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Endocrinologist Gregory Dodell joins us to discuss myths and facts about hormones, including the problems with doing diets and supplement protocols for “hormone balancing,” why weight-loss recommendations aren’t helpful for hormone health, how to manage thyroid conditions without falling prey to wellness fads, the truth about “adrenal fatigue,” the Ozempic craze, and more.
Gregory Dodell, MD FACE is a board-certified endocrinologist. He received his medical degree from Albany Medical College. He completed his internal medicine and endocrinology Fellowship at St. Luke’s-Roosevelt Hospital Center, affiliated with Columbia University. He is the President of Central Park Endocrinology, PC.
Resources and References
Christy’s second book, The Wellness Trap: Break Free from Diet Culture, Disinformation, and Dubious Diagnoses and Find Your True Well-Being
Gregory’s practice, Central Park Endocrinology
Become a paid subscriber on Substack for extended interviews and more
Christy’s online course, Intuitive Eating Fundamentals
Transcript
Disclaimer: The below transcription is primarily rendered by AI, so errors may have occurred. The original audio file is available above.
Christy Harrison: Welcome to Rethinking Wellness, a podcast that offers critical thinking and compassionate skepticism about wellness and diet culture, and reflections on how to find true well-being. I'm your host, Christy Harrison, and I'm a registered dietitian, certified intuitive eating counselor, journalist, and author of three books, including Anti-Diet, which was published in 2019, The Emotional Eating, Chronic Dieting, Binge Eating & Body Image Workbook, came out on February 20th, and The Wellness Trap, which came out in 2023 and is the inspiration for this podcast. You can learn more and get them all at christyharrison.com/books.
Hey there. Welcome back to Rethinking Wellness. My guest today is endocrinologist Gregory Dodell, who joins us to discuss myths and facts about hormones. We talk about the problems with doing diets and supplement protocols for quote unquote, hormone balancing, why weight loss recommendations aren't helpful for hormone health, how to manage thyroid conditions without falling prey to wellness fads, the truth about quote unquote adrenal fatigue, the Ozempic craze, and more.
Paid subscribers get to hear the full episode, which includes lots more of this great conversation with Greg, including our discussion of Ozempic and related drugs, the Glucose Goddess, pre-diabetes, and more. To upgrade to paid, go to rethinkingwellness.substack.com. If you do, you'll not only get to hear extended interviews like this one, but you'll also get subscriber only Q and A's and essays, full access to our archives, commenting privileges, and subscriber threads where you can connect with other listeners and more. Plus, you'll get my undying gratitude for helping support the show, and you'll keep this an ad and sponsor free space. Just go to rethinkingwellness.substack.com to sign up or click the link in the show notes. And thanks so much to everyone who's already supporting the show. It really means the world to me.
I also want to make sure you know about my second book, which is called the Wellness Trap. The book was the inspiration behind this podcast, which I launched to continue the fascinating conversations I was having in my reporting. And if you like the interviews here, I think you'll love the book. It explores the connections between wellness and diet culture, how the wellness world became so inundated with misinformation and scams and conspiracy theories, how integrative and functional medicine can lead to disordered eating and other harms, including dubious diagnoses like adrenal fatigue and genuine hormonal problems and how we can both protect ourselves as individuals and reimagine well being as a society. If any of that sounds interesting, check out the book at christyharrison.com/thewellnesstrap or pick it up in your favorite local bookstore. With that, here is my conversation with Gregory Dodell.
I wanted to have you on because I wanted to have you help address some myths about hormone health that are so pervasive in wellness culture these days. I feel like everybody's talking about hormone health and hormone balance, and it's all so convoluted and there's so much misinformation out there. So you as an endocrinologist, and particularly one with a sort of anti-diet stance on things I think could really help bust some of those myths. So I'm really excited to get into all that. But first, I'd love to have you tell us a little bit about your background and how you came to do the work that you do.
Gregory Dodell: So I always wanted to be a doctor, so there's that. Always thought I wanted to be a pediatrician, but got to medical school, and I had a wonderful professor who's an adult endocrinologist who ran up and down the stairs, the auditorium, and was so excited about hormones and this and that. And I was like, this seems like an amazing way to practice medicine. And that's what made me really like endocrinology. And just the fact that hormones really affect the whole body and a lot of specialties and specialty medicine these days is so focused on one organ system. What I loved about endocrine is when you make the correct diagnosis, not only is that important for the patient at that time, but you can also follow them over the course of their life. And pretty much everything we do has a therapy or a treatment associated with it that can make someone feel better. So the science was interesting, and then also just the treatments and the lifelong relationships that you can have with these patients is interesting.
And I'm married to a psychologist, Alexis Conason, and we both did our training at the same time from a very weight centric model. And then she went into private practice and came across health at every size and mindfulness and all these wonderful things and really opened my eyes to practicing that way. And it's really been really wonderful to do so and to really take this approach because it is unique in what I do. And one of the first things I did when she brought this to my attention, she recommended your first book, Anti-Diet, and I read it on vacation, which is totally captivated by it. And that really set me off more into practicing this way. So I'm grateful for you for that.
