Adrenals & Stress: The Impact On Your Health

Marcelle Pick, OB/GYN, NP

What had its bumps along the way, let me tell you, because we have ostracized so much. When we went to ground rounds, they would make fun of us because we were in the back sitting together, the granola docs on the hill.

Jennifer Simmons, MD

Yes, I am sure that is what you were. When you were talking about functional medicine in the 1980s, they had to have thought that you were a quack.

Marcelle Pick, OB/GYN, NP

They did. Yes.

Jennifer Simmons, MD

If I am being honest, I discovered functional medicine, not for any other reason other than becoming a patient. I get sick, and I get faced with a life-threatening illness. Even though I am deeply steeped in traditional medicine, I somehow knew that surgery, chemo, and radiation were not for me. I went and listened to a talk by Mark Hyman. This is probably in, I do not know, 2016. He gets up on the stage and introduces himself as a functional medicine physician. At this part and this point, I have been a doctor for 20 years. I say to myself, There is no such thing as a functional medicine physician. What is this quack talking about? This is in 2016 when he probably already had three or four bestselling books, maybe even more, when I had no idea who he was. I cannot even imagine the adversity that you must have come up against in your career, especially talking about this stuff in the 1980s.

Marcelle Pick, OB/GYN, NP

It was intense. There is no question about it. Fortunately, there was a group of us; there were four of us that were in practice together. Then we had many other people come on board who joined us and then learned about it, and they went on their practice. We had to just support each other. We knew deep inside because we were steeped in the science; only we were looking at the science that was in the labs as opposed to coming out in peer-reviewed journals. Once we started to understand that, I knew about triple antibiotic intervention for helicobacter pylori way back in the day for ulcers. We were using probiotics in 1986.

A lot of the things that we were doing and we were doing, we never went and prescribed the conventional form of hormone replacement therapy. It was very unusual. We were one of the first to start using compound pharmacies in Madison, Wisconsin. We were very clear in terms of the outcomes that we saw in our patients. In-house, we are still doing surgery. That is not; I was not, but my colleagues were. We were still in that world, but we always looked at the big pieces. As time went on, then we started looking at the other modalities with, still testing. I was doing that, probably in 1987.

Jennifer Simmons, MD

Yes, amazing. It was amazing at that time, you were able to keep a foot on each side. Because even though it is 20, 30, or 30 years later when I tried to do that, I did not feel I could. I stepped away from surgery because I did not feel I could operate again. Pardon the pun, but within the confines of the traditional medical system and deliver the medicine that I thought I wanted to deliver. Let us talk about your background a little bit as we segue into what we are going to talk about today, because your specialty is hormones, and you do a lot of the hormone instruction for IFM, for the Institute of Functional Medicine, and you lecture on a variety of topics, including weight loss, resistance, infertility, stress, illness, or adrenal dysfunction. When we talk about the fact that people do not get breast cancer in a day, This is a process that has been going on for quite some time. It is usually at the end of the road of hormonal dysfunction where, maybe, in the teens and 20s, we see PCOS or in the 20s and 30s, maybe we see infertility, and in the 30s and 40s, we see menstrual irregularities. All the while, this is compounded with stress, and the ovaries are not functioning on their own. This is a concert. I think you use that term to mean that this is a concert. I think I got that from you.

Marcelle Pick, OB/GYN, NP

Yes, it is an orchestra. Absolutely. Yes. What is so interesting about medicine is that we, unfortunately, come to a diagnosis and then of treatment, not starting to understand. Well, how did that start? What was the beginning of the beginning? The cause of the cause, which is what we talk a lot about in functional medicine, is why I think it has become so important. Even when we talk about cancer and disease, there was a point in which it started many, many moons ago. My specialty is certainly the notion that if we do not deal with our story, our story deals with us. 

What we mean by that is that we all have stories that we grew up with. We all have issues. There was a very large study called the ACE Study that I was introduced to by my father in 1998. It put everything together for me because it is something I have always known and believed, and that is that they looked at 17,000 men and women, middle-class Americans, to see does stress impacts health later. The person who did the study, Dr. Valiani from Kaiser Permanente, said, I think it is only, but sure enough, what the outcome was, it was, Oh, my God. 

The higher your stress as a kid, the higher your risk profile was for obesity, heart disease, cancer, disability, early death, early retirement, and heart disease. It was, Woah! We know that when I was teaching for IFM, we did not have data to support that. We had so many peer-reviewed journals that support the notion that this stress complex increases autoimmune disorders, immune issues, metastatic cancer, cardiovascular, and gut microbiome issues, and now we are starting to understand that endometriosis is about the gut microbiome, that a lot of the gradual changes are gut microbiome. The microbiome of the uterus is important here as well. Is there such a thing as a microbiome of the breast? I do not know. We do not have data to support that.

Jennifer Simmons, MD

No, there is.

Marcelle Pick, OB/GYN, NP

There it has to be connected.

Jennifer Simmons, MD

Yes, there is. We can change that if you think about it. Anything that has contact with the outside world has a microbiome. Our ears have a microbiome. Our eyes, our nose or mouth, our vagina, anus, everything. The breast is in contact with the outside world. That is where the ducts terminate. Without question, the breast has a microbiome. How we can improve that microbiome, optimize that microbiome, and make an ideal. I think that is the question. Everything else, I suspect is going to come from the gut.

Marcelle Pick, OB/GYN, NP

Yes, I cannot agree with you more. Yes. When I have anyone who comes to me with anything, I always look at the gut first. Yes. adrenals because, as we understand biochemistry, the adrenals; we do not ever talk about them in the world of medicine. We do this when people have Cushing’s syndrome, too much or too little cortisol, or Addison’s. But other than that, we never talk about it, which is ridiculous because we know about those biochemical changes. The American Academy of Endocrinology came out with a statement several years ago saying there is no such thing as adrenal fatigue. Well, the name would.

Jennifer Simmons, MD

What is that about?

