Beth Bundy uses the analogy 'The Three Legged Stool' to represent the triad of the adrenal, thyroid and sex hormones and their interplay. In this follow up podcast we dive deeper into appropriate & necessary use of functional pathology testing of the thyroid, adrenals and sex hormones . Beth expertly draws from her experience to paint a picture of the complex presentations patient's walk in with when one or all of these areas of their health are depleted.
Covered in this episode
[01:08] Welcoming back Beth Bundy
[01:49] What is the three-legged stool?
[03:15] Leg 1: The thyroid
[05:02] Iodine supplementation and testing
[11:00] Leg 2: The adrenal glands
[14:02] The impact of gluten on thyroid
[16:54] Cortisol and cortisol testing
[23:20] Treating imbalances caused by stress
[31:26] Leg 3: Sex hormones
[35:31] Clinical examples
[40:19] Hormone testing
[41:45] Treating the three-legged stool
[44:10] Additional resources
Andrew: This is FX Medicine, and I'm Andrew Whitfield-Cook. And with me on the line today is Beth Bundy, who's a qualified naturopath of over 17 years, specialising in integrative and functional medicine. Beth worked previously as technical consultant with PathLab, one of Australia's original functional pathology companies, and is currently training health practitioners nationally as clinical consultant at NutriPATH Integrated Pathology Services where she's in high demand as an engaging and informative speaker. She also works as a functional medicine practitioner in a busy and highly successful integrative medicine practice, a nd I'll welcome you back to FX Medicine, Beth.
Beth: Thank you. Thank you.
Andrew: Beth, today we're going to be covering part two, we're going to go in depth of the three-legged stool. So I think right from the outset, can we just recap what is the three-legged stool for our listeners, please?
Beth: Three-legged stool. So if you recall on a previous podcast, we talked about the thyroid, adrenal, and sex hormones that I like to look at as a base for my patients.
Andrew: And why a three-legged stool? Why are these sets of glands so important as an interplay?
Beth: Well, I think you may remember getting in trouble at school, Andrew, for swinging on two legs of a chair. So when the teachers said, "Put all feet on the floor or you'll fall over." And well really, that's kind of how I see our patients will figuratively fall over if we're not looking at all the legs or all the aspects of the three-legged stool in the one, you know, equation.
Andrew: Yep.
Beth: Because, they're so interrelated with each other that if we just work on thyroid without supporting the adrenals, we don't get as good effect as we would have if we dealt with those. If we just do the adrenals and we're not looking at the hormones, and especially if they're ladies, the female hormones, they're not going to get as good as results as they would have had we looked at the three-legged stool.
Andrew: So it's really hard to sort of discuss this is an interplay without looking at, I guess, each on their own first. So let's start with the thyroid because it governs the rate and rhythm of every cell in the human body. What do you see in your clinic and how are you treating these sorts of patients?
Beth: Well, we generally see suboptimal thyroid levels. We can see that often. We'll put, we may see, you know, quite a few patients that have been put on thyroxine because of an elevated TSH, but they don't feel any better. And, you know, I'm sure many practitioners have these patients. And we probably see positive thyroid antibodies, I would say, in my clinic in about 40% to 50% of people.
Andrew: Wow.
Beth: Yeah, yeah. So to varying degrees. I mean, I've seen some, you know, frightful measures. And then we also look at the adrenals and the sex hormones at the initial consult, because, you know, as I mentioned, the adrenals affect the thyroid, affect the sex hormones, affect the adrenals. And, you know, a good example of this is like with weight gain. So we have the patients that come in with weight gain, and you might jump with, "Oh, it's thyroid." But, of course, can the adrenals cause weight gain?
Together: Absolutely.
Andrew: Yeah.
Beth: And as can the thyroid and as can the sex hormones. I mean, let's just talk about oestrogen.
Andrew: Yeah.
Beth: So those three things can all be a part of a patient's presenting complaint weight gain. So, you know, if you have a lady come in, she's complaining of the weight gain, but she's also hyperthyroid, oestrogen-dominant, and adrenally-driven and she's only been given thyroxine, I don't think she's going to feel too crash hot, you know, or any skinnier.
Andrew: Well, what about those already on, as you say, thyroid medicines? You know, we have seen some,…they were heroic, I would say, albeit silly dosages of things like iodine, where it just threw everything out. And, you know, the industry basically bears the brunt of those interventions because those who don't know about integrative medicine just labels us all as “dangerous” or something like that. So, how safe is the adjunct use of supplements, generally?
Beth: Oh, well, I'm quite comfortable with using them completely. I mean, I think that's why they're complementary, really, to patients on thyroid medication such as thyroxine. And I've not seen any adverse effects. That being said, I don't do heroic iodine. I do like to do small bites of a little bit of everything as needed. And, of course, we know for a fact that the thyroid needs selenium, zinc, iron, as well as iodine. So it's important to support that.
