If you have Hashimoto’s or hypothyroidism, there’s a good chance you’ve had your cortisol checked at some point and walked away with the wrong conclusion. Not because the test was bad, but because cortisol is one of the most misread hormones there is, and your thyroid has far more to do with that misreading than almost anyone realizes. Most people treat cortisol as a single number to lower, when the real story is about how much you make, how much of it is actually active, and how well your body clears it. Your thyroid sits right in the middle of all three.
Dr. Jaclyn Smeaton has spent years at the center of this exact question. As a naturopathic physician and the Chief Medical Officer at Dutch Test, one of the most respected hormone testing companies in functional medicine, she has interpreted thousands of cortisol reports, and she is refreshingly honest about the places she got cortisol interpretation wrong for years. What she has learned is that a normal cortisol result can be completely misleading, that the amount you make is not the same as the amount your body holds onto, and that your thyroid is running the one step in this process almost no one is looking at.
Why the Thyroid and Adrenals Are So Deeply Connected
There are many bidirectional relationships between the thyroid and the adrenal glands, but the central idea Dr. Jaclyn wants people to hold onto is that cortisol sits at the base of the entire endocrine pyramid. It is a master hormone, and when it is out of balance, it becomes very difficult for everything above it to function properly.
We tend to think of cortisol as a stress hormone, but Dr. Jaclyn reframes it as a resource allocation hormone. It mobilizes glucose, raises blood pressure, increases blood flow to the muscles and brain, and provides feedback across every other endocrine system. She describes it as the puppeteer pulling the strings for so many other hormones. When cortisol is not aligned, dysfunction shows up downstream, and the thyroid is one of the places it shows up most. Cortisol can even hide thyroid dysfunction, which is exactly why so many people stay stuck.
Cortisol Is Not the Enemy, Despite What Social Media Says
Thanks to social media, most people now equate cortisol with belly fat and treat it as something to eliminate entirely. Dr. Jaclyn is passionate about debunking this myth, because cortisol is actually one of the most important hormones in the body. She likes to compare it to a fire extinguisher mounted in the corner of the room, always present and ready to respond the moment there is a fire.
On a normal day, cortisol supports countless essential functions. When a real stressor appears, whether that is inflammation, infection, injury, or emotional stress, cortisol becomes the first responder, reallocating resources so the body can meet the demand. Using the classic example of being chased by a tiger, she explains how cortisol shifts blood to the brain and muscles and mobilizes glucose so you can react, with the intention that the system then switches off and returns to a parasympathetic rest and digest state where reproduction, digestion, and immune function can happen. The trouble is that most of us are no longer returning to that calm baseline. Cortisol was never meant to stay switched on around the clock, and it is the constant stimulation of this system that leads to problems in the short term and a long list of downstream effects over time.
Why a Single Morning Blood Cortisol Test Misses the Problem
Many people ask their doctor to check cortisol, and it is almost always measured in the morning through a single blood draw. Dr. Jaclyn explains the significant limitations of relying on that number. The reference range for serum cortisol was designed to catch Addison’s disease and Cushing’s disease, conditions so profound and symptomatic that they rarely need a lab to confirm them. Everything in the enormous middle ground, where most people with real HPA axis dysfunction actually live, gets missed entirely.
There is also the question of what is being measured. Blood cortisol reflects total cortisol, which includes both the portion bound to carrier proteins and the small fraction that is free. Just as we look at free and total testosterone, cortisol has its own binding protein, and less than five percent of your total cortisol is actually free. Since only free hormone can interact with your cells and tissues, a single total cortisol reading tells you very little about what is really happening.
The Dutch Test and the Three Things You Have to Look At
To get an accurate picture, Dr. Jaclyn looks at cortisol in three ways at once. She measures free cortisol across four time points during the day to reveal the diurnal pattern, she looks at the total cortisol metabolites from urine to understand how much cortisol the body is truly producing across twenty four hours, and she evaluates the timing and rhythm of its release. All three matter, because they can tell completely different stories.
This is why she works with Dutch testing, which is done conveniently at home through dried urine and saliva. Saliva is the gold standard for measuring free cortisol, and urine has been validated in clinical research to match it. She shares a humbling example from her own practice. For years she relied on saliva only testing and looked mainly at the diurnal curve, until she realized she was missing the metabolite piece. She now sees that a meaningful subset of patients, roughly twenty to thirty percent of those with seemingly low cortisol, actually have very high metabolite levels. These people are producing plenty of cortisol but burning through it rapidly, often because of an underlying issue like insulin resistance or infection. Treating that pattern as low cortisol and trying to stimulate the adrenals would be exactly the wrong move, and it is the kind of misread that even trained practitioners make when they only look at part of the picture.
The Cortisol Awakening Response, and Why Your Morning Spike Matters
The Dutch Plus test adds a closer look at the morning through the cortisol awakening response, or CAR. This requires saliva collected the instant you wake up, before you even get out of bed, followed by another sample thirty minutes later. What Dr. Jaclyn wants to see is a rise of fifty to one hundred sixty percent between those two points.
That morning surge is what helps you feel alert and awake, and it is deeply tied to circadian rhythm, which is why darkness at night and natural light during the day matter so much. The awakening response essentially functions like a mini stress test on the body, similar in concept to the ACTH stimulation test used in conventional medicine to assess cortisol production. It is also one of the very first things to shift under chronic stress or chronic illness, with a large body of published literature showing it becomes either blunted or exaggerated in complex conditions. If someone drags through the morning and needs three or four cups of coffee before they feel human, this is very often where the story begins.
Reading the Diurnal Curve, Including the V Pattern
The first thing Dr. Jaclyn evaluates is the shape of the curve. In a healthy pattern, cortisol is high in the morning, gradually comes down through the day, and bottoms out at night. She and Inna discuss the many ways this can go wrong, including the fully flipped curve where cortisol is low in the morning and high at night, patterns that stay elevated all day, and patterns that stay low all day.
Inna raises a subtler version that shows up often in practice, where cortisol drops appropriately through the day but then flattens out in the evening rather than continuing to decline, creating a V shape. Even though it is not the dramatic reverse pattern, it still signals that something is unresolved, and it is exactly the kind of nuance a single reading would never reveal.
Why the Amount of Cortisol You Make Isn’t the Whole Story
Here’s the reframe that changes everything. We tend to assume that if someone has too much cortisol activity, they must be producing too much. But production and clearance are two entirely different things, and the marker Dr. Jaclyn keeps coming back to is the cortisol clearance rate, which reflects how quickly your body actually processes cortisol at the level of the cell. When clearance is slow, cortisol builds up even when you’re making a normal or low amount, and you end up feeling anxious and wired, not from overproduction, but because you can’t get rid of what you have.
This is where the arrow most people draw actually points the other way. Everyone talks about how cortisol affects the thyroid. Far fewer people know that a struggling thyroid is one of the single biggest reasons cortisol doesn’t clear, and this includes subclinical hypothyroidism, where your TSH still looks acceptable. It’s such a strong link that when the clinical team at Dutch sees slow clearance, one of the first questions they raise is whether the patient’s thyroid has been properly evaluated. So the anxiety and the wired feeling that so often get blamed on a thyroid medication dose, especially T3, can actually be cortisol your thyroid won’t let you clear. Pulling back the dose doesn’t fix that, and it can leave you worse.
