Dr. Mary Pat Roy is a board certified endocrinologist, with an interest in women’s health and osteoporosis. After graduating from the University of Notre Dame in South Bend, Indiana, she completed her medical degree at Loyola-Stritch School of Medicine in Maywood, Illinois. She had residency and endocrine specialty training at Baystate Medical Center in Springfield, Massachusetts. Mary Pat has worked in both hospital-based and private practice settings, enjoying meeting and helping wonderful people. Outside of medicine Mary Pat finds joy in her family, her cat and reading romance novels.
Transcript of Episode 13: The Adrenal Glands and Chronic Illness
Cindy Kennedy: Welcome to Living with Lyme. This is your host Cindy Kennedy. We have a great podcast today. My guest is Dr. Mary Pat Roy. She has received her medical degree from Loyola University. She is board-certified in endocrine, diabetes and metabolism, as well internal medicine. She has more than 26 years of experience. Today, we’ll be talking about the adrenal gland, its function, and its association with illness. Oh my God, Mary Pat, it’s so great to have you here. Hello.
Dr. Mary Pat Roy: Hello, hello, Cindy. Thank you for inviting me.
Cindy Kennedy: This is awesome. Your expertise is very important because our adrenal glands are really important for our health. For my listeners here, tell us about what they are and where they are.
Dr. Mary Pat Roy: The adrenal glands, there’s one on each side of the body, and they’re just right above on top of the kidney. They don’t touch the kidney, but they’re near the kidney. That’s where the word adrenal comes from. Renal means kidney, and A-D means next to, so next to the kidneys.
Cindy Kennedy: That’s really cool. What do they do?
Dr. Mary Pat Roy: The adrenal glands primarily make several different hormones. They can make cortisol, aldosterone. They can make male hormones, testosterone and DHEA, and then the very center of the adrenal gland makes the adrenaline, the epinephrine.
Cindy Kennedy: Oh, fight or flight.
Dr. Mary Pat Roy: Fight or flight.
Cindy Kennedy: When you are frightened or when-
Dr. Mary Pat Roy: That saber-tooth tiger is running after you, you bet all these hormones are going to be sky-high.
Cindy Kennedy: I understand that. Now, when you’re not well, whether you are acutely ill or you’ve been chronically ill, does it impact the adrenal glands?
Dr. Mary Pat Roy: The main impact of stress, whether it be due to a car accident, due to an illness, due to a death in the family is on the cortisol.
Cindy Kennedy: That is a particular hormone produced by the adrenal gland.
Dr. Mary Pat Roy: Correct, and in a normal person, what happens is there’s something called diurnal variability, meaning our cortisol levels are highest about 8:00 in the morning, they fall slowly throughout the day, they hit an all-time low at midnight, and then from midnight back to 8:00 in the morning, it rises again. Our cortisol level is not straight across the board. It is highest in the morning and lowest at midnight, and it’s supposed to be like that.
Cindy Kennedy: That is … Oh, Lord. If anybody can hear that, that’s Toby again, and he has, he’s talking about his cortisol level right now, but we don’t have to worry about that. Adrenals and cortisol, and it sounds like that has a lot to do when you say diurnal, it has nothing to do with a toilet, right?
Dr. Mary Pat Roy: Correct.
Cindy Kennedy: No diurnal. It’s, okay, so it has two phases.
Dr. Mary Pat Roy: The highest and the lowest, correct.
Cindy Kennedy: It almost impacts sleep?
Dr. Mary Pat Roy: It can impact sleep. It can impact stress. It can impact immunity. As you mentioned, this is one of the key stress steroids. When we are stressed, this is the steroid that’s going to help us get acutely through that stress that we just had.
Cindy Kennedy: Because it revs the system?
Dr. Mary Pat Roy: It turns everything on.
Cindy Kennedy: Okay, so it’s more like something’s not right, it’s identified, and then we have an impact on the adrenal glands. What happens if you put out too much? It’s kind of like all of a sudden, there’s a fire, and we have one source of water, and it’s from a well, and we’ve been fighting this fire, and then the well goes dry.
Dr. Mary Pat Roy: Yeah, you’d be a little bit stressed with that. What would happen is cortisol levels will go up very quickly and very high, but even if it continues, even if the stress continues, they go back down to normal within 24 hours, so they do not stay up all the time. The immediate boom, let’s take care of the stress that’s going on, then we’re back to normal.
Cindy Kennedy: For people who are ill for a long period of time, whether it be Lyme disease, whether it be they’re fighting with a cancer or something like that, does the body, literally, does it overcome the process of the stress so that the adrenal glands can settle in?
