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

Adrenal insufficiency is a relatively new term for when the adrenal glands do not produce enough cortisol. Did you know that steroids can play a role in cortisol suppression?

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

My guest today is Dr. Carrie Jones, 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 how long-term exposure to steroids (creams and inhaled) has the potential to affect cortisol levels.

Have you experiences adrenal insufficiency as a result of long-term steroid exposure? Let me know in the comments!

In this episode:

  • What are hydrocortisone and cortisone cream?
  • Can topical steroids cause problems with brain signaling?
  • How does steroid use affect cortisol production?
  • How can the DUTCH Test help?
  • Are cortisol and hair loss related?

Quotes

“Hydrocortisone is really hydrolyzed cortisol. So hydrocortisone is really cortisol in a tube.” [3:34] 

“Cortisol is really responsible for our blood sugar regulation. It's really helpful for our immune system. It's really anti-inflammatory, it's really important to help us switch us into alertness in the morning. It's really helpful to monitor in effect auto immune disease. It's really important for memory and mood. And it's like Goldilocks, we don't want too much, we don't want too little.” [13:14]

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. 104: Topical B12 For Skin Rashes w/ Dr. Peter Lio

Follow Dr. Carrie on Instagram

153: Steroids + Cortisol: How To Pinpoint Adrenal Problems w/ Dr. Carrie Jones FULL TRANSCRIPT

Jennifer: Hi everyone, welcome back. Today I have a guest with me who has been on both the Healthy Skin Show before, as well as The Eczema and Psoriasis Awareness Week. Her name is Dr. Carrie Jones. You guys might recognize her because she is connected to something called the Dutch Test. And we are going to talk about that today because the topic we're discussing, I think the Dutch Test could be incredibly helpful for people that are having trouble finding answers in other avenues, especially when it comes to exposure to all of these different steroids, inhalers, all sorts of things around steroid use. So Dr. Carrie Jones is an internationally recognized speaker, consultant and educator on the topics of women's health and hormones. She graduated from the National University of Natural Medicine School of Naturopathic Medicine in Portland, Oregon, where she completed her two year residency in women's health, hormones, and endocrinology. Later, she graduated from Grand Canyon University's master's of public health program with a goal of doing more international education.

Jennifer: She was adjunct faculty for many years, teaching gynecology and advanced endocrinology fertility, and has been the medical director for two large integrative clinics in Portland. She is currently the medical director for precision analytics, and they are the creators of the Dutch Hormone Test. Dr. Jones, thank you so much for being back on the show.

Dr. Jones: Thank you so much for inviting me. I'm glad that we had that conversation in New York and here we are.

Jennifer: I know we were nerding out, all and out, cortisone, cortisol, topical steroids, all this stuff. Because I started to think about people who have had longterm exposure to these things and my audience, many of them have, right? Because we don't unfortunately get the best guidance all the time. Sorry, docs. But it's true. A lot of times dermatologists don't give the best warnings to their patients right now because it doesn't seem to be a standard about how to appropriately use topical steroid creams.

Jennifer: And some folks also have asthmatic issues. So they're using inhalers and other medications to help deal with their allergies that also contain steroids. And so what happens is, people end up with this situation of steroid withdrawal. So when it comes to the skin, it's called topical steroid withdrawal. You guys know that I've talked to other people about that. But as I was talking to Dr. Jones, I was asking her, I'm like, could the DUTCH Test help us better understand what's happening? And she's like, “Yeah”, sent me this amazing study, which we'll touch on today because I think you guys are going to find this fascinating.

Jennifer: But first I want to ask you a question so that we can clear up some misinformation about what these different medications are in reality. So we've got hydrocortisone, we've got cortisone cream. What are those?

Dr. Jones: It's so frustrating because … So the body makes cortisol, right? Cortisol is our big stress hormone and it's incredibly anti-inflammatory. So what the pharmaceutical industry did is they created hydrocortisone cream. Hydrocortisone is really hydrolyzed cortisol. So hydrocortisone is really cortisol in a tube, is what it is, because cortisol is anti-inflammatory. And it's a naming thing by the pharmaceutical industry. So it's really confusing when you read the ingredient label, when you flip your little tube over of hydrocortisone, and it says hydrocortisone 10 or three or five or whatever it is, it's actually cortisol that you're putting on your body.