Slowed metabolism from any source can do the same thing, which is what makes the GLP-1 connection so timely. Dr. Jaclyn is seeing more and more of this hypometabolic pattern in patients newly on GLP-1 medications, because when appetite is suppressed and calories drop sharply, metabolism slows to match, and you can see it show up directly as slow cortisol clearance on the metabolites. She loves having this marker for GLP-1 patients precisely because you don’t want your metabolism grinding down while you’re on one, since that’s exactly what sets you up to regain the weight the moment you come off. Poor liver, bile, and mitochondrial function round out the picture, since the same enzymes that clear cortisol are also busy handling estrogen and environmental toxins.
The Three Ways Cortisol Suppresses Your Thyroid
Dr. Jaclyn breaks down three well studied mechanisms by which chronically elevated cortisol suppresses thyroid function. First, it acts centrally on the hypothalamic pituitary thyroid axis, inhibiting TSH secretion and altering thyroid binding proteins, which can make TSH look normal or even slightly low in someone who feels distinctly hypothyroid. Inna notes how often this shows up as a low TSH alongside a low total T4, a pituitary pattern that conventional interpretation misreads entirely.
Second, high cortisol blocks the conversion of T4 into active T3, so a person can have plenty of T4 on board and still be functionally low at the cellular level. Third, elevated cortisol shunts more thyroid hormone into reverse T3, an inactive form. All three are invisible if you only look at TSH, or even TSH and T4, which is why a full thyroid panel evaluated alongside cortisol is so essential. The practical takeaway is powerful. If you are not feeling better on thyroid medication, you cannot simply keep raising the dose to outmuscle a cortisol problem, and doing so can create real side effects, because part of what you are dealing with is a conversion issue rather than a supply issue.
When Cortisol Clears Too Quickly
The opposite pattern is also common. Fast clearance means less free cortisol and more metabolites in the urine, so it can look like a person does not have enough cortisol when in reality they are making plenty and burning through it. Hyperthyroidism can drive this, though it is far less common than hypothyroidism. The bigger drivers Dr. Jaclyn sees are chronic inflammation, elevated BMI, and metabolic dysfunction such as high insulin and blood sugar dysregulation, patterns her team has published on in peer reviewed literature.
This is where the Dutch test becomes a window rather than a diagnosis. Because cellular changes happen long before blood changes, a fast clearance pattern can point toward an early metabolic issue and prompt appropriate follow up like fasting insulin, fasting glucose, HOMA-IR, and hemoglobin A1C, even in someone who does not look like a classic case. Dr. Jaclyn uses the analogy of cells covering their ears against too much insulin, the same way the body compensates internally with cortisol long before anything shows up in the bloodstream.
What You Can Actually Do to Support Your Cortisol
The most effective interventions for regulating the HPA axis are free, though free does not mean easy. The first is light and circadian rhythm. Getting as much natural light as possible within the first thirty minutes of waking, without sunglasses and without reaching for your phone, anchors the morning cortisol rise and supports the entire system. In the evening, the goal is to curate a genuinely relaxing wind down, avoiding food late at night, stepping away from screens and stressful content, and doing something that actually calms your body before sleep.
Routine itself is therapeutic, because the HPA axis thrives on predictability, whether that is consistent sleep and wake times, regular meals, or exercising at the same time each day. From there, adaptogenic herbs can help, and which ones depend on what the diurnal pattern actually shows. Dr. Jaclyn notes that most women she sees are stressed and wired rather than stressed and tired, and she gravitates toward calming, well tolerated herbs that have a long history as food, including ashwagandha for its antioxidant and HPA balancing benefits and reishi mushroom for immune support and nervous system calm, along with options like maca and rhodiola. These are now easy to find in powders, capsules, and even coffees the herbs steep into.
The Deeper Work That No Supplement Can Replace
The conversation closes on something bigger than any protocol. Dr. Jaclyn is candid that no amount of ashwagandha can resolve a fundamentally dysregulated life, and she speaks openly about how a profoundly difficult year reshaped her own relationship with stress, rest, and the nervous system. Inna and Dr. Jaclyn talk about how many women carry an impossible load, running on the belief that they should keep doing things simply because they are capable of doing them.
Both of them point to the same truth, that joy, connection, time in nature, and the ability to actually receive help are not soft add ons to a healing plan. They regulate the nervous system, and they belong at the center of the work. Inna shares her own experience of releasing activities she kept up purely out of obligation, and Dr. Jaclyn reflects on how learning to say yes to support changed the trajectory of her life. Receiving, they agree, is not a weakness. It is a gift to the person giving as much as the one receiving, and it is one of the deepest ways we build the community our health depends on.
Connect with Dr. Jaclyn Smeaton
Website: dutchtest.com
Instagram: @dutchtest
Personal Instagram: @dr.jaclynsmeaton
FULL EPISODE TRANSCRIPT
Inna Topiler CNS MS (00:02.039)
Dr. Jacqueline Smeaton, welcome to Thyroid Mystery South, Hashimoto’s and Hypothyroidism Revealed.
Dr. Jaclyn Smeaton (00:08.027)
Thank you so much for having me. I’m really thrilled to be here.
Inna Topiler CNS MS (00:10.508)
Yeah, I am so excited for this conversation because we know that the thyroid is responsible for so much, right? We need thyroid hormone literally from our head to our toes. And it just governs so many things. But also the adrenal glands play a really big role in governing what the thyroid is doing. And I often refer to them as sister glands. And what I find interesting is that many people understand this connection, but they don’t know exactly.
why that’s the case and why they’re so important together. But even more importantly, people don’t really understand what they can actually do to help this connection so that they can start to feel much better. So can you tell us exactly how is the thyroid and the adrenal glands connected?
Dr. Jaclyn Smeaton (00:54.098)
So there’s so many bi-directional relationships between thyroid and adrenal, but I think the the main takeaway that I would want people to have is that cortisol.
Is a really important hormone for every other endocrine system. It’s kind of like a master hormone. And when we think about hormones, I like to think about them in a hierarchy. And cortisol is like the base of that pyramid. If your HPA axis isn’t functioning properly, then resources aren’t allocated the way that they should be. We think about cortisol as a stress hormone, but really it’s a resource allocation hormone. It mobilizes glucose, it raises our blood pressure, it increases our blood flow to muscle, and it helps with feedback across.
Across all of our endocrine systems. So when it’s out of whack, it’s hard for everything else to function. And there’s a lot of direct interaction between thyroids, thyroid hormones, and cortisol that we can get into. But I think if you can walk away with anything, it’s that cortisol is kind of like the puppeteer that pulls the strings for so many other hormones. And so if it’s not aligned, it’s not functioning well.
You can see a lot of dysfunction and thyroid is definitely an area where we see that. And it can be it can kind of hide thyroid dysfunction in a lot of ways as well.
Inna Topiler CNS MS (02:07.244)
Yeah. Now, when a lot of people hear about cortisol, and especially with social media and all of the different things that we see, most people equate it to, cortisol equals belly fat. And so I think for so many people, they just have this negative association. Cortisol equals bad. And so I love that you’re saying that it’s actually really important, but it has to be aligned. So can you talk a little bit more about what that means and what’s bad about cortisol? But then
Dr. Jaclyn Smeaton (02:18.696)
yeah.
Inna Topiler CNS MS (02:35.48)
What’s good, right? And like what does it need to be? Because I think people think, you know, no, no, we don’t want any cortisol, but that’s not really the case.