Marcelle Pick, OB/GYN, NP

I do not know. The name is probably a result of social media that came up with it. The adrenals probably do not get fatigued, but in some ways, they do because if you have too much cortisol for too long, the body makes cortisol from cholesterol. If we have too much need for that cortisol because of work stress, or life stress, our story has not been resolved as we get older. Then we have Lyme. We have chronic or any of those things. Will bypass making estrogen, progesterone, testosterone, and DHEA and only make cortisol. There is too much need for cortisol. Ultimately, what goes on and what goes up must come down. If it is too high for too long, then it starts to come down. That is, when people experience what I call unrelenting fatigue, or what I call a flatliner in my book, they just get up and go. 

The things I look at are our gut and adrenals, and then I might look at the other pieces, including some of the thyroid pieces and all those things because they are so interconnected in regards to our overall well-being. Unfortunately, our stress response is a huge part of what we do not talk about, and in the world of medicine, we never talk about it. Are you a perfectionist? What happened as a kid? How much trauma did you have? Did you feel unloved? Do you not feel enough in life? This goes on and on because I work with predominately women, and I hear this story every single day in, well, in the 70s or 60s. 

Jennifer Simmons, MD

I think, going back to what you were saying before about your story is that, even though that trauma happened to you 30, 40, or 50 years ago, if you are still reliving it, it is still affecting you. That is the constant stress that is on you, which gets layered with whatever is happening today. But if you are reliving that trauma over and over again, then it has not left you.

Marcelle Pick, OB/GYN, NP

What is so interesting about what you are saying is that it is not just about reliving it. It is not even knowing that you are. For example, let us use me as an example. My father and mother were both Holocaust survivors. They pulled their bootstraps up in the lights, and I do not think they were ever able to get to the depths of that pain. I am not sure how you ever do that, but he was a man who very seldom yelled, but he was so rageful. You could feel it from him. Albeit a perfectionist. I would hear people speak, and sometimes my body reacted to that. We do not even have to know that we are in that place. But it is understandable if we take the time to look back. So what was it for me? How did I respond? How was that? That is not saying my parents were bad, because they were not. They did the best they could. But we adapted behavior for that later in life, which then became maladaptive. That is the key piece to what can drive that fight or flight response. For women in menopause, I say menopause is a journey of self-discovery. Who am I? What am I going to do for the second half of my life? The veiling of those things that have been stored oftentimes happens there as well. 

Jennifer Simmons, MD

It is a crossroads.

Marcelle Pick, OB/GYN, NP

Absolutely. What an opportunity. But so many people do not see it that way.

Jennifer Simmons, MD

Just going back to this concept of adrenal fatigue, it is like leaving something on forever. In the beginning, it may be able to keep up with that, but then eventually it is just going to get overworked and not be able to put out what it could put out before. That is exactly what is happening: our bodies were not designed for sustained stress. Either we came out of the cave in the morning and encountered the saber tooth and did not run away and escape, or we got eaten and died. 

But we are never meant to run away from a saber tooth tiger for three hours, three weeks, three months, or three years. We are just not built for that. It is not who we are or what we are. Yet we spend most of our lives in that sympathetic state, running away from saber-tooth tigers. Our phones, the constant emails, the constant alerts, the feeling you have to be available, whether you are in a bad relationship, have a tough boss, have a tough job, or are living in a tough place. It is just that it is never-ending. We never developed the tools to deal with it.

Marcelle Pick, OB/GYN, NP

It is sad because it is so true. One of the things many years ago was that zebras do not get ulcers. The whole notion is that zebras are out. It gets chased by a tiger. It does not get killed. It comes back to the field and starts eating again. Whereas what we do is, Oh, my God, I almost got killed by a tiger. I got to tell my friends. It just goes on and on and on and that is what you are describing, which is the whole notion of constant sympathetic overload. Now we do not have that time at night. We have electricity. We stay up late at night; we stay on our computers. We are watching what is going on in the world. We see a bomb when it happens. Then we had COVID, then we got our children, and it is just nonstop.

It is interesting if we look at some of the work from Jody Spencer and some of what was happening. I had a patient who had breast cancer, and she had a lumpectomy because it was just DCIS, and she had an abnormal mammogram that she did not follow through. Fast forward a couple of years, and it was metastatic to her bones. Her daughter got into a Joe Dispenza retreat, and she had a healing with 14 people. I was calling her to say because I thought she was going to be in hospice by this time. She goes, Hey, how are you doing? I am. Excuse me? She goes, How are you doing? She went either in a wheelchair or on a walk. I do not know which one. She walked out, and she went hiking the next weekend. I followed up with her about two weeks ago. She has not had scans done, but she was on pain medications every 30 minutes, she did not have the rod put into her leg, and she is doing incredibly well. She just came back from the retreat center. Now, what happens?

Jennifer Simmons, MD

You are saying that she is no longer reliant on pain medicine, like her pain is gone?

Marcelle Pick, OB/GYN, NP

Yes. Now we do not know her scans. She is supposed to get them in the next couple of weeks. But, is that healing possible? What does it take? Does it happen to everyone? It does not. But there are some interesting things that we are becoming aware of in that world: that the connection that she made to me is Marcelle; it was my life; it was my stress that co-created the pieces to the puzzle; hormones; and all the other things that we are talking about. It is truly finding out for ourselves: how do we have a life of inner peace, and how do we find that balance to get into the parasympathetic, whatever that is? That is the key piece for so many people: acknowledging that they have that place. number two, and of course, diet, the microbiome, and hormones.

Jennifer Simmons, MD

We all know the things to do, We all know to stay away from processed foods. We all know sugar is bad for us, and we all know that we have to move. We all know that we have to prioritize, sleep, and avoid toxins. We know all of that. But the thing that most people do not realize is that you cannot eat right or think wrong. If you cannot do that, it will not work. Your mind and your mindset have such a profound impact on your health. 

