204: Licorice + Topical Steroid Exposure -- Should You Be Concerned? (PART 2) w/ Dr. Carrie Jones

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This is a two-part interview! Check out part 1 by clicking HERE!

Today I'm continuing my conversation with Dr. Carrie Jones about licorice root, and whether it is a steroid. We also dive into environmental exposures, adaptogens, glandular support, and more!

Or, listen on your favorite app: iTunes (Apple Podcasts) | Spotify | Stitcher | TuneIn | Subscribe on Android

Dr. Carrie Jones is an internationally recognized speaker, consultant, and educator on the topic of women’s health and hormones.

Dr. Carrie graduated from the National University of Natural Medicine (NUNM), School of Naturopathic Medicine in Portland, Oregon where she also completed her 2-year residency in women’s health, hormones and endocrinology.

Later, she graduated from Grand Canyon University’s Master of Public Health program with a goal of doing more international education. She was adjunct faculty for many years teaching gynecology and advanced endocrinology/fertility and has been the Medical Director for 2 large integrative clinics in Portland.

Dr. Carrie is the Medical Director for Precision Analytical, Inc, creators of the DUTCH hormone test.

Join us as we talk about licorice and topical steroids.

Have you been concerned about licorice? Tell me about it in the comments!

In this episode:

  • Why you shouldn't use licorice as a crutch
  • Topical use of licorice root
  • How do environmental exposures come into play?
  • Different botanicals that may have an effect on cortisol
  • Could glandular support be helpful in people nervous about licorice?
  • Are adaptogen herbs also steroids?
  • Cortisol awakening response

Quotes

“There's a lot of research on licorice and how it can increase cortisol. But licorice does not act like prednisone. It does not go in and suppress the brain communication down to the adrenals.” [28:28]

“As a whole plant licorice has been used, like I said, for centuries and centuries and centuries.” [29:35]

Links

Find Dr. Carrie online

Adrenal Insufficiency in Corticosteroid Use: A Systemic Review and Meta Analysis

Use coupon healthyskin50 for $50 off a DUTCH Complete or DUTCH Plus test

Healthy Skin Show ep. 203: Licorice + Topical Steroid Exposure – Should You Be Concerned? (PART 1) w/ Dr. Carrie Jones

Healthy Skin Show ep. 072 Sex Hormone-Skin Rash Connection w/ Dr. Carrie Jones

Healthy Skin Show ep. 153: Steroids + Cortisol: How To Pinpoint Adrenal Problems w/ Dr. Carrie Jones

Follow Dr. Carrie on Instagram

Licorice + Topical Steroid Exposure — Should You Be Concerned? (PART 2) w/ Dr. Carrie Jones FULL TRANSCRIPT

Jennifer: So for somebody who say, let's give an example here of someone going through withdrawal, they're not on any topical steroids anymore, no more steroid exposure. They start doing low dose type licorice and then they feel better and then they stop it and they almost have a flare like a crash. Is that because there's nothing there now to prevent that deactivation of the cortisol or is that literally a steroid rebound thing that's happening?

Dr. Jones: I don't think it's a steroid rebound. What I would guess is that it's like me as an example. If you don't work to address the cause and in that case, it's to get the brain and the adrenals to come back online again. And when you go to the adrenals, we're all the way down in the mitochondria. And so if you're just using licorice as a crutch, because you read about it or you're listening right now and you're like, “Heck yeah, Amazon licorice.” But you don't address the brain stuff, the mitochondrial stuff to get those two talking so that you can make your own cortisol again and not necessarily need the licorice then yes. If you do licorice and you're feeling good and you stop it… Or I should say, and if you're feeling better and burning yourself out.

Dr. Jones: So you have been feeling like crap and you take some licorice and you're like, “Oh my gosh, I'm starting to feel better. I have more energy. I'm back in my body again, let me just go ahead and push it. Let me just go spend all the money in my bank account.” And now you're in a negative again. And then if you stop the licorice, you're in more of a negative. And so it's being very mindful. Licorice is a great bandaid it's a great crutch, but you also have to make sure that you don't take your new found energy and burn it all up, so to speak. And that you are also working to improve the brain connection down to the adrenals specifically, the mitochondria so that you're making your own cortisol and can do it yourself. That's the ultimate goal is that you can do it yourself.

Jennifer: So what I'm hearing, because I think this is important. I want to boil it down to something simple too, that people can… So licorice can in some instances be a bandaid right?

