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Season 2, Episode 19: The Adrenal Glands: Supporting Your Organ of Resilience with Marcelle Pick, OB-GYN, NP

By Jodi Cohen

A promotional graphic for the "essential alchemy" podcast, featuring an episode on "the adrenal glands: supporting your organ of resilience" with guests jodi cohen, ntp, and marcelle pick.

With Marcelle Pick, you’ll learn about how your adrenal glands support resilience, what compromises adrenal function, and strategies to support healthy adrenal function and cortisol rhythms.

  • How your adrenal glands support resilience
  • What compromises adrenal function
  • Strategies to support healthy adrenal function and cortisol rhythms

 

About Marcelle Pick

Marcelle Pick has been helping women jumpstart their health in a supportive, nurturing way for over three decades. She is a certified nurse practitioner for both OB/GYN and pediatrics, as well as a double-board certified functional medicine practitioner and the co-founder of the Women to Women Healthcare Center. She is an author of three best-selling books, has appeared on national television networks and The Dr. Oz Show, and has been featured in national women’s magazines, including Glamour and ELLE. Most recently, she’s become a weight management specialist for women who want to lose weight — the right way.

 

If you’re enjoying the Essential Alchemy podcast, please leave Jodi a review on iTunes.

 

Jodi: Hi. I’m Jodi Cohen, your host, and I’m so honored to be joined by Dr. Marcelle Pick. She is an OB-GYN nurse practitioner who is passionate about transforming the way women experience healthcare through an integrative approach. Marcelle is currently a faculty member at the Institute of Functional Medicine and has served as a medical advisor to Healthy Living magazine. She lectures on a variety of topics including weight loss resilience, infertility, stress and illness, and adrenal dysfunction.

She is the author of several bestselling books, including Is It Me or My Adrenals? which we’ll discuss today, and has appeared on Dr. Oz, Fox, and her PBS special was seen by millions. Welcome, Marcelle. It’s a pleasure to have you.

Marcelle: Thank you so much. Thank you. Thank you.

Jodi: So, first question is, how do you define resilience?

Marcelle: So, I have for years been wondering about that because everybody’s a little bit different. And we all have different stories. And what I say to people is, look, if you don’t deal with your story, your story is going to deal with you. And the way that it comes out is if you had some type of resiliency support as you were younger.

So I’ve been using the ACE study in my practice for a long time, which is a study that was done by Filetti, and I’m sure other people have talked about it here, so it’s finding out what your ACE score is, but then also finding out what your resiliency score is. And what that means is, did you have a teacher that supported you? Did you have a neighbor that really told you how amazing you were?

Did you have somebody in your life that really supported all of your health goals so that the trauma perhaps that you may have had as a kid didn’t impact you as greatly, biochemically and emotionally, as it might have without that? And as we’re adults, the question’s going to be, how able are we to get into that toolkit again to use those pieces of information?

For example, if somebody feels like they’re not enough and they were told that over and over again as a kid and they didn’t have somebody to support them, that’s going to be a rebound for them. So they need to find tools for themselves to have either affirmations or to use some support for neurotransmitters, and then be really careful with their diet to get that resiliency back up, because it is unfortunately inherent in how we grew up and what we learned as kids.

That’s our biochemistry as we get older, and the piece that it affects so greatly is our cortisol level and our adrenal levels. And that plays out, for example, if you feel like you’re not enough–let’s use that as a term–and you grow up and you get into a relationship and you blame yourself because it ends and you’re always going back to that same place. If you had some support as a kid and you’re like, “I know how to bounce back from this. I can do that. I know my tools,” you have some affirmations. You get over it very quickly.

Other people don’t, and they worry and they think about it all the time, or they’re perfectionistic, and they think about it all the time. Their cortisol levels go up. And unfortunately, when that happens it causes huge amounts of adrenal dysfunction that then has major, major physical manifestations.

Jodi: I love this. So you’re really addressing the adrenals of the root cause. Not just let’s help your adrenals release more cortisol and other hormones, but let’s figure out why they’re over…so can you elaborate on that?