I tell people in the beginning when I start to work with someone with advanced-stage breast cancer, and of course, the first question that everyone wants to know is, Are they going to live and are they going to survive this? My only answer is that I do not know. Truthfully, only you know because that power is yours and you have to tap into it. People live as long as they think they are going to live. We hear stories like this all the time. I just want to live for my daughter’s wedding, and they die the following week. I just want to live to see my granddaughter graduate from college and die days later. This happens all the time. We somehow can summon that strength to survive the thing. Then we give up afterward. But what if we do not give up? What if we say we are just going to live? I think that is a lot. What Joe Dispenza is working on with people is setting himself up to believe that they are in control of their destiny. They can design their destiny, and we are not taught to believe that.

Marcelle Pick, OB/GYN, NP

I was just going to say that the unfortunate part is that many people are surrounded by the opposite and give their power away to other people. Well, how long do I have and the date? The reality is that none of us know. We think we know from statistics, but we do not know. Years ago, if you look at functional medicine, it was in 1985 when we started doing this. We were just considered to be crazy people. It was one of the fastest-growing practices in Maine. We had to get more and more file folders because, at the time, we had paper and we could not keep up with the demand. People at that time were searching for other answers. The whole notion of hope—where is that in this? understanding that there is a lot more that we know now than we ever knew back then. The guts, that our thoughts predict so much for us looking at screening function, looking at heavy metals that play into this, looking at mold, how does that play into this? All of these are pieces of the equation that we do not give any credence to. We just talk about this issue. I needed to do something about it. Well, it is a bigger issue than that. As you said, it does not just start today. It started years ago.

Jennifer Simmons, MD

Yes. You and I started to talk about the fact that what this society generally does is give away its power. Much of the time, we are looking to someone else to help us, to save us, to cure us, and to heal us. But I think that that is one of the most profound differences between the functional medicine approach and the traditional medicine approach. Because in the traditional medicine approach, the doctor or provider is the hero. I am going to give you this, and you are going to get this. Whereas in functional medicine, we say, Here are your tools, but it is up to you to use them or not, and only you can be the hero of your story. It empowers the individual, but it takes a certain individual who wants that empowerment. Not everyone wants it.

Marcelle Pick, OB/GYN, NP

Absolutely. But I also think people have been brainwashed to think that they do not know the answers. I think for women, it is interesting because I was talking to your friend the other day, and I think that I was marching for the NRA and doing all kinds of things. I was a feminist from the time I was 15. I am not sure it did a disservice. I think in some way it did us a disservice because now we are mothers, daughters, friends, and CEOs, and we still have this pull of so many of those things, and we cannot do it all well. I think that what has happened is that, unfortunately for so many women, it has pulled them in too many different directions. Self-care has never been great for women anyway. Then they do even less of it because they do not have the time. These other priorities come first.

Jennifer Simmons, MD

Yes, it is the first thing that everyone abandons,?

Marcelle Pick, OB/GYN, NP

Totally. Self-care is so important. What I say to my patients is, Look, our kids are watching what we do, not what we say. If we are going to impact our society, especially our young girls, we have to walk the talk. That is easier said than done because, in the end, it requires. Well, what do I let go of? How do I have that dance, and how do we have the medical? We do not know what is going to happen tomorrow, but we do not necessarily live by that motto. But just starting with baby steps, looking at adrenals, for example, it is, do I have stress as a kid? Looking at an ACE score, what is your ACE score? What is your resiliency score? Because that, fortunately, counteracts some of the ACE scores and then expresses very high. That is not a result. That is just the beginning of, what I never realized. How do I move forward differently?

Jennifer Simmons, MD

Yes, it shows you where your work is.

Marcelle Pick, OB/GYN, NP

Totally. Yes. It is so interesting because it is absolutely territory that we do not go into whenever we go for an annual or something like that. Then I spent a lot of time in that place with people. How do we move out of that and what are some of the tools, the mind, and make recommendations for people because they do not have to stay in that place and they do not have to do years and years and years of therapy either? But it is understanding that place of acknowledgment that our mindset plays an enormous part in our tomorrows.

Jennifer Simmons, MD

I love that mindset plays an enormous part in our tomorrow. You started to say in the beginning that in functional medicine it is about asking, Well, why did that happen and why did that happen? Backing up three steps to try to figure out how you got here, which is not a part of the traditional medical model at all. When I was a surgeon for 20 years, what I was trained to say was that breast cancer is a multifactorial disease. Several things have happened to you in your life. Just bad luck. That is the answer that I was taught to say. I say it about a thousand times a year. For the woman who is getting diagnosed, is living with a diagnosis, or has had a diagnosis and does not want another one, how do they go about it? People ask me this all the time, if I cannot come work with you in Pennsylvania, how do I figure out why? Where do you tell people to start?

Marcelle Pick, OB/GYN, NP

Probably find someone who is trained in functional medicine, and the reason that is so important is that if I do an intake with people, I am looking at what the mother’s pregnancy was like for you. Were you breastfed? Were you a C-section baby? How many food problems did you have as a kid?

Jennifer Simmons, MD

How many of you can just back up and say, Why is whether or not you were breastfed important? Why is whether or not you were born by C-section important? Because people do not consider these things.

Marcelle Pick, OB/GYN, NP

The interesting thing about a C-section, baby, is that if you think about what happens when you go down the birth canal, you are inhaling the bacteria. The bad news is that if your mom had gut problems, you are probably going to have gut problems, too. But if you are a C-section baby, you do not get that exposure. Your gut microbiome was already behind the eight ball if you will. Our gut microbiome is established by age two. If you are a C-section baby and you have had multiple antibiotics, those are the people who oftentimes have Candida or autoimmune issues because their gut microbiome is so dysfunctional.

Jennifer Simmons, MD

Can I ask you something, if a mother does have gut problems and, for whatever reason, the child still gets born by C-section, do you recommend inoculating them? is some of that microbiome.

Marcelle Pick, OB/GYN, NP

Any of that?