And, of course, you always need to monitor the patient's thyroid levels. And that means TSH, and T4 and T3. And, of course, if reverse T3 has been done previously and was elevated, you know, I'll always check that too, and make sure that's back in its box, or at least heading closer to its box. Because that will, you know, be, could be relevant to cortisol again. And I also find that antibodies, you know, can have various reasonings to why they are elevated. So, again, complementary supplementation and nutrition is very important with helping, you know, that.
And I've actually used iodine to good effect with some of my Hashimoto's girls actually, but I will stress that this is in a very low dose, like literally in one of the products I used 3 drops of the iodine is less than 300 micrograms, and I gave the patient 2 drops. And that was enough, apart from, you know, other supportive therapy. But their antibodies fell amazingly. And so, again, I don't think we have to be frightened of iodine if we use it carefully and rightly.
Andrew: Yeah, responsibly, yeah, yeah.
Beth: Yeah.
Andrew: I mean, the no adverse effect limit is 1,100 micrograms. Pregnant women, advised by the National Health and Medical Research Council, all pregnant women should actually receive a supplement on top of good diet, and that's on top of the fortified foods, a supplement of 150 micrograms throughout pregnancy because they know that the diet itself is not enough to make up for the shortfall that we have in our Australian diet which is deficient of iodine.
Beth: Yeah. And I also find that, you know, 150 micrograms is not anywhere close to 50 milligrams.
Andrew: No. No. And this, you know, I think we've spoken about it before, you know, there's an interesting argument between Dr. Guy Abrahams who used hugely heroic doses, and Dr. Alan Gabby who cautioned him, let's say, on that such use saying that he actually...with his mathematical working out of the dosage that we require, he actually got the doses, or the concentration of wet and dry seaweed, mixed up.
Beth: Ah.
Andrew: So it's a very interesting argument, let's say, or debate, let's say, on the tandem that is for doctors.
Beth: Yeah. And I guess that's generally why I err on the side of lower doses for those sorts of things. And I have seen some pretty frightful things in the hormone range too, where patients have been, you know, prescribed quite larger doses of hormones. And when you test them, it's like, "Oh my goodness, you're right off the scale." And I always say that it's easier to top people up with things rather than trying to suck it back out of them.
Andrew: Yeah.
Beth: And, you know, once they are highly elevated iodine, it's really hard to get that out of them in a jiffy. And also what we have to remember is that we also have the iodine loading test, where they are actually...the patient is actually given a high dose iodine of 50 milligram, but a once-off, and then they're measured for 24 hours, their urine is measured 24 hours after to see what is eliminated. The concept being that if they are replete with iodine, they will wee most of it out and not retain much. But again, that is you can't use that on every patient, you have to be careful because of the high dose. And, again, it's a once-off opposed to, you know, some people that are prescribing very high doses and then causing, you know, the other halide detox of your bromines and your chlorides and what have you, fluorides.
Andrew: You know, that will be very interesting to look at to see if it actually explained these two phenomena that happen when you give high loading dose, short-term of iodine. And one is the Jod-Basedow phenomenon, the other one is the Wolff-Chaikoff effect. So they're the sort of, you know, juxtaposed-phenomena that occur with short-term high dose iodine. One's a recovery phase.
But the important message is that they're transient. And indeed, we used to use it in hospital before patients went in for ablation therapy for their thyroid, we'd give them Lugol's solution to shut down to basically aid the medication before surgery in shutting down the thyroid, so that it was basically stable for them to go into the operation.
Beth: God…
Andrew: Now you also cover adrenal glands. And I'm so glad that you, you know, include this in the three-legged stool because this is something that we're all so aware of in our 21st-century living, because we're all so darn stressed these days and it's got a huge impact on the thyroid, because what I've seen in the past is people only addressing the thyroid and they'd get things like nausea or rebound issues. So tell me how you incorporate looking after the adrenal glands with the thyroid?
Beth: Well, first I want to say oh my God, most of us are terribly stressed and most of our patients are terribly stressed. And, you know, I mean, we sit in ridiculous peak hour traffic. Let me tell you, nearly three hours in traffic today because of the weather here in sunny Melbourne, not.
Andrew: Not.
Beth: We eat ready-made packaged foods, and I use the word food loosely. We have deadlines, we have bills to pay, we have difficult people to deal with, we have to do exercise, we have to have Tim Tams, we have to have coffee, we have to have vodka, we have to stay up late on the computer, and then we don't sleep and we get up in the morning and do it again. So needless to say, we're constantly “on” and trying to turn ourselves “off.” Because if you add things like blood sugar swings, gut dysfunction, food intolerances, and especially gluten…
Andrew: Yes.