Dr. Jones: Mm-hmm (affirmative).

Jennifer: So you gave us the example of your personal experience, but in some people it might actually be a helpful stepping stone. It doesn't mean that it just delays. If you're doing all the other things and you are really suffering, it could possibly be helpful to especially if… I have clients who cannot sleep, their hair's falling out, they're in a ton of pain. Their skin is super bright red, I personally am of the feeling every person should make an educated decision of what's best for them. And if the place that you're in is not, the situation's not good you cannot be here this might be helpful to get you to a more comfortable place.

Dr. Jones: Stable, yeah. And for some people, they need that boost to do the things to feel better. And sometimes I would have patients that were so depleted on a scale of zero to 10, they were down at like one. And I'm asking them to do some things, to make some changes in their life to help and they're like, “Carrie, I literally can't.” I'm like, “Okay, let's give you a boost. Let's get you some cortisol let's help your body keep some cortisol active longer so that you go from a one to maybe a five and then you can start doing some of the gentler things that either are around I don't know detox or lifestyle or whatever habits you're trying to implement just to give you the oomph.” Because some people, their head is underwater and I just need to get it above water so they can move forward.

Jennifer: Yeah. I wanted to also point out too that there can be other inhibitors of 11β-HSD two. I saw some of your slides, I found some slides things like phthalates, organicnitants, perfluorinated substances. So it sounds like-

Dr. Jones: The bad things.

Jennifer: Yeah. So some very bad environmental exposures can also do the same thing in inhibiting this enzyme that we're talking about.

Dr. Jones: I'll be honest, usually we see that a lot more in the people who have higher free cortisol. So it's not like I have a low cortisol, so I'm going to start drinking out of plastic because it'll raise my cortisol. Don't do that. Let's be smart about this, but what I can see is when somebody has high cortisol and we can't… They're doing all the things they're resting, relaxing, self-caring supplementing what have you, but come to find out they do use a lot of plastic or have a history, or they've got a history of exposure depending where they grew up or whatever it is then that could be the reason they have higher cortisol.

Dr. Jones: But for deactivating, I believe it's skullcap. I believe skullcap is an inhibitor. So if you have high cortisol, so just as an FYI people, I believe skullcap can bring it down. So if you can't sleep and you're like, “Oh my gosh, I'm taking skullcap.” Again, it's dose and person-dependent. And it's one study that I found. And then a part of Magnolia it's the active ingredient in Magnolia is called honokiol with an H, honokiol. And honokiol great for anxiety, great for sleep, you will see it all over the interwebs. But one of the big ways that it works is it reduces cortisol. If you already have reduced cortisol might not be the best thing.

Jennifer: Yeah. And I wanted to point out too. I found some interesting research showing that grapefruit juice can actually inhibit… They didn't specify whether it was the HSD1 or HSD2, there are other things. And curcumin can be inhibitory for HSD1. So it's not just licorice. This is complicated. This is a lot of biochemistry. It's not as simple as just saying, “Oh, well I read this thing online. Or I read somebody's experience.” There is a lot of science behind this and I think you would even say that we're still learning.

Dr. Jones: We are still learning. And a lot of studies aren't done in human, right?

Jennifer: Yeah.

Dr. Jones: They're in cells in a Petri dish, they're in a mouse they're in a fish, which is a helpful initial but mice doesn't always translate over into human. Fish doesn't always… Cell in a Petri dish is great, but it's very controlled environment. It's very sterile. And then you put it in an interacting human in the world and who is not sterile and we could get very different results. So if somebody is listening to this and thinking, oh my gosh, I take curcumin should I stop? No, not necessarily, we don't fully know. We know a lot about licorice. There's a lot of research on licorice and how it can increase cortisol. But licorice does not act like prednisone. It does not go in and suppress the brain communication down to the adrenals.

Jennifer: Yeah. I think that's an important point. It doesn't suppress that communication. It acts in a very different way. Is there impacts to this in a similar fashion on using a topically like, I'll give you guys all one example because I got this question a few times. I was looking around on the interwebs to see if I could find any research.

Jennifer: And there was one study I found it was a placebo-controlled double-blind study from 2019 using… So this was interesting. It was using UV light therapy combined with a cream that include gentian root, licorice root, and willow bark extract. And they found it to be as effective as 1% hydrocortisone. And I'm like, “Yeah, but what did what?” Nobody knows. There are too many muddy factors there. We can't just point toward the licorice root as being the sole reason for improvement.