Jennifer Simmons, MD

None.

Marcelle Pick, OB/GYN, NP

Yes. Many of the progressive hospitals are starting to do that. Swab the inside of the baby’s mouth from mouth to nose. Absolutely. Then if you are bottle-fed, we do the best we can in formulas to give the baby amazing kinds of things. Back in the day, they did not put any essential fatty acids in there, which are in breast milk. No matter how hard we try.

Jennifer Simmons, MD

This is still not great.

Marcelle Pick, OB/GYN, NP

I know. But no matter how high,

Jennifer Simmons, MD

Fructose corn syrup. Why?

Marcelle Pick, OB/GYN, NP

I know. If it has to happen, then you do the best you can. It would be helpful if you did not want to breastfeed to at least pump so that you had that ability.

Jennifer Simmons, MD

Because that makes a huge difference. It is breast milk; it is a jumpstart in this child’s immunity, and it is going to determine their path for the rest of their life.

Marcelle Pick, OB/GYN, NP

Yes. But I do not want to make people feel guilty that if they cannot do it, it is just because of the where. Then what essential fatty acids might you need to add or use some type of probiotic because they have a massive influence? There are several things you can do, but unfortunately, it does create some problems about some of those issues later in life. Also, how many times we were sick as an adolescent, what were some of the life circumstances that happened then and then going all the way through and then looking at what was going on stress-wise, what was going on with food, what is going on with mindset, how much exercise are you getting and then looking at the endocrine system, looking at the cardiovascular system, looking at the hormonal system. It is putting all of those pieces together and then making a summation. 

I just started doing some one-on-one again after I stopped for a year. I have, I do not know, 50 pages of questions initially that I want for my people. What is your sleep? What is your exercise regime? What history do they have? All these things then I could develop a formulation of what I needed to do to test the adrenals first, gut where I started anyway, what about hormones? What about toxicity? Is that something I am concerned about? Because more and more of those all play a part in health and the adrenals. If you have molting, it is very hard for those adrenals to stabilize and be in a normal situation. It is looking at all the possibilities, and we are all different. There is no such thing as one size fits all. It just is not anything. Putting in those pieces so that you can figure out who created this and what we need to do to change these things.

Jennifer Simmons, MD

Yes. I do not know that someone cannot come to this on their own, but it would take a very long time, which is why we advocate for working with a functional medicine provider just because they speed up your timeline.

Marcelle Pick, OB/GYN, NP

Getting some of the testing done is very difficult to do as an individual. I am involved in another group talking about hormones every week with this particular group of people. I am floored. They are very educated at how hard it is for them to figure out that these pieces are just along; they cannot say with the help of someone who can navigate these pieces.

Jennifer Simmons, MD

This and I even think every doctor needs a doctor. Every coach needs a coach. It is so hard to navigate these things on your own. I think that this whole adrenal concept and how it relates to breast cancer are pretty unclear for people. Can you lay out a picture so that people can understand the connection and what is happening?

Marcelle Pick, OB/GYN, NP

Sure. When we have enormous amounts of stress, which I would say is either present or past, because our body does not know the difference between present and past; it perceives it as the same thing. If you had the feeling as an adolescent or a young child that you were being chased by a tiger, that same feeling can be initiated very quickly as an adult. What happens then is that cortisol is produced and produced and produced, which depresses the immune system. With that constant depression, you want your immune system to be as healthy and active as you can so that you might have a cancer cell. When we have that method of consequences, we do not belong here because the balance is there, our physiology. It is unfortunate.

Jennifer Simmons, MD

Part of the reason why high levels of cortisol suppress the immune system. Because if you are running away from a tiger, you do not need to fight off a cold. You probably will not live with the cold.

Marcelle Pick, OB/GYN, NP

That is exactly what happens: the response in the body is so taken aback by having to deal with the stress so much that it is no longer able to do that phagocytosis of that cancer cell. It is almost preoccupied with the enormity of what that stress response is doing. Other physiological changes going on about inflammation. We know that people who have high cortisol levels have more inflammatory markers as well, which also increases their particular issues about cancer. What is interesting is that if we look at some of the studies I am sure you have talked about, we can see people’s stress levels from 5 to 7 years before the diagnosis. Is stress the only thing that causes it? Of course not. But as you said, early in your life, they may have had some endometriosis, and they may have had infertility. Then they had this, and we had that. We do know that, as I mentioned before, cholesterol usually makes our sex hormones. If we have less progesterone, we see that with endometriosis. We also see that with what we call luteal defects, they are having infertility problems, and there is a beginning of that hormonal cascade that goes on that is problematic for people and puts together a gut microbiome that is not very happy with the endometriosis and low progesterone. Therein lies this issue that no one is addressing because, looking at the possibility of endo being a hormonal piece that may cause estrogen dominance, that may contribute to too much estrogen, and then that metabolizing their estrogen properly, we do not even look at that in the conventional world. 

Jennifer Simmons, MD

That is true.

Marcelle Pick, OB/GYN, NP

We have got them on all kinds of things. Not necessarily that they are bad, per se. However, if you are not metabolizing properly, we need to balance that out properly.

Jennifer Simmons, MD

Yes. I was going to say, as you talk about that, you are not making your sex hormones because all of the cholesterol is being funneled towards making cortisol. Cortisol is a stimulatory hormone. Then you are also not making progesterone, which is our calming hormone, and now you are not sleeping. On top of all of this, you take away sleep. Sleep is where the healing happens. That is where all of our repair mechanisms kick into gear. Now you have the perfect recipe for this use?

Marcelle Pick, OB/GYN, NP

Absolutely. We can do something about it. It is just understanding it first and not getting into this blame game. I should have. None of that helps anything. It makes things worse. It is more about how you begin some of the steps for self-care, and even if it is just that, I am a Tony Robbins fan, and there is something that he does all the time. It is 10 minutes, so it is Tony Robbins priming, so you are looking at the things you are grateful for. You are looking at things that are working in your life and giving back to those things that you are grateful for. Then you are doing some creation of what you would, what you want, and what you expect for your future and getting into that regime. If you cannot meditate, some people cannot because it is just too time-consuming, or doing some of Joe Dispenza’s or whatever works for you. That is a key piece. For some years I did ballroom dancing.