Marcelle: So much true, because here’s what we find, is that…I have been doing adrenal support in my practice for 40 years.

Jodi: Right.

Marcelle: What I find is the same people come back and back and back. And the reason is that they’re not addressing that issue that’s keeping them stuck in that adrenal fatigue. Does that make sense?

Jodi: Completely.

Marcelle: Maybe you’re someone who’s a perfectionist, or if you’re someone who has no resilience and you get in relationships and you’re always blaming yourself, or if I’d only done that differently, if I’d only tried that, if I’d only whatever, then that takes you down the bunny hole, which causes the cortisol levels to go back down, in spite of the fact that you’re on adrenal support, definitely any adaptogenic herbs. And I even use DHEA in my practice, pharmaceutical-grade DHEA that I get at a compounding pharmacy.

But quite honestly, Jodi, it’s not enough, because you’re always having that cortisol pull you down a different pathway. So what I say to people–and I have an adrenal program–and what I say to people is, look. We have to start to understand that you have to start with yourself. You have to be kind. You have to be forgiving. You have to understand what is it that is that message?

If you grew up with a lot of abuse, for example, and you had a lot of trauma in the household, every time you hear a noise that’s similar, [gasp!] your body goes like that and you’re back down to… because your body doesn’t know the difference between present day stress and past day stress. And what happens then is cortisol levels go screaming. Or sometimes, they’re very low because we don’t have enough reserves.

Now what we don’t talk about a lot is what happens when the adrenals are off. And here’s the piece that’s so important. I teach for the Institute of Functional Medicine, as you know, and I’m a stickler for research because I really want to see what the data is. So I’m a little bit of a geek in an alternative world too.

And we know now more than we ever have before that when you have adrenal dysfunction it increases autoimmune disorders. It suppresses your immune system. It causes your thyroid to not have that T3 that’s active, which we need. It causes hormonal hell, I call it, because what happens is cholesterol normally makes our sex hormones: estrogen, progesterone, testosterone, and DHEA. If we have it being needed to make cortisol all the time, it says forget it. We’re bypassing the hormones because we can live without the hormones. We can’t live without cortisol.

So that’s when you see people with PMS, because their progesterone levels are down. Or you’ll see estrogen levels that are high, but they’re normal, and their progesterone levels have plummeted. PMS, perimenopausal symptoms, irregular periods. Huge translation into low progesterone, low testosterone levels, lower estrogen levels.

We also see that people have digestive issues because there’s such a correlation with the microbiome and cortisol, as well. So we can see now that there’s a huge connection to our biochemistry from trauma and stress.

Jodi: I love that. You’re reverse engineering. If you have this symptoms it’s because you’re high cortisol. And when cortisol’s high it dysregulates other things. And if you’re high cortisol, taking it back a notch, here’s why. Keep going. That’s amazing.

Marcelle: Absolutely. And for the longest time, we would say to people in conventional medicine, “Oh, for God’s sakes, it happened yesterday. Don’t worry about it.” And it’s like, right. And now, what we know is that the biochemistry of the body is very associated with those connections.

And resiliency is the key here, because if you had a tremendous amount of trauma…and what I loved about what you said is that’s why siblings are so different. If somebody didn’t have that support and that work there for themselves, that trauma was internalized, and it gets reinvigorated, as you will, on a regular basis as you become an adult.

Jodi: This is so serendipitous, because actually I have the perfectionist program. I have the good-girl program. I apologize when it’s raining. And just even being aware of that and unpacking that and moving through that…how do you help people with that process?

Marcelle: The first part is to understand it and then do things that you need to do. I have 21-day programs, for example, in which I say, look. We’re going to start today. And I want you to just begin by thinking of three wonderful things that are new that happened today. Not just a gratitude journal, but just to really get in the habit of looking at the wonders that are around you. Journaling for yourself. Doesn’t have to be long, maybe two minutes.