Dr. Jones: But remember licorice root is a whole plant… and we're talking about cortisol, just cortisol because that's the theme of today. But as a whole plant, licorice has been used for centuries. It's definitely very healing and helpful and anti-inflammatory as an entire plant down to the root, the root is what we use the most.

Dr. Jones: Heck it's a flavoring, people love licorice or they hate it. And so it's good for cough. It's a good demulcent, it's good for illness. It's been used for a lot things, which is why herbalists tend to really like it and use it as a harmonizer. And so again, as a doctor, still I'm careful if I'm giving it as a supplement, if it is a higher dose of blood pressure and potassium.

Dr. Jones: But you will see a lot of people will probably go and look at their sleepy time Tea and go, “Oh my gosh, I didn't realize there's a little bit of cortisone or cortisol licorice.” Or they'll look at their stress relief tea. And they're like, “Oh my gosh, licorice is the last ingredient.” Because herbalists like it, because in a tiny bit it's a nice harmonizer. And so as a topical cream it can definitely be anti-inflammatory. It's not same, same, we're not apples to apples here. It's definitely a botanical route. So “effecting” it like hydrocortisone is different than a 100% “acting” like hydrocortisone.

Jennifer: So this brought up another question and this is sort of an aside. So in this case where let's just say, someone is nervous with licorice. Would maybe a glandular adrenal support be possibly helpful in this type of situation?

Dr. Jones: Yeah. And I will give the caveat. So first of all, a glandular comes from an animal. And they take the, you'll hear of thyroid glandular, you'll hear of ovarian glandulars. So they take the hormone out in theory. And so it leaves behind the tissue, which has the nutrients and other pieces and parts that is to help nourish. That's the idea behind what a glandular does is to help the gland do its job as a nourishing thing. But I will be honest, there are zero scientific studies on glandulars, that I can find.

Dr. Jones: If somebody can find one and send me, that'd be amazing. But I will say I have used glandulars for… I don't even know, 15 plus years with my patients. And I do find them to be quite amazing when I need them. So an adrenal glandular is not a steroid. It is not acting like prednisone. What it does is its more, let's say nourishing. And I do find it to be supportive when you're very depleted. So it's almost stimulatory. And so yes, an adrenal glandular could be helpful. If you were very low cortisol, you've gone off your steroid and you are really, really struggling. Yes.

Jennifer: All right. That was a good question. I didn't think to ask that.

Dr. Jones: It's a great question. I don't find the blood pressure, potassium things with glandulars I will say that people go, “What do you worry about with glandulars?” The biggest thing I worry about with adrenal glandulars is that you don't take it late in the day, because it could cause insomnia just like licorice, licorice can cause insomnia. And it can potentially in some people because it can be extra nourishing, increase anxiety. So just like licorice, you've got to be careful that it could do its job and stimulate you. And if you're low in cortisol for some people that just brings them back from the dead and for other people that push them into a little bit of anxiety.

Dr. Jones: So you've got to be careful. And again, dose-dependent. How many are you taking? Do you take it in the morning as opposed to… Be careful, anywhere past lunch. I personally like glandulars I know practitioners don't for the reason that it's not “evidence-based”. Well, I have 15 plus years of experience with it and I think that plays into my comfort level. I've done a lot of looking into them, a lot of reading, a lot of experience, a lot of patients who've been on them and love them as well.

Jennifer: Cool. Okay.

Dr. Jones: If you're vegan or vegetarian sorry [crosstalk 00:33:49]. Yeah, vegan or vegetarian-

Jennifer: They are glandulars.

Dr. Jones: Yeah. That's the other caveat, sorry.

Jennifer: Or if you have an allergy, like if it comes from a pig or cow you have to be careful with that.

Dr. Jones: It is different than dairy allergy. So I have had people say, “I can't do dairy.” I'm like, “No, this isn't milk it's glandular.” But if you don't do beef, you react around cows I don't know some people know, like you're allergic cats, you're allergic to cows so maybe don't do that. Yes.

Jennifer: All right. So I have one final question, but it's like a group of questions more so because it has to do with other adaptogenic herbs. So again, I started looking other things up because I have seen whisperings online that ashwagandha is a natural steroid and that ginseng is a steroid and that Rhodiola is a steroid. And look to be fair, I can understand a layperson going online and looking up ashwagandha and seeing that it contains naturally occurring C28-steroidal lactone triterpenoids. And they see the word steroid in there and they're like that has steroids. So do these adaptogenic herbs that are commonly used in a lot of different formulas and have been used for centuries?