Jennifer Simmons, MD

I was going to say we happened to have someone who has a very special way of compartmentalizing her stress. Did you so obviously? You cannot ballroom dance when you have just escaped a car accident or some other stressful thing. I imagined in my head that if that were your true stress reliever, would you run through dance routines in your head when you needed to calm down? Someone else would just dance.

Marcelle Pick, OB/GYN, NP

I was in a lawsuit with a business partner for five years, and I just danced my little brain out, and, five days a week, six days a week. I truly if I had not had that, I do not know what would have happened to me because it was so stressful. Now that scenario knows that. But it was intense. But the dancing was sometimes two or three hours, five times a week.

Jennifer Simmons, MD

That is amazing, though. What an incredible gift, because it checks a lot of boxes, if it is your checking, your stress management box, it is also checking your movement box. It goes a long way.

Marcelle Pick, OB/GYN, NP

Absolutely. It is incredible how it can do that. There are those of us who are crazy about dancing that way. For all of us, it is the same thing. I got into it because I was getting divorced and I wanted to be touched without strings. I took lots and lots of lessons so that I could become better at them. Isn’t that great?

Jennifer Simmons, MD

I love that. Wow. 

Marcelle Pick, OB/GYN, NP

I took lessons so that I did not have to. 

Jennifer Simmons, MD

I guess you were into Tinder.

Marcelle Pick, OB/GYN, NP

It is not at this time. 

Jennifer Simmons, MD

You know that I am joking.

Marcelle Pick, OB/GYN, NP

I do know you are joking. But it was something helpful for me and many of my contemporaries who dance, too. What is interesting is that I competed several times, and in the competitions, it is not unusual to have 80 and 90-year-olds competing.

Jennifer Simmons, MD

I watch it on TV all the time with absolute amazement. It is just so beautiful. That is what I gave my husband as a present for the holidays this year, as we are doing dance lessons because it is just such an amazing form of intimacy. I never get to identify a problem without offering a solution. Adrenal fatigue, we are going to call it that, even though they say it is not a thing and we know it is. This is mostly a lifestyle and mindset-mediated issue.

Marcelle Pick, OB/GYN, NP

Yes. The good news is that what I say to people is, look, you may not have the ability now or the energy to deal with what caused the problem. Let us get to feeling a little bit better. Do we need some DHEA? Do we need some cordyceps, astragalus, rhodiola, and licorice root? What do we need? We have to test it first to find out where we are. Then, when you have your energy back, you get up and go. Then let us look at how we got here. Because what I would see in my practice time and time again, and that is why I wrote my book, Is It Me or My Adrenals? Is it going to come back, get better, come back, get better? I needed to help them look at where this stress was coming from. Are you a perfectionist? Well, let us do something about that because there is no such thing. The good news for those of us in medicine is that we usually are, but it does not serve us well.

Jennifer Simmons, MD

Now it does not.

Marcelle Pick, OB/GYN, NP

Fortunately, we do, because then we do not get sued. Nonetheless, we are staying at night, we are taking phone calls, we are doing this, we are doing that.

Jennifer Simmons, MD

We are in a mentorship together with someone who specializes in helping physicians overcome their perfectionism. It is a real thing.

Marcelle Pick, OB/GYN, NP

Hands down. The good news is that you can do something about it. You do not have to be in that place; this is going to be my life for the rest of my life. It can be quite different than that. That is good.

Jennifer Simmons, MD

You help to support people in the beginning because they need it it is so hard to motivate yourself because part of our motivation is adrenal function. If your adrenals are not functioning, it is very hard to even get motivated to help yourself heal. You support them in the beginning. You do some testing. Are you using the Dutch test? Is that the one that you like?

Marcelle Pick, OB/GYN, NP

I use a company called Diagnostics. I have not found the Dutch test that helpful for me. I may just be old school because I started with them, but I will do the saliva protocol. Five tests as soon as you wake up. An hour later, noon, mid-afternoon, and then at night.

Jennifer Simmons, MD

You are doing a five-point cortisol test?

Marcelle Pick, OB/GYN, NP

Then I will use that information to make recommendations. If they have breast cancer, I am probably not going to recommend DHEA, but there is controversy around that as well. Nonetheless, I would then address what needs to be done at every point where there is an issue. Then we start unwrapping. Where did this stress come from? Is there an emotional issue? It is a toxicity issue. Is it some of the stress component of what is going on in their lives? Then we start to address that.

Jennifer Simmons, MD

People are probably trying to understand the connection between mold and stress. Can you unravel that a little bit for us?

Marcelle Pick, OB/GYN, NP

Any time you have any mold or Lyme disease, the body’s immune system’s going to be hyper-vigilant. When that happens, the adrenals kick in. It can be stress that causes that cortisol elevation, or it can be a chronic illness that causes that as well. The implications can be the same. Oftentimes, it is both. It is the stress piece because very few of us do not have it, and then there are the components of mold. We sometimes have to dig into it. Is that going on? You oftentimes see other health parameters that are abnormal with mold, but not always heavy lead, high levels of lead, and high levels of mercury can contribute to the body feeling like it is under assault.

Jennifer Simmons, MD

Yes, and the bottom line is that your body does not know what war it is fighting. It just knows it is fighting a war, so it can either be fighting a war against an individual or a situation, or it can be fighting a war against mold or some other infection. But these infections are subclinical in that sense. It is not when you get a cold and you get a stuffy nose and you are sneezing and you have a fever; it is not that. so it often goes unnoticed and unappreciated. You do not feel right, but you know it is not obvious enough.

