looks more like a man's. But, you know, if you're that muscly person. Right, yeah. As opposed to the woman who is straight because she's carrying a lot of weight around the middle and so her middle matches her bottom. Right. Because we're supposed to have a waist to hip ratio of 0.8, meaning that your waist is. Is 20 times. 20. No, 20%. Sorry, yeah, 20% smaller than your hips. So I include that and then I do all the other labs that you talked about.

You know, it's interesting.

I've read. I don't know if you've read this also. I was reading about the concept and it needs more study of testosterone to estradiol in women. So these authors were saying, as women go through the menopausal transition and they get the belly fat, they turn into an apple shape as opposed to a pear shape. One of the contributing reasons, there are several. One of them is there's a relative decline of estradiol faster to testosterone. Not every woman loses testosterone as she goes through menopause. Some have still amazing levels, but estradiol declines faster. And so now the body says, oh no, that's a lot more androgen hormone testosterone compared to estrogen. And women's androgen hormones receptors tend to be in the midsection, in the middle body. If you think, for those of you who are aware of, or maybe have pcos, polycystic ovary syndrome, they tend to be, again, that androgen dominant. They tend to gain weight in the middle. They tend to have the apple shape that testosterone. Estrogen discrepancy with testosterone kind of winning relative to estrogen increases visceral fat, not subcutaneous fat. These authors I was reading were like it's very androgen receptor dominant visceral fat, which is inflammatory and increases more weight gain and more risk for metabolic syndrome. So now what I do, what I've been looking at is when these women going through men perimenopause or very early menopause is. I'm gauging how fat, how far is your testosterone dropping relative to your estrogens, who's winning? And what's your body shape looking like? It's the same I would do with PCOS women, androgenic women.

Yeah.

But you may not, you may have gone your whole life, normal weight, let's call it typical weight, expected weight for your height. And all of a sudden you're like, what is this apple shape?

Yeah.

One of the contributing factors I'm looking at is this, this whole flip in hormones. So it doesn't even have to necessarily do with your crappy diet or your lack of exercise or your, you know, stress or whatever. Just the act of these hormone shifting seem to be contributing to the story.

Yeah. And think about what men look like and where men gain weight. Because we start to have a lot of the physiology start to be similar. It starts to be similar when we get to that phase. Right. Where estrogen has do dropped off. Testosterone will drop off too, but it lags behind the estrogen for years. Right. And so then we start to adopt male physiology and this is what we see borne out all the time, where estrogen is protective against cardiovascular disease. But then postmenopausal women have cardio cardiovascular disease rates similar to men. Yeah, right. It's only before, it's only when we're premenopausal that we have that protective effect. And then the same thing with women postmenopausal, they start to gain weight in their abdomen like men, like you look at men, and that's where they put their weight. And it's not that they have fat rolls, they don't. They have these big kind of bulging abdomens because of that visceral fat, that fat that's inside that's covering the internal organs.

So.

So it's interesting that we can actually see that borne out. Right. That's what we see is happening.

And then the National Institutes of Health estimates 24% of people have fatty liver. I would argue it's a lot higher. And I say that just because liver biopsies are wildly invasive. But right now, as it stands, 24% of adults have fatty liver. And given that we know more than 90% of metabolic dysfunction and fatty liver can go with that and worsen that visceral fat. I mean, unfortunately, the cycle just goes round and round.

Are you ready for a breast cancer screening revolution? Well, I'm thrilled to introduce to you a breast cancer screening tool that I have only recently learned about, but I have universally adopted. This is the ARIA test. This groundbreaking at home breast cancer screening test is one that I believe will completely change the game. So imagine a screening test that's as simple as shedding a tear, because that's aria. It's a non invasive, convenient and perfect for all bodies and all breasts. Dense breasts, implants, no problem. ARIA makes it clear for everyone, even.

Women as young as 30.

Aria is backed by over a decade of clinical trials, thousands of samples and it's developed alongside top breast health experts. Here's how it works. You collect a tear sample at home and then ARIA then analyzes it for protein biomarkers that can signal early breast cancer. And the best part, you get a consultation with a breast health specialist to review your results. Now, ARIA isn't replacing breast imaging. I am using it alongside qt. It's complementing it and giving you a fuller picture sure of your breast health. Knowledge is power and ARIA is putting that power back in your hands. It's time to take control of your breast health and ARIA is another way of doing it. Go to Aria Care a u r I a care and use my code, Dr. Jen 20 in Capitals d r j e n n 20 to get 20% off.

Back to our show. Foreign.

Hello my beautiful listeners. I'm taking a quick break here to share something truly transformative with you today. If you're ready to take control of your breast health journey, then you need to get your hands on a copy of my book, the Smart Woman's Guide to Breast Cancer. I wrote this book to make a massive impact in the world of breast.