Beth: …seems to be really becoming more and more to the fore, chronic infections, environmental toxins, auto-immune problems, inflammation, all of which is causing our adrenals to pump out more stress hormones. And I think it's interesting that I've noticed that a lot of patients often don't see themselves as stressed. You know, you'll talk about stress to them and they'll go, "Oh, no. I'm, no, not really…
Andrew: Oh yeah, I’m fine.
Beth: …I’m absolutely fine." And I think this is because all this busyness that it's just normal for them, you know. So they don't associate their symptoms with stress, they don't necessarily understand the implications of their hormones on their health, you know. And so if your patient complains of feeling worn out, moody with weight gain, you know, are they stressed or are they hyperthyroid? And I think these symptoms are of both, which is, of course, both your adrenals and your thyroids.
Andrew: Yep.
Beth: So it's important to, you know...and they feed each other as stress can aggravate hypothyroidism. You can be stressed because of hypothyroidism.
Andrew: Yeah. Yeah. I think this is the danger of compartmentalism, isn't it? We want to treat one thing.
Beth: Yeah. Well, this is only just looking at...let's just look at T4 and T3 or, you know, this is why it's helpful to consider reverse T3 because we know that that can be elevated when we have cortisol issues or adrenal issues. So I just think it gives a much better... As I mentioned in the previous podcast, it is like more pieces of the jigsaw of the puzzle of our patient. And so I do like to look at adrenal definitely if I'm looking at thyroid as well.
Andrew: I was talking with Dr. Mark Donohoe just recently…
Beth: Yes.
Andrew: …about the impact of gluten in non-celiac patients, and the impact that gluten has on thyroid and thyroiditis. And he was really amazed at the results, you know. Like, there seems to be this swing that, you know, firstly, it's only relevant to celiacs, and then somebody takes a hold of it and it's everybody has an issue with gluten. And then you get the swing backwards and there seems to be this anti-gluten problem movement, as in gluten is not really a problem for all those who think it is, right?
Beth: Yes.
Andrew: But the fact of the matter is that a lot of these patients actually do better when you remove gluten from the diet. So there may be this sort of segment of the population who are not celiac, but they still actually do well when they avoid gluten. So how easy do you find that?
Beth: And I also think it's depending on the form of the gluten certainly.
Andrew: Ah, that’s interesting.
Beth: So I am actually gluten-sensitive. And so here in Australia, me and white bread are not friends. But recently when I went to Paris, I was having a meze up with croissants and beautiful fresh French bread and without any overt signs. I mean, heaven knows what it was doing on the inside, but overtly no symptomatology and I could, you know, I wasn't getting tired and I wasn't getting irritable guts or anything like that that I do here, which I think is a whole another fascinating aspect about gluten.
Andrew: Okay. So here's a question for you. Because of the interplay between the thyroid and the adrenal glands, could there be that impact where a little bit of gluten is okay as long as you're not worsening your symptomatology with adrenal stress, i.e. when you're relaxed?
Beth: Oh, I think there's a big part of that, big part of that. I mean, it's like when you go on a holiday, and all of a sudden you don't get those headaches or you don't get those sore shoulders, or all those sort of symptoms that you thought were "normal" kind of go when you don't have the stresses of your everyday life about you, I think is interesting, as is interesting that some people go on holidays and get sick promptly. You know, two days in it's like their body's been holding them together, holding them together, and then that's it, they collapse. and they spend their whole, you know, week in Bali, feeling revolting.
Andrew: Yeah.
Beth: And I think there's, it is definitely, you know, there's the science behind how all these things work, and then there's how the individual deals with all these particular suboptimal levels of, you know, cortisol, thyroid, and girly hormones.
Andrew: Well, I'm glad you hit the girly hormones, which men have most of, anyway. I'm glad you talk about the cortisol there because most people think of the adrenals with adrenaline, maybe noradrenaline, but they're two glands in one, aren't they? There's a real protection mechanism in there. And we're talking cortisol here, cortisol production.
Beth: Yeah. Well, I think, yeah, it's very easy to think of adrenaline about the adrenals. And that certainly plays a part if we look at neurotransmitters too.
Andrew: Yeah.
Beth: And oh my goodness, that means now I'm going to have to bring out a four-legged chair, ain't I? But if we remember the adrenal gland has two parts, it has the outer cortex and the inner medulla. And it is our cortex that produces the cortisol, and aldosterone, and androgens such as DHEA. And cortisol is really about homeostasis after a stressful response. Yeah, so the cortisol... You know, and we know that standard medicine really is looking at cortisol pathologies. So we've got Addison's where you're deficient or Cushing's where you're excess.
Andrew: Yep.
Beth: And that's predominantly really what the blood code is always looking for, is they're looking to, you know, be able to label you as deficient or excess. Whereas when we are looking at our salivary cortisol, we are looking for that homeostasis. We're looking for when everything is as it should be, and you're not running away from the tiger, where are you at? You know, what's happening? You know, where are the levels at? And also what we have to remember is aldosterone looks at our salt and fluid balance.
