Female Hormone Expert: How To Lose Fat, Reduce Stress & Stay Young After 40 | Dr. Sara Gottfried

you've shared that after the age of 40 going into our 50s and Beyond there's this metabolic crisis that most women will go through you yourself have stated that when you were in this period of your life you just couldn't lose weight right around that time so many women that tune into this podcast and are consuming this health information they're asking what the heck is going on with my body and why is it so much bigger for them than just gaining a little bit of extra weight in our bellies and other parts of our bodies that

we typically didn't used to there's a number of events that conspire against us after 40 I think the biggest one is the change in estrogen and progesterone so as estrogen starts to decline you get this redistribution of your weight so it used to be before you went through menopause like through your 20s and 30s that as a woman you deposit fat at your breasts at your hips at your buttocks after 40 as estrogen starts to wildly fluctuate and then go down you don't distribute it there anymore you distribute it at your waist so along with

that you also gain about five pounds of fat and you lose about five pounds of muscle every decade unless you're doing something about it so that's one change another change is you become more insulin resistant so glucoses start to go up and this is really the metabolic Health crisis that's going on it's related to how mitochondria are functioning some women notice it in terms of not being able to zip up their pants that sort of insulin resistance where you store fat no matter what other women notice it more in their brain they've got more brain

fog they've got what Lisa monei calls cerebral hypometabolism you just don't use glucose the way that you once did there's also a cortisol problem you get more stressed you may find that you fly off the handle more easily C cortisol tends to rise as you get older not for everyone there's some people who get a burnout state with cortisol and it can become low can even be high or low within the same day but that tends to also Drive blood sugar and then the fourth issue is your thyroid so thyroid tends to become less functional

as you get older and most of the people who are affected by thyroid dysfunction are women do you feel that for those that are listening in today if they stick around for this conversation and get a chance to hear all your incredible expertise that you have on this topic that there's a different way of being that this common way that many people not just women right just going broader in the population are aging in a way that makes people almost afraid to age sometimes that there's it doesn't have to be that way that's the Crux

of this conversation Drew because it doesn't have to be that way so I think a lot of us look at the aging process especially after 40 as this burden you know all these hormones that are changing do we want to take hormone therapy bioidentical hormone therapy yes no do we want to be working with our hormones in a different way and I think the problem is conventional medicine just isn't set up to solve this for us and I know because when I was struggling in my late 30s I can still remember being 39 going to

my primary care doctor and saying I can't lose the baby weight I had my second baby at 38 I feel stressed all the time I've got premenstrual syndrome that's on steroids it's way worse than it ever was what do you have to help me and I was offered a birth control pill I was offered an anti-depressant a selective ser and reuptake inhibitor and he told me to exercise more and eat less and that was the moment where I just realized okay if I'm not being served well by the advice from conventional medicine then there are

millions of women who are also not being served well and so that was my moment where I just I stood up and said okay we got to do this differently we've got to find a different path that allows us to navigate these hormonal changes and to do it with Grace and to do it in a way that is natural and healthy doesn't cause any long-term problems and really allows us to serve our purpose here on the planet not just kind of disappear and melt away and become more fat as we get older you know you

made a video recently on YouTube and you shared it beautifully there you said that you regularly hear from patients that they go to their doctors obviously this is before becoming a patient with you with symptoms of per menopause like I'm gaining weight I can't sleep I'm more Moody I don't have energy like I used to I'm so hot all the time I have night sweats I've lost my sex drive and they take these to their doctor and often their doctor is not super helpful in fact many women including like yourself feel that they were dismissed

let's zoom out a little bit big picture and we're going to come back to weight gain and some of the strategy and tips that you've implemented in your own life and that you teach your patients but let's zoom out big picture what did you learn as a medical doctor about these combinations of these symptoms especially as women are gearing up for per menopause well the conventional approach that I learned is that there's this laundry list of symptoms that women start to experience and it kind of depends on how sensitive you are whether you notice more

or less of them and those can start as early as 35 it can start with your period getting a little closer together and that's a progesterone effect as you make less progesterone you run out of right bags the other thing that I learned is that the conventional approach is really to give a birth control pill and not usually to offer bioidentical hormone therapy so I was really taught to tell women this is just part of the aging process get used to it but I found that totally unsatisfying and when I was there myself and struggling

with a lot of these symptoms I realized there's got to be a better way there's got to be science behind a better approach that allows us to navigate all of these hormonal changes and to do it in a way that um really allows us to live our best lives in middle age so that's what I said about doing and I think what you're asking is what did I learn when I kind of took that right turn when I turned away from conventional medicine and said okay I've got this low progesterone my periods are getting closer

together what can I do about it oh there's this herb called Chase Berry for randomized trial show that it helps with PMS it helps to raise your progesterone levels it helps to kind of nudge your ovary to make more progesterone when you're in that early per menopausal phase so that's just one example of some of the things that I learned when I I took to the science to be able to answer some of these questions so I think that's what we have to do because if we zoom out a little bit part of the problem

here is that women were part of a vast uncontrolled medical experiment for about 59 years as they were going through per menopause and menopause so they were given synthetic estrogen and progesterone premine and Prova without a randomized trial to show that it was safe and effective and so many women were taking these hormones in fact premin was the number one prescribed medication in the United States for decades so we finally had a randomized trial that was published in 2003 that showed that it was potentially dangerous and risky and then millions of women came off of

their hormones and they weren't offered really any alternative so we have to find the middle path here what's science-based and what can be the most effective to help us with these symptoms and I also learned there's more than a hundred symptoms that you can experience through per menopause and menopause it's not just you know a few that I learned when I went through my OBGYN training so we need to be tuning into this bigger picture and then if I put my hat on as a precision medicine doctor what we now know is that there are

these dramatic vast changes that occur not just in your hormones but the entire Matrix of your body your immune system your metabolic system your neurological system and your hormones are all changing in concert and we want to be aware of all of those changes so that we're not just focused on okay what's your estrogen level what's your progesterone level we want to be thinking okay what's happening with glucose metabolism what about Upstream with insulin how is estrogen talking to your insulin how much stress do you have are you someone who's experienced trauma and you've got

a disregulated response with cortisol and we need to address that we need to clear the trauma so we want to be thinking about all these threads that lead to a woman who's going through this change typically sometime around 35 to 45 this change into per menopause and needs our help help you know needs a way to navigate it and not just be told oh you're getting older get used to it so that's dismissal and then it can even become more like gaslighting of well that's not what I see in my other patients and I don't