Marcelle Pick, OB/GYN, NP

That is why it is so important to listen to yourself, but also know that the stress hormone can complicate the picture in terms of what is going on. That is why it is helpful to have somebody look at all the pieces together. Women, one in one in three women are sexually abused. Does that hugely play into this—one in five men? Understanding the ramifications of the enormity of that trauma is also part of this equation. We all have to unwrap all of that and help women. Most of the people I see are women who uncover for themselves what is going on.

Jennifer Simmons, MD

Yes. Can we go back to the comment you made about DHEA? You said if it was someone with breast cancer, you probably would not consider DHEA. I am going to ask you: does that go for hormone-negative women as well? Do you avoid DHEA in women who have hormone-positive tumors, and where do you stand in terms of, do you think estrogen causes breast cancer? Do you think that bioidentical hormones have any negative effect on women who have breast cancer? Let us help women understand this a little more.

Marcelle Pick, OB/GYN, NP

Well, you are putting me on the spot.

Jennifer Simmons, MD

I am sorry. if you want to know how I feel about it first to not make you uncomfortable, I do not think that estrogen causes breast cancer. I think that while menopause, whether surgical, medical, or natural, is mandatory for women, I think that suffering is optional. I do not believe in suffering.

Marcelle Pick, OB/GYN, NP

I completely agree with you. I was going to say the same thing anyway. In my experience over the years, I have used a lot of hormone replacement therapy, bioidentical only; I never prescribed it, or I think in one case, I prescribed it because she begged me, was so symptomatic, and had been on it for so long. I do use DHEA, however. I do not generally use it alone, primarily because it is a hormone and has an orchestral impact. We do not just tune the piano if we are going to have an orchestra; we do not just tune the piano. We have to tune all the pieces to the orchestra. You also have to look to see what is going on downstream of this. Do I think that?

Jennifer Simmons, MD

Do you want to see how people are breaking down their estrogen before you put another compound in them that is going to break down to estrogen? Maybe you could explain this to people because I do not think that the hormone synthesis cascade is well known. Maybe you could explain to people how we make the hormones in our bodies so that they can understand why you would intervene with hormones or not.

Marcelle Pick, OB/GYN, NP

When we are looking at people’s histories, one of the things that we do not do in the conventional world is test for one, but the other thing that we do not do is see if that particular individual breaks down that estrogen. We can see it in the stool test if we have something called elevated beta-glucuronidase, which is making me suspicious, that person, number one, has a bacterial overgrowth or multiple bacteria. But number two is that she’s not breaking down her estrogen properly. It is going to recirculate and make her more what we call estrogen-dominant. I do not believe in the concept of estrogen dominance. It just means that in that situation, the ratio is very off.

Jennifer Simmons, MD

Yes. You are talking about the ratio of estrogen to progesterone?

Marcelle Pick, OB/GYN, NP

I am, yes. If they are someone, and that is me, I do not metabolize my estrogen properly. There are three different pathways that estrogen can go down. I call it; The good, the bad, and the ugly in my book. The good down pathways two, then we have got 16 which is the bad and then we have got the ugly pathway four. You want most of your estrogen to go back down pathway two. The only way to know that is to have a test done. If we do a blood test, we can see two and 16, and we can see four. We need a urine test to look at the four. When I am doing hormone testing, I am going to be looking at urine once a year and then blood, two and 16 the other times.

Then I can make a decision. But here is the beautiful thing: even if it is going down the pathway in the wrong way, we can change the diet, have more fish oil, have more exercise, and introduce indole-3-carbinol which is from the broccoli family called Sulforaphane, or DIM i3C, and that helps in that pathway breaking down, and the good news to that is that adding flax also makes a difference in that regard. We test and we find out, and I just did a podcast with that piece and she went into the hard data on what we know about hormone replacement therapy and breast cancer. Let us get down and dirty about what we know. Interestingly enough, in my practice, of the women who were on hormones and got breast cancer, I never saw anything but estrogen and progesterone receptor positive. and Her2 negative, I just never saw it. They did not have metastatic cancer. They did not have bad cancer if you call it that.

Jennifer Simmons, MD

Statistically speaking, the people who get breast cancer and are on hormone replacement do better.

Marcelle Pick, OB/GYN, NP

Yes, hands down. That makes sense. Yes, of course. Which is interesting. That is a physician who’s in Texas, Dr. McWherter, who has been doing it this way for several years. He is a functionally trained doctor as well, and he developed a protocol for a cream that he had patented to put on my breast with green tea in it. We are starting now to look at it. The problem is that the party line is that they are dangerous. It is what caused the problem. People get very nervous on the call Monday nights that I do when I explain to them that sometimes they have vaginal atrophy, which means they do not have enough estrogen in the vagina. They, well, I cannot take that, and I would well, talk to your oncologist because you probably can, especially estriol that does not have a downstream effect. But many of the party lines still say it is what caused it. It is the issue. Get it out of the body as much as they can. The part that is so hard for me is to witness what happens when that happens because of the effects of anti-estrogens.

Jennifer Simmons, MD

Yes. They are not insignificant compared to the things that the medical oncologist does. Well, first, let us talk about the fact that all this is borne out of two studies, which the rest of the studies all found favorable for hormone replacement in the breast cancer population. However, the two studies that we did not find favorable are the women’s health initiatives, of which we know that the study was halted within two years of its inception. As we talked about earlier, breast cancer is happening on a very long timeline. Those women had breast cancer before that study even started. The other thing is.

Marcelle Pick, OB/GYN, NP

Once we got that study, which is so important, and that study was done on women, most of the people in the study were ten years postmenopause. 

Jennifer Simmons, MD

Yes. The average age was 63.

Marcelle Pick, OB/GYN, NP

I think if we have a cell that has not been exposed to hormones and then you blast it with high amounts of hormones, this is premarin and a progestin that is not progesterone. We knew from studies before that that had adverse effects. Then we say, Well, look what it did. Well, we cannot do that because, then, they looked at the study for menopausal women, and we did not have the same outcome. You did not.