Dr. Jaclyn Smeaton (02:42.578)
I love that you bring it up that way. And that’s the same impression that I hear all the time. And so debunking this myth of cortisol equals bad or cortisol equals belly fat, right? All of these are so important because cortisol actually is one of the most important hormones in our body. I like to think about it when I talk to patients. I say it’s like your fire extinguisher. It’s always there, ready to launch, you know, ready to kind of release its chemicals to put out a fire. And it works really well. It’s a very
well adapted system that’s there that has functions on the day to day. And we can talk about that and what that looks like. But then when your body has additional need due to stressors, due to inflammation or infection or injury or emotional stress, it is what
Is the first responder on the scene. And it’s it is that fire extinguisher that helps to kind of quench the fire. And when I say it is in charge of resource allocation, that’s exactly it. So if you have, for example, let’s use that classic example of like being chased by a tiger, right? That triggers your fight or flight response. Cortisol reallocates resources in that time of stress. So normally we want to be in a state of what we call parasympathetic nervous system function, which is rest and digest is the
It’s all those things that are
Like they take a lot of energy to do, but they’re not critical for life. Reproduction, digestion, and immune function really are the three big systems there. You have to be in a chill state for those to happen. Now, when you get triggered in a fight or flight, like being chased by a tiger, cortisol gets released, it’s a glucocorticoid, and it shifts focus to blood to your brain, blood to your muscles, mobilizing glucose, raising your blood pressure. And the intent there is to help you respond to like run, to things.
Dr. Jaclyn Smeaton (04:31.148)
Clearly in the moment, so you can make a smart decision. But the intent there is that eventually that shuts off and everything kind of goes back to that rest and digest state. Now, we live in a place where a lot of us are struggling to live in that rest and digest state. And that’s where you get the problems with cortisol, because it wasn’t a system, it wasn’t a light that was ever intended to be left on all the time. And that’s where we tend to see problems. So
You know, cortisol is meant to move in a diurnal pattern. I think people know that, but we can definitely talk through what that looks like in a healthy situation. And then it’s almost just like always ready, like a fire extinguisher in the corner of the room. so that when that functions well, it keeps all of our other systems in check. And then when it goes awry, when we’re over-stimulating that system, it can lead to dysfunction in the short term. And then what we see now is in the long term where people have a lot of downstream effects of that system being constantly stimulated.
Inna Topiler CNS MS (05:25.998)
Yeah. And unfortunately, so many of us have this situation in just the day-to-day life and everything that we have coming at us all of the time. So let’s talk a little bit how people can know what’s going on with cortisol, because typically, traditionally, doctors don’t test cortisol, though once in a while, you know, I’ll get someone’s labs where, you know, they come from, you know, an endocrinologist or maybe a more conventional doctor, and you’ll you’ll see a cortisol.
Dr. Jaclyn Smeaton (05:29.318)
Yes.
Dr. Jaclyn Smeaton (05:33.649)
Mm-hmm.
Inna Topiler CNS MS (05:55.865)
Typically it’s gonna be in the morning because that’s when they get their labs done. And they’ll say, yeah, yeah, you know, my crozil’s not too high or not too low. It’s normal. But why is it a problem when people just have this one level?
Dr. Jaclyn Smeaton (05:57.927)
Mm-hmm.
Dr. Jaclyn Smeaton (06:08.23)
That’s a great question. And so I think a lot of patients go in because they they ask their doctors, can you check my cortisol too? Because want to see if it’s normal. And when you look at the cortisol levels in blood in serum, which is how most like GPs or any kind of specialist that you go to, even some functional medicine doctors, they really look at cortisol just in the morning, just in blood. And there’s some problems with that. The reference range is set to identify disease. So we have Addison’s disease and Cushing’s disease with cortisol. These are the extreme ends of
Dysfunction. And that’s what can be picked up in blood. The number of people who have Addisons and Cushings is very low. And to be honest, there’s such profound illnesses that you don’t even need to measure to know they’re there. Like symptomatically, they’re so symptomatic. But it doesn’t do a very good job of looking at all the dysfunction in the middle. There’s a couple of reasons for that.
One is that cortisol in the blood is total cortisol. And just like every hormone, there’s core hormone that’s bound to a carrier protein, and there’s hormone that’s free. We think about this with testosterone. We look at free and total testosterone. And a lot of times people have heard of sex hormone binding globulin, which is a carrier protein for sex hormones. It’s the same thing. We have a corticotropin binding protein as well. So when you look at cortisol in the blood, you’re looking at the total amount, but actually less than 5% of
That is free. And you need free hormone to interact with cells and tissues. So just generally, it’s not a great marker. The reference range isn’t great to pick up dysfunction. So what I like to do instead is that we look at cortisol in a couple of different ways. One, we want measure free cortisol.
So there’s a couple ways you can do that. Saliva is the gold standard, and urine is also validated in clinical research to be the same as saliva. So when we look like I work with Dutch test, when we measure cortisol, we look at four time points across the course of a day. That’s really critical. You want to see the diurnal pattern. And then we look at free, and we also look at the metabolites, which tells us more about how much you’re making across 24 hours. And you really need all elements of that. You need your free 24 hours.
Dr. Jaclyn Smeaton (08:18.374)
Cortisol, the total cortisol metabolites, which tells you how much is made, and you need the timing or the diurnal rhythm or the pattern. And all of those things matter. I’m sure you’ve seen this before on a lot of test results, where actually the overall 24-hour cortisol is normal. But when you look at the pattern of its release, it’s very dysfunctional, and you just know.
I wouldn’t have caught this if I caught one time point or I only looked at total cortisol. Because it matters. You want it to be released in the morning. That’s what wakes us up. We actually have this thing called the cortisol awakening response, which we can talk about. That’s another great measure. but it cortisol should spike in the morning. That’s what helps us wake up.
feel awake in the morning, feel alert, and then it should be slowly, gradually coming down through the day, and then it should be quite low at night. And sometimes cortisol levels are okay, but you have people, and this is predictable in the clinic, who they wake up in the morning and they don’t spike cortisol.
Okay. Or they might be low through the day, but then they spike it at night. You know, and we see that sometimes with chronic issues. Like maybe people have a stressful home environment. We can see that in the evenings their cortisol goes up. It’s always an interesting conversation to have to have with like well, what’s happening when you come home at five o’clock at night? or you see the patients that they just feel like they’re dragging in the morning. They’re like, I have to have three or four cups of coffee before I can actually be alert and work. So normally we’re like, I bet I bet we’re gonna see low cortisol in the morning, and that very often
Inna Topiler CNS MS (09:32.813)
Yeah.
Dr. Jaclyn Smeaton (09:45.17)
And bears out. So when we look at cortisol, we always look at people’s symptoms, how are they feeling through the day, and then we look at total, free, and the pattern of release.
Inna Topiler CNS MS (09:56.995)
Yeah. And that’s so helpful because most people don’t realize that you have to look at all of these things. And it’s similar with thyroid, you know, where we can’t just look at free T three and free T four. And I talk about this all the time on the show. So I think everyone listening probably knows I don’t want to sound like a broken record, but it’s a similar thing. You know, the free is important, but it accounts for a small percentage. So we want to make sure that we see what the total is too. And then we look at them in relativity because just looking at one.
Dr. Jaclyn Smeaton (10:10.096)
Yes.
Inna Topiler CNS MS (10:26.294)
Or just looking at the other is not going to give us the full picture. So I love that you’re explaining this and it’s so similar here.
Dr. Jaclyn Smeaton (10:33.04)
It’s interesting, as a healthcare provider, I think I probably misinterpreted a lot of cortisol tests earlier on in practice. And I bring that up with like real humility and honesty because I looked at the diurnal pattern and for a long time I did saliva-only testing, which is just the that’s the company that I did. It was four saliva samples over the course of the day, and they’d plot the diurnal pattern. And l saliva is the gold standard for measuring free cortisol. However,
When I started learning more about cortisol, I realized that when I didn’t look at urine metabolites, I was missing the total amount that was being made. And sometimes there’s a mismatch. This was just a real light bulb moment. So if you have practitioners listening.