think that's related to per menopause or menopause or uh I don't think we need to check your levels because they fluctuate so much it's not worth it to measure it so there's lots of behaviors that happen I think in conventional medicine I'm not blaming them I'm just saying this is the way that we're trained and it's not serving these women you know you talked about the concert of hormones that are there and the interplay between them what do you feel are the top misconceptions that people have about this interplay misconceptions okay misconceptions or even misunderstandings

there's a lot of them so I'll start with the one I had when I was in my 30s so I thought menopause was this Cliff that I would fall off of you know sometime around 50 or 51 and that I really didn't need to worry about my hormones until then and that's just not true because if you look under the hood there are these subtle changes that can happen 10 to 20 years before your final menstrual period And so just to Define some of these terms please menopause is when you have a year from your

final menstrual period and that can be somewhat confusing because a lot of people kind of use menopause as a broader term but menopause is really one day it's a one one day anniversary or if you're someone who's had a hysterectomy like I have then it's when your uh control hormone for your estrogen your follicle stimulating hormone or FSH is above a certain level usually 25 to 35 so we've got this definition for menopause meaning of 51 to 52 in the United States but then there's this 10 to 20 years beforehand that can be you know

really kind of a wild ride some of the time in terms of per menopause and with Perry menopause I even like to divide that a little bit further if you're still with me here y so the first half of per menopause is when estrogen fluctuates wildly and we can see it all over the place like if you measure estrogen it can really fluctuate day to day and then the second half of per menopause is when estrogen starts to decline and then that leads up to your final menstrual period so per menopause can go on for

quite a while so I started around 35 and I'm now 56 and I am still in P menopause so depending on how attuned you are to it it can go on for a very long time so that's the first misconception that you know menopause is this future thing that's going to happen to you you don't have to worry about it until you're 50 I want people to be thinking about it much sooner and preparing for it because this is where lifestyle becomes so important the way that you eat move think your sense of purpose and

meaning your connections all of those map to your experience of per menopause so that's misconception number one misconception number two I would say is that you're you're just getting older and you're kind of stuck with all these things that are happening that you have no agency you have no control over it totally disagree with that so I've spent the past 15 20 years really trying to teach people taking them by the hand and teaching them how to navigate these you know sometimes Rocky roiling hormones hormone experiences that they're going through and there are so many

ways that you can kind of gently uh guide your hormones in a particular direction you know if we take cortisol as an example cortisol is the main stress hormone and some folks just think oh my cortisol's high I'm stuck with that or my cortisol is low I've got maybe post-traumatic stress disorder I'm stuck with that but you can actually change your cortisol on a hour by hour basis and I I really encourage people to come up with an olart menu of all of the ways that they most like to manage their cortisol and I even

like to think of cortisol as being kind of like your retirement account because you know a lot of folks think that the money they have in their 401k and their Ira is the most important thing in terms of retirement I would say cortisol is the most important because here's why there was a study done at the University of Texas in San Antonio that showed that women who have a High cortisol level in the morning they measured it in the saliva in their 40s so me age of 48 those women with a high cortisol level shrunk

their brains they had a decrease in their total brain volume and they also had a change in their memory and we're not talking about women who are 65 70 75 these are women with a mean age of 48 wow High cortisol decreased brain volume decreased memory so we want to be thinking about this I'm not trying to scare people I'm just trying to motivate you to realize that you can start to change this so you know what do you do to change it meditation for me it became non-negotiable to be a meditator starting in my

30s I mean I I learned um Transcendental Meditation when I was in college I've practiced yoga all of my life I love yoga as a form of managing cortisol and we all have our favorite ways you know I wanted to take this opportunity while we're setting the stage for the big picture uh recently I saw you give a presentation there was a couple Graphics that I thought would be extremely helpful and if we can pull up uh the first one Tessa it is talking about some of the symptoms of menopause as they relate to aging

first starting with I believe per menopause right and then overtime and I think this could be very helpful to around some of the conversation visually especially for those that are watching on YouTube could you walk us through this graphic over here oh I would love to so I think it's critical to realize that we're starting at age 35 so depending on how attuned you are to these symptoms you may notice that you're having more cramping your period might get a little heavier might get closer together as we talked about maybe you're not sleeping quite the

way that you used to maybe you're having vaginal dryness or weight gain or you've got fibroids that are growing so all of that can start around 35 to you can see a dotted line on this particular graphic right around age 43 and 43 is important because 43 is when the brain becomes more resistant to the function of estrogen so there's less glucose metabolism so the mitochondria the powerhouses in your brain cells just aren't picking up glucose the way that they once did glucose tends to rise peripherally so if you have a continuous glucose monitor or

you're checking a fasting glucose you might find that it's climbing over this period to about age 43 so all of those things are happening in the background and then if you keep in mind that age of 43 and then you look at the symptoms that are listed on the upper half of this graphic most of these are brain symptoms so mood swings loss of libido hot flashes insomnia night sweats even the irregular periods depression all of those are brain symptoms so a lot of people think that the action is in the ovaries that you're you

know not producing an egg every single month you don't you're running out of ripe eggs and so estrogen and progesterone levels are changing but it's really I think I think of it more as this bigger system a network between the brain that hypothalamus and the pituitary the way that it's talking to your ovaries the way that it's talking to your adrenal glands which is where you produce cortisol as well as these other sex hormones that we're talking about estrogen progesterone and testosterone and cortisol and it's also involving your gut because your gut is a really

important source of hormones a lot of people don't realize that they don't know that you know the fiber that they haven't been getting in their diet might be leading to excess estrogen in their system so we want to be thinking about I call it the HPA TGG so hypothalamic pituitary adrenal thyroid gatal gut axis now that's a total mouthful but just to understand that it's not just the ovaries we're talking about it's really this bigger system that we want to be considering so those symptoms that are happening from about 43 until I would say about