Cancer, empowering women everywhere to make informed.

Choices and educated decisions. You have so much more power and control over your health than you might think and this book, this is a roadmap to harnessing that power. Inside, you'll uncover the truth about conventional treatments. They're often overestimated benefits and underestimated, under explained and under disclosed long term side effects. But more importantly, you'll discover the true drivers of health and how the choices you make at home every day can lead you to the best health, the breast health of your life. Even after a breast cancer diagnosis. Whether you're looking to prevent a diagnosis, avoid recurrence, or simply live your healthiest life, this book is for you. Join Me on this journey to empowerment and health. Grab your copy of the Smart Woman's Guide to Breast Cancer today and let's revolutionize the way that we approach breast health together.

We are not of the watch and wait school. We are of the if your levels are not ideal, and we're looking for ideal levels, and I would love to hear what your ideal levels are. We talked about glucose. We talked about insulin. Glucose, you want a fasting glucose below 90. Insulin, you want a fasting insulin somewhere between 2 and 5.

That's what I say. 2 and 5. 2 and 6. Yeah. Yes.

A1, C. You're looking for a number that's less than 5, I would guess. Yep.

5 or less, ideally.

And then where are you in terms of the vitamin D school? Where do you like to see that number?

If I can. If we can get it somewhere in the, like, 50 to 70 range, 50 to 80 range, I would be thrilled.

Yeah. Yeah, me too. I mean, I go a little higher just because I live in the world of breast cancer. So I. I like people to have a little more reserve. And incidentally, I think the numbers are like 80% of people who are diagnosed at breast cancer are, at the time of diagnosis, profoundly vitamin D deficient.

Which that so many times over through the many years. And I don't understand why that's not part of standard breast screening. If you go get a breast imaging, if you get. If you see your ob, like, if you're concerned immediately, I feel vitamin D should be part of that story.

It's awful. It's absolutely awesome.

You get a pap, you get a vitamin D, you get a breast exam, you get a vitamin D. Like, you get, like, Oprah. You get a vitamin D, you get a vitamin D. Well, that's how it should be.

It's certainly how it should be. Right?

Yeah.

Okay. And then I do want to ask you about thyroid, and then I want to move on. What are you looking for in those thyroid numbers? Because that TSH range that is called normal and is deemed acceptable by the, you know, mainstream medicine is way too big for my liking. And I think there are so many women who are walking around with hypothyroidism, which incidentally, is a risk factor and linked to breast cancer. Because when your thyroid is dysfunctional, that is the center of. Of your metabolic system. We talked about metabolic health, and loss of metabolic health is a huge risk factor for breast cancer. And this is often where we see the start of this metabolic dysfunction. So what are your thyroid ideals?

So when somebody does a tsh. Let's assume they're not on medication. They're just getting a screening Tsh. I like them to be around the number two. So that might be somewhere between 1.8 to sometimes, depending on the other numbers, up to 2.5. That is not the range. The range, depending on your lab, usually goes up to 4.5 or 5, but I'm a lot tighter than that. I want, again, like 1.8, let's say to 2.5, depending on the person.

Yeah.

If they're on medication, your TSH might actually be quite a lot of it lower than that. And that's different because of the medication. Now I'm more focused on T4 and T3. I'm not quite as focused on TSH. If your TSH is going up, I evaluate that. But if it's down, if you're one point, if you're like, gosh, I'm on medication, and my last TSH was 1. Okay. What are your T4 and your T3 levels? Yeah. Now your free T4, I want around 1, ideally higher than 1. So if you're 1, up to, you know, 1.4, 1.5, great. Your T3, free T3, I want around the number 3, but ideally higher. So 3, 3.1, 3.3. That's about what I go up to.

Yeah, Mine are very similar.

Okay. Yesterday, I consulted on a case, and their free T3 was 2.2, and 2 was the cutoff at this particular lab. And they had all the symptoms that you said earlier. Dry hair, dry skin. She knew eyebrows.

She feels awful. Horrible.

And of course she was, you know, everything's fine, you're fine. I said your. Your power pack, your T3 in the cells is struggling. Why? We need to get, like, what. We need to figure out why, what's going on.

Yeah, yeah, exactly. Absolutely. Exactly. So let's talk about that. This woman a little bit, because this woman is told that her labs are normal and she knows that she feels far from normal. So what are the functional tests like? Obviously, you're going to do a complete panel because our mainstream medical. They are missing the patterns of dysfunction. They're not recognizing the patterns of dysfunction. It's not their fault. They're not taught to. But what are the functional tests that you then start to incorporate to help people to get to the. Why? Because we can easily prove that they have thyroid dysfunction. What next?