I just think this is a place I got things wrong for so long, where if you the diurnal pattern might look okay, or maybe the level looks low, relatively low of cortisol, and you think, gosh, this person’s not making a lot of cortisol. I need to stimulate their adrenal glands, maybe give them some herbs, get them to make more. But what I’ve seen now, because I look at thousands of reports, is that a subset, it’s not a small subset, probably 20 to 30 percent of patients with that low cortisol actually have really high metabolite levels, which means they’re actually making
so much cortisol, they don’t have a problem producing it, but they’re burning through it really fast. And that’s normally because of some kind of underlying issue like insulin resistance or infection. So your body, it’s like making a lot of fire extinguishers, but it’s pulling the, you know, pulling the ring and spraying it everywhere all the time. So it looks low. And that’s a very different problem than not having enough around. So anyway, my point is you really have to look at at least those three pieces to get a clear picture.
Inna Topiler CNS MS (12:15.682)
Yeah. Let’s unpack that a little bit more because I think for everyone listening, it’s gonna be interesting because unless they’ve done a Dutch test, which many people haven’t, but even if they did, just as you mentioned that you were interpreting it wrong, not the Dutch necessarily, but just like how you’re seeing it, I think that sometimes people order it on their own and they may not know how to read it. And sometimes what they’ll do is they’ll ask their provider to order it, but sometimes the providers don’t know as much. And so they’ll be very
kind and say, sure, if you want this test, I’ll order it for you. But then they’re not reading it just because they may not be trained. Again, not saying that someone is doing something wrong, but it’s just maybe not in their wheelhouse. And so I think that it’s very common to look at the curve because that’s kind of more mainstream, if you will. And so people kind of sort of, I mean I don’t even say 100%, but they sort of know that yes, you know, we should have that higher in the morning and then slowly go down. So if it goes up at night. And even with that,
You know, I think there’s so much with relativity because sometimes you’ll see it higher in the morning and then it’ll go down, down, down, and then maybe in the evening it is the same. So it doesn’t go up. So it’s not that like traditional reverse where it’s like, you know, it’s low and then it’s high, right? It does the pattern, but then like it just doesn’t continue to go down as much. It’ll stay the same. And
Dr. Jaclyn Smeaton (13:29.442)
Like a V. Mm-hmm.
Inna Topiler CNS MS (13:36.246)
You know, I I don’t know if you agree with this, but in my book, that’s an indication, okay, but it’s not continuing to go down. So something’s still going on. It may not be as much as like it going up, but it’s not going down, you know? Yeah.
Dr. Jaclyn Smeaton (13:46.503)
Mm-hmm. Definitely. So I think if I had to give you like the one, two, three of interpreting cortisol, the first thing I would look at is the diurnal pattern because the pattern is really important. So like you said, you wanna see it high in the morning, you wanna see it come down throughout the day and then bottom out.
Inna Topiler CNS MS (14:03.212)
And can I just clarify one thing with you because I think everyone listening are they’re gonna be really interested in this? You mentioned this spike, right, when you wake up, but typically it doesn’t happen instantly, right? So how should it look, right, when someone wakes up and then say an hour or two after that?
Dr. Jaclyn Smeaton (14:06.321)
Mm-hmm.
Dr. Jaclyn Smeaton (14:23.836)
So with that’s what we’re talking about, the cortisol awakening response. So with Dutch, when if we have two tests, we really run the Dutch complete and the Dutch Plus. The Dutch Plus adds the cortisol awakening response. So there’s a couple differences. Dutch complete, we do it in urine, which is really easy. You like pee on a piece of paper and send it in. The Dutch Plus, you do saliva and you do more samples right upon wake up. You have to do saliva because saliva is like an instant snapshot, like it is in your blood. Urine’s not. It takes hours for things to come out through your urine.
For example, we measure melatonin on the test in your first morning sample because it looks at how much melatonin you made throughout the entire night from the last time you peed before you went to bed. So you’re looking at hours and hours of time when you look at urine, which is fine for cortisol through the day, but you can’t do the cortisol awakening response because timing really matters. So when we do the cortisol awakening response, you collect it immediately upon waking. Like your alarm goes off, you put the tube in your mouth, you don’t even
Get out of bed. It has to be right away. Then you collect 30 minutes later, and then 30 minutes later, and then you keep going through the day, and you have the other samples that you’d normally collect. What we want to see is that there is an increase that’s predictable from that time point when you wake up to 30 minutes after waking. And that 30 minutes after waking is really critical. We want to see a rise between 50 to 160% of your waking, between the waking and the 30 minutes post. So let
Let’s say just for the sake of easy numerical values, basically you’d wanna see it go up. If if the level was one at Waking, you’d wanna see it at 1.5 or what would that be?
2.6, I can’t do my math, but you want to see an increase of 50% to 160% between the zero time point and the 30-minute time point. That is really a lot like a stress test on your body. And in fact, in conventional medicine, when they test your ability to make cortisol, they do a test called an ACTH stimulation test where they give you the hormone that makes you make cortisol and they see if you make it. And waking is actually a little mini version of that. So you want to take a look.
Dr. Jaclyn Smeaton (16:35.282)
At that cortisol awakening response. So you want to see it high in the morning because that’s showing you that you’re getting that alert wake up. And a lot of this is related to circadian rhythm. You need darkness at night, you need sunlight during the day, you know, you need melatonin at night, you need vitamin D during the day. And cortisol really responds to that.
So that’s the first thing, is it rising in the morning? Even if you don’t do a car, there’s a range that you’ll notice is much higher in the morning for that first waking sample. And timing is really important. So for example, if people
sometimes we get samples in where people woke up in the middle of the night or they woke up at like 4 a.m. and then they go back to sleep and they get up at 6 and they take the test. Sometimes the results don’t look quite right because even that earlier waking throws things off a little bit. It can get complex to interpret, but that’s the basics of it.
Inna Topiler CNS MS (17:25.955)
Yeah.
Inna Topiler CNS MS (17:29.678)
Okay. So that’s that morning response. And so if they do the Dutch plus, they’re doing the saliva and then they’re they’re doing the urine for the other ones. Yeah. Okay.
Dr. Jaclyn Smeaton (17:33.296)
Yes.
Dr. Jaclyn Smeaton (17:38.481)
The daytime. Yeah, they’re doing saliva actually through the whole day. But their saliva and urine are comparable. and you actually do urine as well because we look at other things on the test, but the cortisol comes from saliva. So really you wanna look at that diurnal pattern.
Inna Topiler CNS MS (17:49.037)
Right.
Dr. Jaclyn Smeaton (17:53.861)
And if though you wanted to add the cortisol awakening response to the test, that would be really part of the diurnal pattern. It’s like zooming in on that first morning section. And the reason I might order a car on a patient is when they have chronic illness or chronic stress or complex disease where you think, gosh, they’ve been in a state of inflammation or chronic stress a really long time. I want to see what their resilience is. And the car is one of the first things to change. There’s actually quite a lot of
published literature on car being blunted or being too high in the morning when people are under chronic stresses from even complex illnesses. So the diurnal pattern is the first thing. Does it have that natural shape? You’d mentioned a flipped curve, which we see sometimes where it’s low in the morning and high at night, or sometimes you see it low throughout the day or you see it high throughout the day. And there’s various iterations of that. But that’s the first thing we want to look at is the timing of it right.
Okay. Then we the second thing you’d look at is the total free cortisol. That really comes from the diurnal curve, so normally those match up. And then you look at metabolized cortisol. That comes from urine. And that’s where you wanna see is there are do those match or not match. Generally you wanna see them like we have dials that show them both. You wanna see them line up.
