Dr. Joe Tatta: Welcome back to the healing pain summit. I am your host, Dr. Joe Tatta. Today we are talking about the link between adrenal insufficiency and chronic pain. My guest today is Marcelle Pick, who is a women’s health nurse practitioner and a functional medicine specialist. She called founded the world renowned women, two women in 1983 with the vision to change the way women’s health care is delivered. Enter practice, Marcel treats illness but also helps inspire limits to make positive choices to enhance their life and prevent disease. In 2001 Marcelle created women to women with the goal to inspire and educate women. There were successful website information on many women’s health issues are provided as well as home solutions to some of the most troublesome healthcare symptoms. Marcel is also a faculty member at the Institute for functional medicine. She’s also the author of the core. Balanced science is in me or my adrenals and is it me or my hormone Marcelle Pick. Welcome to the Healing Pain Summit 2.0 it’s a real pleasure to have you on this year.
Marcelle Pick: Thanks so much. I really look forward to actually doing this with you. I’ve been looking forward to it all day,
Dr. Joe Tatta: So I’m very excited to talk about adrenals, adrenal fatigue with you. I know it’s something that you see in practice. You’ve been treating women for over 25 years, both in your clinic and online. Tell me how common it is to see adrenal issues in women with pain.
Marcelle Pick: Oh my God. Um, most of the people that come into my office that have pain also have adrenal issues at the same time and it’s a huge issue in my practice period. It’s one of the first questions I ask people is how much stress do they have? And oftentimes it’s one of the things that I’ll test them for is to see what the cortisol levels are.
Dr. Joe Tatta: So why don’t you, I want to get it to testing. But when you start talking about adrenals to patients, do you find that they’ve heard about it, they know about it, or is it really the first time they’re saying, wow, no one’s ever talked to me about the adrenals or what they do?
Marcelle Pick: Well, the good news is I think now it’s become a huge um, point of um, expertise online as well as people are starting to read about it. The bad news is that in conventional medicine we still don’t acknowledge it as an issue. When you look at the endocrine society, they came out with a position statement in 2009 that there is no such thing as adrenal fatigue. Yeah, I don’t disagree with the fatigue part. It’s kind of like this notion of the adrenals get fatigued, but there are certainly, we are becoming more and more aware that adrenals and what happens because of the huge amount of stress we all have, including from problems that cause inflammation that caused pain. Adrenals are the things that are compromised the most. And many of my patients are actually coming in with the question, do you think it might be my adrenals? So I think more often than not, they know about adrenals now. Whereas 10 or 15 years ago I was the person that was teaching them about that.
Dr. Joe Tatta: Yeah. I know you have a long history of teaching both at IFM and as well as online. Are there other conferences about? So it’s great to have you here to talk about it. Um, so are patients coming in with just one key symptom or do they have a cluster of symptoms that are kind of unknown to them and they’re saying, well, could this be my adrenals? Is it my hormones? What is it?
Marcelle Pick: Well a lot of times the coming in is that my thyroid, cause that’s kind of the first thing. It’s my thyroid. My thyroid’s off, I’m gaining weight. I can’t figure out why. What’s so amazing about the adrenals is that they’re really the master gland that helps so many things. So if we have some adrenal problems because we’ve had too much stress or we’ve had a sickness or we’ve had a virus or something for a long time, including childhood issues, which we’ll talk about in a moment. What we see is that the adrenals have an impact on blood sugar regulation on hormones on the digestive system, on, on thyroid say actually prevent the proper conversion either from T four to T three or they block the active form of T3. So unless you’re doing a whole gamut of testing around the thyroid, you don’t know what’s going on at all that’s related to the adrenals, which is amazing. And also digestion the immune system that autoimmune disorders. It’s not unusual for somebody to say, my God, I had all this stress last year and now I’ve got several autoimmune problems. Do you think it’s related to the answer is yes, absolutely. There’s a connection and now we need to work with the adrenals to see if we can kind of get the body back into balance.