Christy Harrison: Thank you. I'm really grateful to hear that. That's awesome that my book was relevant for you and helped you kind of shift your practice. And I think in terms of what I've seen, I have a thyroid condition that we'll talk about. So I've seen a lot of endocrinologists in my day, and I feel like endocrinology, in my experience, has been a very weight focused, sort of not a very forward thinking paradigm in terms of that. So it's cool to see an endocrinologist like you kind of showing how to do it a different way. And hopefully, more and more people in that field will start practicing in a more weight inclusive way.
Gregory Dodell: I know all my colleagues are well intentioned, and we all came from the similar training, which by nature, really is weight focused. And unfortunately, because of this approach, and I hear it firsthand from patients now, and I hear it from things on social media, people message me, is that they avoid going to the doctors and specifically endocrinologists because they don't want to just focus on their weight. They want to focus on how they're feeling. They don't want to be faced with assumptions about their behaviors just based on how they look or what their blood tests are. So I think we could be doing better in that regard. And I think that's going to have to do with really training people from residency and fellowship and then having this discussions, like on podcasts and obviously social media and things like that to open people's eyes and look at things differently.
Christy Harrison: Yeah. And I think it's totally understandable, like you said, that people would be so steeped in a weight normative paradigm and sort of think in a way that was really anti-fat biased from their training because that's what the training is for, not just endocrinology, but a lot of fields, I think, in medicine.
Gregory Dodell: Right. And the research, even there was a great study that came out that with first year medical students who are already coming in with bias with regard to weight just because of the culture that we obviously live in. And then as you go through medical training, it just becomes more and more ingrained, and it's really hard to get away from that paradigm. And thankfully, as I said, I'm married to Alexis, and it took about a decade, probably, for me to, in all honesty, figure this out. You learn something one way, and that's your training, and that's how you practice. And it's really hard to be objective and look at data and get out there and say maybe I should be doing things differently.
Christy Harrison: Yeah, for sure. I'm curious to talk a little bit about the wellness culture side of this, because it seems like everyone from wellness influencers to integrative and functional medicine practitioners, naturopaths, chiropractors, all these different folks in wellness culture are recommending diets and supplements and sometimes really out there really restrictive things for, quote, unquote, hormone balancing. And they don't really seem to have any basis in reality. So I'd love to get your take on that world in general, those recommendations in general, and then we can drill down a little bit more into specifics. But I'm curious, first of all, why are people making these claims about hormone balance and hormone health, and is there any evidence behind them?
Gregory Dodell: Yeah, I mean, it's a very important question and something we have to look at because people are spending hard earned money and time to try and make themselves feel better and they're consumers. And I think when you mentioned influencers and you mentioned integrative health and things like that, I think you have to look at as a lot of ways it's a business and there's a market for it. So I think that's where a lot of it's coming from. And in traditional academic medicine and you obviously, in all the work that you do, we have to look at research and we have to look at what makes sense and how to treat various conditions.
So I'm a little skeptical, to say the least, when someone's selling supplements out of their medical practice or out of whatever they're doing online, because there's a lot of bias there. Obviously, people over the years have said to me and even reps and whatever, said, "Oh, I have this great product and, for example, for diabetic neuropathy, and you can sell it, you can buy it wholesale, and then you sell it for this markup," and this and that and just human nature. I think there's obviously a bias and there's a profit that comes along with that. So you got to question that.
And people come to me all the time with pages and pages of lab results of things that I never learned in medical school or endocrine training as being significant. And people are spending thousands and thousands of dollars on supplementing things based on a lab value that's maybe not even, I'd say, that's reliable and all these kinds of things. So I think most endocrinologists are a little skeptical about all the things that are going on out there with regard to people restricting diets and eliminating major food groups and cleanses. And all these kinds of things that are happening, and you can't blame the consumer. They're just trying to feel better.
Christy Harrison: Right and I think that's a big part of it is that people don't feel like they're getting answers or maybe their symptoms aren't totally gone, and so they're trying to take matters into their own hands. And these wellness practitioners are sort of preying on that. They're preying on this vacuum of information. Because, like you said, people will be afraid to go to the doctor, and sometimes with good reason, because they've had bad experiences with doctors in the past. So then they're at a loss for really any sort of guidance from a medical perspective. And they're getting all this information from wellness influencers and alternative practitioners online, or ones that they go and see and kind of get further and further down these rabbit holes of nontraditional medical tests and supplements to fix supposedly suboptimal lab levels or whatever it might be.
What do you think about those? Because I see this a lot in functional medicine where they'll say, "Well, the traditional labs just look at what's the threshold for sickness, but we're looking at what's the threshold for optimal functioning. And so our levels are going to be different than a traditional labs levels because we're really focusing on optimization." What do you think is behind that? And is there any real evidence for that?