Yes, absolutely. So it's generally other parts of the body that we're looking at. So saliva testing, urine testing, stool testing as examples to get help us dig deeper. Now, when we're looking at hormones itself, you're in trying to get more advanced. We talked about cortisol earlier as an option. I'm either looking at a urine test or some people do a saliva test. And the reason is that when you're looking at cortisol and you mentioned circadian rhythm. A circadian rhythm is your cortisol goes up in the morning to a, to a natural. It goes up to a normal high and drops down at night so you can sleep. That is the circadian rhythm. And then melatonin comes out. So melatonin's higher at night and drops down in the morning and that's your rhythm. If your cortisol is too low, you may wake up tired, you're hitting that snooze, you're going for caffeine all the time. If your cortisol is high at night, you can't sleep, you can't fall asleep, you can't stay asleep. You feel anxious, you're spinning, you're jittery, all the things. So I want to see this rhythm. But we don't want your blood drawn four times in the day. That sounds awful. So now we can do saliva testing four times in the day. We can do urine testing where you basically urinate on a strip of paper, let it dry four times in the day. And now I can see the rhythm with that. In addition, with urine testing specifically, we've known for a very long time that we can get other information out of urine testing back in the day. I'm sure some people have done a 24 hour urine. You collect your urine all day, all 24 hours. You put it in this big ugly urine orange jug and then mail some of it off and you get, I have one of them right here, information that became cumbersome. So some labs have said, you know, I think we can accomplish this by splitting it four times in the day and just evaluating those four pieces. It's close enough to a 24 hour. The reason urine is so helpful is it gets what's called a metabolite. And metabolite is a fancy word for the breakdown product of. You make estrogen, where does it go? How does it break down in your body and come out the other end? Because not all ways and pathways that estrogen breaks down is ideal. You make testosterone, it breaks down. Where does it go? Not all those pathways are great. Some of the pathways encourage hair loss and cystic acne and anger and irritation and other pathways don't. So it's Nice to have these metabolite pathways to see extra information about your hormones. I like to know what your estrogen is like in a blood test we mentioned earlier, but also, where does it go? Because as you talk about all the time, breast cancer prevention, some of those pathways do have increased risk, let's say, for potential cancer formation.

Some of those pathways are very unstable molecules that damage DNA. Right. And that is kind of setting the stage for these. This cellular damage is setting the stage for cancer. Yeah.

And you can't get that in blood work. Unfortunately, we're not there yet. We have to do it in urine, and then we have stool testing. Stool testing is to give us a snapshot, some insight into your GI tract, your gut health, which plays a role in your whole body inflammation, how you are, aren't digesting things, absorbing things. In women, the decline of estrogen and progesterone going through menopause greatly impacts our GI tract. We're at a higher risk for gas and bloating and constipation and heartburn. We're at a higher risk for what's called leaky gut. We're at a higher risk for increased inflammation because of this. So sometimes having this extra information, plus, my goodness, if you've picked up a parasite or candida or an amoeba, like, I'd like to know this about you so we can address it.

Yeah.

So we, depending on your symptoms history, where you been, we have a lot of really cool options for extra functional testing.

Yeah. So I would love to know, are there any functional tests that you are running on everyone? Like there. Is there any go to for you?

So depending on the person, my go to urine is called the Dutch test by precision, analytical and. Or I will do. Especially if that they're very symptomatic. I will choose a stool test. I'll have them poop in a cup for science, for evaluation. Sometimes I'll do both. Sometimes I will just start with the stool test. If a woman comes, she has all sorts of GI issues. Yes, of course she has hormone issues, but GI is really dominating. I will start with the GI because I know, you know, like that's it starts in the gut, and let's focus on the gut. And oftentimes as we improve the gut, the rest of the body gets a lot better. Maybe not 100%, but significant percent. Other women are like, Nope, I have no GI symptoms, nothing. My stools are like clockwork. I have no heartburn, no issue, but my hormones are a trash mess. I'm like, all right, we're going for the Dutch test. I want to see all your metabolite pathways, I want to see your cortisol through the day. I want to get all this extra information. I want to dig deep.

So you, you, you've brought up the Dutch test twice. This is probably the most common question that I get. So I get, do I need a Dutch? Right? This is like my Instagram is filled with do I need a Dutch? So can we dig deep into the Dutch test and talk about what it is, what it does, what you learn from it? And I would love it if it could include a little talk about the organic acids, which are also included in the Dutch test. What does that mean? What do we learn?