Dr. Joe Tatta: Hmm, interesting. I mean it’s very common for people to come in with just a traditional TSH test for their, their thyroid dysfunction or thyroid function, I should say. Um, is that enough and should people be looking to the adrenals first before they actually treat the thyroid?
Marcelle Pick: Such a good question. Um, I always treat the adrenals first. And when I have people with PMs, so hormone problems and menopause, I always treat the adrenals for us because if you don’t, what happens? Those hormones stay on regulated. What a lot of people don’t understand is if we have a hormone called cholesterol, a lot of people have heard about cholesterol makes our sex hormones. So if we have too much stress for whatever is going on in a body, that cholesterol actually makes cortisol. And then you have what we call a cortisol steal. So you have less congestion, which is a huge problem for so many of my patients in perimenopause. I’m going to pause. And those people don’t have PMs, so is actual biochemistry that goes on because of the adrenals that affect the hormones. So it’s all connected. Everything’s a piece of the puzzle. So when you ask the question, well, is there one symptom they come in with? Now they can be fatigued. They cannot be sleeping at night. They can feel wired and tired. They get sick all the time. Their immune system is not working. The thyroid’s not working. They have digestive complaints. I mean it’s really the whole gamut that you have to kind of weed out what’s really going on.
Dr. Joe Tatta: So it’s fascinating. So if you have any type of adrenal, let’s say it’s efficiency, since fatigue is not the right word or dysfunction or whatever you want to call it, um, your cortisol is going to steal from all your hormones. What are the hormones that you may see affected by having dysregulated cortisol? The biggest one you see is
Marcelle Pick: pedestrian, but you can also see estrodiol or estrogens and you can see testosterone. So people come in oftentimes complaining, I’ve had all this stress and I’ve got, you know, my husband or a partner or relationship is so upset with me cause I couldn’t care less about sex because that hormone is being diverted to making cortisol. So as we get their adrenals a little bit happier, they start having a sex drive again and their partners are really happy because they’re back and they feel better about themselves as well. But it’s really looking at what’s the foundation. And for me, I’m always interested in what’s the cause of the cause, what happened first? Where’s it coming from? Instead of just saying, Oh, you need testosterone, that doesn’t make sense to me.
Dr. Joe Tatta: I mean, you’re talking about testosterone. Testosterone is important in a female as well as a male.
Marcelle Pick: Absolutely. Yes, it absolutely is. You don’t want as much testosterone. But in order to build good quality muscle, to have stamina, strength, and also to have a sex drive, you do need some testosterone. And sometimes for some people, if they have PCLs or polycystic ovarian syndrome, it can have very high testosterone levels. So we work with them to make the dietary changes to have those numbers come down.
Dr. Joe Tatta: So if someone’s listening to you and they’re saying, you know, this may be the one thing that I haven’t had tested yet. How do you test people’s adrenals? What are you looking for? What is the test called? What can people ask their practitioner for? Yeah,
Marcelle Pick: sure. Well, here’s the bad news. Unless somebody’s familiar with functional medicine, many people in the kind of conventional world that they live in don’t test for it. In the world of medicine. Now in endocrinology, we either have high cortisol, which is Cushing syndrome, or very low cortisol, which is Addison, which is what president Kennedy had. But what we don’t look at is what about those people that are two degrees above the norm of the low or two degrees below the norm of the high? Those people are considered normal and they’re not. They’re the people that are still having the problems that really need to have some support. Do they need drugs? Not necessarily. Do they need Cortef? No, they don’t necessarily need that. Some people might for short time, I don’t use it very often in my practice, but there’s many nutrients. But the key piece is lifestyle changes.