Gregory Dodell: Yeah, I'm not sure there's any evidence behind it. I think, just going back to your point, I get that people are probably frustrated with traditional medical care because most of us take insurance. You have a limited time with a patient, which could be like 30 minutes for a new patient, 15 minutes for a follow up. And that's what I do in my practice, which is an art, to be able to really listen to the person and address their needs and figure out how to navigate all these things. And I think people get advice like, "Oh, just go out and diet and exercise" as they walk out the door at the end of the visit.
And I totally get if you don't feel good and you're just getting these blanket statements, you're going to go try and look for something if you have the means to do so, to get more testing, to take more supplements, to do whatever you're going to do. But again, I would caution that if there's not evidence behind it, you have to really think is this the way to go? And I think it's an N equals one. I mean, some people go and they probably do these things and if they feel better, that's the objective. However they get there. If that's what they're looking for and they're going to feel better, that's great. But a lot of times that's not the case.
Christy Harrison: Okay. I want to get into some of the specific endocrine stuff that's coming up in wellness culture and that people might have heard of. One is cycle syncing. So I answered a question on the podcast about this somewhat recently, which cycle syncing is the idea that people are supposed to intentionally change what they eat, and in some interpretations, also how they move their bodies at different phases of their menstrual cycle. And there's this vague promise that it's going to help balance their hormones and optimize hormone health. And it's not super specific, although in some cases, I see people saying that it's going to address particular hormonal issues as well.
And when I looked into this, I found that there was no good evidence behind cycle syncing, and also no good evidence behind this related concept called seed cycling, which is kind of a similar thing, but you're supposed to eat different seeds at different times of the month. And yet these practices are very popular in certain corners of wellness culture, and there are people who really swear by them. So why do you think that is? Why do you think these things are popular, despite a lack of evidence?
Gregory Dodell: So I'll disclose off the bat that I'd never even heard about this.
Christy Harrison: It's a very online thing, I guess, maybe.
Gregory Dodell: Yeah. I don't know. I'm on the grid. I'm on social media, and I've never heard about this, so I don't know if that says anything about it, as a traditional, academically trained endocrinologist, but I think that, as we said, people are looking for answers. I don't know that there's any evidence behind certain types of exercise, whether I could extrapolate, like, maybe later in the cycle you should be doing yoga, versus earlier on, you should be doing intense exercise. There's nothing I'm aware of that's been studied, maybe there's something to it. But I certainly wouldn't go out there and recommend that people do exercises or eat a specific way just based on where they're at in their cycle.
I really firmly believe that we're all different. I mean, there's so much we don't know about our bodies and just throwing out any blanket evidence, such as cycle seeking versus everyone should be eating Atkins or Mediterranean, or if you have this condition, you need this amount of sleep, I don't buy it. I think that we have to look at evidence and we have to say, even if the evidence strongly supports something, that doesn't mean it's going to work for everyone. I mean, research in and of itself is not perfect. Try these things.
But I think you have to take, certainly something like this with a grain of salt. But if you find, hey, right after your period, if you've been tired, or maybe your nutrition changes, or maybe after a period, maybe you're a little bit anemic, or you're low in iron and you're craving tomato sauce or foods high in iron, listen to your body. Your body knows, and that's great. And maybe yoga is a better thing to be doing at that point than crossfit, but listen to your body. I think that if we could be intuitive about what our body needs and feels, that's the answer.
Christy Harrison: Yeah, that's interesting, because that was part of the question the person had, too. When I answered this question on the podcast, they said, "Is it in line with intuitive eating to be doing things at different times of your cycle?" Because it's sort of promoted out there, I guess, in some corners of social media, as this is in line with intuitive eating. And I said, yeah, it can be intuitive if you're listening to your body, just like you said, if you're feeling more tired at certain times of the month, doing a movement or rest practice that honors that eating foods that you're hungry for and the foods that you want might have something to do with what your body actually needs, but it's not intuitive eating to say, "Okay, I'm going to prescriptively do this particular thing because I know I'm at this point in my cycle and I'm going to deliberately change it and use my diet in this instrumental way," because that's sort of the opposite of listening to your body, actually, it's imposing something on your body.
Gregory Dodell: Right. Totally. And listening to some external factor that someone's telling you or prescribing without knowing anything about you, something you read online or listened to or whatever. Again, with something like that, mixing up the exercise or whatever, I don't see any harm with that. But I think in the end of the day, listening to ourselves and what we need is the best thing we can do, which is really hard when there's just so many external voices out there telling us what we should be doing and probably some guilt and feeling like I'm not doing everything I'm supposed to be doing for myself. And I'm not putting myself first and trying to take ownership by doing things and trying to listen to all these other voices maybe feels like, all right, I'm going to reclaim my health instead of really just trying to silence that is probably the best thing you could do.