Inna Topiler CNS MS (19:14.104)
And I remember the dials, like you don’t want them like this.
Dr. Jaclyn Smeaton (19:17.058)
Exactly. You want to see them kind of line up. We also have a measure that does a calculation between those two that we call cortisol clearance rate. Again, this is something that’s come out in literature in the last number of years. But essentially, you want to be with an average cortisol clearance rate. But sometimes cortisol clearance can be high or it can be low. And actually, thyroid is one of the biggest reasons why we see changes. Not the only thing, but one of the biggest reasons, which oftentimes you’ll see slow clearance of cortisol.
And one of the first things our doctor team thinks of when they talk to clinicians is, have you checked this patient’s thyroid? Because hypothyroidism can lead to slow cortisol clearance. And that can also lead to people feeling like quite anxious because you’re not able to clear the cortisol that you’re making. So you’re almost overstimulated in that way.
Inna Topiler CNS MS (20:05.24)
Yeah. And I think that’s so important for people to understand because we always think, well, if there’s too much, that means we’re making too much. Right. And it’s the same thing happens with hormones, right? And estrogen. And we always think, well, we’re making too much estrogen. It’s like, well, are we? Or are we just not metabolizing, detoxifying, and clearing? And it’s the same thing here. And I think the estrogen piece people understand a little bit more about just because they think there’s more on that. Whereas I just don’t think there’s
Dr. Jaclyn Smeaton (20:24.114)
Mm-hmm.
Inna Topiler CNS MS (20:31.936)
As much talk about cortisol clearance, or at least maybe not in as much mainstream, you know, media as some of the other stuff. So that’s really, really important. So tell us a little bit more about, you know, with cortisol clearance. So you mentioned that when someone’s thyroid is not optimal. And I and I want to mention too, is it hypothyroid where it’s not controlled at all? Or can it happen if someone is more subclinical, or maybe, you know, their TSH is, say, within
Dr. Jaclyn Smeaton (20:38.225)
Yes.
Inna Topiler CNS MS (21:00.606)
normal optimal range, right? It might be in like the two, right? It’s not like there’s seven or eight in TSH. But perhaps maybe their T3 is low. There’s something else going on where their thyroid isn’t functioning. So they may not have like that traditional hypothyroid, you know, because they’re supported, but maybe they’re just not optimally supported. Can that still affect?
Dr. Jaclyn Smeaton (21:05.436)
Yeah.
Dr. Jaclyn Smeaton (21:20.676)
It definitely can. And I mean, keep in mind, we haven’t gotten into this relationship between cortisol and thyroid hormone, but when cortisol is chronically elevated, it can actually create a deceptively normal or low TSH. So you might have a patient that looks euthyroid when you measure TSH, meaning it looks normal, but they feel hypothyroid. It is that kind of subclinical picture. But what we care about is not always what’s happening in the blood. We want to know what’s happening inside the cells, inside your tissues, because that’s
What matters when it comes to how you feel. Okay. So with cortisol clearance rate, we’re actually looking at how cortisol gets used inside of your cells because we’re looking at urine. So we look at the metabolic byproducts of your cells that get dumped into your bloodstream, filtered by your kidneys, and eliminated through the urine. So we can really get a window into what’s happening inside the tissues with urine, which is a really cool way or a reason why I like Dutch testing. I always do serum testing.
As well, it’s very useful. It tells you about production, but it doesn’t tell you what happens downstream. So when I we add urine metabolites, it almost takes a two-dimensional picture of hormones and brings it into three dimensions. You know, you get so much more info. So that hypometabolic pattern where you have slow clearance, and what it would look like is that you have more free cortisol relative to metabolized cortisol. It looks like you’re making less, but you are keeping it all as free. Hypothyroidism includes.
Including subclinical is one of the biggest things that we see. So we always want providers to kind of dig into that. The other big thing that we see, and this is happening right now, especially, is low caloric intake or anything that slows your metabolism. If you’re not eating a lot of calories, your metabolism slows down to adjust. And we’ve seen this a lot in patients who are newly put on GLP1 medications. And so this is another thing that we’re seeing a lot more hypometabolic cortisol because people might be just due to their hunger being suppressed.
Eating a lot less calories and their metabolism comes down. I love having this marker on the Dutch test for patients who are on GLP ones because you don’t want to see your metabolism slow down. You want to see, you want to eat enough that it’s maintained because what happens if you go off of it? Your metabolism’s all funky and you’re just going to put weight back on. So those are really the two big things. There’s other things like poor mitochondrial function or poor bile function and liver function that can increase that can slow that down. But thyroid.
Inna Topiler CNS MS (23:37.112)
Exactly.
Dr. Jaclyn Smeaton (23:50.246)
and low metabolism are really the big ones there.
Inna Topiler CNS MS (23:53.315)
Yeah. And and I think it’s so important for people to understand that. And especially you mentioned in front in terms of symptoms, right? And if someone is not metabolizing, they may not have a ton of cortisol they’re producing, right? But if they’re not metabolizing, it’s gonna appear to the body, right, that there is too much, even though they don’t have too much, right? And people often say, Why do I feel anxious? But yet, you know, because we look at thyroid hormones, right? And if someone’s feeling anxious, especially if it’s
a new symptom, we think, okay, well, maybe you’re taking too much thyroid medicine. And especially if they’re on T three. And a lot of conventional providers tend to shy away from T three if someone has anxiety or if they have history or propensity to it. But, you know, it’s the cortisol connection is so important here. And you know, I just don’t think people realize that because yeah.
Dr. Jaclyn Smeaton (24:43.153)
Right.
Yeah, I mean there’s really three ways that cortisol suppresses thyroid function. These are all really well studied. The first is a central suppression, so it like affects the whole axis, the hypothalmic pituitary thyroid axis. It can really inhibit TSH secretion, and it changes the amount of thyroid binding protein in the blood as well. So what this is where I’m saying that you can have a chronically stressed patient where TSH might look normal or even slightly low.
Which would indicate that you have more thyroid horm hormone than you need when you really don’t, right? Because that can be a cortisol overlay. The second, and you mentioned this, is that core high cortisol actually can prohibit or block the conversion of T4 to T3. So you might have plenty of T4 in your body, but you’re not activating it. And if you have a lot of cortisol, that activation rate goes down. So again, if you’re only looking at TSH or TSH and T4, you can totally miss that. The third is that it actually shunts more.
More thyroid into reverse T3 when there’s a lot of cortisol around. So again, this is where that full panel really matters, and you want to be looking at that full complete thyroid panel, which I’m sure you’ve talked about a million times here on the pod, and also be looking at cortisol because you want to s you want to see.
Whether that low thyroid cell activity or like the way your cells are hungry for more thyroid hormone, is that because of thyroid, or is thyroid almost like the victim of dysregulated cortisol? And you can’t give enough levothyroxin to outsolve that problem. It doesn’t work because it’s a conversion problem, too. And in fact, there can be some pretty severe side effects with that if you keep bumping up the levo dose without fixing the cortisol problem. So it really is something that is a
Dr. Jaclyn Smeaton (26:29.992)
Very important connection. I would say some people’s thyroid stuff is so straightforward, but if you’re not feeling better when you’re supplementing with thyroid hormone, this is something that you should look into.
Inna Topiler CNS MS (26:42.734)
Absolutely. And you know, that connection you mentioned with the low TSH, we see that quite a bit, you know, and it’s really that pituitary pattern, right? Where it’s not stimulating the thyroid. And then we see a low TSH, which conventionally doctors say, low TSH, like you’re not hypo. If anything, you’re hyper, but it’s that low TSH together with low total T4 is how we know, wait, there’s something else going on here. So yeah, that’s really important. So for everyone who’s listening, I think that they can
Dr. Jaclyn Smeaton (26:51.249)
Yeah.