Dr. Mary Pat Roy: Well, no. What happens with long-term or chronic, which means anything that goes on more than three months, so if there’s stress that continues on, the adrenal gland losses the ability to have the highest cortisol in the morning and the lowest cortisol at midnight. It’s making the exact same amount of cortisol for 24 hours.
Cindy Kennedy: Oh, it stays flat?
Dr. Mary Pat Roy: It stays flat. In the body, the total amount of cortisol is still normal, but it’s not going to have a high and a low. It’s going to be flat lined. By flat lining, there’s some really good research coming out showing that that’s what interferes with the immunity, that is why people gain weight when they’re stressed, that is part of the reason why people don’t sleep when they’re stressed because you’re not having a high and a low. You’re having it just steady across the 24-hour day period.
Cindy Kennedy: How is cortisol tested?
Dr. Mary Pat Roy: Cortisol can be tested, basically, in all the ways we can test anything. You can do a blood test on it. You can do a 24-hour urine collection. You can do salivary cortisol testing. When the cortisol is made by the adrenal glands, the definition of a hormone is a, hormone is a protein that is made in one part of the body and works somewhere else. When the cortisol level is, excuse me, when the cortisone is released from the adrenal gland, it goes throughout the body and can get stored in our salivary glands.
Cindy Kennedy: Aah.
Dr. Mary Pat Roy: If you do a salivary cortisol, because at midnight, nobody can go into the hospital and have a cortisol level done, so if we need to check a midnight cortisol, which is when your cortisol level should be very low, we give you a piece of cotton to chew on so then the cortisol, which is in the saliva, is entrapped into that cotton, and we can measure the cortisol level in the saliva.
Cindy Kennedy: I can understand that is at a specific time. I understand if you draw blood, it’s at a specific time.
Dr. Mary Pat Roy: Correct.
Cindy Kennedy: When you collect a 24-hour urine, how is that, it’s a total amount. How would you assess if the, quote-unquote, “rhythm” is correct?
Dr. Mary Pat Roy: With a 24-hour urine, you won’t be able to check the rhythm. You are checking is it the right amount, over a 24-hour time period, is there a right amount of cortisol in the body. Too much cortisol is a disease state called Cushing syndrome, and too little is called adrenal insufficiency, the most common reason being something called Addison’s disease. If you want to check diurnal variability, one of the easiest ways to do it is you would chew on this piece of cotton at 8:00 a.m., noon, 4:00, 8:00 p.m., and midnight, so you’d get a whole 24-hour pattern because you can’t have, well, you can have, but it’s very inefficient to have, go to the hospital, have your blood drawn at 8:00. Show up again at noon. Show up again at 4:00. When we’re looking for diurnal variability, it’s mostly the cortisol in the saliva that we’re testing.
Cindy Kennedy: Just so people understand, it’s not the same cotton ball. We’re not-
Dr. Mary Pat Roy: Yes, thank you.
Cindy Kennedy: … recycling it. These cotton balls go into their own little test tubey things?
Dr. Mary Pat Roy: Little plastic test tube.
Cindy Kennedy: Okay, and it’s labeled 8:00 a.m.-
Dr. Mary Pat Roy: Noon-
Cindy Kennedy: … noon-
Dr. Mary Pat Roy: … 4:00-
Cindy Kennedy: … 4:00, 8:00, and 12:00-
Dr. Mary Pat Roy: Right.
Cindy Kennedy: … so it is different test tubes.
Dr. Mary Pat Roy: Correct. It’s different-
Cindy Kennedy: Different test tubes.
Dr. Mary Pat Roy: … test tubes.
Cindy Kennedy: Okay, so that’s great.
Dr. Mary Pat Roy: Oftentimes, what we will do, especially if we’re looking at the midnight, is you’ll do it two days in a row so you can get reproducibility.
Cindy Kennedy: I see. For all of those times?
Dr. Mary Pat Roy: No. Usually, when we’re just looking at pattern, you’ll just do one each.
Cindy Kennedy: Okay, and then the next night, you do it at midnight?
Dr. Mary Pat Roy: Yes, to see-
Cindy Kennedy: Just-
Dr. Mary Pat Roy: … to make sure-
Cindy Kennedy: … that one extra time.
Dr. Mary Pat Roy: Right, because you want to make sure that, indeed, there is a high and there is a low because without the high and the low the body is not efficiency, and-
Cindy Kennedy: And-
Dr. Mary Pat Roy: … it is reflecting the stress of whatever kind that’s going on in that body.
Cindy Kennedy: Are either of the two diseases that you mentioned have anything to do with an autoimmune issue?
Dr. Mary Pat Roy: Cushing syndrome, which is the one that has too much cortisol, is not autoimmune.
Cindy Kennedy: Genetic?
Dr. Mary Pat Roy: No, it’s a benign tumor. It’s not a cancer. It’s a benign overgrowth of either the adrenal gland or the pituitary gland.