Marcelle Pick: You know, what kind of dietary changes do they need to make? And also where’s that stress coming from? Is it a biochemical problem? Is it a, uh, some kind of virus? Are they having chronic inflammation? And what’s so interesting is we now know from the study that you and I’ve talked about the ACE study, which was a study that was done in 1998 looking at, if you were a young child and you had a lot of adverse events in your childhood, either an alcoholic parent or an abusive parent or a sore, a parent get hurt, a parent that separated and divorce, if you had a score of four or higher, your chances of early disability were about 340% higher of chronic pain, significantly higher. So we know that there’s a foundation of that stress response that happens early and it changes the brain biochemistry that absolutely affects pain and also biochemistry of the hormones and also adrenal dysfunction because that fight flight response is starting very early and then it continues on until they understand that yesterday is not today and our body doesn’t know the difference between yesterday and today. So it’s a very complicated scenario. So there’s multiple things that we always need to address when we’re looking at what’s going on with the adrenal clan.
Dr. Joe Tatta: Hmm. That’s fascinating cause I think you know it causes people to maybe pause for a minute to look back into their life. That may be six months ago, it may be six years ago to say, okay, what are the factors? What are the lifestyle factors that are attributing to my pain or my symptoms? And I guess the question is you’re talking about cortisol on a much grander level, which I love. So does cortisol have an effect on your nervous system? You mentioned the brain. So does it have an effect on the brain and the nervous system as far as let’s say, storing memories of past events?
Marcelle Pick: Absolutely. The amazing thing about the cortisol and the whole scenario about life events is that we have two parts of the brain called the amygdala that sit on top of the ears and it’s the primitive brain. So it’s the, the body memories of that parent that may have screamed at you. They meant well, but they were screaming all the time and the body has this immediate fight, flight response. You may then have a boss later in life that sounds very similar to that parent. And you get re triggered again. So the body’s producing more and more cortisol, which is the fight flight response. Now the bad news to that is that cortisol, and we need it. We can’t live without it when we have too much of it. It’s an inflammatory agent. And what happens then is it affects the immune system, effects of thyroid effects, the hormones. We have this continual problem with the body being in sympathetic overdrive. Then we have the news and then we have the TV, and then we have our computers, and then we have our friends and we have our family, we have our kids, and we have all these things and our body’s like, Oh my God, I can’t manage all this. And it’s been producing too much cortisol with all the serious side effects that can come from it.
Dr. Joe Tatta: So the question is when someone comes into your practice and you’re working with someone one on one, do you maybe start to talk to them first about Corso as far as how we can fix it as far as supplements and diet or do we go straight to the thoughts, the emotions, the cognitions as a way
Marcelle Pick: you do it all? So when I see somebody in the practice, I’ll kind of ask me the question about the testing. So regular practitioners don’t test, however I do test and there’s several companies around the country that look at cortisol levels. And what you want to do is you want to be able to look at a cortisol throughout the day. It’s usually heist in the morning and lowest at night. So I need to, I can’t tell from somebody’s responses even on a quiz, are they high in the morning, low mid-afternoon, or what the do I need to do to adjust that. So doing a saliva profile at seven in the morning, noon, four in the afternoon and around 10 or midnight at night, that gives me that. And there’s a lot of companies you can go on my website and find out what they are. Um, there’s a company in California, there’s a Genova diagnostics that does it.
Marcelle Pick: There’s doctor’s data that does it. There’s a number of companies ZRT labs that test cortisol. So it’s helpful to know what they are. You don’t need to have a blood test cause the blood test gives you a 24 hour one value and that’s not very helpful. And then I’ll look at it. I’ll see what do we need to do to make adjustments with food. It’s the first place I start and lifestyle. Where is that stress coming from? And sometimes I will say to people, look, let’s just get the supplements on board. Let’s have you feel better so that you have the energy to do the work you need to do to see what got you there to begin with.
Dr. Joe Tatta: That’s a great place to start. So you mentioned morning, you mentioned evening. So I stopped thinking about sleep. And sleep is so important. Chronic pain. If they can’t get to sleep, it’s so difficult to heal, to rebuild the tissue. What effect does cortisol have on our sleep pattern?