Some type of meditation or doing seven-seven-seven breathing in the office. Inhale for seven, hold for seven, exhale for seven, seven times. You then become into a habit of, oh, this is how I do that on a regular basis. And then we can get a little bit more aggressive, making sure that there’s no toxic chemicals on their face and their skin and that their perhaps dopamine levels are normal. We look at the neurotransmitters. Because almost always, they’re off. So there’s many different ways we can do it.

And then diet. Food is the most powerful drug we have, so cutting back on sugar. And being loving with yourself. If you make a mistake, it’s like, oops. Okay. I’ll change it next time. And that’s the most important part for the perfectionist. Oftentimes, they did it to survive and be okay as a kid. And we have these amazing mechanisms that help us survive. Thank God we had them. The problem is, when we’re older they don’t work for us anymore. In fact, they work against us.

So it’s being honest with yourself and saying, oops. I’ve got some issues. Don’t we all? And I need to work on them. So, how do I unpack them? And if I can’t do it myself, how do I find somebody that can work with me? And just knowing you can turn it around, no matter how old you are, no matter what’s going on. You can change that pattern of behavior.

Jodi: Right. And let’s talk about just walking people through the process. Something goes wrong. It’s not even something we’re responsible for, but we feel bad about it. We blame ourselves. Then can we talk about the whole hypothalamus-pituitary axis stress response and how that unravels in the body?

Marcelle: Sure. So what happens then is as you go down that bunny hole, cortisol’s released. And oftentimes, if it’s been going on for too long, you have cortisol up, up, up, and for some people that comes down. Now, what are the symptoms you might experience? Fatigue, brain fog, inability to cope because DHEA levels come down. And when you don’t have enough DHEA, you have what I call road rage. You react like this when it should just be like this. And you don’t have a sense of balance.

So it’s really finding those tools for yourself will calm you down. I’m a ballroom dancer, so ballroom dancing is my thing. And if I’m on the dance floor, I can’t think of anything else because I’m dancing, and if I forget I end up tripping or something like that. So finding out that place for you. Maybe it’s meditation. Maybe it’s yoga. Maybe it’s walking in the garden. Maybe it’s gardening. Maybe it’s knitting. Maybe it’s cross-stitch. Maybe it’s, for guys, going to the gym.

Whatever it is, finding that tool for you that helps you so that we can get that cortisol level down. And here’s the truth, Jodi. If people don’t begin to understand where that stressor’s coming from…and it could be physical. They could have Lyme disease, and that’s going to cause stress, too, or something else. If they don’t address that at the same time they’re on the adaptogenic herbs and the DHEA and the supplement support, what happens is the cortisol level continues to be a problem.

And then I’ll do my cortisol levels on my patients and they look almost the same as they did before. So it’s like, wait a minute. I talk to people in my office quite often, and it’s like, “How much stress do you have?” “Oh, I don’t really have any.” And then I start asking the questions, “Well, how hard are you on yourself?” “Well, on a scale of 1 to 10, a 9.” That is the piece that you’re talking about, is that “it’s always my fault,” “I always did it wrong,” and “if anything happens, the look on our face is because I did something.”

That’s all about you taking it too personally, and finding then strategies and doing some work. You can do emotional freedom technique. You can do EMDR. You can do many different types of body work that can help you no longer be in that place. And you just have to remind yourself of the neocortex. Say, “Oh, that’s old stuff. That’s not today. The worst is over. This is what’s going forward now.”

Jodi: Yeah. And in terms of resilience, can you talk about how the adrenals support our resilience, and the more we help to… the benefit of doing this work and moving through it?

Marcelle: Yes. So, as I mentioned, when you have cortisol levels that are off, what happens is that you have a feedback system that creates a lot of havoc on the body, from digestion to thyroid to hormonal imbalance to autoimmune disorders to immune dysfunction.

As we get the body to be less reactive, as we get the body to start to understand the worst is over, I can now have a normal life without being in over-reactivity, then the adaptogenic herbs can be immensely helpful, and DHEA can be immensely helpful, and I might use other hormones as well, depending on what’s going on. What we find, then, is that there’s that balance that comes. As long as we’re not always in overdrive or perfectionism or any of those continued problems, we can gain enormous changes that sustain us for the rest of our lives.