Christy Harrison: Yeah. It's so tricky, right? It's complicated to listen to yourself and trust yourself when there's so much noise coming from other sources. And something that came up for me earlier when you were talking about being like a traditionally trained endocrinologist and that you hadn't seen all these complicated labs that people are bringing in and stuff, it's this idea of like, Occam's razor, right, where we're trying to get to the most likely explanation for things and sort of cut away the rest. And I think about that a lot with wellness culture stuff because there's this proliferation of, "Oh, well, it's this and it's that, and this thing is suboptimal. And you have to look at nontraditional lab values and you have to take all these supplements and then restrict these things from your diet. And then if you're still not feeling better, do these other restrictions and add more supplements."
It's always more, more and more. And I feel like for all the flaws a conventional healthcare system has, and there are many, and we can probably talk more about that. As you said, this lack of time for one thing and sort of only having 15 minutes to devote to patients and check in, I do think conventional medicine, despite those flaws, does a pretty good job at cutting away a lot of the stuff that doesn't really matter.
The fact that you are traditionally trained and haven't heard of a lot of these things. I think obviously, the training, again, as we have said, can be weight biased and can have other problems, but it also doesn't overwhelm you with things that you don't really need. And I think that is one thing that people can get out of working with medical doctors that they don't get from wellness culture and integrative and functional practitioners that isn't so obvious because they're getting a lot of empathy, they're getting a lot of support, they're getting a lot of interventions. And yet sometimes the most supportive thing for people is to have fewer interventions and to be doing less.
Gregory Dodell: Right. I think that makes sense. I mean, I think when we have so many choices and so many things on the table, sometimes it's hard to make a decision and come to a rational conclusion because there's just so many moving parts. And I think in the end of the day, just focusing on the things that we know are important, like sleep, movement, nourishing ourselves, managing our stress, those things are all super hard to do, but at the end of the day, that's the big picture, that's the equation. And all the rest of this stuff has a lot of noise and not a lot of evidence behind it.
Although I would like to see some studies on some of this stuff. Let's do some real research and see if any of these things make sense. But until that happens, I think it's hard to tell people, "Okay, go put a lot of money into these supplements and a lot of your time and efforts" when something's not working, there's always going to be another door to open there that's going to try. It can be disconcerting for people.
Christy Harrison: And more money to be made by the practitioners, as you alluded to before. Right? Because piling on interventions does also mean more contact with the provider and more money spent and more testing and more time and all of that. So I think that's something to think about too.
Gregory Dodell: Right. I mean, I've seen patients and I know a lot of endocrinoma and an endocrine Facebook group of endocrinologists. And people feel bad because I have patients that come in who are on high doses of thyroid medication, which could be very dangerous as far as, like, heart rate and bone density and all these things. And I say, "Let me see the labs of what they were before you started the medication." Totally normal. Maybe like T3 without getting into the weeds here, but maybe the T3, which is one of the hormones that comes from the thyroid, is like one point below normal, but all the other levels are normal and they're on huge doses. And I'm like, this just doesn't make sense. So I think there's some harm that could be done.
Christy Harrison: Totally, yeah, the unnecessary interventions can absolutely cause harm. And that's really interesting about the thyroid. I feel like there's a sort of nexus there of probably, like anti-fat bias and over treatment and all of it. So I have, as I mentioned, a thyroid condition. I have Hashimoto's thyroiditis. And that, as you know, is both a hormonal condition and an autoimmune condition. And those areas are both very rife with misinformation. And every few years I do a deep dive into PubMed and once again find like, nope, there's still no good evidence for changing your diet for Hashimoto's or most other autoimmune diseases.
And yet you wouldn't know it from looking at social media, wellness influencers, or talking to alternative and functional medicine practitioners who often push elimination diets for these conditions. So what do you tell patients who are dealing with Hashimoto's or other autoimmune endocrine disorders, like Graves' disease or type one diabetes or other more rare conditions, who are wondering if they should try a restrictive diet?
Gregory Dodell: Yeah, I love this question. And I generally tell people when they ask me, I say, "If we want to talk about the thyroid, whatever is good for you in general tends to support your thyroid the best way it can." So as I mentioned before, making sure you're getting your rest, managing your stress, nourishing yourself, protein, fruits, vegetables, all that stuff. And that's what we can do, unfortunately, at least with regard to the endocrine system.
Now, for something like thyroid or even diabetes, it's really replacing the hormones that your body's not producing at that time. So, for example, just for the listeners, Hashimoto's, as you said, is an autoimmune condition, which basically means that the body is producing these antibodies, these cells that interfere with thyroid function over time. So the treatment at this point is to give someone thyroid medication to compensate for whatever the thyroid is not producing. Hopefully at some point, like they've done with other autoimmune things, these immunomodulators, like rheumatoid arthritis or MS or anything like that, is really to get to the root cause.
But we don't have that at this point yet with thyroid, at least. So the restrictive diets, as I'm sure you talk about on many of your episodes, is more harmful in the long run, because when you restrict something, you're eliminating something your body may need and also not sustainable. So I really try to focus on telling people that nutrition should not be about subtraction, it should be about addition. So adding in things that feel good, taste good, and support your overall body is the way to go.