Marcelle Pick: It’s gigantic. So imagine that normally cortisol is supposed to be low at night and you have a high level at night. So the body’s already in fight flight ready to kind of have that battle. You can’t sleep. So what happens then is we need to get that cortisol level downs that you’re not feeling so agitated or you’ll fall asleep and then wake up and your mind’s racing. So there’s a number of things that I have people do. There’s something called fascial tail, searing, that’s fantastic to take at nighttime. And that really helps bring down cortisol levels so that people sleep and then they can begin to have the body begin to heal.
Dr. Joe Tatta: So where are the mistakes someone might make as far as diet goes? I know obviously functional medicine is a food forward approach. It’s one of the first places we go where, what can someone do to start to heal themselves through diet first?
Marcelle Pick: Great question. So from my perspective, it’s having a plant based diet as much as possible, as many colors as you can on your plate. Having protein at every meal. Protein is really helpful to keep those carbs quiet and cutting back on carbohydrates, cutting out sugar and gluten is usually the first place I’ll start, especially if somebody has thyroid issues because thy word is so affected by gluten by so many people. I might add some selenium, I might add some iodine. I do iodine levels on people to see what their thyroid status is with the I dimes at the same time. So I began with a multi with fish oil, looking at evening Primrose oil. I put all that in there kind of initial visit so we can start to rebuild and sometimes I’ll even test amino acids and I’ll look at nutrients as well to see how deplete are they so I can start to rebuild their body biochemistry.
Dr. Joe Tatta: Hmm. I think it’s talking about proteins. One of the, one of the challenges that people face often, especially women, is deciding whether or not soy has a place in their diet, whether it’s good for them, whether it’s bad for them. Can you comment on that? Cause obviously there may be some conflicting views about soy in women’s health.
Marcelle Pick: You know, it’s so interesting. Years ago I was at a conference with someone who was a researcher name was looking at using soy in mice and he was comparing the effects in the mice with Tamoxifen. And what’s so interesting about soy is you have an alpha and a beta receptor on the estrogen receptor and estrogen goes to the alpha receptor story goes to the beta receptor. So biochemically it actually blocks that receptor. So the question is does it really help prevent breast cancer? And some of the Chinese studies would suggest that perhaps there’s a relationship there, but in America soy has become the devil and I have people in my practice that you soil and they are not having symptoms of menopause and the most. So I think you really, from my perspective, I tend to really look at the individual, can you tolerate it? A lot of people can’t tolerate it causes a lot of digestive issues, but if they feel well on it and it complements a biochemistry, I think it’s a fantastic option. There are many of my contemporaries that would totally disagree with me, maybe even burn me at the stake. I don’t know. But I found it very helpful and I’ve used it for years in my practice with great success.
Dr. Joe Tatta: So if someone’s listening to this video, watching this video and they’re thinking, you know, this might be a protocol that I need in my life that may help me heal not only my adrenals, but also my chronic pain. How fast might they see their health turnaround once they get started?
Marcelle Pick: So that’s a really good question. I see people get better within three weeks, two weeks. You know, especially when they make the dietary changes, get sugar out of their diet, cut back on carbohydrates, have a huge shift with the processed foods. They change the thinking that they really begin to understand that there is, I do something called emotional freedom technique or EFT with people and that together with the dietary changes together with the supplements, say there with a mindset, you know, I deserve to feel well and believe that about themselves. Cause when you have chronic pain, the, the notion is, Oh my God, I’m never going to get there. You know, I had a patient the other day who has had serious, serious problems post shingles and I used a combination of a compounded product using um, a naltrexone and a number of other things in it. And she’s pain-free and her life is transformed. But we changed her diet. We had to do different things with exercise. I’ve got her on tons of supplements. I did something called a neutral one, a Val to find out what nutrient store she was deficient. And so I built the stage for this and now she’s paying free and it’s been five years that she’s had pain. So she’s ecstatic.