All the things. So the Dutch. First of all, Dutch does not test for Dutch ethnicity or genetics. Oh, that's such a good point. It is an acronym. It stands for dried urine test for comprehensive hormones. Heavy emphasis on the comprehensive. And it is an at home collection test. You literally are given what are like thick filter paper cards. You urinate on them four times in the day, on waking, two hours later, around dinner and before bed, you let the cards fully dry and you mail them off to the lab. Does everyone need a Dutch test? Of course not. But do I run the Dutch test on a lot of people because of how comprehensive it is? Yes, because the people who find me are saying, I don't feel well. I've already been to the doctor, I've been told everything's fine. I have a comprehensive history of a complex history of a lot going on. Like, well, we need a test to match that. When with the Dutch test, like I said, you will get information about your estrogens, your progesterone, your testosterone, your cortisol, but you get that next layer down. I get to see where your testosterone's going. Are you converting it into the downstream metabolites we call them, that cause the hair loss, the acne, the pcos, the anger, the irritation. Because guess what? I have diet and stress reduction techniques and supplements and even medications that can help flip that. I can look at estrogen and see where you're going. It gives me insights into what we call your estrogen detox or estrogen metabolism. So estrogen goes through phase one, it can go through phase two and then it gets excreted out of the body. I want to make sure it's not going down, hopefully the DNA damaging pathway that you mentioned. And guess what? We can use diet choices, we can use some supplements to help, we can use some lifestyle factors to mitigate this, like, how fun is that? I can look at the progesterone and see how your progesterone kind of breaks down. And for some women who struggle with sleep and anxiety and irritation and irritability, it's possible when their progesterone breaks down, they're breaking down what's called the beta pathway, which doesn't really help that. But if you break down the alpha pathway, you're less likely to be anxious. You tend to have better sleep. Or I know if I'm going to put you on progesterone that I need to put you on enough that we can at least support the alpha pathway.

It.

So I just get really cool information even on how to work with your hormone therapy, if that's the option route you go. And then you mentioned organic acids. Organic acids give us insight. The ones on the Dutch test, they give us insights on into certain nutrients. So we have insights into vitamin B12, which I mentioned earlier, B6, glutathione, which is one of your most potent antioxidants. Melatonin, which is one of your other most potent antioxidants and very important for sleep. We think of melatonin only for sleep, but remember melatonin. Melatonin's been around billions of years. That's with a B, as the car commercial says. Like, melatonin knows a thing or two because she's seen a thing or two billions of years, but she's in almost every cell of the body. Like your mitochondria love melatonin, she's super potent and helpful to killing things off that aren't supposed to be there. So Dutch gives you insight into your melatonin, and then it looks at some other markers. It looks at a biotin marker, and it looks at a marker for your gut health. It's called indicin. If your indicin is elevated, it gives me already, like, a screening marker of oh, ruh, roh. Like, we need to be looking at your GI tract. This isn't good. Indicin increases with what we call it sounds gross putrefaction where you're not breaking your food down. Yeah. And it's stagnant and it's spilling over and it shows up in the urine. So we can see really cool markers on that. And then I tie it all together, like, oh, this vitamin impacts this estrogen pathway. Oh, this impacts the testosterone. Oh, here's why. Your cortisol may or may not be following the correct pattern. So we get all this really cool insight, even in the cortisol people don't even believe this. The cortisol pattern on the Dutch test, there are certain patterns that can indicate to me that you have a thyroid problem. So let's say you run a Dutch test and you have a particular. I can go, oh, have you had your thyroid tested in a While? Specifically your T3 because it's showing up. You might have an issue here. So it can even point me in other directions if you haven't had that tested yet. So it's pretty comprehensive.

I want to know why. What is the physiology behind. Why do you look at a biotin on the Dutch test?

Well, a lot of it, biotin, believe it or not. Of course we know of hair, skin and nails.

Yeah, that's what everyone thinks about it.

That's what everyone thinks.

That's why I wanted you to talk about it.

Biotin is also helpful for breaking down carbohydrates in proteins. So we do need biotin for more than just hair, skin and nails. So if you do have metabolic dysfunction and you're kind of a carb addict, you may find that you need more biotin than the average person.

We know that the what happens in our gut ends up really being important in dictating our health. That 70 to 80% of our immune system is housed in the gut. And our biggest exposure to the outside world is through what we eat and what we drink. And through what we eat and what we drink. That has a big effect on our microbiome, which is which are the organisms that we house in the gut. I mean they're everywhere in every contact with the outside world, on every surface. But the majority of our microbiome is in our gut. And the health of our microbiome usually dictates the health of our immune system, so on and so forth. So I, I routinely use gut testing to evaluate people, where they are, what they need, even if they don't have GI symptom. It's kind of my go to start. I'm curious as to what you do about gut microbiome testing, how often you use it, what is your go to test and what do you like about that test?

I do microbiome testing all the time, or I could say when I was in full time practice I did microbiome testing all the time. I consult on a lot of microbiome testing. There are some big companies out there for microbiome testing. I'm curious which one you use. But the big ones, one is called DSL to the GI map. One is called Genova. Another company is Doctor's data. And a fourth one that I really like is Vitrak V I T R A C T. And I've done, obviously I've guinea pigged myself on all of them, worked with all of them. Curious what your favorite one is.