Andrew: Yep.
Beth: And so because without aldosterone, if we lost too much salt with it we'd go out of fluid and we'd get dehydrated. And that's why sometimes when people are adrenally-fatigued, they go for the salty foods rather than the sweet foods and that's trying to help that. And, of course, DHEA is very important too when we're talking adrenals as our anti-ageing hormone remembering that it's in its peak in our young adulthood when we should be at our peak. Do you remember those times, Andrew, at all?
Andrew: No.
Beth: It was a long time ago.
Andrew: They're too far away.
Beth: And then, of course... And really, that's what I find too when I'm measuring DHEA is, you've got people in their 40s that are really running on DHEA levels of their grandparents. And this is not good, because older people have all these things go wrong with them. And, you know, we don't want our middle-aged people to be getting all these old people symptoms. I mean, look at all these conditions that we're hearing about, you know, diabetes is getting younger and younger and younger.
Andrew: I know.. Can I ask you there though? Like, one of the problems I see is, you know, you've got to see patients all day, so you've got to see patients at various hours of the day. And so you're going to be, if you wanted to take a test, let's say, you know, to their blood to check for adrenal metabolites, or thyroid hormones, or whatever, then you're getting a spot sample at that point of the day. So don't you have diurnal variation with production of these hormones?
Beth: Oh, absolutely, absolutely. And that's why cortisol should be more prevalent during the morning to get you up and happening, and then should be reducing by the end of the night, so melatonin gets its turn and gets you into a restorative sleep. So that is the other benefit of the four-point salivary cortisol measurement is we can actually see the rhythm of someone across the day.
Andrew: Right.
Beth: So rather than in the morning, they're peaking and then they collapse, or you'll have someone starts off really low and then gets on their little metaphorical bike in their brain, and off they pedal and they get more wound and wound as they go, and which is a classic adrenal fatigue, then these people can't sleep. So they're not getting restorative sleep.
So the benefit is when we see a couple of points across the day, I find that then I can target my therapy where I need to lift them and when I need to, you know, tie a string around their ankles and pull them back down to earth.
Andrew: So when do you test during the day? Is there set times?
Beth: Yeah. So generally on rising in the morning, and then around midday, so just before lunch, then I would look at in the afternoon when they're usually starting to get a bit drowsy and fall asleep on their keyboard, and then before they go to bed. I like to look before you go to bed because it's like, well, where is your stress hormone when you are actually trying to destress and sleep?
Andrew: I'm going to ask you a weird question here. Do you know of any research? You know how you do, get the 24-hour blood pressure holsters now?
Beth: Yeah.
Andrew: So has anybody looked at the total variance in diurnal production? I say diurnal as two, but the total variance in production of these hormones throughout the day, and also including the sleep. Has anybody done that sort of research? They'd have to have a canureter in so it'd be rather hard.
Beth: Yeah, not that I'm aware of, but it'd be interesting especially while people are sleeping because I don't usually like to wake people up to ask them to spit the tube for me.
Andrew: Now, there's a stress response.
Beth: Exactly. Turn on the light and spit in the tube for me. So that's why I like to do it before they go to sleep…
Andrew: Yeah.
Beth: …so they're supposedly winding down to get that sleep. And I think this is another thing about, again, the other option you've got for testing cortisol is a 24-hour urine collection.
Andrew: Uh-huh.
Beth: But again, with that, it just ends up all in the bucket and you take a sample of that and you get one figure. And I've seen, definitely on the saliva hormones, that someone can have a ridiculous morning level and then flat line it for the rest of the day.
Andrew: Yeah.
Beth: If you look at the daily cortisol and it looks normal…
Andrew: Yep.
Beth: …because when you add all those figures up, you know. it's like cholesterol. When you look at total cholesterol, people forget that that's a couple of measurements, you know, added together.
Andrew: Talking about treatment, Beth, what sort of things do you find works for your patients who have these thyroid hormonal imbalances and adrenal imbalances because of stress?
Beth: Well, this is why I have a magic wand in the office, Andrew, which I do use quite regularly, especially when people say, "Don't you just have a tablet or something?"
Andrew: Yeah.
Beth: ”No,” I say, "sometimes you have to actually eat food during the day and not just drink coffee."
Andrew: Yep.
Beth: And actually, I must say about my prize-winning patient who clocked in at 14 coffees a day…
Andrew: Oy.
Beth: …with no food and wondered why he couldn't sleep and had mad anxiety. Like, sheesh.
Andrew: Treatment would have been easy. Pretty straightforward.
Beth: Yeah. Needless to say, he wasn't very happy when I said, "Do you think you could reduce your coffee and eat food?" So this is why I need a wand really, sometimes I need to turn it up the other way and hit them over the head with a stick instead of waving at them. But generally, my first and foremost is make sure people are eating well during the day.
Andrew: Yep.