55 those really tend to concentrate on the brain and then after that you get these more long-term consequences of running low on estrogen and that includes osteoporosis more vaginal discomfort maybe even recurrent bladder infections you can have breast cancer you can have heart disease so those are some of the things that we tend to track especially in the randomized trials that are done like the women's health initiative and those are are things that we think about in older women and as I said earlier there's about a 100 symptoms that you could map to per menopause

and menopause but these are really the ones that are the most common and so in that period if your last period is somewhere around 51 52 you you really have a dramatic decline in estrogen the lower half of the the graphic illustrates this significant decline in estrogen and that's critical because estrogen is the primary regulator of the female body the primary regulator and so as estrogen declines a lot of women just find that they don't feel as vital as they used to they've got more moodiness maybe they've got depression they may have more anxiety that's

not listed here but it's a consequence often of insomnia and it also is related to which estrogen receptors are being stimulated because some estrogen receptors are anxio otic so they reduce estrogen other estrogen receptors are anxiogenic so they increase anxiety so there's all these symptoms that women are experiencing and we want to be looking at the total picture and not just saying oh you have insomnia let's give you an Ambien that's not a solution that is masking symptoms it's not getting to the root cause you know as part of this conversation we're going to zoom

in and zoom out a little bit and I want to pick up on a thread that you just shared a little bit earlier you talked about estrogen and the connection between that and fiber you know we know the stats that past individuals have shared on this podcast which is you know average American adult American is getting less than like 15 grams of fiber a day so in that particular instance especially for individuals that are going through per menopause and getting close to menopause or maybe in menopause if they don't have adequate dietary fiber in in

their diet right how does that actually show up as symptoms they might be dealing with inside of the body the way that I think of it drew is that estrogen and progesterone are like Tango partners and you want to have a really good dance between the two you want it to be well balanced you don't want one to lead or you know one to be dominant and so having this balance between estrogen and progesterone is something that I want women to focus on regardless of their age so if you're 35 40 45 5050 Etc focus

on the balance between estrogen and progesterone so the fiber becomes important because if you don't get sufficient fiber if you um I think of fiber as in some ways inactivating estrogen so the golden rule of estrogen is that you want to use it and then you want to lose it so you want to use it you want to stimulate your receptors and and then you want to poop or pee it out you don't want it endlessly recirculating in your body usually through your gut almost like Bad Karma you want to be able to get rid

of it so fiber helps you to get rid of it the other thing that you want to think about is that there are three bacteria in the gut that produce an enzyme called beta glucuronidase or BG for short and if you've got too much of these particular bacteria you might have a high level of this particular enzyme and that can be associated with higher estrogen levels so fiber I think is kind of the easy thing to reach for here we know that the average American woman gets about 14 grams of fiber as you said and

they should be getting somewhere around two to three times that so the way I frame it is I want you to be eating about a pound of vegetables a day you know divide it up put it in your smoothie if that sounds like an outrageous amount get it in your salad at lunch have your steamed vegetables plus a salad at dinner you need to be getting about a pound a day so my recommendation is generally somewhere around 30 to 40 grams of fiber per day that's fantastic thanks for zooming in for a moment there now

I want to zoom out again and look at sort of things from a little bit more of a evolutionary biology lens even though that is not either of ours background but you are more qualified to be able to like at least try that hat on what is going on in our modern world especially that has changed life so significantly for women that when women look around they see a lot of examples of people essentially abnormally aging is what you have shared and kind of called it a little bit earlier in the interview so what has

been going on these last 00 years that we are looking at things that are um these whole host of symptoms that you were saying some if I understand correctly and please correct me if I'm wrong some aspects will be a natural part right it's not that like certain things will just never exist but to the degree that which they exist is part of what you're highlighting that it doesn't have to be that way is that accurate that's accurate yeah I I would say there's a number of different forces that have really changed over my career

what I see with women I mean certainly we see the Obesity epidemic this crisis of metabolic health and I think there's a number of different factors it's not just one thing it's certainly the food industry and how food has become more hyperpalatable we've got such a high intake the highest ever of ultra processed food and that has changed our system I mean we just our bodies can't produce hormones as normally as they used to eating the kind of foods that we're eating would you put that as number one on your list well it's hard maybe

together we could pick what the top one is because I think along with that and there's some interdependence kind of bidirectionality here is the rise of stress and Trauma so we know that especially post pandemic we're more stressed and more polarized than we ever have been before so when you think about the stress response in you know whether you're listening to a news cycle or you're just trying to cope with your kid going off to college and some of the things that they're facing I just feel like stress is at an all-time high and we're

not equipped to deal with stress the way that it's coming at us right now and this is another important sex and gender difference so sex differences are biological gender differences are more socially constructed we know that women experience more stress than men so if you look at National surveys by the American Psychological Association for example it's somewhere around 60% of women experience significant stress where it's whereas it's more like 50% of men so women seem to experience more we also have again post pandemic I think more trauma globally than we've ever seen before and whether

that's losing someone in the pandemic or it's uh climate change and what it's doing to your community the risk of floods and hurricanes and that sort of thing I think we're managing more stress than ever before and alongside IDE that is the availability that we have with the use of cell phones so more stress and women have more vulnerability so a higher stress load a higher cortisol load and then they in addition when men and women are exposed to the same stressors the same toxic stress women have higher rates of post-traumatic stress disorder so I

think when you look at this more evolutionary perspective we're at a time in our lives where there's more hormone disruption than I've ever seen in my career so another thread is the chemical industry so the kind of toxins that we get exposed to endocrine disruptors if you just look at something like bisphenol a drinking from plastic bottles as an example bisphenol a is not just a xenoestrogen a fake EST estrogen that stimulates receptors and can cause problems it's also an anti-androgen so it can mess with your Androgen levels including testosterone it's also a thyroid disruptor

so it's one of those chemicals that can really influence your hormone levels and you may or may not know about it so those are some of the things that I think about but I imagine you've thought about this too maybe you want to add to the list no I think that's a great recap of the top things that are there and all those added up together even though they happen very gradually it's an important reminder that this is not the environment that we were meant to thrive in which is why so many people and in

this context here we're talking about women and the symptoms that they're going through and the challenges they're going through through per menopause and menopause why there is so much suffering that's there is because we're living in an environment that our bodies cannot handle anymore and they're tipping over from all the different insults that they're being exposed to so I think that summary was a perfect summary um it's such a good point because you're speaking to this mismatch between our genetics and our environment and I feel like a lot of us create our lives architect Our

Lives kind of doing the best we can learning from our parents whatever we were modeled by our parents we come up with okay this is the career I want to pursue here's where I'm going to go to college okay I'm going to get married in my 20s here's who I'm going to marry there are ways that we set up our environment that may not be the right fit for our genetics and so really taking a close look at that I think is really valuable because a lot of hormone imbalance is related to that mismatch that

you're talking about so for instance I had a job where I worked in medicine I worked at a health maintenance organization I was seeing 40 patients a day wow I was stressed out of my mind I had two kids I'd come home and I would pull up in the driveway and I would just sit there and vegetate for about 10 minutes just trying to muster my energy to go be who I wanted to be with my children you know like show up with my love lights that was not a good job for me and so