Jennifer: And this is cortisol that is normally made by your adrenal glands.

Dr. Jones: Normally made by your adrenal glands. And then there's the steroid like you take prednisone, but you can put that in a cream as well. So this steroid is different than cortisol and has a suppressive effect on the adrenals, on the HP, the brain [inaudible 00:04:33] adrenal axis. So you can actually give yourself cortisol or you can suppress yourself cortisol depending on which cream you have.

Jennifer: And for people, just to be very clear on this, if you are applying topical steroids. Okay? So you're applying cortisol to yourself. Could that cause problems with your brain signaling?

Dr. Jones: Yes.

Jennifer: And communicating to the adrenals?

Dr. Jones: Yes, absolutely. For sure, it can. If you're taking the steroid form, just like you would have a steroid nasal spray or a steroid inhaler, steroid pill like prednisone, if you're taking a steroid form of the cream for your eczema, for psoriasis, for your rash, whatever it is, over time, what it does is it goes up to the brain and it suppresses the signal to make cortisol out of your adrenals. So now your own production of cortisol goes down because whatever steroid you're taking is causing a suppression at the brain level. What we call it and the study I sent you, it's called adrenal insufficiency. So it's the inability to produce cortisol because the brain is like, oh, she's on steroids right now. Got it. Yep. Won't make cortisol.

Jennifer: And shuts it down. And it's not like you can just flip a switch and turn that back on. Right?

Dr. Jones: Not, not usually. I mean, it depends right? If you use the cream one night, nothing's probably going to happen in a night, but most people don't use it just for one night. Most people are using it pretty consistently for weeks, months. I've heard years, you know, pretty consistently, maybe not every day, but four or five times a week is really pretty consistent for their rash or their thing going on. And then as a result, they have all sorts of adrenal issues. Now, maybe they're struggling with their cortisol production. They're tired, they're less motivated. They get more infections. They're struggling with autoimmune stuff because they've suppressed the cortisol production out of the body, maybe blood sugar issues, weight gain. I mean, it can be a lot of longterm things that come out of it depending on the person.

Jennifer: Well, I wanted to share too, so the study we're talking about is called Adrenal Insufficiency in Corticosteroid Use: A Systemic Review and Meta Analysis. And I will link to this in the show notes. That way people can actually see this particular study that we're talking about. There was a couple of things that jumped out at me. So the one statement that really took me back was, “Neither treatment dose and duration nor administration form, nor random serum, cortisol measurements seem to accurately predict the development of adrenal insufficiency after the use of corticosteroids.” I was like, wow, there is literally no formula whatsoever to figure out who's going to end up with this. Which is probably one of the reasons why we're literally in the infancy of trying to get some sort of warning added to these products.

Dr. Jones: It's why, if I used steroid cream and you use steroid cream and maybe after four weeks, nothing happened to me, but after four weeks, not even realizing it, you're like, “Man, Carrie, I'm so tired. I think I might be getting sick. I don't know what's going on with me. I don't feel well.” And I'm like, really? I'm not. I feel just fine. That quote just embodies that. You can't compare person to person. You can't compare well, it's just cream. It's just cream. It's it's not like I'm taking a steroid pill. It's not like I got an injection. Yes. The pills, the injection's way stronger than this, this study shows that it's much, much stronger, much more likely to cause adrenal insufficiency, but you could also be in the small percent of people where the topical cream causes the insufficiency.

Dr. Jones: And you may be thinking, well, I just apply it to my elbows at night. It's not like I'm taking prednisone the pill or it's not like I got a joint injection. It's like, you're right. You didn't. But it to you, it didn't matter. Your brain was still like, oh, too much. I don't like this. And shuts down the production for cortisol.