Dr. Joe Tatta: Fascinating. One of the things I’ve been asking everyone on my summit is that this year the media and the government has done a pretty good job at bringing opioids to the forefront and really starting to, you know, a really good discussion around, you know, where should we use opioids? How should we use them? Are they appropriate for who they not appropriate for? I think a lot of that conversation is slowly turning toward obviously physicians and nurse practitioners because they are the two groups that have the prescribing power. Um, so just as just as a, as a general, where do you see we can help people as far as, you know, getting them to be educated about what an opioid is and do they need it? Does it have a place in our society doesn’t have a place in pain?
Marcelle Pick: Yeah, so very good question. I mean I tend to look at all the other pieces to the puzzle first. And with this particular patient, for example, I’m using homeopathic doses of naltrexone for her. That’s really kind of been the game changer for her. And that is in the opioid pathway, isn’t it? So it really is, there is some truth to that. Just kind of refocusing what was going on. That was probably biochemically correct. And I think for any patient in my practice, I’m going to do whatever it takes to get there. Will that be the first line of intervention? It isn’t for me because I think there’s too many other pieces to the puzzle that are off, including, you know, the emotional stability that that person has, including their diet, their lifestyle, what stress do they have in their life? Are they good about being careful about not being codependent? Does everyone else’s life come before them, before their own? And for women, this is a huge issue is that they’re taking care of everybody that themselves. So I’m always looking at all those questions and if the came to the point that we still weren’t better, of course I’m going to do whatever it takes.
Dr. Joe Tatta: Yeah. So another question I have for you, cause obviously you run a great website called women to women where you help women, you know, support and transform their health. Women at times can be anywhere between five to 10 practitioners before they get help. And if they don’t get help at that point, a lot of times they’ll just kind of like drop off, so to speak. We empower women to keep looking for the solutions, the natural solutions they need, whether it’s healing their genomes, whether it’s healing, chronic pain. How do we continue to motivate them to look for those solutions so they can, you know, live a healthy and active life.
Marcelle Pick: When I started women to women, actually in 1985 very long time ago, we were the first to come out of the closet, so to speak, to say we need an all women practice. We want to be able to teach women. How do you become your own midwife in figuring out your own issues in life? And that was our purpose and our goal and Chris Northrup and I, dr Chris Northrup and I started the practice with that intention and then I went online by myself in 2001 but the same concept. I wanted to have as much information as I could out there so that people could take quizzes, they could get the information about what was their problem and I’d been involved in functional medicine for all that time as well to help other practitioners learn about the model because women need to figure it out. They need to be able to go to that practitioners and say, look, I think this may be going on.
Marcelle Pick: The most important part is that they know something’s wrong and they need to continue to listen to that because so many times it’s like, Oh, you know, you’re going to gain five pounds every year until you’re, you know, whatever. And it’s not true. It doesn’t have to be that way. We might have to figure out what’s wrong or are you going to, you’re just tired, you’re getting older. What do you want? And those things I’m urging to never ever take at face value. They need to dig a little deeper because we all can be vital until we’re 85 and 90 I see it everyday in my practice and I know it to be true. We just need to empower our patients to be able to understand and know that to be true.
Dr. Joe Tatta: Yeah, it’s really important, especially if you talk about pain. One of the things that people say as you get older, you’re going to, as you get older, you’re going to have pain. There’s no way around it. And I say that’s not true. I have plenty of friends in their fifties sixties and seventies that look very active, healthy, vital life that do not have any pain at all.
Marcelle Pick: No, absolutely not. And if you do, then you’re starting to understand where is it coming from, what did I do, what do I need to change in my diet? You know, where the nutrients do I need to add to really help. And so much is coming out now about some of the antioxidants that we can really use to offset some of the things that we were experiencing. Because unfortunately we have a lot of Texas city that we deal with every day. So you’re 100% right. We don’t have to have that. And that’s the key piece. People are drinking the Koolaid and the Koolaid is wrong. It’s not true.