I had to figure out okay I got a mismatch here between my my system my network of my body my genetics the way that my genetics are being expressed in my body and this environment that I've created and so I had to change it and so that's one of the things that I I want to give people hope about that you can you can make a lot of changes with your environment so that you you may not be cursed by hormone imbalance you know for years on end I want to piggyback on that because I've

also heard you share that one one important reminder that you share with many of your patients and that you talk about in your different educational videos and books is that when you start to talk about getting your life back in control and having agency on your health which is you being the CEO of your health sure you can hire different people you can have a different doctor you can bring people on board as part of your team but you're the CEO of your health when you do that and you start to look at the things

and women start to look at the things that be necessary to start feeling better it can feel very overwhelming but even that feeling of getting very overwhelmed and not having the same maybe tenacity that you felt that you had years ago that itself could be a symptom of disruption in hormones is that accurate it's a really good point because I hear I hear about overwhelm all the time and I've been there myself like I I know what it's like to be given advice okay I need to you know get on my pelaton five days a

week I need to do power Zone training oh I need to eat differently I need to like decrease my carbohydrates and I need to do that together with you know having these two kids that I adore and have full responsibility for and I've got a husband like managing it all can be totally overwhelming and you're right it's important to realize that that often is a symptom of this time of life so this life cycle change from our reproductive lives and kind of having the regular same level of hormones each day of a hypothetical 28 day

cycle to having things be more wonky in Perry menopause and menopause it's really common to feel like you just can't handle one more thing you just can't so I think it's it's important to realize that that's a symptom it's not like a permanent state of mind and then I think it's also important to realize that when you start to correct these hormonal changes I think of them as the hormonal Charlie Angels so when you start to correct cortisol when you start to correct estrogen and you start to correct thyroid and you get them back into

balance you may notice that the overwhelm disappears so agency I think is really critical here and in some ways kind of leap of faith that as you put in the work to get your hormones back into balance that feeling of overwhelm May dissipate you know you have a incredible graphic it is the hormonal Charlie's Angels and I think the visuals are also very helpful again if you're listening on audio will link to maybe this image with your permission sure of course in the show notes as well so let's describe this image here the Charlie's Angels

of hormones as just a little bit of a recap of what you were sharing yeah I mean there's so many hormones that are critical for women but these are the three that I I I focus on the most as a clinician so cortisol is the main stress hormone it is the priority in the body and it governs your blood sugar it's also involved in managing your blood pressure and your immune function so a lot of people who uh are trying to get their hormones IM balance and they're making their way through per menopause they kind

of leave out cortisol and that's not doing them any service so you want to focus on cortisol really first and foremost so you can get away without having estrogen like your body will survive without estrogen your body will not survive without cortisol it is the priority so it's not a democracy in the body with all these hormones I would say the two most important are cortisol and Insulin so when you think about the female body and these three hormones the Charlie angels of hormones cortisol talks to thyroid so a lot of women experience especially after

40 what we call thyrus so that's this gradual change in terms of thyroid function usually it's in the direction of low thyroid function or hypothyroidism can sometimes be in the other direction hyper thyroidism and somewhere around 90 to 95% of thyroid dysfunction is related to autoimmune disease so I'll just kind of asteris that maybe we can come back to autoimmune disease absolutely but thyroid is you know pretty much every cell in your body has thyroid receptors it affects your metabolism it's kind of like the gas pedal if you think of your car your body as

a car it's critical to energy production and then we've talked a little bit about estrogen it is the primary regulator in the female body it regulates mensturation it builds the uterine lining to uh prepare for pregnancy if that's something that you want and if you don't get pregnant then you shed your lining it also keeps women lubricated in terms of their joints in terms of their vagina it's got about 400 jobs so I just have two that are listed here but we want to be thinking about you know okay maybe you notice that your shoulder

has become more um stiff like you don't have the mobility that you used to have in your shoulder or maybe the same thing in your knee or your hip and if you're someone who's in that age range of like 40 to 45 to 50 you want to be thinking estrogen you want to be thinking about okay seems like my lubrication just isn't what it used to be and so we can track all of these hormones we can track these Charlie's Angels of hormones and then I also I like to just mention for the guys I

I think of it as the Three Amigos we want to be really considering testosterone thyroid and cortisol in men and one interesting thing that I learned from your content is that also for women testosterone plays a big role in their health and is it accurate that it's the most abundant like it's more abundant than estrogen yeah testosterone if you you know if you're someone like me who gets a a hormone panel once a quarter and you look at the concentrations of your different hormones the one that has the highest concentration is testosterone it is the

most abundant hormone in the female body we think of it as a male hormone but it is so critical for women so critical and if you think about confidence and agency and just feeling like you know you get up in the morning and you're ready to face your day a lot of that is testosterone I didn't pay as much attention to it when I wrote the hormone cure because my testosterone levels were fine and then I found you know as I wrote more books my last book in particular women food and hormones that my testosterone

was on the decline so that had me to pay a lot more attention to it and to track my levels over time and then once I dip below a certain level I started to use uh bioidentical testosterone and it's made a huge difference so yes testosterone is so critical we think of it as important for muscle growth for um you know it's one of the growth and repair hormones it's an anabolic hormone hormone so especially at night it helps you with you know seeing a response if you're someone like me who likes to lift weights

you should see a response and testosterone is one of the mediators of that certainly it's involved in sex drive we all think of it in that regard and that's true for men too in terms of their um sex drive their muscle response to exercise it's also critical in terms of mood and anxiety so men need to have a certain level of testosterone and women do too so even though men have a lot more you know somewhere around 10x what women have women are still exquisitely sensitive to it and so we want to make sure that

they've got the right amount of it that's fantastic just a tiny little sidebar because I'm always getting my labs done last year when I turned 40 I was really inspired by a mutual friend of ours to start taking strength training way more seriously than I did Dr Gabriel l so I did a full body composition measure I did it right after a big trip to Italy so that probably wasn't the best idea but it was very motivating I remember that trip looked like a lot of fun it was a lot of fun I had a

blast my wife was there my friends were there their wives were there we had such a good time a few of a few of the guys were all turning 40 came back did my body composition and was shocked in a good way and motivated in a good way and also got my labs done and I saw that my testosterone was in the sort of normal but not like Optimal right I think it was like came in around like low 400s right and then just through primarily uh improving my body composition adding lean muscle mass strin

training as a byproduct of strength training three to four days a week because I wanted to take it seriously upping my protein which is a big part of it I kind of grew up underere eating eating protein undereating protein and being on a more uh vegetarian diet I was vegan for seven years before I you know discovered the world of functional medicine and integrated medicine and completely changed how I operated and in less than a year I increased my testosterone by almost 100 points just through that no uh you know no testosterone patches you know