Jennifer: Yeah. And I also wanted to point something out that you actually brought to my attention. So in this study they discuss what a short term use of this is. Whereas just to preface this conversation, I had Dr. Peter Lio on the show, I'll link to that in the show notes, where he discussed appropriate topical steroid use. And he said something to the effect like, “Well, basically five to seven days would be an appropriate timeframe. And then you really need to be off the steroid cream for two to three times the amount of time that you're on it. And then you can possibly go back on it.” We have to be much more judicious and more contained. And yet this study is saying that a short term duration is-

Dr. Jones: 28 days or less consistent. Moderate duration is 28 days to a year. And then longterm is considered greater than a year. And in the study, there were people that were using these steroids, whether it was topical or inhaled or nasal, or what have you for greater than a year. I mean, they're part of the study.

Jennifer: And the other thing to point out too, is that this isn't just about topical application, right? So if you are using various products, it could be in capsule form, tablet form creams, you're inhaling because you got stuffy nose. So you might be in your nasal spray or an inhaler, all of these different forms add up together. Correct?

Dr. Jones: Yeah. And that's what this study says too. And multiple people often go multiple routes. So you have exercise induced asthma, or maybe it's that time of year, it's spring. And so you're using your steroid inhaler more often, but because it's spring, you're also out in your garden and the histamine and the allergies is flaring up under eczema. And so now you're back on your topical cream, because again, it's allergy. So you've added back in your steroid nasal spray, because your nose is drippy and you're congested. So now you have an inhaler and a nasal spray and a cream routinely, or maybe it's somebody who has rheumatoid arthritis or something really significant. And they're doing prednisone every day to keep the rheumatoid arthritis in check with their practitioner. And oh, by the way, they've also developed eczema or something.

Dr. Jones: And so their doctor's like, “Here, just use the steriod cream. It'll be fine. Just put it on topically. You'll be okay.” So they have this really potent oral, and then they've added in topical or they're on oral and oh, it's spring time. I'm going to go ahead and use my nasal spray. But the doctor's like, yeah here sure here's a steroid nasal spray to add on top of it. And it's more common than we think, because some of this stuff is over the counter. And the nasal sprays are over the counter and inhalers are pretty routine. And so we think of them like ibuprofen or Tylenol. Right? We're just like, I'll just pop one. I'll just pop a few, oh, I'm exercising. I'll just hit my inhaler real quick. It's no big deal. And it may not be a big deal or it may be the biggest deal ever. And just the quote you read, we can't quite predict it, but we sure feel the symptoms.

Jennifer: Yeah. And so how does that happen then in real life, as far as hormones are concerned? So normally with a cortisol, the healthy cortisol pattern, you have this elevation in the morning, and then you slowly drop down toward evening time. So what would happen to somebody who has this … I guess they've suppressed things so much that now the body's really confused, what's going to happen?

Dr. Jones: So they tend to have, just like you explained, the normal pattern looks like a mountain. So it comes up to a point like a mountain, and then you get this gradual slope. And instead, what can happen over time is they start to look like maybe a flat hill or a low hill, or maybe just a road, it's just a straight line.

Jennifer: Driving through Kansas.

Dr. Jones: Right. You're just driving through Kansas right now. Exactly. And so you don't get that nice bump and you don't get the healthy response because cortisol gets a bad rap, but cortisol is really responsible for our blood sugar regulation. It's really helpful for our immune system. It's really anti-inflammatory, it's really important to help us switch us into alertness in the morning. It's really helpful to monitor in effect auto immune disease. It's really important for memory and mood. And it's like Goldilocks, we don't want too much, we don't want too little. And then we have too little, all of those things I just listed off can be affected. And so you may be thinking, oh, I'm just a little bit tired and not piecing together that your worsened autoimmune and your worsened mood and your worsened memory, and you're worsened inflammatory flare is all related to a degree to that flattened cortisol, because you can't get the rise. You can't get the stimulation that you need because of the steroid.

Jennifer: And so with the DUTCH Test, because that's the one thing that I thought I started to think about this. I'm like, how could we really visualize what the heck is going on? And I've had some clients who are in topical steroid withdrawal. It's very difficult a lot of times to support them because they want to try all these things. And a lot of things might work. Some things may work for some people, some may work for others, but overall, the overarching problem for many people is that they have this really messed up cortisol response.