Christy Harrison: Yeah. And I think in my experience with Hashimoto's, probably many people have this, an onset over a longish period of time, a couple of years or something, that my thyroid was fluctuating and I was feeling really tired and having symptoms, but it wasn't caught until, I think, at least a year in. And then it finally showed up on blood tests, and then it was like, okay, and my mom has it. So it was always sort of in the realm of possibility that I would develop it.
But when I was diagnosed, I was also in the throes of my eating disorder. And I think that what I was doing, restricting and being on a restrict binge cycle, which then became a restrict binge over exercise cycle and cutting out gluten and trying to cut calories and carbs and all this stuff just exacerbated the condition, just made me feel more tired, more rundown. I stopped having a period. It was all these things that compounded and that I think worsened the thyroid condition as opposed to supporting it.
And I think about that now. At the time, there wasn't this before even social media existed. This was back in like, well, it might have existed in very early stages, but it was before any of its current incarnations. So there weren't wellness influencers on Instagram and TikTok saying, you should cut out gluten for your Tashimoto's or you should follow this quote unquote, autoimmune protocol or whatever it is. And thank God that that didn't happen for me. And I really feel for anyone who is exposed to that kind of messaging now because it is so harmful and it is so seductive, too, when you're feeling bad and thinking you should do all this stuff to support your thyroid health.
And even at the time, even though there wasn't that sort of misinformation machinery there, I did fall into Internet message boards that were like, oh, cut out gluten, do this, do that. So it was already there a little bit, and I was thinking that that was helpful, but really it was, I think, just making the problem worse. And when I recovered and stopped doing all that, I found that my thyroid was actually much easier to manage in terms of my dose stayed more consistent. I wasn't all over the place and having to come back every three months to get levels adjusted and stuff like that. And I just felt so much better overall, too.
Gregory Dodell: Yeah, no, totally. I'm sorry you went through that. You're helping so many people by doing the work you do now, so it's nice that you're able to share the story, and hopefully everyone listening will benefit from that. It's true. I mean, I talk about it all the time. The thyroid is so important. It's so great. And it does react to stress, and there's something even called sickyothyroid, which is like someone's in the hospital or recovering from an illness. You don't necessarily even go by the thyroid levels because they're in this kind of like, fight or flight stress response recovery phase. So it really does react to those things.
I just saw a study recently on Graves', which you mentioned. So Graves' in some ways is the opposite of Hashimoto's. That's an autoimmune condition that causes overstimulation of the thyroid, which is hyperthyroidism. And this study was a metaanalysis, and it looked at onset of Graves' disease after inciting life stressor and what happens. And they showed a large correlation between stress and new onset Graves' disease. And as people had stress relief from whatever they were doing, yoga, therapy, acupuncture, all those things, they saw the thyroid healed and they were able to come down or even off the medication.
So it totally does react to stress and restriction and anything where you're not nourishing yourself or if someone's over exercising. Any of those things. It puts the body in a fight or flight response and affects the thyroid, it affects cortisol levels. All these wonderful hormones that are in our body to help us survive and thrive are impacted by us not taking care of ourselves and not listening to our bodies and going to one extreme or another.
Christy Harrison: Wow. Earlier you used the term root cause, and I feel like that's such a buzzword in the wellness culture spaces that I've seen in functional medicine and naturopathy, integrative medicine and all that. And when people in those spaces talk about root causes, I think it often comes back to diet and supplements and exercise. And there's some kind of quote unquote lifestyle stuff talking about sleep or talking about stress. But I think it really tends to lean heavily on the restrictive diets and supplements and not really focus on stress management or sleep and rest as much as really people need to focus on that stuff.
And I think that's so interesting about the evidence on Graves' disease being related to major life stressors and that stress management can help reduce it. And again, in wellness culture, I see a lot of like, oh, put your disease into remission, get off medication, like using food to get off medication, using food as medicine, quote unquote, fix it with food and A, not thinking about how stressful that is actually to be on a restrictive diet and how that kind of stress can just exacerbate things and B, not looking at the true, quote unquote, root cause of stress and kind of maybe letting food go and not having that be a first line treatment.
Gregory Dodell: Right. And I think that we don't know the root cause of a lot of these things. And a lot of the conditions that we deal with and treat and we live with are genetic based. And like you said, your mother has Hashimoto's so unfortunately, a lot of it's out of our control at this point. And I think just kind of accepting that and doing everything we can to manage it without looking for kind of like a magic answer or a root cause and getting the treatment that we know works and is evidence based.
We're fortunate to have these things like thyroid medication, insulin and things like that, and just accepting that this is the condition and this is what I can do about it and this is how I'm going to manage it the best way possible. There could be some reassurance and relief in that.
Christy Harrison: I have found such relief from not trying to get to the quote unquote root cause anymore, not quote unquote fixing things with food because I have a number of other conditions as well, chronic conditions, other hormonal stuff that I've had in my life. And trying to address those things with food always just led me to feeling more stressed and exacerbating my disordered eating and never actually solved the problem in the first place. Versus finding a care team that is empathetic, which was no small feat. And also like changing insurance all the time because I'm on Marketplace plan and had different jobs before that I had insurance through and was always changing.