Jodi: And one thing that I’ve always been curious about. Cortisol and inflammation. Can you explain the connection there?

Marcelle: Absolutely. A little cortisol, we have to have. We cannot live without our adrenals. If we’re being chased by a tiger 400 years ago, cortisol went up. We either got killed by the tiger or we were falling back in life again, we’re partying. And cortisol came back down. That isn’t the type of life we have anymore. We’re seeing things that are going on on TV. We’re watching the news. We’re worried about the pandemic or all those kinds of things. We have kids. We’ve got a dog and we’re multitasking.

Jodi: A puppy.

Marcelle: How cute. What kind of puppy is it?

Jodi: He’s a Havanese. He’s nine weeks old.

Marcelle: Oh, my God. He’s so cute.

Jodi: Yeah, but not sleeping, so therefore, high cortisol.

Marcelle: Exactly. So what happens then is that we have to take charge of our lives in some ways by saying, “I’m turning that off. I’m not going to watch the news. I’m going to take any sabbatical from my computers and from all my tech stuff and my wi-fi.” We are mindful of the food that we eat. We’re mindful of the thoughts that we think. All of those play together because that’s ultimately what feeds cortisol level.

Now cortisol, when we have too much, is an inflammatory hormone. Okay? We need to have some. We cannot live without just a bit of cortisol. But when we have too much for too long, it does contribute to inflammation.

Now what women experience tremendously is when their cortisol levels are up and their adrenals are not functioning properly, they cannot lose weight. No matter how little they eat, no matter how much exercise they have, their body just goes, “Girlfriend, not gonna happen.” And it happens to men, too, but I’m more familiar with women. And they get so frustrated because they’re doing everything right.

Jodi: Right.

Marcelle: Their body’s saying, “Na-ah. I’m storing these calories for a rainy day. I don’t know what you’re gonna do next to me.” So, I oftentimes will have people go on keto. Not to lose weight, but keto to get them out of the insulin resistance, because that’s exactly what’s happened. The insulin resistance has started, and the body locks down. And no matter what, you won’t be able to lose the weight.

Jodi: Can you explain, unravel, how high cortisol levels contribute to insulin resistance, for people that might not–

Marcelle: So, if you imagine that the body’s under assault, and it’s having a lot coming at it. And if you have high cortisol, that war that we’re talking about 400 years ago, the body goes, whoops. So you don’t need as much food. You don’t sleep at night. You sure don’t have a sex drive. You may empty your bowels, and your body goes into protect.

But it also goes into a mode in which it says, “This might be my last calorie. Might be my last calorie. So I’m going to store everything. And there is no way I’m going to let it go, because I don’t know what’s going to happen tomorrow.” Now that was great 400 years ago. It doesn’t serve us anymore. And our body’s still responding in that primitive response.

So it goes into lockdown. And what happens then is it doesn’t matter how little you eat. The body says, “Oops, this could be my last calorie, so I’m going to store it, and I’m not going to let go of any of it.” We have to stabilize that by doing keto. Keto is a fantastic way to do that, and many times people don’t eat breakfast.

I’m not recommending that for people that have very significant adrenal dysfunction. I make sure that they have breakfast, lunch, and dinner, and sometimes even snacks in between. Only to get them out of the insulin resistance.

Jodi: Right, and for people, listeners, who aren’t familiar with keto, it’s a highfat, low-carbohydrate diet, which can you explain why that’s beneficial to unravel insulin resistance?

Marcelle: Yeah. So what we know is…I don’t like people using a lot of saturated fat. I’m not a big fan of that for keto. I like to have it be really good quality fats, like avocado, olive oil, nuts and seeds. And what that does is it helps the body get nutrients, and also when you’re doing lots of carbohydrates, no matter what the carbohydrates are, it gets converted to sugar. And so what happens then is that really implodes physically for you. And what happens then is it makes the insulin resistance actually worse as opposed to better.