Dr. Joe Tatta: There’s one more question I have for you cause I think I, I can’t let you go from this interview without asking about biodentical hormones cause we always have a question about them. So where do they have a place in medicine today and are they better than traditional pharmaceutical hormones? So to speak.
Marcelle Pick: That’s a great question. I used viral dangle Homans and my practice is the first line that I use. No, I’ll make all the changes that you and I talked about. Look at adrenals, look at food, look at lifestyle, look at exercise, and then I, for many of my patients, I use a vaginal combination that’s really helpful for people, especially when they have a trophic changes in the vagina and so many people come in saying, I was just, I just thought I had to live with this for the rest of my life. And it’s like, Oh my God, no. So I always use that. In terms of other types of hormones, are they better? We don’t have a ton of research to support that notion, but because I’m using much, much lower doses, I’m much more comfortable kind of looking at all the pieces and I always do hormone levels.
Marcelle Pick: I’m looking at something called two, four and 16 ratios because it’s the good, the bad, and the ugly of how we metabolize our estrogen. That’s more of an issue than if you’re on estrogen or not. And many people that are not on hormones also have that issue too. So it’s even for them, it’s important to know that. So yes, I use them in my practice all the time and I also monitor how long they’d been on it. And then we have a discussion almost every year about, you know, where do we go with this? And most of my patients are ardent and say don’t ever take me off. I feel fantastic on them. Then I have others that are like, I don’t think I really need them. So it really depends on the patient and what her needs are.
Dr. Joe Tatta: And what I liked that you said, you said that you use the lowest dose possible and then you test and retest to make sure your levels and that’s obviously a smart and safe thing to do. Is there a ratio that you look for when you’re testing those different types of estrogen hormones?
Marcelle Pick: Yes. Um, I tend to want to go in the middle range of the normal range that I have with the particular labs that I use. So I don’t want to high and I don’t want to low, but I’m also listening to symptoms that they have. And I’m always looking at that two, four and 16 ratio so that I have a good complex of what those numbers are cause I don’t want it to be too high. And then I make lifestyle changes and I’ll use nutrients to intervene to make that big difference. So it’s, it’s really all about what do I need to do for my patients to have them feel amazing and they can feel amazing into their seventies and eighties because I have patients like that.
Dr. Joe Tatta: And the reason why I bring estrogen into the picture is because when you have adrenal dysfunction, estrogen can be affected. Yeah,
Marcelle Pick: absolutely. And pedestrian hands down. No question and testosterone. So yes, of course you’re going to be kind of playing with those as well to get people feeling great. Excellent
Dr. Joe Tatta: self peg. It’s been wonderful having you on the healing pain summit this year. I know we kind of went on a little bit of a tangent going from adrenals to thyroid, which is so much fun actually for, for us science geeks out there. But can you tell everyone how they can learn more about you?
Marcelle Pick: Sure. Um, women to women.com we have a newsletter that you can sign up for and we have a tons of information there. Um, as my first uh, enjoyment in life is to get people educated to know about their bodies. So that would be the best place to do it is women’s women.com and I also am developing a website, Marcel pic.com too. So it’ll be another place for them to get information about me there as well.
Dr. Joe Tatta: Great. So I want to thank Marcel pic for being on the healing pain summit this year. It’s been a real pleasure and makes sure to check her out on our two websites, women to women as well as Marcelle pick.com and make sure you check out her free gift, which is on the homepage of the website or the home page of the summit. You can help Marcel by spreading our message. You can click the like button below to share it out on Facebook and on Twitter. And without further ado, I want to thank Marcel and most of you next time on the Healing Pain Summit.
Marcelle Pick: Thanks so much, Joe. Have a good day.