But finally, I have kind of a care team that's consistent and that I really like and enjoy working with and just being able to trust them and trust that they're managing, helping me manage my medication and that I'm doing my part by getting blood tests and taking my meds and doing the things I need to do to take care of myself that has taken such a weight off my shoulders and I feel so much more able to. I just feel so much better now that I'm managing it that way versus obsessively trying to, quote unquote, get to the root cause and doing all these things that are not evidence based and not ultimately helpful.
Gregory Dodell: Yeah, well, it certainly takes pressure off people if they have a care team and they have clinicians that they know have their best interests in mind and it's a non-judgmental situation and there's not bias involved. Like, they're not selling supplements and doing all this testing and things like that, and they know that, look, using evidence and this is what we have, and we're going to work together to make you feel the best that you can. And that takes pressure off I think, put it all on the person to go out and try and fix it or figure it out themselves.
But unfortunately, it's a process because it's hard to find a team and a clinician and whoever that everyone's going to trust. And people see me, I'm sure, and it's not the right fit and whatever. So it's a process, and it's time consuming, and people are working hard, and people are limited by insurance, as you said, and not everyone takes insurance. And it's just a lot of variables, and it makes it hard. And that's why, of course, it's human nature. We're unfortunately all on our phones and all this stuff all the time. Sometimes it's easier just to scroll through and hashtag Hashimoto's or hashtag adrenal fatigue and see what's out there and is free to educate ourselves on.
Christy Harrison: Right. Which, yeah, goes back to the systemic problems with the healthcare system and healthcare access and all of that. And people having a hard time finding someone who's going to be empathetic or take their condition seriously or just finding the right fit can take time, too. So there's all of that at play.
You mentioned adrenal fatigue, and that is something I definitely want to talk about, because that's another thing that comes up so much in wellness culture that, I mean, I'm curious to hear your thoughts about this, but in my research, I've found that it's not really a true condition, that it kind of describes symptoms that are real, but it's not an accurate diagnosis, and that can lead people so far astray. So what do you tell patients who come to you thinking that they have this supposed condition, and why do people believe that? Why has that become such a popular thing to self diagnose with?
Gregory Dodell: Yeah, so, I mean, that's definitely a buzword amongst, in wellness culture and then also academic endocrinologists is like, "Oh, this is not a real thing." And this is kind of the uphill battle that we're dealing with, which, again, I'm not putting it on the patient or the consumer, because that's just the information that's out there and available and that they're seeing. So, the adrenal glands, just like a little physiology 101, the adrenal glands are responsible for putting out many hormones, one of which is cortisol, which is a fight or flight hormone, that also puts other hormones out that help us manage our electrolytes, like sodium and blood pressure. So it's a very important glands. There's two of them that sit on top of the kidney.
And if we're under stress, of course, we go into this fight or flight mode where you put out cortisol to help maintain our blood sugar and blood pressure and all these things. So the term has been thrown out in wellness culture, as you said, adrenal fatigue, which I'm not even sure what it means, but basically that maybe the cortisol or the adrenals are burned out so that you're not able to have that fight or flight response when needed, or it's causing exhaustion, or, I'm not sure what they're claiming it's causing, but I guess exhaustion.
Christy Harrison: And like, a whole host of other things, I think, too.
Gregory Dodell: Tell me. Yeah, what else?
Christy Harrison: Let me actually look at my book, because I wrote about it, and I'm just going to pull it up to see, because it's kind of wild.
Gregory Dodell: Yeah. You know, the problem and maybe what I like about endocrinology is you got to tease all these things out, because even like the thyroid and the adrenal glands, the symptoms could be so big. Right? Like fatigue or trouble sleeping or change in appetite. There's so many variables that it's hard to pinpoint what's going on, but adrenal fatigue is not something that's been substantiated. I think the way to rule it out would be to get a morning cortisol level like a real blood test. I know a lot of wellness culture also is like the saliva testing and the urine testing and all these things which are not been studied as far as, like, a reliable assay and making a detection of a physiologic condition. So I would say see an endocrinologist, get a real blood test that morning cortisol is the best way to look at it, and most of the time, it's going to be normal, and then you got to look at other factors and behaviors and things like that that could make you feel better and try and figure out what's actually happening and causing the symptoms.
Christy Harrison: Yeah. And they can be so nonspecific, too. I think that's the problem. Like weight gain or just, like, persistent malaise and fatigue.
Gregory Dodell: You pretty much nailed it because those are, like, the vague kind of symptoms that are out there. And I would say if there's a question, there's no harm in going to see someone and getting a morning cortisol test and making sure that it's normal. And if it is, that's reassuring, and you move on. And if it's not, then go down the route of trying to make sure the adrenal glands and the thyroid and all the other hormones are doing what they're supposed to be doing.