no prescription testosterone and it's just such a reminder of how powerful the body is when we create the right environment for this and I can imagine that You' probably had female patients themselves also too because you're a big fan of resistance training have seen their own improvements you know um hormonally just by putting some more intention into this area of uh resistance training such a critical point you know I feel like in the debates that we have scientifically about low testosterone in men or low testosterone in women it tends to be this this PO ized

conversation about should we do testosterone replacement therapy and what gets lost is the lifestyle changes that can really make a difference with your hormones I mean if you think about it the food that you eat is really the backbone of the hormones that you make and then the way that you are utilizing your body like if you're using it the way that it was intended you know our our ancestors on the Savannah were not sitting in chairs s and sedentary they were moving around they were lifting Boulders they were doing what we approximate now with

strength training and I I think it's really critical so to see that kind of change to have this bump in your testosterone just with lifestyle change I think is so important so yes protein consumption has been shown to make a difference reducing sugar has been shown to raise testosterone uh the way that you exercise like with strength training can really make a difference and then for some people you know even taking some of the precursors like DHEA which is over-the-counter can help to raise testosterone that especially Works in women it doesn't work quite as well

in men it tends to be aromatized to estrogen so you have to be careful about that but I love this point about how lifestyle change can cause significant changes in your hormone levels and I imagine you felt a lot better too yeah I felt incredibly I felt like there was a little pep in my step yes which is what a lot of people notice you know I want to take some of this and I want to contextualize it in your story and of course your books where you have fantastic protocols that you've written that women

can follow with the links to your books and the show notes below when you went through this moment of having gone to your doctor and him giving you a birth control pill and an anti-depressant and saying you know lose a little weight eat better or lose a little weight and move a little bit more um and you said there's got to be a better way I'm sure that sent you down this whole hero's journey where you started to unpack some of the core aspects that were within your control these different levers that you could start

to pull to feel better and because I've seen you educate to patients and you're an incredible educator you're really good about sort of chunking them to help patients figure out where to start first second third and then kind of continue so where did you start in your own Journey as you started to peel back the layers of the onion and look at this interplay of the hormones and see that a lot of what you were dealing with was essentially from a biological lens abnormal version of Aging that women go through and that it didn't have

to be that way where was one of the first places that you started and prioritized in your journey to make a shift the first place was cortisol so I left that doctor's office and I went straight to the lab and yes I've got medical training and so I could order my own labs and I realize a lot of people don't have that but I decided that I was a hormonal hot mess and I just wanted to see what my levels were and this is from conventional training at Harvard Medical School and MIT and UCSF like

we weren't taught to just run a hormone panel when you don't feel good in your late 30s so this was a bit of a hunch but I found that my cortisol was about three times what it should have been and that was my first clue because my other hormones were off but they weren't off as much as my cortisol was so I paid attention to my cortisol because it was three times really what I considered to be normal my thyroid was a little bit off my TSH was a little bit high thyroid stimulating hormone which

tells me that my brain was shouting louder at my thyroid to make more thyroid hormone but I also realized that could be secondary to the cortisol there's a few other factors involved that we'll get to but um and then looking at my estrogen and progesterone estrogen was a little bit High compared to Progesterone again late 30s you start to run out of these eggs you start to run out of ripe eggs and so progesterone tends to decline but cortisol can also play a role in that so it seemed like the primary problem to face first

was cortisol why am I spending so much time on this because I see this all the time in the people that I take care of more women than men I take care of both women have more disregulated cortisol than I see in men so this really high cortisol level I remember when I first saw it I called one of my mentors at UCSF and she's a psychiatrist who orders cortisol on our patients because she uses it as a suicide marker and she also tracks it in depression because about 50% of people with depression have high

cortisol and she said welcome to the club Sarah every female physician I know has a cortisol that's two to three times what it should be wow and I thought okay it may be normal but I don't want to be normal like this was before I saw that study that showed that you can have brain shrinkage in your 40s associated with a high cortisol level but I had a sense in my 30s that okay this is what I really need to manage I need to get this under control so I had a little bit in place

already I was already a yoga teacher I kind of needed it to manage my cortisol I didn't know cortisol was so high but I had a sense in my body that I needed it I really felt like yoga and meditation for me were non-negotiable and still I would skip it on occasion I had two kids like toddlers life was busy life was busy and I was still working at the health maintenance organization so I made yoga and meditation non-negotiable 30 minutes every single morning no excuses that helped a lot H how quickly if I don't

if you don't mind me interjecting how quickly did you notice a difference once you made it a priority every morning a shift in your mood that you could notice I would say within a week I mean and you're a meditator yeah um not really not really okay not really well have you I've G I've gone through long periods of my life yeah where I've been very good about meditating yeah I've gone through long periods of my life where I haven't meditated but I'm not ashamed to say that I'm not a daily meditator I really appreciate

you sharing that I think it it helps for people who are listening to us and they're thinking why can't I meditate so but you've probably had the experience when you were meditating regularly of some days that just oh my gosh it just feels like the stars aligned and you just feel so good after whatever time you committed to meditation you get up off the cushion and it just you know it just feels like oh that was a good one so there are days like that that I think accelerate this recovery with the stress response system

and they create balance between the sympathetic nervous system kind of the on button of your autonomic nervous system versus the parasympathetic nervous system which we're activating with meditation so there are some days that are better than others but I would say on average about a week that's when I really notice a change so cortisol was the first place you started and prioritizing the sort of rest and Recovery aspect rest and recovery and let me layer in a couple of other things at the time I was a runner so I was running about four miles four

times a week and so when that doctor said to me you need to exercise more and eat less and I just knew in my bones that that was wrong I started to look at the literature on running and I realized oh I'm already a High cortisol person I go running and I'm raising my cortisol even higher I wasn't doing any strength training I was doing chronic cardio at that time and that was adding to the problem so high cortisol kind of day in and day out and I was still one foot in conventional medicine one

foot in this more functional Integrative Medicine world and so I still had this idea well is there a pill I could take so I started looking at the literature on supplements because I was thinking well there's all these adrenal tonics right like ashwagandha and uh jinings and couldn't those help riola and there is quite a bit of literature showing that riola in a randomized trial reduces cortisol levels we know that ashwagandha seems to reduce cortisol levels at least in animal models there's not as much human data but it's got you know thousands of years NAA