Dr. Jaclyn Smeaton (27:02.129)
Mm-hmm.
Inna Topiler CNS MS (27:12.51)
really understand now why it’s so important to look at cortisol more than just, you know, getting a one-time serum snapshot of it. So the Dutchess is an amazing way to do that. Now is that something that people can order on their own or is it something that they asked their provider about? Tell us a little bit more about that.
Dr. Jaclyn Smeaton (27:30.397)
So we recommend you go through a provider. We don’t really have an easy access to be ordering it directly. And that’s because we really want you to get support from a provider when it comes to interpretation. I’ll tell you that you know, we train doctors on how to interpret, and it’s complex to learn. And so I think working with someone who can help you interpret and figure out what’s going on is so helpful. And the report is very comprehensive. We’re talking about cortisol today, but on every Dutch complete and Dutch Plus, we look at really three families of hormones estrogen and
progesterone, androgens, which is like testosterone and DHEA, and then cortisol. And they’re really important because they all act together. So especially for women who are in that perimenopausal to menopausal transition.
Looking at everything in totality is so critically important. And we do get a little bit of a window into thyroid health through this cortisol backdoor. But in my opinion, this is a test that really every woman who’s in that late reproductive stage, like it’s really nice to get that a baseline of what’s happening, particularly around cortisol, because not only does cortisol
engage with the thyroid gland and impact its function, but also with estrogen and progesterone, also with androgens, and independently. So a lot of times women feel a lot of fatigue, for example, and they think, I must need HRT. Maybe you do, but it maybe also could just be thyroid or cortisol or something independent.
Inna Topiler CNS MS (28:54.872)
Yeah. Yeah. Exactly. Exactly. And I remember, I mean, this was many years ago when I was running a lot of Dutch tests. I talked to your team all the time because it is complex to interpret and learning all of that. And it’s it’s been a while. I don’t see patients one on one as much anymore. And I feel like some of those pathways, I mean, they’re always in your brain, but you know, as you learn new things and especially when you have little kids and you’re in perimenopause, sometimes, you know, you put one thing into your brain and then something else comes out. So
Dr. Jaclyn Smeaton (29:19.826)
I unfortunately I can relate with that.
Inna Topiler CNS MS (29:24.174)
so yeah, some of the pathways are not as sharp as they were, but it’s it’s it’s it’s very complex, but it’s also extremely revealing in what it shows. And I think that that it’s just so important for people to understand that. Now, if someone looks at their results and you know, maybe they’re working with a provider, but they want to make sure that they’re doing as much as they can to support this. And let’s just say that they have
Dr. Jaclyn Smeaton (29:32.688)
Mm-hmm.
Inna Topiler CNS MS (29:52.309)
low cortisol during the day and then they do have that spike in the evening. What are some things that you would recommend? That’s like some first kind of basic things that, you know, anyone can do to support that. Are there any lifestyle things you recommend? Any supplements that you really like for that?
Dr. Jaclyn Smeaton (30:07.952)
Definitely. So the the really I guess the good news and the bad news about regulating your HPA access is that the best things that you can do are free.
And they’re simple, but they’re really hard, right? They’re simple doesn’t always mean easy. So I always recommend that people start with light exposure in circadian rhythm patterns. So what that means is that when you first wake up, you should try to expose yourself to as much natural light as possible. Open the window shades, take your dog out to pee in the sunlight, you know, don’t wear sunglasses, don’t look at your phone, just natural light for the first 30 minutes or so while you wake up. It can be great to like step outside with your cup of tea or coffee.
Inna Topiler CNS MS (30:22.84)
Yeah.
Dr. Jaclyn Smeaton (30:49.383)
and give yourself time to wake up.
Likewise in the evening, really thinking about curating a relaxing environment. So there’s a couple pieces to that. After dinner, I wouldn’t eat more food because that metabolism kind of keeps it going. We want everything to start to quiet down. And again, this is the time that I think is harder for patients and for myself, if I’m being candid, is to have a wind-down routine that doesn’t involve staring at your phone until 11:30 at night, doom scrolling. particularly right now, where no matter what your belief system is.
There’s everything online to stress you out about the way things are going in the world. But really thinking about how can you curate a relaxing routine. Maybe that’s reading books, maybe that’s taking a bath, maybe that’s going for a walk after dinner or being outside with your family, you know, doing things that actually relax you. And this can be complex. I mean, it sounds very simple, but if you’re like a working single mom, your evenings are probably pretty stressful as you like make sure your kids do their homework and you make them dinner and then you clean up and then you pack lunches for the next day. So part of
This is really a systemic challenge where we need to make sure we are all supported in the ways we need to be so that our system can rebalance. So once you start doing those things, that would be the first is a light exposure. I think the second thing is routine.
We are creatures that thrive on routine and our HPA access is like that as well. So having some things in your life that you can do predictably day after day. Maybe it’s you wake up or go to sleep at the same time, you exercise at the same time, you eat your meals at around the same time. It may not be all of those things, but find a couple of things that you can do consistently to help your body get into this patterning. And then from there, it’s a matter of
Dr. Jaclyn Smeaton (32:36.408)
Adding things like herbal medicine and stuff like that, which there are so many wonderful herbs that support adrenal health. And which ones are right for you really depend upon what that diurnal pattern looks like. But in my experience right now, most women that I see they need to relax more. And when I think about the way people respond when they’re stressed, some people are stressed and tired, and some people are stressed and wired.
I don’t know about you, but I see much more stressed and wired.
Yeah. So generally when you’re thinking about herbs to support, like these adrenal herbs are meant to be part of our food supply. Like if you look back historically, you have like maca, which is like a tuber root, like a sweet potato that was eaten as a food by the Peruvian people. You have like rhodiola from Siberia that was consumed as a daily food. And there’s really nice ones out there that are very safe for the most part. A couple of my favorites are ashwagandha.
that has nutritional benefits as an antioxidant and it supports adrenal function as well or HPA axis balance. That’s a really nice one to look at. a lot of mushrooms, too, like Rishi mushroom, which are great for the immune system, and also calming for the HPA axis, are great. Those two are probably my favorites if I don’t have like more information about a patient. But now you can find them in powders that you can blend into a smoothie. There’s even coffee that has it in it that when you brew your coffee.
the herbs like steep into your coffee. There’s just so many creative ways to get into it.
Inna Topiler CNS MS (34:13.986)
Yeah. Yeah. Now what about if someone has low cortisol clearance and say that they look at their thyroid and you know, maybe they do have a conversion issue, or maybe they do have an issue with binding where the free hormones are just not getting into the cell. So they’re working on that and they’re doing things to support that. Do you find that as they do that the clearance gets better, or is there something else that they need to do in addition to supporting their thyroid that can also help that clearance?
Dr. Jaclyn Smeaton (34:43.194)
No, we absolutely see that improve when you work on HPA axis function. So remeasuring your cortisol diurnal pattern is a really nice way to check in on whether those like lifestyle and supplement things are really helping. So and it really you’ll see changes in the thyroid, particularly in how you feel, even before your labs change.
Inna Topiler CNS MS (35:07.606)
And what about the liver? And we actually had Carrie Jones on a few weeks back and we talked a lot about estratine detoxification and all those pathways. But what about the liver as it relates to cortisol? If someone has a sluggish liver, you know, if they’re getting too many toxins, if they are not clearing them well enough, how will that affect cortisol clearance at?