Christy Harrison: Yeah, well, and I think that's the thing with such nonspecific things, because it's body aches, fatigue, sleep disturbances, nervousness, digestive issues, weight gain, all of these things can be so unrelated, can be related to other things, don't necessarily have one underlying cause for all of them, and can be signs and symptoms of different conditions, too. So blaming it on so called adrenal fatigue can lead people down the really wrong path and getting treatments that they don't actually need or supposed treatments, and also missing things that they actually have.
In my experience, fatigue was definitely a huge symptom of Hashimoto's thyroiditis. I'm sure there's other adrenal conditions that have that as a symptom as well. And so a lot of these other things could have other causes and other treatments, but you wouldn't know that unless you're getting tested properly.
Gregory Dodell: I mean, to me, it really just sounds like you're burned out. That's like adrenal fatigue. It's just burnout, which is unfortunately very common in our society and all the stuff that's going on in the world and whatever. So, yeah, maybe with burnout, obviously, a lot of these symptoms can come about, but the adrenals, unless there's a real pathologic condition, are able to mount enough of a fight or flight response over time. And you certainly, I think taking supplements and all these other things to support the adrenals without evidence behind it to me, doesn't make sense. To me, trying to figure out what's going on and the behaviors and other things to support yourself is a better route to go. And certainly seeing a medical professional and ruling out some kind of hormonal thing is important to do.
Christy Harrison: Yeah, I talked to someone for The Wellness Trap, my second book about adrenal fatigue, who'd gotten misdiagnosed with that by a functional medicine nurse practitioner. And she told her she needed to take all these supplements and actually put her on a steroid medication as well, because she said that would help her energy levels and promote weight loss. Although from what I've seen, steroid medications can actually increase the likelihood of high blood sugar and diabetes and weight gain. So it's not kind of the opposite of what she said it was going to be. And steroids might not seem very, quote unquote, natural, but they're actually used a lot in functional medicine for supposed adrenal fatigue to, quote unquote, jumpstart the body's natural cortisol production, and even some of the over the counter supplements for supposed adrenal support can contain at least one steroid hormone and sometimes a thyroid hormone as well, even though they're not supposed to, because those are controlled substances.
And from what she said, this was actually the exact wrong thing for her, because. And in my research, too, I found that taking steroids when you don't need them can actually put you at risk for adrenal insufficiency, which is a real condition that can come about like secondary adrenal insufficiency, in my understanding, and you can tell me if this is accurate, but that secondary adrenal insufficiency, one of the potential causes is being on steroids long term. So could you share a little bit about what adrenal insufficiency is, or Addison's disease, which I think is like a similar thing. These are real adrenal conditions versus what people are calling adrenal fatigue.
Gregory Dodell: Right. So what's so interesting and intuitive about the endocrine system is it all works on a feedback loop. So, as I said before, you have the adrenal glands, which sit on top of the kidneys, and those adrenal glands, and specifically cortisol, are stimulated by the pituitary gland, which is a small gland in the brain, which sends out a signal called ACTH. And if there's not enough cortisol being produced from the adrenal glands, that's adrenal insufficiency. We call it primary adrenal insufficiency. And what happens is, you see the pituitary gland in the brain working really hard, pumping out all this ACTH hormone to stimulate the adrenals to make more cortisol. So when you go to make this diagnosis, if someone has primary adrenal insufficiency, or Addison's, as you said, the cortisol level will be low. Best to check it first thing in the morning, because cortisol works on a circadian rhythm. So it's supposed to be higher first thing in the morning and then tapers off physiologically during the day, because you don't want your cortisol level to be high at night when you're trying to go to sleep and rest.
And so when you do that blood test, the cortisol will be low in the morning and the ACTH will be high at night. So that's primary adrenal insufficiency. And what you're alluding to with secondary is if you give someone cortisol over time, what happens is their body then says, "Oh, I don't need to produce this. I'm getting this elsewhere." And it can kind of shut down that normal feedback loop that I'm describing. And it's really important to then taper off that steroid if you've been on it longer than three to four weeks, because if you just stop it immediately and your adrenal glands have been suppressed, you won't put out cortisol, and that's very dangerous. You can go into like an adrenal crisis, which is your blood pressure can go very low, your blood sugar can go low, you can get very dehydrated, your sodium level can go low. So in the example you're giving, if that woman was given steroids that she didn't need and then just stopped them, then she would be at risk for the secondary adrenal insufficiency.
Christy Harrison: Interesting. And that is something that I think a lot of people don't know or sort of have a deep understanding of in this alternative and functional medicine space. Right? They're just like, try this, try that, do this supplement, add this thing without sort of an awareness of the potential long term implications.
Gregory Dodell: Right. I mean, there's a reason why medical training is as long as it is, there's a lot to learn and a lot of training. And even as I go through, I'm now twelve years in or something like that, I'm learning all the time from colleagues and from patients, and there's a lot to know. And I think in these spaces, not only is the training probably not been there, but if you're not looking at evidence and you got a lot of biases and things like that can be risky for people.