Cindy Kennedy: The pituitary gland is where?
Dr. Mary Pat Roy: Is in the very enter of the brain, go directly back behind your nose, and right above your hard palate, and there’s your pituitary gland, and if you remember from high school biology, it’s the master gland.
Cindy Kennedy: It’s in charge.
Dr. Mary Pat Roy: It’s in charge.
Cindy Kennedy: It should not be large, but it definitely is in charge.
Dr. Mary Pat Roy: Correct.
Cindy Kennedy: Correct.
Dr. Mary Pat Roy: Now, adrenal insufficiency, which is the broad term for not making enough cortisol, in the United States, the number one reason for that is something called Addison’s disease, which is, indeed autoimmune, but believe it or not, worldwide, the number one reason for adrenal insufficiency is still tuberculosis.
Cindy Kennedy: Aah. There’s not a lot of that around, right?
Dr. Mary Pat Roy: Not in the United States.
Cindy Kennedy: Thank God. Let’s make an association. People who have Lyme disease, we know that their sleep can be hugely impacted, especially because the melatonin production is not the way it used to be. You have left melatonin, and therefore, you don’t get restful sleep. We know that there can be triggers that set off an autoimmune issue, whether it be the thyroid gland for, they don’t know the reason exactly, but we do know there can be issues with that, and with our adrenals and the impact of being stressed when you’re either just not feeling well or because you may be one of these people that you’re gone doctor to doctor to doctor and you’re not getting the help you need and you’ve been sick for a long time, will that impact the adrenal?
Dr. Mary Pat Roy: Oh, absolutely. That’s when the cortisol level is going to be normal but flat lined, so you’re going to lose that variability we talked about. When that happens, the body loses several different functions, one of them being the immune system in general, so it will be tougher to fight off an infection. The other part of the immune system is the whole autoimmune that you just mentioned. We know stress is an absolute trigger for all autoimmune. Thyroid being the biggest, but all autoimmune conditions can be triggered by stressed.
Cindy Kennedy: Just for people who don’t know the term autoimmune, can you tell me what that really means?
Dr. Mary Pat Roy: The best way to think about autoimmune is you get a run-of-the-mill cold over the winter, you get a winter virus, and what your body will do is it will make antibodies to get rid of that virus. Well, what autoimmune means is your body decides a part of your body is foreign. Your body decides, “This isn’t my thyroid gland. It’s not supposed to be here,” and it literally makes antibodies that attack your own thyroid. Now, the antibodies don’t hurt you, but they hurt the thyroid. Antibodies-
Cindy Kennedy: It destroys it?
Dr. Mary Pat Roy: It destroys the function.
Cindy Kennedy: The function of it.
Dr. Mary Pat Roy: The function.
Cindy Kennedy: Okay. All right. Well, that doesn’t sound good at all.
Dr. Mary Pat Roy: No.
Cindy Kennedy: All right, so what can we do? We do know that, with stress, we have a lot of other issues going on with our body, our immunity, like you said, our levels of certain hormones. I know from practicing gynecology when I get people that are overstressed, losing weight, over-exercising, it can really impact their menstrual cycle.
Dr. Mary Pat Roy: Absolutely.
Cindy Kennedy: There are different theories. I’m sure there’s different research, and there’s certainly people who have better knowledge of this, but what do we do? We’re stressed, we’re sick, we are just at our limit. What day-to-day activity can we do that will help all of our systems, especially our adrenal glands?
Dr. Mary Pat Roy: Cindy, that’s a beautiful question because what you brought up, and I’m going to put words into your mouth if I may.
Cindy Kennedy: [inaudible 00:13:15]. Okay, I got it.
Dr. Mary Pat Roy: What she was saying, indeed, is this is not a disease state. Stress is not a, what stress does to the adrenal glands is not a disease, but it is more of a nonfunctional/dysfunctional adrenal gland. Because it’s not a disease, there is no, if you will, medication to fix it. Indeed, what can we do non-medicinally to help? The key is getting a better sleep pattern, and whether that be with mindfulness, with yoga, with meditation, with whatever works for you, because it may not work for your next-door neighbor, but if it works for you, that’s what you need. You need to work on the sleep, and you need to work on, basically, stress-reduction. You need to be kind to yourself, and if your body says, “I need a 10-minute nap on the couch,” give your body a 10-minute nap on the couch.
Cindy Kennedy: How about what your diet?
Dr. Mary Pat Roy: Oh, diet is huge because what happens, cortisol is very closely died to carbohydrates, to sugars.
Cindy Kennedy: Ooh.
Dr. Mary Pat Roy: A lot of times, when a person is stressed, what you’re going to reach for is the carbohydrate. You’re going to want the cookie, you’re going to want the toast, you’re going to want that-
Cindy Kennedy: Mashed potatoes.