But by cutting back on the carbohydrates, you’re supporting the biochemistry of the body and you’re helping the body come into this, “Ah, she’s going to feed me,” state. And then your body’s no longer as locked down into that insulin resistance as it was before.

Jodi: Yeah. Someone once said that if you think of building a fire, carbohydrates are like the kindling and fat and protein is more of the slowburning logs so you don’t have the rollercoaster spikes.

Marcelle: And that’s what you want. Especially when you’re in that position of having a lot of stress, you want to be able to have that nice stabilization go on for yourself.

Jodi: What are some other strategies that are highly effective? If people are listening who are like, “Oh, my gosh, that’s me. How do I unravel this?” What else?

Marcelle: Yeah. I mean, there’s many ways to do it. I am a big fan of getting it tested. And the reason for that is I’ve been surprised. I thought somebody was going to be low all day and they’re high all day. So I’m going to use different nutrients to support them. And it’s also fun for them to be able to see, wow, look it is changing. I am making a difference. Thank goodness.

Jodi: What test do you advise? Do you like the saliva test, the DUTCH test?

Marcelle: I like the saliva test. Yeah. I like the saliva. Because, I mean, the DUTCH test you can do as well. I’ve been using the saliva test probably for 40 years, so I’m pretty familiar with it. And I also like to do a gliadin profile, because that gives me information to is that person having a gluten sensitivity that may be contributing to the adrenals as well.

And I oftentimes like to see DHEA levels, as well, and if I can’t get it in the saliva I’ll get it in the blood with a DHEA-S level so I know whether I need to support the biochemistry with DHEA or not. And when I do that, then I’ll use nutrients specific to their test results.

And then, we’ll talk about all the pieces. The ACE score, the resiliency score. What are some things that they perhaps can do differently?

If they notice that they’re starting to say things like…women are horrible about being negative about themselves. “Oh, my God, my hair today or my arms or my”–whatever they do.

Jodi: Yeah.

Marcelle: And that’s really negative thinking, so I really try to help them to change even the neocortex and even do a pause of the thought that they had and to have another thought. We know, from The Biology of Belief by Bruce Lipton, we know our thoughts predict our behavior and our biochemistry.

So it’s doing everything in your power to change that dynamic. Even though you were told as a kids perhaps you were just nothing and…it’s like, no, no, no, no. What I sometimes will have people do is I’ll have them have their girlfriends or friends tell them all the things…10 things they love about them. And I’ll put them on an index card, and I’ll have them laminate that card.

And every time they have that thought coming up about, it’s my fault, it’s this, it’s like, no, no, no. Look at this. This is what’s the truth. And sometimes put it on the refrigerator, so that you have a concept of what’s reality and what’s not, because all of that is also dependent upon how much resilience you had as a kid, and that sets the framework for what your thoughts are later.

Jodi: I love that. So you’re hitting it from all angles. You’re hitting it from diet. You’re hitting it from really addressing supplements. What about sleep? Talk to me a little bit about–

Marcelle: Oh, my God. Sleep is huge.

Jodi: Yeah.

Marcelle: And exercise and doing something that you love, being out in nature, going outside with your feet planted on the floor, being mindful of wifi. I mean, these are all part…making sure that you don’t have any chemicals on your skin, avoiding toxic foods, so the toxic 12.

But sleep is crucial. And the problem that many people have is when they have adrenal dysfunction is their cortisol levels are up at night, so they can’t sleep. And they go to bed at a reasonable time and they’re just tossing and turning, or they fall asleep and wake up. And that oftentimes is a cortisol issue. So I’ll put them on something like phosphatidyl serine that brings cortisol levels down because it’s not always a melatonin issue. And that is very, very helpful in getting their support for their adrenals.

Jodi: Yeah. I talk about that a lot, the relationship between cortisol and melatonin. Can you explain that a little bit and how phosphatidyl serine helps to bring down the cortisol levels?