Christy Harrison: There's a lot of anti-fat bias in the name of hormone health, as I know, you know, and probably our listeners will know, like the idea that weight loss will supposedly fix hormonal symptoms and that high weight is caused by eating the quote unquote wrong foods, which then disrupt hormones. And so it's like a lot of shame and blame on the person for things that they supposedly did to affect their hormones. What's your take on these ideas and why are they so problematic?
Gregory Dodell: Yeah, I mean, first of all, I like to always talk about endocrine with regard to weight and say that diabetes, PCOS, Hashimoto's or any thyroid condition occur across the weight and size spectrum. So just by the fact that that's happening, you can't say that weight is causing these things. So that's the first thing to talk about. And then to blame something on weight when a lot of these studies look, maybe a correlation, but not all these other factors such as fitness and sleep and stress and all these things people are. So in Reagan, who I know you've done interviews with and things like that, who's just amazing with research, as I learned this from know, people are so quick to blame weight for know when things don't look the way they're supposed to with regard to health versus know when you take the weight out of it and things are going well, they're quick to pat weight on the back.
So there's just so much bias out there and in the research also. So I think it's really dangerous to put things on the weight because then you end up, obviously, with people restricting calories and over exercising and all these things which you were alluding to even with your Hashimoto's that make people sicker and make people worse. So putting everything on weight is really harmful. And my approach to any patient, no matter what their size is, is to really try and focus on the behaviors and the medication as needed to help to support them in those behaviors.
Christy Harrison: Yeah. So let's talk a little bit about some of the specific conditions that can be conflated with weight. I think PCOS and menopause are two areas that I think the intersection of anti-fat bias and hormone health is really striking. So for each of those conditions, what would your take be on how to handle them in a weight neutral way?
Gregory Dodell: So PCOS, just to reiterate, does occur across the size spectrum that's important to note. And PCOS is really a metabolic condition, that there's a large genetic component to it. And that foundation of it is really this insulin resistance. And so no matter what size someone is, it's important to try and figure out how to handle this insulin resistance, because that's the foundation what drives up all these other hormones that can dysregulate the menstrual cycle and cause changes in hair and skin and metabolism and blood sugar and all the things that we talk about with regard to PCOS.
So my approach is to talk about behaviors. No matter what size someone is like, what are they doing for movement? What do they enjoy? Are they pairing up their foods and having what we call mixed meals? So a lot of the advice out there with PCOS, which I think is wrong, is to eliminate carbs or reduce carbs completely, which, number one, is not sustainable long term. And number two, your body needs that fuel, because then if it doesn't get it and it's tired, then end up going like the other route, the other direction. So I try and talk to you about mixed meals, which for people listening, if you're not aware, means if you're having a carb or starch, which we all need to having it with a protein and a fat to kind of balance that out so you don't get this fluctuation in insulin level and blood glucose levels, which make people tired and irritable and all those other things that we know about with blood sugar spike.
So again, it doesn't matter what size someone is when you're talking about something like having a mixed meal or what they enjoy for movement or how they're managing their stress. And telling people to restrict is never a good idea, in my opinion.
Christy Harrison: Yeah. What about for menopause? That's definitely something that I see people pushing weight loss for, or people who are going through menopause saying, I really wish I could lose weight, I wish I could lose this belly, all of this stuff. And I'd love to hear a little bit about kind of the hormonal aspects of it, like what's going on in people's bodies when they're going through menopause or even perimenopause. And why is the pressure to lose weight not the right way to go there?
Gregory Dodell: So it's really interesting because when I say this to people that are kind of fixated on the weight of patients also, it's hard because I get, as we age, our bodies change, and that's really, I think, a hard thing to come to grips with because not only culture, but we're used to looking a certain way and whatever. And so when we go through those changes and may have some menopausal symptoms, whether it's sweating or not sleeping well or metabolism slowing down, that's a hard thing to go through. So I just want to obviously acknowledge that.
But estrogen actually comes from fat cells. And my thinking on it, I'm sure there's research on it also, is that as less estrogen is being produced from the ovaries during perimenopause and menopause itself, the body probably in a lot of ways, is trying to hold on to some fat because that's a component of estrogen. And that's what I try and encourage people to recognize. And then the data also shows as we get older, it's actually safer to have a little more fat, to have a little more of a higher weight in some ways, because being frailer and older makes you susceptible to fractures and all these things. So our body knows and evolutionarily speaking, it's probably beneficial that metabolism slows down as we get older.
So if we look at it from that lens, I think that people are receptive to it. That can make them feel better. The body is actually doing what it's supposed to do. That doesn't mean you shouldn't try and continue to focus on behaviors and trying to optimize your health and what you're doing and nourishing yourselves, but restricting at that point, just like any other point in life, I don't think is the answer. And it can make people sicker than not.
Christy Harrison: Let's talk about GLP-1 agonists like Ozempic for weight loss. In popular culture now they're being touted for weight loss and framed as diet drugs. And I've been talking about them as diet drugs and about the problems with that and the potential harmful effects of them.