Jennifer Simmons, MD

The other thing that we do not talk about when we talk about the results of the Women’s Health Initiative is that, allegedly, 70% of these women were overweight, and 70% were not healthy. I know it is not politically correct to say, but I am sorry. You cannot be overweight and healthy. It is just not a thing as much as we would like to have women. I want you to love yourself and accept yourself. But you cannot be healthy and be overweight. I am sorry. These women were not healthy. 50% of them were smoking or had a history of smoking, which we know contributes to breast cancer. At least 30% were taking antihypertensive medications; these women were arguably not healthy. 

Then that finding was only found with data mining; they had to look. We took an inappropriate population of women who were 10 years past menopause, and they probably already had those breast cancers. We then gave them hormone replacement. and then we interrupted the study before we could truly find the findings. Then they dug for those findings. There were so many things wrong with that study. Yet, generations of physicians have mended their practices because of that. Generations of women have suffered unnecessarily. 

Marcelle Pick, OB/GYN, NP

Absolutely. Unfortunately, even in men’s medicine today, it is still not recommended. If you have hot flashes, it is still recommended that you have an answer. 

Jennifer Simmons, MD

I know.

Marcelle Pick, OB/GYN, NP

I am not, they are saying to me that I am not depressed. I am just having hot flashes. Maybe I am. 

Jennifer Simmons, MD

They know it is a sin. What we have done and there was a retraction paper printed in 2022, I think about three people read it, me and maybe two other people.

Marcelle Pick, OB/GYN, NP

One of the things I have always said, even with the ACE study, is, Why was this not on the front page of The New York Times? If this is having such a profound impact on heart disease and the recurrence of cancer, why are we not talking about it? ACE study and I went to a conference afterward, and it was, I had to go see use, and in the audience, we were talking about opioids. This was years ago, and I raised my hand and said, Is anybody doing an ACE study on people before you decide on opioids? They did not know what it was, and that was back then. I am sure that has changed since then.

Jennifer Simmons, MD

But it has not changed that much. I ran a cancer program for 15 years. We never talked about it, ever. I did not know about it until I became a functional medicine physician.

Marcelle Pick, OB/GYN, NP

Well, it is, for me, such a crime because that gives people the ability to say, Not that I am bad or wrong, but I have a place to start to learn about. What are some of the things that I can change today? I can change my mindset today. Yes, you are going to need skills. Annie Hopper has a program that you can go to. This trauma program is now available. We can do these things at home on our computers. Now we look at some of these pieces. Is it helpful to have a guide? Of course. Nonetheless, you do not have to spend a fortune to do this.

Jennifer Simmons, MD

I use the Annie Hopper program for my mold patients. Because, when we say when people go to a traditional doctor with complaints of mold because they are so vague when I had mold illness, I was getting shooting pains down my legs at night when I would roll over in my sleep. What did my doctor tell me? That I was crazy. Because they did not know. They tell you it is all in your mind. It is. Because it does affect our central nervous system. That is what happening with mold illness. One of the things that is happening with mold illness. I love that Annie Hopper program.

Marcelle Pick, OB/GYN, NP

There is also another program called the Hoffman Institute. I learned about it in 1991, she talked about, the person that I got connected with infertility. What is the relationship between our emotions? I am like, How dare you say that? As arrogant as hell at the time? Then I started looking into it. The concept of the program is: How does our biography become our biology? That is the key piece to the pieces, to the puzzle. It is just a five-day, six-day program. Looking at it, how do you come away from this without that storage of baggage that is not serving as well in life later on? Another option for people is when they have programs in California; it has been around for 50 years. This is all over the world. We have options now, which is so exciting because we can change our mindset, no question.

Jennifer Simmons, MD

How do you approach the woman who has been through breast cancer treatment and has either been put into menopause by the treatments or is just menopausal and suffering? How do you approach that woman?

Marcelle Pick, OB/GYN, NP

The thing that I will probably start with is adrenal function because one of the things that I find for so many people who have breast cancer is that they are terrified of going on hormones. There is just no way they have been in that place. Looking at adrenal function is one of the things that we can do. Also changing the diet, but also the mindset. The fear that comes with the diagnosis of breast cancer is enormous, and helping them navigate those pieces and then see where they are on the other side. I oftentimes use phosphatidylserine as a supplement to help with high cortisol levels at night, especially so I can get some sleep, and then start to unpack all those pieces of the equation.

I will probably know. I have not been seeing people for a year, so I probably now, will not prescribe hormones to somebody in menopause and does have breast cancer. Will I refer them out to have somebody do that? Absolutely. Because I see that a lot of times what they will say to me; Marcelle, my sensuality is gone. I do not have a sense of being a sensual, sexual woman anymore. I feel dead inside, and, we do not want that to happen. Groans make a difference. Absolutely. As to jumping on testosterone, it helps our thyroid function and helps decrease autoimmune disorders. They are crucial hormones, and we are living longer than we ever have. Do we need to replace those hormones as we get older? I think we do.

Jennifer Simmons, MD

Yes. You just said something so interesting: that testosterone helps suppress autoimmune disorders. Is that why we see so much more autoimmune disease in women than in men? Because men inherently have more testosterone.

Marcelle Pick, OB/GYN, NP

Unfortunately, testosterone is a hormone that does not get a lot of airtime. We do not prescribe testosterone DIMS for women. We have lots of receptors in our bodies. We do not have as much testosterone as men do, but we have lots of receptors in our body that build muscle, which helps with our get-up-and-go. It certainly helps with our libido. We need tons of it. No, we do not. But we do. As we get older, if we have low levels, it can make a big difference for us. We do know that it also helps with thyroid dysfunction, and we know that stress can affect thyroid functioning, but people do not ever talk about that because it increases something called reverse T3, which is the brakes on the thyroid.

Jennifer Simmons, MD

Yes.

Marcelle Pick, OB/GYN, NP

Cortisol in particular.