Dr. Jaclyn Smeaton (35:30.237)
There’s not quite as much research, if I’m being honest, on that topic in the published literature, but we do know that poor liver function will slow the clearance of cortisol. And that makes a lot of sense because we have enzymes in our liver that are breaking things down, estrogen.
other hormones and environmental toxins. And many of them actually use the same enzymes, toxins and hormones. So when you’re adding to the load or adding to the burden by like putting more things in the bucket that your liver has to process.
It slows down the conversion or the detoxification of the things that you your body wants to find in balance. Of course, that’s critical because you need to need to detoxify the toxins as well, but it all ends up contributing. So really doing things again that limit your toxic load as much as possible is always a great idea. You know, I and I think I do think about things like endocrine disrupting compounds. Of course, that’s really important overall with liver function, but I would also think about things like alcohol that people
sometimes you’ll be focused on cleaning up your skincare routine, but then you’re still having three glasses of wine at night. So I just it’s I know no one likes to hear that. Don’t mean to be the bear bad news, but making sure that you’re doing things in moderation to just allow your liver to detoxify what it should naturally expose to.
Inna Topiler CNS MS (36:38.968)
Good point. I know.
Inna Topiler CNS MS (36:49.026)
Yeah, absolutely. Now, do you ever see the opposite pattern where someone may be clearing it too quickly? And so then they have, you know, they may be producing enough, but they are clearing it so quickly that then it makes it that they it seems like they don’t have enough cortisol.
Dr. Jaclyn Smeaton (36:56.839)
Mm-hmm.
Dr. Jaclyn Smeaton (37:04.41)
This is really
Common. So hyperthyroidism could produce this state of like fast metabolism. So that would mean that you have less free cortisol in more metabolites in your urine. But hyperthyroidism, as you know, is really not as common as hypothyroidism. But there are some other really common drivers of fast metabolism. The biggest ones are chronic inflammation and obesity, and then metabolic dysfunction. So like high insulin and blood.
Blood sugar dysregulation. All of those things can drive to faster conversion. Chronic stress can do it too, but we see this very often in people that have an elevated BMI. We’ve published some data on that in peer-reviewed literature that you can see changes in the cortisol clearance rate based upon patients who have obesity, but also blood sugar dysregulation, which again, the Dutch test is not a diagnostic test at all. And it’s definitely not diagnostic for thyroid dysfunction or glucose metabolism.
Metabolism, but it gives you a window into what’s happening inside the cells, in this case with cortisol, that really can point you in the direction to say, hmm, you might want to do a metabolic workup on this patient, even though they don’t look classic for it. Do a fasting insulin, do a fasting glucose, look at their Homo IR, their hemoglobin A1C, look at their blood glucose dysregulation. And sometimes we do pick that up early. And that that’s what’s so cool about looking at metabolites.
Because when we look at hormones in our blood, that is the last place changes happen. Our body is so amazing at trying to find rebalance, right? It’s always trying to restore a state of balance. And so changes actually happen inside of our cells long before it can’t tolerate it anymore, and the changes happen in our bloodstream. Glucose is a great example of this, and I think people know this. When your blood sugar is too high over a long period of time, you get
Dr. Jaclyn Smeaton (39:03.166)
Insulin resistance. People know this because you have a high blood sugar, you have a lot of insulin. And so what happens is eventually the cells like block their ears because they’re like, stop screaming at me, insulin. This is too much, I can’t handle it. And they block their little receptor ears. And then you start to see blood glucose go up. But the change happens first at the cells. It’s exactly the same with cortisol. When you’re under chronic stress, we see changes in the cells first. We see changes in cortisol levels last.
So if your diurnal pattern looks abnormal, your body’s already tried to compensate through the levels in your tissues. So it’s really it’s a great thing to be looking at this from all these different directions. But I’m sure you guys listening can see how why we recommend you work with a practitioner because it can get kind of complex.
Inna Topiler CNS MS (39:50.081)
Yeah. But I think it’s just so amazing for people to understand, you know, even if they can’t understand all of the different steps because it is very complex, it’s really helpful to understand that there is this whole kind of thing to look at because so often people go to their providers and they have basic tests and they’re told there’s nothing wrong. You don’t have hypothyroid, so I can’t give you medicine. Or they’ll say things like, Well, you just have Hashimoto.
But don’t worry about it. You know, like your thyroid is fine. And yet they feel terrible and they’re not really given direction. And then there’s just this feeling like, but but my labs are okay, so everything is fine. So I I know for me, when I was going through my journey 25 years ago, when I started working with my original naturopath, and he was also a clinical nutritionist, I was so happy when.
He found like literally a hundred things wrong with me. And most people are like, Why were you happy? And I’m like, Because that means that this if there’s something wrong, we can actually fix it because these are specific pathways, right? Versus like, well, you have this thing, there’s nothing we could do, or you have nothing. So you’re so you must be crazy, or maybe you’re depressed, or whatever else that people are told.
Dr. Jaclyn Smeaton (41:05.702)
Right.
It’s infuriating. And I think we have a very reductionist healthcare system. And it really needs to be, because we go in to a specialist, you only have five to ten minutes. You know, you have to clarify the problem and they have to solve the problem and the doctors do it again and again. And so there’s all these layers of like our payer systems and how clinics make money and how much time doctors can spend with patients. Most doctors would love to spend more time with patients, but it makes it really tough to take this comprehensive look. And so I don’t fault conventional providers who
Don’t learn this stuff because it’s not part of the paradigm. And it’s also takes a lot of time to learn. And then it takes a lot of time to implement. So you’re totally right. In my experience, naturopathic doctors, functional medicine providers who can look at this from a broader picture. Sometimes you have to zoom out and look not just at the one tree in front of you, but the whole forest to see what’s going on.
Inna Topiler CNS MS (41:58.575)
Absolutely. Absolutely. And I hope that everyone listening can really see that there’s so many avenues. One of things I talk about a lot on the show is that like the answers are out there sometimes. There may not be like in your direct view, and you just have to look a little bit this way or a little bit this way, but they’re definitely out there. So, Jacqueline, I just appreciate so much you explaining this so eloquently, but also making this very simple because it is complex, but I think that
Everyone listening can understand, yeah, like there’s this and there’s this and there’s this. And yes, like you’re gonna need someone to support you a little bit more and help you to interpret it, but at least you kind of now understand the bigger picture of that. And the good news also is that even if you’re not able to see a provider just yet, you can start doing some of the things to support that, right? Even if you don’t know exactly what it is, but just all of the tips that you gave about exposing yourself to light and creating.
the pattern, you know, and also I think, and I’ve been talking more about this recently, but it’s just really thinking about what makes you happy. As women, we are so conditioned, most of us, right, to do things because we should. And of course, there are many things that we need and should be doing, right? Taking care of our families and some of those things. Like we can’t give those jobs away, though we can delegate better, I think.
Dr. Jaclyn Smeaton (43:03.098)
Mm.
Inna Topiler CNS MS (43:22.35)
That’s a whole other story. But but I think we, and I know this is something I’m working through myself in like the more recent years, is I was so conditioned that, like, well, you should do this because like that’s what we do. And there were so many things that I did. And they weren’t things that had to happen, right? But just certain activities that I did, whether they’re extracurriculars or even just like for my work that I didn’t enjoy. But there was this guilt that, well, but I should.