So for years I used the GI map and I still really like the GI map because I think it is not so overwhelming for both patient and provider. I think you get a lot of good information there. Is it the most comprehensive test? Absolutely not. I have used the GI effects in the past. That's more comprehensive than the GI map. Currently I'm using the zoomer.

Oh yeah, I forgot about the zoomer. Yeah, I've never done a zoomer. I think that's why I forgot about it.

Oh, you should do a zoomer. I recently did a zoomer and you know, more isn't always better. And so I may fall back on the GI map again. I'm not certain yet. But right now I'm in the season of the Zoomer.

I in practice for years because GI map didn't exist back when I started practice. I did Genova their what was called a CDSA comprehensive stool digestive.

Now it's called a GI effects.

I think it's called something 360. I think Genova's gonna listen to this and go, how did you get it wrong? But I have a, I actually have a doctor's data kit right here to do, which is quite good. They have excellent feedback. And I just recently, within the last year did a vitrac, which is very fascinating in the way that they do their stool test as well.

So.

Honestly, a lot of them run the same things. They may, their science, their methodology may be different. So if you're a practitioner, listening like, you gotta be aware what their methodology is. There are a few key pieces I look for, like the inflammation pieces, I look for the estrogen piece called beta glucuronidase. And actually it's not just estrogen. It affects progesterone, it affects testosterone, it affects all your hormones. I look to see, I look the often they run gluten markers in there. I look at kind of like your, like a soldier, like how many soldiers you have down there. It's called secretory iga. So as long as we've got some key pieces, you know, that I make sure I look at every time and it's a reputable company, I'm familiar with using it.

Yeah, I agree. And if you could recall, I would love to hear just your experience where you had a Patient whose functional testing really made a difference in their course, that what you learned from their functional testing really dictated what would happen with them. And, and was kind of the, the key, the, the light bulb to, to what was happening and, and how you corrected it.

One that comes to mind was very recently where somebody, there was a woman who had all the key features of pcos, Polycystic ovary syndrome. She'd seen her OB GYN who did testosterone in blood work, ran a testosterone and it was completely normal. And the OB said, well, it's not PCOS because your testosterone's normal. And that's a diagnostic criteria. You have to have high androgens and high androgenic symptoms. She had the symptoms. So she came to my group and we actually ran a Dutch test on her and her testosterone was normal. But all the markers underneath as testosterone can break down into what we call alpha or more androgenic markers were all very in the red. So it was almost like a wolf in sheep's clothing where the testosterone was a fake out. It was totally normal for whatever reason. But as it moved downstream, it just got more and more potent. And so I said, you have, you have pcos and while your testosterone's not high, look, these other markers are high and this is why you have all this cystic acne and you're losing your hair and, you know, experiencing these symptoms. And guess what, there's a lot we can do about it where she had been brushed off as well. I don't know, you know, good luck, like, let's try Accutane for your acne and like, let's try some other stuff with these symptoms. Yeah, I said it's androgenic. It's like we can do something. And oh, by the way, we should look at your insulin, which is not a diagnostic criteria for pcos, although everyone should have it run. And it was like 17 or 18, which of course is much too high for you or me. And that's very stimulatory to androgens. That can increase the, the hormone output of the ovaries. And so we just sort of pieced together as we went down this whole trail. And then on top of it, she had very dysfunctional cortisol. It was very elevated. She had a lot of very chronic stress and inflammation. And of course, cortisol. We love cortisol. We cannot get rid of cortisol. It's very important in our body. But of course, like anything, the goldilocks and the three bears too much. The soup bowl is too big and too Hot. We have a problem. And she had that. And so all that cortisol was just worsening the problems. It was. And encouraging her weight gain. And she couldn't sleep. And she was just so grateful to have on paper to see all this red. Everything was red. And she wasn't worried or scared at all. She was like, I have answers. I have answers that I haven't been able to get for years.

They're tremendously relieved.

Yes.

They're tremendously relieved when they have that piece of paper. And I suspect that you knew what you were going to find.

Oh, I did.

But isn't it amazing that you can have a piece of paper that demonstrates all of this?

Yes.

Right.

Absolutely. People put it on the fridge. Yeah. So, yes. They're so relieved.

Yes.

They're validated.

It's validating. That's exactly right. They feel validated. And for. Probably for these women, it's the first time in a long time that they feel validated because they've been searching for answers that weren't there before.