Marcelle: Sure. It’s an adaptogenic herb, and it’s specifically for high cortisol levels. So, if I have somebody that has high cortisol levels at night, you really can’t sleep. No matter what you try to do, you’re exhausted. So I call them “wired and tired,” and they can’t get to sleep.

And that’s one of the patterns that you see. They might be low all day long and then high at night, and that makes them even worse because they can’t sleep and they get more exhausted. And they’re like, “I’m trying to go to bed on time. It’s not working.” So, phosphatidyl serine is an adaptogenic herb that pulls cortisol levels down.

Now, there are times that we need melatonin. Melatonin is the herb that really helps us get to sleep when it’s dark out. That’s the melatonin level, and as we get older, we have less melatonin. And if you are someone that needs it, it works very effectively. And some people need one milligram. Some people need three. When I did my health talks, I talked with someone who actually has as much as 200 milligrams a day. I don’t recommend it.

Jodi: Oh.

Marcelle: But, yeah, he uses huge amounts of melatonin.

Jodi: Well, it’s neuroprotective. Yeah. There is that antagonistic cortisolmelatonin. If cortisol’s too high you might need more, but I love that. And how do you support nocturnal hypoglycemia, the people that have the blood sugar dip during sleep and wake up around 1:00 a.m.?

Marcelle: What I oftentimes will do is be mindful of what they’re doing for carbohydrates, and that’s the person that I’ll definitely have have breakfast. And again, those are oftentimes the people that have a lot of internal stress that’s going on.

So I’ll have them do some journaling beforehand. I’ll have them have a book by their bedside and have some kind of twilight–no bright light–so they can write down some of the things that are going on for them. Because more often than not, they’re having some dreams that are really causing some havoc with the body that increases cortisol that increases then the blood sugar load. Because remember, the adrenals are directly responsible for our glucose control. And they’re also directly responsible for fluid retention. So those two things, they go hand in hand.

Jodi: Oh, can you speak to that a little bit? Fluid retention and aldosterone, for people that might be puffy or might not have known that connection?

Marcelle: Yeah. So there’s two major components to the adrenal function. There’s many things that they do, as I mentioned before, but they’re really responsible for the aldosterone fluid normalization in the body and also for glucose regulation.

So if you have problems with your glucose level, it is probably also partly related to adrenals. And that’s what we in conventional medicine never talk about. Also, for fluid retention, same thing. Now, can foods do it? Absolutely. Can blood pressure do it? Absolutely? Can cardiovascular issues do it? Absolutely, of course. And you get those checked out first.

But then the other thing is, what’s happening in your dreams? What’s going on at night that may be giving you keys to what may be happening with you emotionally that may be contributing to cortisol going up and may contribute to that fluid retention as well? So we need to be always looking. I practice functional medicine. I’m always looking at all the pieces to the puzzle. It’s not just one situation. It’s like, okay, what’s going on for you? Is it related to this or this or this? And how do we pull it all together?

Jodi: Well, you’ve been so generous and shared so many pieces of the puzzle. Is there anything related to resilience that we haven’t touched upon that you’d like to add?

Marcelle: I guess the point that I want to add is that we all can change. You just have to understand what’s keeping you stuck. And if we have adrenal issues, it’s looking at how do we come out the other side. And what is specific to you, because we’re all different. We all have different stories.

Just like you said with the siblings, we have different resilience support as kids. So it’s finding out what works for you, and working with someone so that you can figure it out, because you all deserve to feel amazing.

Jodi: So if people want to work with you, how can they find out more?

Marcelle: Sure. So I have a website, MarcellePick.com, and everything’s pretty much there. I also have a weight-loss program called Women’s Transformation Center that they can learn about weight loss, because so many people struggle with that and have adrenal issues too.

Jodi: Well, thank you so much. This was wonderful. I appreciate you.

Marcelle: Absolutely. Not a problem.

Jodi Cohen

Jodi Sternoff Cohen is the founder of Vibrant Blue Oils. An author, speaker, nutritional therapist, and a leading international authority on essential oils, Jodi has helped over 50,000 individuals support their health with essential oils.