Especially if you’re good at something. I played the piano for 20 years and I hated it. And what I was told is, but you’re really good at it. So like how can you not play? You’re so good. I hated it. But and like there’s a lot of conditioning from that. And I think a lot of people can probably relate to this. And you know, just asking yourself what actually makes you happy. And it could be little things. It doesn’t mean let’s quit our job and go live on an island, but
you know, even getting flowers for yourself once a week because they’re so pretty to look at and it’s just gonna give you like a minute of joy every hour that you look at them, you know, or or things like that. You know, I think that people underestimate how much stress it causes us to do things because we think we should.
Dr. Jaclyn Smeaton (44:18.353)
Yeah.
Dr. Jaclyn Smeaton (44:34.48)
I think you’re totally right. And I’m really appreciative that you’re taking it to this like vulnerable part of the conversation. Cause when you talk about, well, let’s just talk about women for a minute. Women are amazing. Men are amazing too. But like just sometimes when I hear the stories of what women carry, and this is like friends, patients, I’m sure like all of you listening.
Many women are raising children, working a full-time job, maybe have a side gig or some kind of passion project. You’re the one that your kids turn to when something’s wrong. You hear mom, mom, mom screaming from upstairs in the bedroom. You’re solving the problems, you’re coordinating the schedules. And all of this stuff might feel like routine daily life, but we let’s we all have too many tabs open in our computers. And we were not meant.
To be doing that much. And so I completely agree with you. Give yourself permission to connect with things that bring you joy. I’ve had a pretty rocky 2026, like my in January, my husband died unexpectedly, and we have five kids. So I’m like working, trying to make sure we can pay the bills and handling all the estate and like all this stuff. Like there can be so much. And I only bring this up because it really it took.
that extreme thing happening for me to be like, damn, I have a lot of stress in my life. And I did before, but now I cannot keep living this way. Like I don’t want to. And so I am on a path of joy right now. So I love that you bring that up. Things that make you happy, things that give you joy, because it can be really hard to prioritize that. But ultimately it’s those are the things that matter in life.
Right? Those are the things that regulate your nervous system. For me, it’s like being outside in nature. And I live in a really beautiful place, but sometimes I don’t take five minutes to go like walk outside in the backyard. Now I really try to, or to connect with the people you love and clear out relationships that don’t serve you. I’ll leave that very generally, but I’m sure you also sit in front of a lot of women who are in unhappy marriages and they’re in it because they feel like they have to be or they have to stay in it for the kids. And maybe that’s your path, but how can you also
Dr. Jaclyn Smeaton (46:46.004)
also bring life through other people, other friends and family into your life to give you the support that you need. These are the deep meaningful things that impact our health. Like
Healing from trauma, making sure you have joy in your life instead of stress, making sure you feel supported. So anyway, thank you for opening the door to that vulnerable side of the conversation because when it comes to HPA access regulation, you can’t take enough ashbagandha to solve a fundamental problem like that. And I really think that we do a disservice to women when we don’t talk about these pieces. And instead we think that we should be telling them they should, I don’t know.
Like take a pill before they go to bed.
Inna Topiler CNS MS (47:28.46)
Yeah. Yeah, absolutely. And my gosh, I did not know that part of your story. Like I am so sorry.
Dr. Jaclyn Smeaton (47:34.372)
Yeah, I don’t I you know, I don’t share it a lot because it’s it’s part of my path and it’s like transformed the way I practice. But ultimately, like the reason why I’m here is not about myself, it’s about other people. But I think for me it really sharing that, it’s like it makes you realize sometimes how much you have on your plate and the tendency to be like, no, I’m okay. I’m okay, everything’s okay. and we need to stop doing that ultimately.
Inna Topiler CNS MS (47:57.655)
Yes. Yes, we do. We do. Well, my gosh. I mean, first of all, my heart goes out to you. I can’t even imagine all of the things that you are going through. I mean, it’s still so fresh. I’m so sorry.
Dr. Jaclyn Smeaton (48:04.092)
Thank you.
Dr. Jaclyn Smeaton (48:12.646)
Thank you. But it does mean it like for me it the there is no silver lining in it, but you have to lean into that rest and digest, that parasympathetic nervous system to survive something like that.
Inna Topiler CNS MS (48:26.21)
Yeah, I mean, and that’s it, yeah. yeah. No, no, but I mean, and I think you know, there are so many people who are impacted by so much tragedy and so much trauma. And you know, you speaking about it openly, but also, you know, just even you saying like I you know, there’s not a silver line because I think we’re also in this society right now.
Dr. Jaclyn Smeaton (48:30.502)
Didn’t mean to take it down a dark a dark turn, but you know.
Inna Topiler CNS MS (48:55.114)
It’s this sort of toxic positivity. You know, and again, I mean, there is something to be said about, all right, let’s look on the bright side, right? But also I think it’s like, this happened, but but it’s because of this, right? And it’s it’s okay to like think about that. But it’s also, I think, so important to kind of be in where you are, but then really understand, you know, not just the coping mechanisms, but really understand, okay, like what is like happening on like a much deeper level and
Dr. Jaclyn Smeaton (48:57.895)
Yeah.
Inna Topiler CNS MS (49:24.438)
Like realizing too, like we are so strong and like how do we like persevere, but also kind of taking into account like it takes a village. And I think for women too, it’s being able to ask for help, right? It’s being able to receive, right? Because for so many of us, we have this inability to receive, you know, and I’m not even talking about receive big things like money or help. I mean that too, but even just compliments. I mean, how many people with Hashimoto’s
Dr. Jaclyn Smeaton (49:27.967)
yeah.
Dr. Jaclyn Smeaton (49:40.113)
Yeah.
Dr. Jaclyn Smeaton (49:51.42)
Yeah.
Inna Topiler CNS MS (49:54.165)
well at anyone, you know, women especially, but I with Irish C B C that it’s like, like your hair looks great. You’re like, really? This is I just woke up this way, you know? Like and we we can’t even receive that. So if you can’t receive a compliment, how are you going to be able to receive like so much more that you deserve, really? So thank you.
Dr. Jaclyn Smeaton (50:01.595)
Ha ha.
Dr. Jaclyn Smeaton (50:10.194)
Mm-hmm.
Yeah, I think that’s a beautiful way to to wrap. It’s like ultimately you are right. Like we are not islands. We can’t do it alone. We weren’t meant to do it alone. And I for people who are hyper independent and I’m one of those people, like I’m capable, I can have all the balls in the air. You know, I when this first happened to me, my mom said, like, whatever happens, just say yes. Whatever people offer, just say yes. Accept the help, accept the gifts, you know, and it really has transformed I I think it’s like changed a the trajectory of my life in that I really did experience
how different it is to be able to receive, you know, and it’s it is something that I think we struggle with because we perceive it as a sign of weakness. But in fact, we’re building strength not just for ourselves by receiving, but by accepting a gift. You’re giving a gift to the person who’s giving it. You know, so I think it really it is this community building experience.
Inna Topiler CNS MS (51:02.158)
Absolutely. Jacqueline, thank you so much for being here for all of the information you shared and just your vulnerability as well. Now for those who want to find out more, who want to connect with you, where can they find you and how can they do that?
Dr. Jaclyn Smeaton (51:07.451)
Yeah.
Dr. Jaclyn Smeaton (51:19.302)
So I work with the Dutch Test. You can find us at Dutchtest.com if you want, if you’re especially if you’re a provider and want to learn more about what we talked about today, and it’s at Dutch Test on Instagram. And then my personal Instagram is at dr.jaclynsmeaton. So at dr.jaclynsmeaton. And I’d love to have you as part of my community.
Inna Topiler CNS MS (51:38.35)
Amazing. We’ll put all of that in the show notes. Thank you so much for being here and for all of this. Of course.
Dr. Jaclyn Smeaton (51:41.298)
Great. Thanks so much for having me.
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