Jennifer: It can take sometimes years. And I don't even know if people fully recover. We still don't fully understand this whole thing. So you have these different urine tests that you can do at home. Okay? So I think that's really great that they're very accessible. If someone was like, “I really want to take a look at this. I know that I have topical steroid withdrawal or I have a lot of the symptoms of TSW. I have a lot of concerns.” What would probably be the best thing for them to check? I know you've got the DUTCH Complete, the DUTCH Plus, is there any particular part of those panels that would be most beneficial to somebody that is dealing with this?

Dr. Jones: Yeah, so absolutely. If it was my patient, I would direct them towards the Dutch Plus. The Dutch Plus is a combination of urine, so it's really easy collect urine on piece of unfiltered paper, let it dry throughout the day. And in combination we do salivary cotton swab. So basically you pop a swab in your mouth, suck on it like a piece of candy, stick it back in the tube. And you're going to do that a couple of times throughout the day as well. And the reason that I want both is out of the urine part, I want what's called metabolized cortisol. It gives me an idea if you're able to make cortisol in general. Metabolized cortisol, it's a rough look of how much cortisol you make in the day. So can you make it? It answers that question.

Dr. Jones: And then out of the saliva, out of the cotton swabs, I get what's called the cortisol awakening response. And we time it so that I can see how healthy of a mountain do you make in the morning. Do you go up and then down? And then through the rest of the day. So that tells me your pattern and it tells me what's free and available. And it's the free hormone that can bind to receptors and do the things. You want the free to be healthy because that's what makes you have energy and fight infection and deal with inflammation, all this stuff.

Dr. Jones: So by putting the two together, I can now answer the question. Can you even make it? Is the brain talking to the adrenals? And then, how much of it is free and available? And then, the free and available you have, is it timed appropriately? Do you go up and then down? Do you just stay down? Are you down than up? What's happening here? And by knowing all that information, now I can be a lot more precise in, okay, we need to really support your brain. We need to really support your patterning in timing of supplements and timing of lifestyle interventions and timing of sleep and timing of light exposure. And to really help dial it in for people and hopefully speed up the recovery.

Jennifer: This is not an adrenal reset problem, it's actually a brain reset problem.

Dr. Jones: It's actually a brain problem unless randomly along the way that they've happened to develop Addison's disease. Addison's disease is true auto-immune. Your actual adrenal gland cannot make cortisol. All of your cortisol production, otherwise, as at the direction of your brain, it's your brain going now, make it now. Oop, don't make it now. Okay, now make it now. And so by seeing this patterning and seeing how much you can make, give us a decent indicator of what's happening at the brain level, and we can do things to help it, which is great.

Jennifer: So have you guys noticed, and I just don't know, because I haven't done a DuTCH Test myself in a couple of years, but on the form, because there's a form right? That everybody has to fill out. Is it important if someone has had massive exposure to oral, inhaled, topical, et cetera, steroids, is that something important that you, as the lab needs to know in order to take that into account?

Dr. Jones: Yeah. And we have a box, we actually have a box that they check and say, yeah. So if they're actively on it, check the box and then they write in what form and dose and when they last took it and how often they took it. Yeah, absolutely. It's interesting because I find that it really fits that quote you read. I mean, we have people that say, “I do a steroid inhaler two to three times a week”, and it doesn't affect their adrenals at all. The HPA axis looks great. Not an issue. I still feel like you should probably get to the root cause of why you need the inhaler so much, but still, not affecting you. And I have other people that are just dumbfounded. They're like, “But I only use this topical, I don't use this topical very often.” And I'm like, “Well, how long have you been using it?” “Oh, years. But I only use it once a week.” I'm like, “Well years, once a week for you seem to have really affected it in part.”