Jennifer Simmons, MD

Yes, I was just going to say that we were talking about you not having an issue with someone getting prescribed hormone replacement after treatment for breast cancer.

Marcelle Pick, OB/GYN, NP

The piece that I say to this, however, is that you have to be working with someone who supports you and has done their research so that you feel very much so that your mindset is that this is going to be helpful for me and not hurtful because everywhere you read that is dangerous and problematic. It is just not what I saw in my practice. The people fared better where it had been on hormones, quite honestly. 

Jennifer Simmons, MD

Yes. and that is what the data shows.

Marcelle Pick, OB/GYN, NP

I do not think there was one case of metastatic breast cancer for people who were on hormones; they were terrified. Of course, at that time, they stopped them because they were working on them with their conventional documents. But generally speaking, I never saw a case of metastatic breast cancer in somebody who was on hormone replacement.

Jennifer Simmons, MD

Yes. It is so sad because women are suffering. I put a post on Instagram last week talking about the many side effects of breast cancer treatment that are not being discussed. For instance, most breast cancer treatments accelerate heart disease, which is by far and away the number one threat to a woman’s life. In every decade from 30 years old on, women die at least two times more often of heart disease than they do of breast cancer. By the time you are 70, it is seven times more likely. If we are solving the problem of breast cancer by creating another heart disease, we are making these women worse off. 

I also talked about heart disease. I talked about dementia because it does increase your likelihood of getting Alzheimer’s, which is a huge fear for women. After all, the last thing you want to do is be in that horrible locked-in situation. Breast cancer treatments do increase the likelihood that you will get Alzheimer’s. I talked about the fact that it increases bone loss. Each year, as many women die as a result of a fracture as do breast cancer. We are never talking about that. I did not even know about that until I read Avrum Bluming’s book, Estrogen Matters. These are very serious consequences of breast cancer treatment. But the fourth thing that I mentioned was the extinguishment of your libido. I got blasted by people saying, How could you put that in the same category? I responded by saying, some people lose their libido and their vaginal health once. What follows? They lose their relationship, they lose their intimacy, they lose their spark for life, and they lose what life feels like to them. While it may seem inconsequential to you, it has huge repercussions. Because if you do not die of breast cancer, you will lose what you perceive as life. How did you help that person?

Marcelle Pick, OB/GYN, NP

All of these pieces are so incredibly important, especially the ones that are libido-oriented, we do not talk about our sexuality much. It is still quiet. We are not supposed to talk about it, but it is a huge part of every single culture. Helping women feel that sensuality and that connection, even just for themselves, is gigantic. Whether they are in a relationship or not. Unfortunately, as a culture, we do not give much voice to that because people, if they are asked about it, do not talk about it, or, as they get older, they do not have it anyway. Well, that is not true, not at all. One of the second-highest incidences of sexually transmitted diseases is in nursing homes. There are lessons. This is going on, whether we like it or not.

Jennifer Simmons, MD

It is. We saw it in the 80s with AIDS transmission. That was an at-risk population with the nursing home population.

Marcelle Pick, OB/GYN, NP

I think that we need to do it in an honorable way. If you do not want to talk about it, that is fine. But it is an inherent part of who we are as human beings. To not give voice to that or understand that does not make sense to me because it is what we are. Some so many women are quietly suffering, especially with that vaginal atrophy in which the vagina is so painful because of low estrogen that we can use creams, gels, lubricants, and all that, but it does not do the same thing. 

Jennifer Simmons, MD

We need to unlearn this because we are hurting so many people, and it is sad. You should not survive breast cancer only to suffer. We should be able to not only help women overcome breast cancer, but we should also get them into better health afterward. We are not in this current system in this current paradigm. We are doing people a disservice.

Marcelle Pick, OB/GYN, NP

I agree.

Jennifer Simmons, MD

Okay. Just to summarize what we talked about today, because it was so much and so good, and people are just going to hang onto every word you said. We first opened up by thinking about, instead of just the diagnosis followed by the treatment, how this started. What was the cause of the cause? Because it is so important that if we do not deal with our story, our story deals with us, and not that you have to dig up every skeleton from your closet, but that you do need to find some way to make peace with it so that your body can be at peace. Because if you are reliving it or are still impacted by it every single day, it is going to have a profound effect on your health.

We talked about the ACE study and the importance of knowing your ACE score, and then where you start with people is looking at the gut and looking at the adrenals, looking at the stress response, thinking about if you were a perfectionist or unloved as a child, had trauma, or were somehow not enough. All of these things continue to impact you, and these things from your childhood shape who you are today. Knowing your ACE score, but knowing your resiliency score, and knowing that your mindset plays an enormous role in your future. Working with a functional medicine professional can help you uncover all of these things and paint your picture. But not only that, it can paint a picture of your past and pave the road to your future. 

That is what we want for everyone. We cannot change the past, but we can positively impact the future. But it is only by learning from our past and being informed by our past that we can do that. Just because you have breast cancer does not mean that you have to suffer and that health is not only possible; it is probable if you do, but you have to take a different approach. You cannot just manage the symptoms. We talked about great people like Dr. Joe Dispenza and his program, the Tony Robbins program, and that, at the end of the day, the power is yours. You may need some help. You may need a trusted guide, but the power is ultimately yours.

Marcelle Pick, OB/GYN, NP

Hands down.

Jennifer Simmons, MD

Yes, I know you do not work with a lot of people, but if someone does want to work with you, how do they find you?

Marcelle Pick, OB/GYN, NP

They can go to marcellepick.com and get all the information there. I am getting together a Master Class that will probably start on May 17th, but I am also developing a program in June. A three-month program on hormones, and I am going to do a three-month program on adrenals and three months on digestion. They will be able to get some snippets of the pieces to the puzzle.

Jennifer Simmons, MD

Wonderful! That is so great and so important. I love what you do, and I love talking to you, and I am sure everyone is just going to hang on to every word from this talk. It is Dr. Jenn Simmons. Bye for now.