Dr. Mary Pat Roy: Mine is white rice.
Cindy Kennedy: Oh, white rice.
Dr. Mary Pat Roy: When I’m stressed, I go for white rice.
Cindy Kennedy: Oh.
Dr. Mary Pat Roy: Nothing fancy.
Cindy Kennedy: Really?
Dr. Mary Pat Roy: White rice because it’s a carbohydrate. What a person who is stressed, carbohydrates aren’t bad, but too much carbohydrate is bad because it’s going to overwhelm the body, and too much carbohydrate can also be a poison to the body.
Cindy Kennedy: I see
Dr. Mary Pat Roy: The-
Cindy Kennedy: Raises your sugar level if you don’t-
Dr. Mary Pat Roy: Raises, and your inflammatory markers.
Cindy Kennedy: Oh, yes, yes, yes, so if you don’t utilize it, because you’re not running a marathon, then you just pack on the pounds.
Dr. Mary Pat Roy: Absolutely. Absolutely, so you need a lot of, you need a healthy diet, you need your greens, you need your fruits, you need your non-processed foods is what you need.
Cindy Kennedy: I tell my patients, think of it as the best food is eating what came out in nature the natural way.
Dr. Mary Pat Roy: Oh, absolutely.
Cindy Kennedy: The whole food and being careful how you’re cooking your whole food, if you’re overcooking, if you’re liquefying because you’re steaming it to death-
Dr. Mary Pat Roy: Right.
Cindy Kennedy: I mean, that, you want to have it as best as you can. I have another thing that was offered to me as a suggestions, and I tell patients that you do a 20/20/20 routine before bed. First 20 minutes is you are starting to power down, you’re kind of getting yourself ready for the next day, if you’re going somewhere, maybe preparing your lunch, maybe getting your clothes ironed whatever. Next 20 minutes, absolutely no electronics. You are now going to do your hygiene, whatever self-care you need whether it be an Epson salts bath, which I always recommend. Two cups in a nice, hot bath to detoxify, power down. The last 20 minutes needs to be quiet time, whether you’re reading, whether you’re doing prayer, whether you’re doing meditation. That can make a big impact on just getting the body ready for sleep. They say that anything with a field such as the light on your computer, your cell phone is-
Dr. Mary Pat Roy: Your book.
Cindy Kennedy: … just, your, yeah. It is difficult, so that 20 minutes of just restful time is helpful as it can get.
Dr. Mary Pat Roy: I agree with that.
Cindy Kennedy: Before we end here, my magic questions.
Dr. Mary Pat Roy: All right. I’m ready for them.
Cindy Kennedy: All right. Are you ready?
Dr. Mary Pat Roy: Mm-hmm (affirmative).
Cindy Kennedy: What ticks you off?
Dr. Mary Pat Roy: I think what ticks me off is a person who cannot laugh at him or herself.
Cindy Kennedy: Ah-ha. That is a, yeah, because if you can’t-
Dr. Mary Pat Roy: If you can’t-
Cindy Kennedy: … you can’t.
Dr. Mary Pat Roy: … you can’t.
Cindy Kennedy: You can’t.
Dr. Mary Pat Roy: That’s going to cause stress. If you can’t laugh at yourself, you’re going to be a stressed-out person.
Cindy Kennedy: Loretta LaRoche. If anybody has never heard of Loretta LaRoche, she is a flipping hoot, and she makes you do belly laughs.
Dr. Mary Pat Roy: Right.
Cindy Kennedy: She’s a great person to laugh with. The second thing is, in life, people get handed lemons. My lemons was this Lyme disease, but my lemonade is doing all of this education and helping people interpret information and doing these podcasts, which is so awesome. Life probably has thrown you a couple lemons. What’s your lemonade?
Dr. Mary Pat Roy: My lemonade is I am a Pollyanna optimistic person.
Cindy Kennedy: Yay.
Dr. Mary Pat Roy: When talking to people, and they’re telling their sad story or their bad story, I can almost always find the silver living, and if you can just for a fleeting second, either in myself or in someone else, just get a smile-
Cindy Kennedy: That’s so-
Dr. Mary Pat Roy: … life is so much better.
Cindy Kennedy: I always tell people, give the least-deserving person a smile, and say good morning, say have a great day, but it just kind of, it might break their, whatever they’re thinking. That’s so great. Oh my God, thank you, Mary Pat, Dr. Mary Pat Roy. It’s been such a pleasure having you as my guest. You gave us such a great bag of information. There’s our laugh. There’s our laugh. To all my listeners, this has been Living with Lyme, and you’ve been with me, Cindy Kennedy. Come back, listen again. Until then, be well.