being used phospha tial Serene at a dose of about 400 milligrams has been shown to lower cortisol same thing with Omega-3s with fish oil is what was studied in the randomized trial so there are supplements that can help and so I layered that on top of the yoga and meditation I changed the way I was exercising so I stopped being I still ran occasionally but I started working more working out more with friends and that provided accountability and community and more attending and befriending and kind of conversations about these things I started doing more adaptive

exercise more pilotes and ways of working with my core and not chronically raising my cortisol level so those things together I would say over about a six- week period really made a difference so I felt a difference at a week with the yoga and meditation but it really took about six weeks to reach this new steady State this new homeostasis and is cortisol which goes into this whole perceive stress and women experiencing more of this perceived stress and real stress inside of their day-to-day lives and often the burden of family and sort of world events

because they feel everything women are much more sensitive in a beautiful way they notice what's happening in this in this world it's their superpower do you feel that for most women who are listening today that that often is the best place for them to start you started there in cortisol and Stress Management and everything like that changing how you worked out is that what you find is where most women could benefit starting from as well I'd say about 80% of the patients that I take care of need to start with cortisol so occasionally I'm surprised

you know I've had maybe 5 to 10% of my patients have completely normal cortisol levels I also have some patients who've got cortisol issues but they've got other hormones that are a bigger problem like they've got hypothyroidism they need that addressed and then we can work on the cortisol so I would say 80% of the time cortisol is the one to start with and so there's lots of ways you can measure this to kind of see what the highest priority is and I love that we're democratizing data I love that you can go to different

labs and you can actually order some of these panels I mean certainly get it through your insurance if you can but there's still a lot of doctors who don't understand the value of doing hormone testing that's kind of a whole other topic but I love that we can go to different Labs now and you can order a panel when your clinician may not want to yeah and in the case of cortisol now the best panel order is that going to be blood or saliva if somebody has the resources to be able to do it so

I start with blood the problem with blood is that it looks at total cortisol it doesn't measure the free cortisol so my preference is to use saliva to look at cortisol and if we want to go a little bit more granular what I like to do is a dial cortisol and that's where you measured at four points during the day usually when you first wake up around noon 4 p.m. and then before you go to bed and it should be almost like a gagna where the cortisol goes up first thing in the morning then has

a gradual decline um um while the Sun is up there's also something called a cortisol Awakening response and that's where you measure your cortisol in the saliva when you first wake up 30 minutes later 60 minutes later and those help to tell us whether the control system is working with your cortisol you know one of the top things that uh women who wrote in when I was talking about doing this episode is how much they notice their sleep cycle is being thrown off especially as they are noticing symptoms of per menopause and then usually when

menopause happens that onee marker after having their last you know period there's so much disruption they notice with sleep and I can imagine that cleaning up our sleep hygiene and prioritizing our sleep is a big part of what also helps us get our cortisol levels in check so how do you think about those things together the struggling with sleep and the symptoms that are often associated with that waking up in the middle of the night which a lot of women experience but then also needing to prioritize sleep to make sure that you're recovered the next

day and to start having cortisol be in a better range sleep is a complicated topic and I'm really glad you raised it because we know that women suffer from insomnia at Double the rates that men do so there's something different about female physiology and I also should say that um I'm talking about men versus women here with the recognition that you know we're talking about those who are assigned male at Birth and assigned female at Birth and there's you know an infinite number of experiences between those two polls so I'm using it I'm using men

versus women mostly because that's how the science gets reported but I want to acknowledge that there may be a lot of different folks in our audience who identify uh in a gendered way or not gendered so with insomnia you know I think of a lot of different factors here when I think back to my 20s and I want you to think back to your 20s too Drew I mean I was going through my medical training so I had the stress of that and being on call and but really I didn't have many other responsibilities I

didn't even have goldfish I didn't have a dog I just had an apartment and I would just go back and forth to the hospital I had very little to manage other than the career that I was starting and then I think of my life now where I've got you know two older daughters that are adult and I've got parents that just moved to assisted living and I think it's a a good representation of how the number of things that we juggle as we get older really changes so a lot of women who are in this

transition of Perry menopause and menopause are in that sandwich generation where they're managing their parents and some of the changes they're experiencing with their health and then they're also managing children and so the demands the kind of things that you can obsess over the the lists of things to do the ruminations really increase exponentially so that is one thing that conspires against you in terms of sleep and I'm curious if you also have kind of seen a difference in your sleep maybe compared to your 20s what have you noticed I've always been a really good

sleeper especially my deep sleep when I track it using my whoop yeah I've always been a pretty good sleeper the only thing that's impacted me which is a completely different topic is uh I've noticed that uh it's really interesting that after I'm happily married my wife's awesome Yasmin prior to my relationship with her I few years prior having met her I went through a breakup and it was a pretty stressful situation you know we both cared about each other but the circumstances were you know very tough uh situation ultimately it didn't end up working out

but we had a lot of love for each other um I noticed that after that period which again a lot of people notice after very stressful periods could be a breakup could be a business situation divorce this that whatever it might be I started grinding my teeth at night yes for the first time and at the same time I also got Invisalign done so I feel like my jaw structure changed a little bit and I would notice that I was developing a form of um almost like an apnea at night where I'd be grinding my

teeth and surprisingly mouth taping was very helpful and then getting something which uh a few dentists have talked about in this podcast before I found a a really great dentist here in LA and he put me on um it's called a dental Appliance and it created some expansion in my mouth once I did that everything improved but again I'm not going to be the typical situation that other people there but yes most people even when I look at my mom when she was going through this phase of her life of entering into menopause she generally

was a really great sleeper and started noticing she was having all sorts of bouts with insomnia that she didn't deal with previously and it was really tough on top of that she was struggling with um some changes in her digestion and she was having uh a lot of challenges with acid reflux which were also keeping her up at night in fact it got so bad at one point in time that um we thought okay did she develop you know um later in life sort of anxiety that was there and she was even given a you

know um anti-anxiety medication for a period of time and luckily knock on wood we found an incredible practitioner who said look it's this cycle that she's in of the acid reflux is preventing her from sleeping well and because she doesn't sleep well she's going essentially she's having all this anxiety and her cortisol levels are really high if we fix the acid reflux in her situation again this is what she was going through we're going to see she's going to start to sleep well and she's not going to have these symptoms what look like anxiety on

the surface during the day and that's exactly what happened uh this uh ENT doctor who specialized in this uh helped her fix her acid reflux and that was her n of one you know situation and she's back to sleeping better but still dealing with these various spouts of insomnia that come occasionally there's so much in what you've just described so the description you gave of noticing that your sleep changed and that you had brism the grinding and clenching of your teeth at night when you went through this breakup it's so critical to notice that because