Beth: Because, this is what I find is a lot of people, you know, they may not have breakfast because they're already stressed before they start the day, and then they expect to do, they go about their business with no food. Maybe a coffee here, and a quick biscuit there. So it's really important that I ensure that they're getting enough protein during the day to keep their blood sugar steady, because, you know, that's a big part of it, and also really try and get them to attempt to get at least seven and eight hours sleep.
Andrew: Yeah.
Beth: I mean, that's really easy, basic stuff for us practitioners to say, sometimes it's not as easy for people to do, but I think it's an easy way to start with people. I also make sure, especially if they've got really poor adrenal status, that they're not over-exercising. Alright, so I’ve still got quite a few patients who complain of feeling so exhausted, but they're then still forcing themselves out five days a week to do boot camp or CrossFit…
Andrew: Yep.
Beth: …and all I have to say is, "Stop it," because it’s, you just...
Andrew: Come home and fall on the floor.
Beth: Yeah. And then they complain about, "Oh, your tablet's not working." Well, because you're really, you know, pushing the boundaries there of what's in your petrol tank to actually be able to use.
Andrew: Do you see…
Beth: The other thing...
Andrew: Sorry.
Beth: Sorry.
Andrew: Do you see a personality profile in some of these patients where they can't learn the concept of pace?
Beth: Yeah, absolutely. And it really is, I guess, to some of the conditioning that we have is just keep going, stop complaining. And, you know, I think the worst ad in the world, which is many years ago, I'm going to share my age, was the soldier on, when good old...
Andrew: Yep.
Beth: …a paracetamol company brought out the ad that says, "Soldier on.”
Andrew: Yep.
Beth: Just keep soldiering on, just take your pill and keep going. And, you know, some people don't allow themselves that good old convalescence when they... You know, people get a cold and they keep going. They don't go, "Look, just have a day off and relax," you know, and their poor little immune system is working overtime.
Andrew: What about these people that are chronically adrenally-fatigued? And I think I remember was it an author, Brownstein maybe who was talking about adrenally-fatigued patients might do well to try and work out with their employer in some instances, if possible, that they change a shift, if you like, or start work later and finish later because they just can't function before 9:00 a.m.
Beth: Yes.
Andrew: I think, was it 9:00 a.m. or 10:00 a.m.? There was some...
Beth: 10:00 a.m. They've actually found that with teenagers too, that teenagers do better later in the day, their school should start later. And I think there's something for that because we should all know too when is our best time? Like, some people work better, you know, it's the old early risers or the later, night owls. Some people can get up at 5:00 in the morning and get a lot of work done and then have to be in bed by 9:00.
Andrew: Yep.
Beth: And then there's the people that, "Look, can I sleep into 9:00, then get up and I'll work through to 7:00 and be very productive?" So I think it'd be good if workplaces could allow that sort of thing would help people a lot. And the other thing is actually allowing people to have fun. That's the other thing that I'm really big on my patients is, "What do you do for fun? You know, do you have downtime?" Because many patients have such stressful work lives and it's hard for them...this apart from changing a job, which is not always practical for them. And if they have stressful home lives as well, and it's difficult to change this, and I think there's definitely the whole superwoman syndrome going on…
Andrew: Yes.
Beth: …where women have high self-expectations as well as being expected by others, to be the wife, mother, lover, worker, taxi, chief cook and washerwoman, and that burns through what I call their little brownie points real quick, and they get exhausted.
Andrew: Yeah.
Beth: So I actually would think it'd be great if we could all have minions. I actually do like...
Andrew: It'd be lovely.
Beth: I do like that idea if we could actually just prescribe some minions for everybody. I'd actually prescribe a few for myself, that'd be great.
Andrew: They’re cute.
Beth: And I've actually prescribed golf for some of my male patients…
Andrew: Yeah.
Beth: …and pedicures for some of my lady patients, purely to allow them that they are allowed to take time for themselves.
Andrew: Yeah. So do you ever institute this new wave of colouring-in, adult colouring-in? Have you ever looked at that?
Beth: I have and I think it's so hysterical that we've had colouring-in books for so long…
Andrew: I know!
Beth: …and now people are making a fortune. Damn, I should have kept all my Disney colouring-in, you know, from the kids Disney books and I would have made a fortune. Look, if absolutely, or any of that sort of thing. I find that whatever it is your meditation, you know, whatever you find that takes you away from thinking too much. If it's colouring-in, if it's... You know, I had a lady that used to, while her husband was suffering through terminal cancer, she would take herself, for a couple of hours a week into her sewing room,
Andrew: Right.
Beth: ..and just sew.
Andrew: Yeah.
Beth: And I thought that was beautiful and healing for her because it was what she did for herself. And it was time away that they knew that mom was in the sewing room, let her be. And I don't actually know if she ever made anything or she just told them that's what she was doing. But I think, you know, that's part of it. Apart from all that beautiful adrenal support herbs, you know, we have beautiful withania or ashwagandha…
Andrew: Yep.