Yes, yes. Now, I had a case recently with endometriosis. Just quickly. So endometriosis. Well, actually, I should back up. She had severe cramps since the dawn of her period. Severe vomiting, lots of ibuprofen. Put took her out of school. She's now in her 20s. She was consulting, and I said, what had been the options? And she said, well, the birth control pill, which I didn't really want to do, tons of ibuprofen, which is awful. But I keep going back to my doctor, and they're just like, yeah, that's what happens. Like, women get bad cramps. And immediately whenever I hear severe cramps since the start of your period, I'm like, has anyone worked you up for endometriosis? Has anyone looked at any of this? She's like, I don't even know what that means. No, of course not. So there's no lab test for endometriosis. I will start with that. But she also, because the organs are right on top of each other. She also had a lot of GI symptoms, a lot of gut inflammation, so to speak. A lot of gas and bloating, a lot of constipation.

The neighbors upset.

Right? Their neighbors. The uterus, the intestine, everything's right there. And I said, all right, we're going to get you evaluated for endometriosis, and I'm going to have you do a stool test, because I need to see what is growing or going on in your GI tract. And of course, sadly, as you can imagine, her GI test was a mess because between just what, you know, her own GI and then of course, all the inflammation, she absolutely had endometriosis. She had exploratory surgery for sure. And I just thought, God, she's been dealing with this since she was like 14 or 15 years old. And I understand in puberty things, you know, can happen or they just try to blame puberty or they're like, well, let's see if it works itself out. And I'm like, nobody, nobody even thought this through. Like when she hit her mid-20s, nobody was like, Geez, that's 10 years of severe 10 out of 10 cramps. Living on ibuprofen, no one thought to look this up or evaluate it. Anyway, she's doing a whole lot better. We've been working super hard on our GI tract. It's really helping lower the inflammation. It's really helping her hormones. It's really helping her pain get our life back.

Yeah, yeah. And just knowing that that's not normal. It's not normal to suffer. It's just not normal to suffer. And usually we can find answers, right? We can find answers. Okay. I have some rapid fire questions for you.

I love it. Let's do it.

Okay, let's start off with coffee. What do you think? Are you a coffee girl? Are you a matcha girl? Or do you think that we should be staying away from both?

I'm not a coffee girl. Only because it makes me my heart race. So I'm so terribly. I'm a very slow breaker downer of coffee. So I personally can't do coffee.

So you're a poor caffeine metabolizer.

Yes, I am a poor caffeine metabolizer.

Do you also not do matcha?

I can do matcha. I can do green tea. I can do black tea. I do have to be careful with the amount how many cups that I have. And that's my go to. I usually. Jasmine green tea is my absolute favorite. Followed by Earl Grey.

Beautiful. Okay.

But I'm not opposed to coffee. There's some good research on coffee.

Yeah. What is your favorite lab marker? The one that makes you go, oh, that's interesting.

My favorite lab marker. Honestly. And I mean this seriously. It's probably insulin because it's so infrequently run and yet it tells such a story. So when I get it back and it's in the double digits, I'm like, I knew it.

Yep. Totally agree with you. That's mine too.

Okay. Love it.

What is the One supplement that you never travel without magnesium.

I don't even have to think about it. Yeah, I. Yes, I can tell immediately if I don't have my magnesium. People ask all the time, if you were on a desert island, what would you take? Magnesium. Obviously, I wouldn't take vitamin D, because I would. I'm assuming sun would be there and I would be out in the midday sun getting my uvb. Yeah. But I would take magnesium.

What's one wellness trend that you wish would go away already?

All the weird stuff people do with castor oil. And I love castor oil. I've been using castor oil since 1999. I'm such a big fan of it on the skin. And it's, you know, just part of all the, like, liver support and things. But I have just seen on social media some weird trends on what young influencers are doing with castor oil, and I'm like, I don't think it works that way. Like, that's so interesting.

Ooh, do tell. Because I haven't seen any weird castor oil stories yet. What's a weird castor oil story?

To pour it in your belly button and put a band aid over it.

Oh, that is weird.

I'm like, I love castor oil, but if you're gonna use it, smear it. Like, it needs to go from your rib cage, especially your right rib cage, all the way across. Like, make it work. Cover the abdomen. Get the groin.

Have it cover the abdomen, because. Yeah, yeah, I'm. I agree with you. I'm not sure that that's doing very much.

I would. And yes. I just have questions like, yeah. Yes.

Yeah.

Okay.

What's something about your own health journey that you think might surprise people?

My own health journey, One of the big ones, like, if I had to go back and do it again, is I'm gluten free, and I've been gluten free for a very long time. And when I look back at my childhood and allergies and skin and acne and hair and energy and things. If I had. If my family had known to give up gluten. We tried dairy and. But nobody went into the gluten part. Everything got better, exponentially better when I gave up gluten. And the longer I've been off of it, the better. Just the better things have gotten over time. Skin allergies, my ability to eat dairy again, like, all of these things just got so, so, so, so much better. And it doesn't mean everybody has to give up gluten. Like, I Tested positive for it. And so I'm diligent. I am 100% gluten free at all times. And I think that has made a huge impact in how I'm in my late 40s now and how well I feel being almost 50. As I think going gluten free so long ago just cleaned everything up. Really lowered my inflammatory load. My immune system worked so much better. I think everything just was better when I gave up gluten.