Dr. Jones: Obviously lots of things go into the brain, adrenal communication, but steroids are a big player. Nothing can beat a steroid, and people will ask me, well, what vitamin can I take? What supplement can I take? I don't have a choice. I have to take this steroid. I'm like, yep, that's fine. If you don't have a choice, the doctor says, they're like, well, what supplement can I take? I'm like nothing beats a steroid. None of my herbs, B vitamins, vitamin C, ashwagandha. Nothing beats a steroid. And so it's a lot of cleanup which your listeners are experiencing.

Jennifer: And can I ask you too, and I'm asking because I actually don't know. You're the expert on all of this. So that's why I love and appreciate having you here. If you have this massive exposure or longterm exposure or whatever exposure is just too much for your particular system can that also trickle down to impacting your sex hormone balance as well.

Dr. Jones: It might, in some people, I tend to see it more in the big players, like your oral prednisone, your repeat injection. Maybe you had your right shoulder injected and then you needed your left shoulder injected or maybe both knees. And so I do in that case, maybe tend to see a suppression a little bit of the sex hormones. Not always, but sometimes we'll see a trickle down there and we'll see it in men. They'll be on prednisone or they'll get injection for joint pain. And then it'll affect their testosterone and it may just be transient for a little while or sometimes it may be more longer term, depending on what else is happening in their life. It's not automatic with steroids. It's not like, oh, take steroid. I guarantee you, your cortisol and your hormones are going to be low, but we do see it.

Jennifer: And one other question, and I don't know if you can even answer this, but a lot of the women that I've worked with TSW, at least notice that their hair starts falling out. Is there any connection between your inability to produce cortisol as a result in hair loss?

Dr. Jones: Actually, it's the fact that you were probably on it and it's affecting your hypothalamic pituitary adrenal axis right in your hair follicle. So you have cortisol production right locally in your hair follicle, believe it or not. So systemic cortisol affects your hair, cortisol. And then you have right in the hair follicle. We call it the HPA axis, even though we know there's no brain, it's just, we don't have to call it yet because it's relatively new find. So what happens is, when you have high doses of cortisol, even the steroid, it can push the hair from the growing phase, into the resting phase and it can do it prematurely and it can even push it into the fall out phase. So there's several phases of hair growth. And you work through the phases depending on the different strands of hair where you are.

Dr. Jones: So in high stress situations where there's a lot of cortisol or even with steroid use, what happens is it directly impacts the hair follicle itself. It can affect the stage of hair growth you are in, it can push it to the the next stage. And then as a result, you can have hair loss when you're going through the withdrawal.

Jennifer: Wow.

Dr. Jones: Yeah. And it's often, hair follicle hair cortisol is a reflection of the last two to three months. So if you have been on topical steroids for the last two to three months, and then you stop them and your hair is falling out now, it's what's happening back then in combination with any stress going on right now, right in the follicle.

Jennifer: Do you have any suggestions of, let's say someone has this massive exposure and bam. They've got this flat road on their Dutch Test. So your adrenals are just, I don't know, man. I don't know what I'm supposed to do. I feel like I'm on break, but I don't know. What are some potential things that listeners should consider doing that could be helpful? I mean, obviously this is general, I want to make [crosstalk 00:23:56] these are general suggestions. And obviously you need to work with a practitioner because A, the Dutch Test is really complicated. I'm always learning something new. It's complicated. So it's not like you're going to get these results back and it's going to tell you every little thing you should do you really need. And especially with hormone stuff, don't mess with hormone stuff yourself. You can really throw things off. Clearly we're putting cortisol on ourselves and there you go, simplest example of how you can really mess things up. But what are some basic things that people could consider if they've got that really low hill or a flat line as a result of this massive exposure?

Dr. Jones: So this is a great question. And it's, I think really easy, that you can do at home. The up and down of cortisol is known as their circadian rhythm, right? What's up with the sun down with the moon and I'm talking to non-shift work people. So normal day work people up with the sun down with the moon. That's how our circadian rhythm works. In the brain, when you get light into your eyes in the morning, it's called entrainment. Light in the morning in entrains your body to produce cortisol and it helps reset your rhythm for the day. Darkness at night, resets it to your geophysical location and to a degree, the timing. So we're on a 24 hour schedule, but actually believe it or not, our brain works, it's a little bit more than 24 hours, how our brains work or these genes work.