Dr. Jones: Beyond. Yeah.

Jennifer: Are they steroids?

Dr. Jones: Again, it's not apples to apples by any stretch of the imagination. It's not like if you take ashwagandha that is cortisol or that is even a fake cortisol, it's prednisone not at all. And it doesn't suppress the brain adrenal axis in fact, it's the complete opposite. It usually works on the brain and on the adrenal glands on the immune system and on the neuro system to harmonize, to communicate, to interact.

Jennifer: So I think what I've heard you say is the steroids suppress the signal between the brain and the adrenals essentially.

Dr. Jones: Actual steroids.

Jennifer: Actual steroids.

Dr. Jones: So remember steroid hormones come from cholesterol and they form into these hormones, cortisol, testosterone, progesterone, estrogen. What we have is that we have a feedback loop so that if you have too much, let's say cortisol. If you have too much progesterone whatever, there's a feedback loop. So the body says, “Oh wow, that's a lot. I'm going to slow it down or shut it down.” And it does happen in your own body. So if you have a lot of your own natural cortisol, you make it, you're super stressed out. It's a terrible time. Over time, the body goes, “Whoa, that's a lot. I'm going to shut this down.”

Dr. Jones: And your cortisol goes down, down, down. Same thing if you're taking what we call an exogenous cortisol or a steroid cream injection, pill, inhaler, doesn't matter. It comes in your body and it looks enough like cortisol and that feedback loop kicks in and it goes, “Woo, that's a lot of cream. You've been doing it for months now, I'm going to shut this down.” And down goes your cortisol. When you take ashwagandha though, that feedback loop does… It's ashwagandha or rhodiola or eleutherococcus it doesn't enact the feedback loop because the feedback loop is specific like a lock and key.

Jennifer: That is a really important point. I just wanted to make sure, because this was a lengthy and I know kind of nerdy, but it was good nerdy conversation. And I really want to make sure too that we didn't lose people. We're not trying in any way, shape or form, and you can hear that Carrie loves to break things down and make it understandable for you. We're not trying to lose you guys. We're not trying to say that anyone's fear is irrational because we understand, this is traumatic. What you are going through is incredibly traumatic.

Jennifer: And I know for practitioners who are listening, who are trying to support people going through this, it's traumatic for everyone. Everyone's just trying to help. We're all trying to figure out how to get you more comfortable. And it becomes like you don't trust your body anymore. You don't trust other things. You become afraid of food. You become afraid of everything in your environment because you feel like you react to everything and then you can't sleep. And it's this awful nightmare. So this-

Dr. Jones: And I will insert that caveat, you can still have reactions to ashwagandha, rhodiola, what have you, but it may not be what you thought it was. You thought you were taking ashwagandha you had a bad reaction it must be because it's a steroid. Now, I hope you understand the whole feedback loop steroid hormone cholesterol. It's not a steroid, ashwagandha is not but ashwagandha is in the night shade family. So if you have a sensitivity to nightshades that could be the reason you react.

Dr. Jones: Rhodiola can be stimulating and it can be drying. So I've had people say, “Oh gosh, I took rhodiola and my anxiety got worse and I felt more amped up. And by the way, my eyes are dry.” I'm like, “Oh yeah, rhodiola can do that.” And I'm not laughing at them. I'm like, “Yes.” So again, it's not acting as a steroid, it is a known side effect of a botanical this one in particular, others love ashwagandha. Others love rhodiola. So if you've tried any of these things and you're like, “Well, I didn't like it. My body didn't like it.” Very valid 100%. Probably not because it was a quote steroid because you understand that now it's probably for other reasons.

Jennifer: Yeah. So I just want to thank you because this has been lingering questions, especially my clients have had them. I see this online and I have found also too, I do want to mention this, the DUTCH test has been very helpful for clients, especially, even if they're not ready to do a full panel. Just the cortisol awakening response for people in this boat can be really helpful to understand how far along they are, how deep they are into this when they start. And are we making any progress? Can you just explain really quickly what that test is, Carrie?