Yeah, I agree with you. And I actually take it a step further because I think everyone's healthier without grains. Now, obviously the non. The non gluten containing grains may be tolerated, but I think everyone gets healthier without grains. And grains we have no, as humans, we have no nutritional need for grains. And if we never had another grain again, we would suffer no nutritional deficiencies. So I actually don't think that we should be consuming things that have no potential benefit for us. So I advocate for a grain free diet. That's kind of the space that I live in. And everyone, even if you're not sensitive, everyone feels better when they avoid grains.

I've noticed that as well. I eat a lot of grains in general, but I do eat some and it depends. Like, I tend to alternate. I do sort of rotate depending on my exercise schedule and where I'm in my cycle. Like, things like that.

You're fortunate to be still young. So I was tolerating a little bit of grains when I was your age, but not so much anymore.

And I hear that, I hear that a lot. And I think that needs to be discussed more often. Things we could, like wine or alcohol. I wasn't a big drinker, but I remember my patients who were older than me say, you wait. You wait. You won't be able to tolerate that one celebratory glass anymore. And dang, if they weren't right.

I don't drink because my trainer and I, yeah, my trainer and I, who we've been friends a very, very, very long time and we talk about like, you know, during the days of our, when we were in our 30s and you know, we would have no problems going out and having, having wine at dinner and being fully functional the next day. And you know, f. And we're not drinking wine at dinner anymore because we can't get up the next day, we can't think the next day, we can't move the next day, we can't be our high functioning selves the next day. And it's not worth it.

It's not. And I don't even sleep. Like, the hot flashes, the blood sugar roller coaster. Oh, it's not worth it.

It's not worth it. Okay, so what is your go to hormones response hormone supporting ritual? Like what. What is. What is something that you. That you do to help support your hormonal health?

D. All of the things I. I feel that I have. And I'm assuming you probably are very similar. I have a lot of. Just naturally built in parts of my day and what I eat. Everything from my hydration to the vegetables to the fiber to the amount of protein that I get in a day, how I start and end my day. I. My middle of my day is obviously, like, a lot of people, chaotic. So I start my day with my, you know, my tea and my meditation, little meditation, journaling, just quiet time. I end my day with my sleepy time tea or my holy basil tea. I read a real book in bed and wind down my exercise routines. The friendships that I keep, my relationship just. I. I do a lot. I'm very disciplined. But my husband always says, you're the most disciplined person I know. I'm like, no, there's more disciplined people out there than me. But I do it for a reason. I want to feel really good for the rest of my life. Again, my longevity friend I mentioned earlier, Dr. Eve Henry, she said we're constantly negotiating against the four horsemen of aging or horsewomen. But it's cardiometabolic disease, it's neurodegenerative disease. So, like Alzheimer's. So, yeah, it's frailty. So break a hip, osteoporosis, and then it's cancer. So I don't want any of those. And my family lives a very long time. I have longevity genetics, regardless of what you do. And I would prefer to do it not in a wheelchair, not with a broken hip, not fatigued all the time, not weak. And so I actually incorporate a lot. And I've been doing it so long now that the discipline feels like my normal every day. It's not a burn.

It's your routine you've created.

It's not too much. It's my routine.

Yeah.

And I'm, you know, 80 to 90% good on it most of the week.

So if you weren't a hormone expert, if you weren't the functional medicine testing queen, what would you be instead?

I would be an Olympic equestrian writer.

Whoa.

That's what I decided.

You eclipsed me. I would have been a wedding dress designer, but that's better.

That's cool, too. I don't know Well, I grew up in Kentucky. Oddly enough, my formative years were in Kentucky and rode horses, showed horses, was all in the horse industry, and then went left for college and then moved to the west coast, so got out of horses. But if I wasn't going to be a doctor and I could still be in the entire equestrian world, I could wave a wand. That's what I would be. I would be known as an Olympic equestrian writer.

Wow.

Why not?

Okay. Was there one book or podcast or something that changed your life?

Yes. Most recently in the last year, I read the Surrender Experiment by Michael Singer. It's a book that I feel has to find you or get you or you have to hear it or be ready to read it. And surrendering is something I needed to work on because I am a firstborn type, a controlling, discipline person. And to read that book was so helpful for me and my nervous system in just releasing, letting go. So it's not so much a health book, but from a. If you. If you can identify as somebody has told you, like, you need to relax, control more, you need to surrender more, you need to trust more. It's a great read about that.

Wow. I'm picking it up. I just put it on my Amazon. I put it in my Amazon cart.

I love it.

Okay, my last question for you. If you had a billboard that every woman could see, what would it say?