Beth: …and Rhodiolas, and we have the three ginseng brothers, Siberian, American and Korean, and, of course, our beautiful Bs and Cs and magnesium, which a lot of people, again, if they're not eating well, they're not getting these basic nutrients into them. So, as well as what we can offer them, I think allowing our patients that they can doctor themselves in a way that they can allow, have time off, they can have fun, they can eat well, they can sleep well, you know, just some basic stuff really.
Andrew: It's really interesting how we've just lost touch with the basics. And often, that's maybe not the answer but it's so important as part of the answer to get them back on track.
Beth: Yeah, because it's not just in a pill. Otherwise, we're just kind of glorified pill-pushers as well.
Andrew: Yeah, that’s right.
Beth: And, I mean, we've got some fabulous stuff, but we can also give them so much. It's really about I think about the physical support as well as the mental and emotional for our patients.
Andrew: Yep. Yep.
Beth: And I think that's why they love coming to see us because we don't just spend six minutes with them, we'll spend anywhere up to an hour with them and have a good, you know, gas bag and that's part of the healing process.
Andrew: The last leg of the three-legged stool, Beth, includes the sex hormones. Now, most people will know the oestrogen or oestrogens, progesterone and testosterone, but again, there are so many more that are higher up this interplay-chain and can be affected by the dysfunction of the thyroid and the adrenal. So what do you test for and how do you decide what's clinically relevant to support, to treat?
Beth: Well, again, as a general rule, I would look at blood and saliva sex hormones, and I would take that into play of what the patient is describing to me, what they're presenting with. I find it interesting that a lot of men will have no idea that their testosterone ever goes away. They believe to be continually, you know, manly and macho. But men's testosterone does decline as they age and does make them grumpy old men. I do believe they've even made a movie about it, or some ladies have probably lived with lots of those gentlemen. And then the same as with the girly hormones, we know that they change at menopause. But I also find it interesting the number of ladies that all they've heard of is oestrogen…
Andrew: Yep.
Beth: …and they're not even aware that they need testosterone and they have a hormone called progesterone.
Andrew: That’s right.
Beth: And let alone not many people have heard of DHEA or sex hormone-binding globulin, or all these other hormones that are in the mix. So, in saliva, again, depending on what the ladies, or gentlemen are telling me is, I would definitely look at E1, E2, E3 progesterone and testosterone in the saliva. And then in the blood, we can do E2 and testosterone. But then we can get the calculated free testosterone, which gives us a big picture, but we need to get that with sex hormone-binding globulins. And you'll often find ladies on the pill that have a very elevated sex hormone-binding globulin which, of course, affects their natural hormones as well. We can do progesterone in the blood as well, but DHEA, luteinising hormone, and follicle-stimulating hormone are done in the blood, and we need those, especially LH and FSH if we're looking at menopause ladies. So often ladies will come and say, "Can you tell me I'm menopausal?”
Andrew: Yeah.
Beth: Well, not necessarily from the saliva, but we can get some indication from an LH and FSH. But often too, you know, it's like, "Well, you're still menstruating, so I would say no, you're not menopausal."
Andrew: Yeah.
Beth: But again, some ladies don't realise that.
Andrew: Yeah.
Beth: You know, I think there's a big part of us having to explain and educate our patients about how it actually works rather than what they're seen, you know, being promoted on television that you're either menstruating or you're not.
Andrew: Yeah, I have this memory of this group of ladies, not together, just this group that I noticed, and I was treating them for weight gain. And each of these ladies was "post-menopausal." Now, what I pulled out because of their symptomatology was that their thyroid and their adrenals were shot. So I supported them. And what happened was they bled again, each of these five ladies, they menstruated again. What I thought was interesting was, these five ladies decided it was more important to not have to worry about menstruation than to bother about their weight gain. And so they chose to address other things. But I thought it was really funny because the reason, of course, being that they were so stressed during their life, their adrenals were so clapped out that their hormone system just couldn't support their natural cycle.
Beth: Yes.
Andrew: And once you gave it some support it came back.
Beth: Yes.
Andrew: And this leads on to my next question. So when patients... When you're talking about drug therapy, they're quite, not always, but specifically targeted, whereas nutrients and herbs, they might have a label of doing something but they're actually there to nourish the body rather than block or up-regulate something. Like we nourish enzyme systems, we don't block them.
Beth: Yes.
Andrew: And that, to me, makes for an inherently safer therapy. But are there any caveats that you've sort of learned over your time in clinic about various patients or various treatments?
Beth: Again, I mean, there's some obvious contra-indications for things and all practitioners should be, you know, cognisant of those. But I think it's... There's a lot that you said about the ladies that their, you know, stress levels had affected their hormones. And I was just thinking back on another example is women that do a lot of exercise and they stop menstruating…
Andrew: Yep.