Dr. Jones: Yes. So the cortisol awakening response which you alluded to earlier, it's a natural response we have in the morning when you wake up and you open your eyes and light comes in, you go from I'm conscious because my eyes are open to alert and that process takes about 20 to 30 minutes. And is in that timeframe your cortisol should go up in a normal, natural fashion. I'm not talking through the roof, I'm talking it just goes up. And then once it's up and you're awake and alert after about thirtyish minutes, it goes down through the rest of the day. So it's your awakening response. Get your butt out of bed, lower inflammation. You've been fasting all night long. Let's support your blood sugar. That's why it goes up to protect you. So we test it, the way we test it is through cotton swabs that you suck on like a piece of candy.

Dr. Jones: So you wake up in the morning as soon as your eyes open up, or your alarm goes off you pop the cotton swab in your mouth, get it wet, stick it back in the tube. 30 minutes later you grab a different tube stick that cotton swab in your mouth, get it wet, put it back in the tube. 30 minutes later… So we're going to do three collections in 60 minutes. Do the same thing pop it in your mouth, get it wet, put it back in the tube. The reason we do three collections right away is I'm trying to see how high does your cortisol go up? Does it go down? Does it flat line? Because it's that rapid response first thing in the morning that we need to see. And just as you were saying Jenn, it's that's what helps you and other practitioners who are working with patients are you back online? How much more work do we have to do?

Dr. Jones: Is this working? Or how flat-lined are you? And so it's really nice to zoom in right there in the morning. Now, the test continues the test you'll do it around dinner and you'll do it around bed because the entire circadian rhythm is very important. We want to see what's going on at dinner? Why are you tired in the afternoon? What's going on at bed? How come you can't sleep? So we do want to see that cortisol too. So that's the cortisol awakening response.

Dr. Jones: And it's nice to know because any kind of treatment you do for the cortisol awakening response is very timed. So if your cortisol doesn't go up in 30 minutes, then whatever your practitioner is going to have you do generally we do within that first 30 minutes, that's our window. It's like, “All right, let's get it up. Let's boost it. Let's have the hurrah in the morning. So let's do something in that 30 minutes, which is really nice.”

Jennifer: Yeah. And believe it or not, you can go to Dutch… Is it dutchtest.com?

Dr. Jones: Yes — dutchtest.com!

Jennifer: And you can actually order that test yourself you don't necessarily need a practitioner to order it for you. And I will say this, you do need a practitioner to help you work on it because-

Dr. Jones: Interpret it.

Jennifer: Yeah, they're complicated tests.

Dr. Jones: It's comprehensive.

Jennifer: Yeah, it's comprehensive. And there's a lot of times different pieces to this puzzle. And we've talked about several of them in our other episodes, which we'll link to in the show notes. And you guys have some really great resources as well for practitioners who are looking to learn more about this as well. Because I just want to say that, that I know that people who are listening to this are not just those going through TSW, not people who are just concerned about steroids.

Jennifer: I know for a fact, because I had so many practitioners who reached out to me before this interview were like, “I need to hear this. Let me know when it's up, because I want to hear what Carrie has to say.” So I know that this can be really helpful. And I'm so appreciative that you were willing to come back on the show and do this and share your knowledge to help hopefully provide people a different perspective on what's going on here. That way they can make an informed decision that they feel comfortable with. So I just want to thank you so much.

Dr. Jones: Absolutely, I'm so honored that you had me come back on because this is what I know. Steroid physiology, steroid meaning hormone, steroid, hormone physiology I've done a lot of study in to try to get it right, but it's an ever-evolving field. And that's what I love about it.

Jennifer: Well, we'll have to have you come back some time. I'm sure we'll find some other topic because you always drop a ton of knowledge bombs. And of course, everybody can go to dutchtest.com to learn more and yeah, that's where you… And you can find Carrie online @dr.carriejones on Instagram. She's an amazing account. Tons of content. You guys will love her and I love her she's great, thank you so much for being here. I appreciate it.

Dr. Jones: Thank you!

REFERENCES

  1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3498851/
  2. https://pubmed.ncbi.nlm.nih.gov/8504732/
  3. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0049976
  4. https://www.sciencedirect.com/topics/pharmacology-toxicology-and-pharmaceutical-science/liquorice
  5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7168306/
  6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6255378/
  7. https://www.medicinenet.com/corticosteroids-oral/article.htm

“There's a lot of research on licorice and how it can increase cortisol. But licorice does not act like prednisone. It does not go in and suppress the brain communication down to the adrenals.”