Dr. Jones: And darkness at night is like, okay reset your clock back to 24. We only get 24 hours in the day, but the brain thinks we have like 24 hours and 11 minutes. And so it's like, no, no, no, no, 24. And then we start the clock over, literally they're called clock genes. So what I tell people, is use the lightness and the darkness to your advantage. When you get up in the morning, open your blinds, open your curtains, go outside, get some natural light exposure, get online and buy a inexpensive full spectrum light box and turn it on first thing in the morning, when you wake up. Buy the full spectrum alarm and use that as your alarm. Don't use your phone, use a full spectrum alarm that gradually brightens the room, which works better if you and your partner, if you have a partner that get up at the same time or you're the second person to get up, otherwise it's annoying.

Dr. Jones: So that's what I tell people in the morning, use the light to go outside, open your blinds, use a full spectrum box. And then at night, use the darkness to your advantage. So red starts to stimulate melatonin production, think like fire, right? People would have fires at night. Candle light, our blue light blocking glasses, which are kind of a reddish orange tint and then sleep in complete darkness. So no nightlights, no computer lights, no blinking lights, no alarm clock lights, no neighbor light that shines in your window. Nothing. You want it in complete darkness, wear a sleep mask if you can't get any of that to turn off because you want complete darkness to reset your circadian rhythm. It will take time. It's not automatic, although some people tell me within a couple of days, they noticed a huge difference, but it can take a couple of weeks to retrain the body of this. But just using the free light or maybe a 20 or 30 dollar light box and the darkness at night with a 10 dollar sleep mask can make a huge difference, huge.

Jennifer: Can I ask you one quick question?

Dr. Jones: Yes.

Jennifer: Some people have issues with sleeping through the night. So insomnia is one of them in extreme cases. So what would somebody who has really has legit difficulty even sleeping do?

Dr. Jones: Right. Because sleep is so important, then to getting our cortisol awakening response up in the morning. So not only do light/dark help with our rhythm, but the actual act of sleeping helps our morning production of cortisol. But if you're a flatline person and you don't sleep, it makes sense. They go hand in hand. So now we're trying to do anything you can do to get you sleeping. So are you not sleeping because it's hormonal? Are you not sleeping because maybe, believe it or not, your cortisol goes up at night. Are you not sleeping because you don't have enough progesterone? Which is calming. Are you not sleeping because you have a blood sugar issue or maybe you drank alcohol before bed? You're drinking caffeine too late in the afternoon. You're stressed out so your mind is racing. It can be a variety of things.

Dr. Jones: And so what I'm trying to do then is use calming herbs, using camomile, using lavender, using holy basil, using magnesium before bed to just try to induce that calmness, avoiding alcohol, avoiding caffeine, again, sleeping in the complete total darkness, using earplugs if you need to. For a lot of people, I'm suggesting you have to evaluate your sleep hygiene, who sleeps with you, who's waking you up, who's snoring, who's interrupting you in the middle of the night. And I know it's really tough. And sometimes you have to prioritize. I don't have a supplement for that, right? So I'm like, you have to prioritize your sleep if you're in this really bad cortisol situation over anything else. So I've had patients sleep in the guest room for a month just to get it back, just to retrain their body, get it back and then move back in to their room with their partner.

Jennifer: And I guess the other piece to this is if you are waking up in the middle of the night and you're just done, right? In the process of trying to retrain, that means you're not turning the iPad on. You're not staring at your phone. So would the light option be literally candle light if you are up? I mean, I'm just trying to think practically, because I'm thinking of the person that's like, but worst case scenario, what do I do?

Dr. Jones: Blue light blocking glasses.

Jennifer: Okay.