Beth: …which again is not necessarily that they're menopausal, it's just that they've...sometimes it's because they're so under fat. And what we have to remember when you mention higher up the scale is we need cholesterol to make sex hormones. So we do need some fat, ladies, but it's about the right fat. And so, I guess it is imperative to kind of look at, do some testing sometimes because people can appear as menopausal or what have you and they're not the case. I had another woman who had read about the low fat thing and how wonderful soy was. So she was going all low fat and soy, I worked out she was having five serves of soy a day.
Andrew: Yeah.
Beth: And so at 36 she came into me saying that she's menopausal. And I said, "No, you're soy-toxic." And we took her off the soy, and she got her periods back in a month,
Andrew: Yeah.
Beth: You know. So those sorts of things are probably caveats in a way is you've got to look at people, what are they doing? Not just necessarily medication, but what are they doing in their lives that can be affecting these things?
Andrew: Yeah.
Beth: And I can think of two stories where patients were on medication and they weren't being monitored…
Andrew: Yeah:
Beth: …and I think that's something too. So we had one woman was, you know, seeing her local GP complaining of fatigue, and she had been originally prescribed thyroxine. And as she came in saying she was more tired, the doctor just kept giving ever-increasing doses of thyroxine. So by the time she came in to see us, she came in in dark sunglasses, wouldn't speak to anyone in the office but me, claimed she had felt so...and she was weepy and claimed she felt so bad on the way here that she was thinking of driving her car into the traffic. I was like, "Whoa." And this was because when we actually looked at her thyroids, they were out of control.
Andrew: Wow.
Beth: You know, she was just so... They'd actually made her hyper and she was beyond herself. You know, she'd almost... She was manic. So it was really about get that stuff out of you or reduce the dose immensely. And she's come good now, I'm going to tell you, it was that all happy ending. But it was just this increasing the medication without looking at things, you know?
Andrew: Yeah.
Beth: And another one I had was a woman who came in so highly strung, we really had to kind of, you know, tie-down. And she'd been on the contraceptive pill for 25 years. And when asked by her local doctor if she'd had a period and she said, "No." He said, "Oh, well, then we'll put you on HRT now," because she's 44 and hadn't had a period.
Andrew: Right. Rather than looking at…
Beth: But the fact is that well because she hadn't had a bleed because she was taking the contraceptive pill non-stop…
Andrew: Yeah.
Beth: …with no break. And, you know, again, this is about asking the right questions, and actually measuring, like, what about measuring to see whether she's menopausal…
Andrew: Yeah.
Beth: …or finding out what the patient's doing? So those are the sorts of things I would probably say when we're looking at medications and giving people is, just make sure we're not missing something in our history-taking that could be why, you know, someone's not bleeding, or someone's excessively tired, or what have you, you know. Like, some people can... Some ladies will be excessively tired and if you go, "Oh, it's adrenals, it's adrenals." But perhaps if you check their iron and you find out that they are anaemic…
Andrew: Yeah. Yeah.
Beth: …because their periods are so heavy. So that's probably where I'd come with the caveat about looking at other aspects of people preventing the bleeds.
Andrew: With regards to the hormone testing, rather than just the hormones themselves, do you test for the metabolites of especially oestrogens?
Beth: I would do... That's usually my thing if I'm not getting anywhere with reducing the salivary oestrogens…
Andrew: Right.
Beth: …or if my ladies have a personal or family history of gynaecological cancers…
Andrew: Yep.
Beth: …I will certainly look at that. The other thing I was also thinking about is with people that have long-term fatigue is another thing to think of is ACTH or adrenocorticotropic hormone. Because, again, we have done that on a few people that just weren't getting, feeling better with all the support. And we actually found that two of them, in particular, had Addison's disease.
Andrew: Right.
Beth: They didn't just have chronic fatigue, that actually, it turned out they did have Addison's. And so that's something, again, we can miss if we're not sometimes going deeper down the rabbit hole of the three-legged stool. But certainly oestrogen metabolites, you know, don't forget your gut. Don't forget measuring your gut. Don't forget measuring neurotransmitters too sometimes with people and their moods too, so...
Beth: ...which is a whole another kettle of fish. Yeah.
Andrew: Yeah. Well, what about treatment for these sort of things? So if you were going to treat the three-legged stool, I know we're talking about a huge arsenal of things that we can use to help balance out thyroid, adrenal, and sex hormones. But tell me about some of the more common things that you might use in your clinic?
Beth: Well, definitely my adrenal herbs. Okay, so as I mentioned before, the Siberian brothers, and the withanias, rhodiolas, things like that. I love those. Love those immensely. Definitely B and C and again, you look at across the board of what else is going on.
Andrew: Yep.