Actually, you can't see it my screen, but I have it over there. It's called Healing happens at joy. Because that's so good. When we think of the vibrations, our vibrational level way at the bottom, we have anger and fear and jealousy. And at the top, you know, we have joy. Well, allegedly, apparently the vibration of healing starts at the vibration of joy. And I find a lot of people are missing joy in their life. They're going through the routines, they're checking off the boxes. They're struggling with their health, but they're not looking around or finding or seeking out or appreciating joy. And joy is different than happiness. Happiness is kind of external. Joy is that internal, like, warm you to your core, fill up the bucket type of thing. So healing happens at joy.

Oh, my God. So I don't know if you know this about me or have heard me tell this story, because right now, like, my mind is being blown when the universe has people who are vibrating on the same frequency when they put them together. So I talk about cancer as being the shift from going from the chemistry of joy to the chemistry of stress, because that's where cancer happens. In stress chemistry. And what we need to do when we get someone who has a cancer diagnosis and they are in stress chemistry is we need to figure out how to shift them to the chemistry of joy.

Oh, my gosh, I love that. Well, now. Now you can. The healing, the vibration for healing starts at the level of joy. I have this, you know, there's all different. I have this card. It has, like, different levels of, you know, anger, shame, and guilt and apathy are at the bottom. And then, you know, then we move up. Willingness, acceptance, reason, and then like, joy, peace, and enlightenment. So we want to be up here.

Yes. Amazing.

Joy is like, can be the little things in life. People, sometimes people think it needs to be all day. I'm like, no, it's hugging your cat or your dog or your kid. It's the funny meme your best friend sent you.

It's.

It's like watching the daffodils bloom in the spring. Like, joyous can be very little accumulations through the day.

Yeah. Yeah, I believe it. Beautiful. Beautiful. This has been amazing. I want two things from you. First, if for anyone who is watching, not listening, it won't help if you're just listening. But if you're watching, Dr. Jones has a gorgeous painting behind her. Like, gorgeous. So I don't know if you can shout out to the artist or maybe if you can't remember her name, then we will put her name in the show notes because the painting is just beautiful. Absolutely beautiful.

I believe I literally just had to look her up online. It's Amira. A M I R. Rahim. R A H I M am Amira Rahim.

Beautiful. Absolutely beautiful.

Found her on Instagram. This came for sale and I said yes.

Yeah. Love it. Okay. And where can people find you? Where can people learn more?

Yes, my website is drcaryjones.com and of course, I am on Instagram r.carriejones and YouTube. YouTube.com doctorcarryjones but really, everything's on my website. You could just link out from there.

Amazing. Dr. Cary Jones, it was so wonderful to be with you today. Thank you so much for sharing your gift, your enlightenment, your real true soul with my community. Because this is information that needs to get out there. Women need to know what tools they need to empower themselves. And I know that medicine, it takes a long time to change. It takes a long time for mainstream medicine to catch up. Right. 20 years. 20 years. But we can all speed up the process as our own advocates. But the only way that that's going to happen is if we know. If we know what questions to ask, if we know what to ask for. And we kind of have to know the answers in advance. Right. Like if they come back and say, well, you're normal. Well, tell me what that means because I heard that it's not normal to have a glucose of 100 and I don't feel normal. Right. So it's conversations like this that need to happen often so that women know and women know to trust their instinct and to keep going, to keep asking the questions until they get the answers and the validation that they want, that they need and that they deserve.

Absolutely. Absolutely. Well, thank you for having me to talk about all things Labs today.

Absolutely. And for all of you out there looking for answers, I hope that you get a copy of my book, the Smart Woman's Guide to Breast Cancer. Because this isn't just about do you have breast cancer? And do you need support on your breast cancer journey? But the truth is that we all need to know about how to promote our health. Health happens at home with the things that you do every day. And the Smart Woman's Guide to Breast Cancer is your key to your health journey. So please make sure that you pick up a copy for for you, for your neighbor, for your mother, for your cousin, for your sister, for whoever, your friend, for whoever has breasts and needs to know this story and know that I will be back next week, same time, same place. It's Dr. Jen. Bye for now.

Thank you for joining me on this episode of the Keeping abreast podcast with Dr. I hope you found the discussion informative and empowering. Remember, breast health is health, so by staying informed and taking proactive steps, you have the power to optimize your well being. My team and I encourage you to apply the knowledge gained from today's episode to make positive changes in your life and share what you've learned with others. If you enjoyed this episode, please subscribe to our podcast and leave us a review. You're Your feedback and support mean the world to us and help us to reach more people who can benefit from these conversations. Stay connected with me on social media where I share additional resources, advice, updates and announcements related to breast health. You can find me on Facebook, Instagram and YouTube. Dr. Jensimmons and remember, my Jen has two N's. So until next time, remember to stay proactive in the informed and confident in your breast health journey. The key to your health is you.