Dr. Jones: Try the blue light blocking glasses. It's funny. I have a lecture that I'm giving here soon. And one of my slides says, if you go to the bathroom in the middle of the night, don't turn on the light. Especially if you have sleep issues because when you flip on the light and you're 45 or 60 watt light bulb comes on, or your vanity comes on, and now what you've done is you've taken your darkness away and you've turned on the light and the brain goes, oh, all right, let's entrain to this. And even though you can fall back asleep sometimes in some sensitive people, it completely screws their circadian rhythm up. And then the morning they're tired or groggy or they just don't feel like they have a lot of oomph when they get up to go to the bathroom.

Dr. Jones: Not everybody. I mean, obviously some people wake up, turn the light on, have no issues, but I definitely get the feedback from people who say, when I go to the bathroom in the night, turn the light, then it's a real problem. It's real shocking to my system. And then I struggle to go fall back asleep.

Jennifer: And so I assume you agree with me, when someone is in this place where they've got this adrenal insufficiency as a result, you really do need help. Right? Would that be your advice?

Dr. Jones: Yeah, absolutely. And especially because I know I said nothing can beat a steroid, but at this point for a lot of people they're wean off or they've come off and they're experiencing the withdrawal and there are various levels and degrees of strength when it comes to herbs or glandulars or brain support to really help get things back online, right? To really help improve communication, talking you through these light, dark, circadian rhythm support. There are other things that can be really helpful. And we're just talking about cortisol right now. What happens if you're also on other medication that's affecting your cortisol and your sleep and your hormones. And we just haven't even touched on it? What happens if you have hypothyroidism and it's not well controlled? That will affect your cortisol.

Dr. Jones: What happens if you're weaning off steroids and oh, by the way, there's a pandemic happening? So you're feeling a little shot and burnt out and anxious and unsure of the future, that's going to affect your whole access as well. And so it's extremely multifactorial. We are focused on a really important part, but seeing a practitioner will then take everything into account of, oh, well, at the same time, your goal is to get pregnant. Wow, that's totally different than somebody who's not.

Jennifer: Exactly. And well, that's why the one thing that's nice is number one, people can order the Dutch Test themselves directly from your website, which is awesome. So you don't need your doctor to write for this. And actually I have a great coupon code for you guys. You were saying, what was the best one? The Dutch Plus is the best one for people in this particular boat?

Dr. Jones: In this boat, is Dutch Plus. The Dutch Complete is a little more general. It is a little cheaper, but for people who are really struggling, the Dutch Plus is what I'm going to recommend, you'll get the most bang for your buck.

Jennifer: Okay. And so with that, if you guys decide you want to order either the Complete or the Plus, which in this case, we're saying that's probably your better option. You can get $50 off by using the code healthyskin50. And thank you so much Dr. Jones for even giving us that because it's a really big help for people to be able to afford that and your team as well. I've called in many times to ask questions. Your team is really helpful at Dutch to be able to help answer different things about what can work, what can't work. They're just super, super helpful. But I do think that if you are wondering how your adrenals are doing, given where you are, and I think too, the other thing to consider is that skin rashes in general are incredibly stressful. It puts a body under a tremendous load of stress and trauma. Let's be honest. There's a lot of trauma that goes along with it.

Jennifer: And then combine that with topical steroid use and possible inhalers, et cetera, you might not be in this flatline place, but you could have some level of dysfunction. And so that's where this could be really helpful. And you better understanding that response and whatnot. So I'm so appreciative that you joined us for this. This was such an exciting conversation. And where can everybody, is it dutchtest.com where everybody can go?

Dr. Jones: Yep, dutchtest.com is the easiest. Everything on there, all our education, all their webinars, all our podcasts are all free, including this one when it goes live. And so yes, everything is on dutchtest.com.

Jennifer: Perfect. And by the way everyone, Dr. Jones has an amazing Instagram. So if you're over there, you can find her at Doctor.CarrieJones. We'll link to all of this stuff in the show notes for you. And I hope that this will be helpful wherever you are on your journey. Thank you so much for joining us, Dr. Jones.

Dr. Jones: Thank you. I really appreciate it. It's a great conversation.

“Hydrocortisone is really hydrolyzed cortisol. So hydrocortisone is really cortisol in a tube.”