Beth: Thyroid, again, sometimes I find unless someone has an overt thyroid situation, sometimes really going in with adrenal support, I find that their thyroid can actually work better anyway, and being mindful of their gut-health as well. So sometimes I may give people, providing they're not too worn out, I may give them a gentle bit of liver and gut support to help the liver metabolise these hormones better.
And then with female hormones, of course, we have various herbs and spices, but also working with an integrative doctor. The doctors I work with do use bioidentical hormones to good effect. And that's often used when, you know, girls... Sometimes I find out herbs may not hit the spot with some of these girls really need a lot of support.
Andrew: Yeah. They need a band-aid now.
Beth: They're very drained. They're very drained. Yeah, especially if they're, what I call pan-hormonally-drained.
Andrew: Yep.
Beth: And these are the girls you'll find they're low oestrogen, low progesterone, low testosterone, low adrenal, their thyroid is suboptimal-hypo, you know, subclinical-hypo. But it's when you see they've got low DHEA just across the board, they are flat.
Andrew: Yep.
Beth: And so these girls will need a lot more support.
Andrew: Yeah. So wrapping up, what sort of clinical advice can you give to practitioners who are looking to help people with hormonal dysregulation? You know, like, for instance, female hormones, I think the seminal textbook for natural medicine practitioners would be Ruth Trickey's.
Beth: Yes. Yes.
Andrew: What about adrenal fatigue or thyroid issues? Is there any key authors or key resources that you might need?
Beth: Dr. James Wilson. He's the adrenal fatigue, what is it? "The 21st Century Stress Syndrome," is a brilliant book. It's really easy reading. I know some practitioners, he's got some little cartoon pictures in there that I know that some praccies have actually photocopied…
Andrew: Yep.
Beth: …so they can actually show their patient, "Is this you? Is this you? Is this... You know, do you suffer from these things?”
Andrew: Ah, yes.
Beth: And because people love pictures.
Andrew: Yes.
Beth: And when they go, "Oh, yeah, yes, yes." And then they think, "Oh my God, well, maybe I am stressed." I mean, this is what I find when adrenally-fatigued people when I, they think I'm a mind-reader when I go, "So when you get up in the morning, it takes you at least that first coffee or maybe the second coffee before you feel good? And then after lunch, you know, then you start looking for the Tim Tams or the little cheeky muffin. And then, you know, in the evening when you get home you fall asleep on the couch. And then when you try and go to bed, you know, three hours later, you're wired."
Andrew: Yeah.
Beth: People go, "Yes. How do you know?" And I go, "Because that's adrenal fatigue for you." And that's a good thing about Dr. Wilson's book is it has the pictures that you can show people, "This is you. You have trouble getting out of bed, you have trouble getting to sleep, you have all these things." So I really like that one. On thyroid, there's a book that I love and a website that I love called "Stop the Thyroid Madness."
Andrew: Right. "Stop the Thyroid Madness."
Beth: "Stop the Thyroid Madness," is, again, easy reading for practitioners and patients alike. These are the sort of books that you can also suggest to patients look at so, you know, we don't have to give them a whole lesson. And yeah, so they're quite handy, you know, taking snippets out of that to tell our patients. And again, just remember the stool is cool.
Andrew: Yep.
Beth: The three-legged stool is cool. It's a good place to start for a lot of our people that come in and complain, "I'm tired. My hormones are all over the place." Or they'll say, "I think it's my hormones. I'm just not right. And the doctor... You know, I've been to the doctor and he said I was fine." That's when I go, "You have come to the right place." And then I, you know, tell them a little bit about the thyroid, the adrenals, and the sex hormones. And I go, "And that's what we're going to look at. Let's go."
And people are usually definitely onboard and love it because then we can show them. We can show them pictures or coloured representations of where they're at and why we need to do the therapy we're going to do. And I find that patients are compliant, because mainly they say, "Oh, no one's ever told me that," or "no one's ever explained that to me." You know, they feel heard.
Andrew: Yeah.
Beth: And I think that's probably the first and foremost, you know, how we succeed as practitioners is we actually listen to our clients.
Andrew: Beth, thank you so much for taking us through a very complex, but you've simplified it extremely well, I've got to say, but a very complex set of interplay between the thyroid, the adrenals, and the sex hormones. So thank you for that. And I'd like to say that I do like the way that you take a fantastic case history as the first thing that you do with your patients to get the true picture of what's been happening, but also the responsible use of measurement and also nutrients in treating your patients. So thank you for taking our practitioners and our listeners through that.
Beth: My absolute pleasure. Always a joy speaking with you, Andrew.
Andrew: This is FX Medicine. And I'm Andrew Whitfield-Cook.
OTHER PODCASTS BY BETH INCLUDE:
- Adrenal Fatigue is a Myth: Part 1 with Beth Bundy
- Adrenal Fatigue is a Myth: Part 2 with Beth Bundy
- Understanding Hormonal Profiles: Functional Pathology
- Assessing Liver Detoxification
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