I feel like for women who are going through this life cycle change they have a lot of kind of small te traumas that occur and they're just trying to manage it all and they may notice that their sleep becomes more disrupted and then you superimpose the changes that are happening with estrogen and progesterone and it just starts to accelerate the whole process and then as you described once your sleep becomes disrupted it affects your cortisol the next day it raises your insulin level it makes you crave carbohydrates more the next day and so you can

have this domino effect that is adding together with the metabolic changes that we described at the beginning so it's really critical I think to dial in sleep it is as close to a panace as we have when it comes to health and I love this example that you gave also of your mother because I don't know if that ENT pract practiced functional medicine Integrative Medicine inte integrative medicine so there's so many different ways that we can work with acid reflux short of you know just using a PPI and so I think it's it's really important

to do this root cause analysis which you're able to help your mom do and it can make such a difference when it comes to sleep because often someone like your mom ends up on Adavan you know like a anti-anxiety medication she ends up on a um proton P pump inhibitor a PPI um and then that causes other gut problems Downstream and that's kind of the standard model of how we deal with that and then maybe she gets a little uh sleeper added to the mix and so here we are masking all of these symptoms and

we're not addressing the Upstream causes so what we want to do is we want to do this root cause analysis so back to you know what women are up against when you've got this decline in progesterone that happens in the first half of per menopause that can cause sleep disruption so you're running out of right bags you don't make as much progesterone if you do a serum progesterone level on day 22 of your cycle and you check it every 3 to six months you might notice that it's not quite as high as it used to

be it may not be 15 anymore maybe it's nine maybe it's seven may be ovulating you may not be and so the first thing I like to do in someone who is having trouble sleeping and say they're between 35 and 50 I'll do progesterone because progesterone is Nature's valum it's really like a anti-anxiety Med medication you'll prescribe them progesterone prescribe progesterone so it's a somnolent meaning that it helps you sleep and there's multiple randomized trials that show that it's really helpful for women who are in Parry menopause so that's typically where I start in someone

who's cycling I'll add a little progesterone because they're probably not making enough and we can confirm that and is that typically topically or is that in uh pill form I prefer oral because I think that helps with sleep much more than trans trans dermal the thing about transdermal progesterone is that it's really not well proven to make much of a difference in terms of your serum levels of progesterone kind of what your receptors are seeing I use it sometimes in women who've had a hysterectomy but otherwise if you have a uterus I like to use

oral or if we're treating sleep I like to use oral so you mentioned that was in like 35 to 50 and what what about for women 50 plus so 50 plus that's where we're going to start to bring in estrogen so I like to start in the first part of per menopause with progesterone only as treatment and you could do an NF1 experiment you could try progesterone for 3 months just see if it affects your sleep and side note I love to be tracking sleep so that we're looking at some of the metrics you mentioned

like deep sleep REM sleep how many interruptions are there what hours are you sleeping how consistent are you is it lining up with your chronotype so I like to measure sleep because I think when when you look at it with that perspective and you've got objective data you can really track it and you can do these n of one experiments and see if progesterone makes a difference so after 50 kind of depending on the woman and what symptoms she's having if she's still cycling or not I'll add in some estrogen and typically at that point

if we're addressing sleep it's going to be an estrogen patch a bioidentical estrogen patch such as the can I mention Brands yeah absolutely so viel dot I love 0 375 milligram in that sort of situation so progesterone I'm assuming there's some estrogen dominance and a small dose of an estrogen patch and then we see if it improves sleep and some of the things I'm looking for in terms of symptoms I'm looking for insomnia so changes in sleep I'm looking for objective data it's one of the reasons I wear an AA ring you have a whoop

and I'm also looking at night sweats hot flashes and in women who were still cycling sometimes what they have is night sweats just the week before their period and that might be when they need extra progesterone just during that week whereas women who are older they're more likely to have hot flashes like during the day not just at night so this was all in the context of cortisol addressing as you had mentioned for 80% of women that often that's a great place to start is sort of helping to think about perceive stress the management of

that and bringing cortisol down because High cortisol levels has a whole host of implications on the whole um concert of hormones that are there that led into the topic of sleep and your suggestions that were there which also encompasses a top question that people had which was bioidentical hormones hormone replacement therapy Etc so we touched on that a little bit let's come back to the sort of sequence of things that you did and that you recommend now that you have a sense of things with cortisol and the listeners have a sense what is the next

place to move on to so in my case I focused on the thyroid next so you can run a thyroid panel and see where you are in terms of thyroid function and I've got the normal lab ranges in my book the hormone cure so there's a whole chapter on the thyroid and you know generally what I like to see with the main test that we do which is thyroid stimulating hormone I like to see it somewhere around. 3 to 1.5 to 2.0 so if it's above that I'm starting to look more deeply at whether there's

some other issues that are affecting thyroid function so for example if I've got a patient who's got a TSH that's six and she's got low T3 that's someone that I'm going to start treatment with thyroid hormone and we talked earlier about how a really common issue that drives the root cause of thyroid dysfunction is autoimmune thyroid disease so Hashimoto is one of the most common and we know that Hashimoto has been increasing in prevalence mostly affects women although I've got male patients too who have it and so along with the thyroid panel or what I

consider part of a thyroid panel is to look at thyroid antibodies so autoimmune disease is when your body has difficulty telling the difference between your normal tissues and um tissues that it's recognizing as abnormal and then attacking usually with antibodies so you can measure those antibodies this is the topic of my next book because what I noticed was that I was seeing more and more people with autoimmune disease who are come to see me things like Hashimoto multiple sclerosis rheumatoid arthritis lot lots of different there's a hundred different autoimmune diseases and I was seeing this

increase in prevalence which we've been seeing globally so about 5% of the world population right now has autoimmune disease about 25 million Americans have autoimmune disease and I also was noticing that it seemed to a very common trigger for autoimmune disease is toxic stress or trauma so that's what got me to focus on that in my next book but when it comes to the thyroid what I suggest is that you do a panel at least once a year to look at how your thyroid is doing how it's functioning one of the most common things I

see in people who don't have hypothyroidism is that they may have a normal TSH but they may have a low T3 and T3 is the three refers to the number of Iodine atoms that's associated with the hormone so T4 is the storage thyroid hormone you take off an iodine and that gives you T3 T3 is biologically active in the body so it's stimulating all those receptors that are throughout the body to uh increase metabolism so with what I see commonly and this is often a cortisol effect is that people aren't converting T4 to T3 so

they have poor conversion and that's something that you can correct there's lots of different reasons for it I would say stress is the most common and also typically the panel that would be ordered it can vary from Doctor to doctor so I'm imagining in your book you have an expanded panel that you know you can ask in a polite way and if your doctor doesn't respond go look for another doctor and get the complete panel so for example would thyroid antibo IES be something that you'd be asking for additionally to also look at sort of

the autoimmune component of it I would recommend that so I think everyone should have uh thyroid autoimmunity checked so what I order in a thyroid panel is a TSH a free T3 a free T4 a reverse T3 and then thyroid antibodies so thyroid peroxidases antibodies and antithyroid globulin so that's the panel that I like to order and what's interesting is that you know I hear all the time from women who go to their doctor and say I ask for hormone panel including thyroid I've got all these thyroid symptoms and he tells me it's normal but

unless you're doing this deeper broader panel you may not know the whole story you know a big part of what we do in functional medicine in um Precision medicine where we pull together genetics together with blood testing and other biomarker testing we're trying to understand like where are your vulnerabilities and so a lot of people who get told that their tests are normal we know that there are folks who are included in that normal population that the lab reports who are hypothyroid MH so if you look just at people who are you thyroid e you

thyroid they tend to have a TSH that's somewhere around 1.5 so we know what normal optimal function looks like I don't want to be normal I want to be optimal and so you want to know the difference between the optimal range with your thyroid tests versus the normal range so your doctor may be telling you you're normal but you might be wanting to be optimal and that's a different goal no that's a great that's a great explanation thank you for that I want to ask you in the context of this and I know we have

a few more where does Diet fit into it and what did your diet look like at the time I know you've learned so much about diet over the years and you are a big fan of especially a diet that prioritizes things like protein balances blood sugar and feeds our gut as well too how was your diet at the time and what are your dietary recommendations for women that want to step into harmony with their hormones well at the time I think you're talking about when I was seeing my primary care doctor and I got angry

with his advice so this is a bit vulnerable Drew you know I would say when I was in my mid-30s up until about age 40 I was a food addict I was eating a lot of carbohydrates I was um Loosely following a Mediterranean diet and I you know I was eating a lot of fresh fruits and vegetables probably too many fruits for my system and for my blood sugar and what I really discovered was that I was using food to soothe myself and that's a very common reaction that men and women have women more than

men and at the time I didn't realize that it was really an unsuccessful strategy so I was overweight I um was drinking too much wine you know it was a big part of coming home from a day of seeing a lot of patients I would pour myself a glass of wine while I was cooking dinner and I'd have another glass of wine when I ate dinner was too much for me two glasses of wine was too much and I basically like couldn't turn off the fat storage until I really cleaned up my diet so there's

a lot of different components to this I'll try to keep it relatively simple but I also urge caution here because what worked for me may not work for the next person and this is where you really have to do some n of one experimentation so I got into food recovery and that made a big difference and I wrote about that in my first and second book so there's a lot more detail there but I realized that the Mediterranean diet actually caused me to gain weight and so I had to do more of a low carb

version of the Mediterranean diet so still getting you know a lot of different colors of the rainbow with the food I was eating I had to focus more on non-starchy vegetables Less on fruits I had to eat more protein because I really found that helped to stabilize my blood sugar and I need a lot more fat so those were some of the things that I had to change and you know what I found was I would say about 35 to age 40 I needed to reduce my carbohydrates and increase my protein in my 40s I

found that as my blood sugar was really changing pretty dramatically that I needed more fat and I needed more fiber so those were some of the changes that I made and then I found starting around age 5050 that I really needed to increase my protein because I was starting to lose lean body mass and that's really critical because you know there's so many women who lose muscle mass and our friend Gabriel lion I think has written a beautiful book about this very topic Forever Strong so I really encourage people to check that out but after

50 I needed more protein and I needed to do these ketogenic pulses I would do them for about four to six weeks weeks to get into ketosis I found that it really helped me with the brain fog and with some of the uh cerebral hypometabolism or slowdown in my brain function that I was noticing and it really helped me to regain my metabolic health so that's a bit of a tableau over time and what I encourage people to do is n of one experiments and the thing that helped me with my NF1 experiments more than

anything else was a continuous glucose monitor well I want to ask you about that and before we go into continuous glucose monitor would you say generally because we have a whole host of people that are listening some people that have been on their health Journey for a long time some people that are just starting that within that n of one there could be some broad Strokes that could be applied to everybody yes um getting off of ultra processed food or highly minimizing ultr processed food and shifting to more Whole Foods diet regardless of how people

maybe even doing at some point in time again unless of you have um some history with disordered eating and you might want to be working with a professional but I generally find for most individuals there's not really even a sense unless they audit their total calorie and protein intake like just doesn't have to be that the way that you are measuring your food all the time or tracking calories but even for two weeks getting a sense of like how much are you just eating in terms of total calories that are there from our diet yes

healthy food today processed healthy food tastes better than ever it's so easy to even overeat on that those types of things and total calories while they aren't the entire picture they still matter especially when it comes to body composition so staying away from and minimizing ultr processed food um maybe doing a little bit of an audit situation generally most people are going to benefit from including and getting more diversity of fiber yes in their diet as well as one of the um last ones that would be there would be we mentioned protein already um yeah

anything else you would add to that that mix that I would say fat I think really paying attention to fat fat is the backbone of all the sex hormones that you make so if you think about um the diagram of how sex hormones are made in the body they're made from cholesterol yeah a lot of people realize that a lot of folks don't realize that so cholesterol fat gets converted to pregnenolone that's the mother hormone that goes on to make progesterone and cortisol and DHEA and then testosterone and the estrogens so getting quality fat I

think is critical could you explain what quality fat is and some of your favorite sources for for individuals yes so I I love fat that is from Plants I would say I favor that first so avocados coconuts nuts seeds those that's probably my favorite Source o olive oil I think we can all agree that that's really healthy I'm someone who's an omnivore so I do really well with eating animal protein I realize that's not true for everyone but I love uh Wild game and so I get fat from the meats that I eat I tend

to eat the cuts that are a little fattier um I think fish are a really great source I think the pescatarian diet is one of the health healthiest that you can have so I also like MCT oil especially when you're doing ketogenic pulsing I think it can be really helpful because it helps to um it's been associated with weight loss and it also helps with alcohol cravings if that's something that you struggle with so I think fat is really critical it helps you feel satisfied longer and it also helps you with blood sugar stabilization on

the topic of uh blood sugar stabilization you know which goes into continuous glucose monitoring before we get into monitoring uh through a CGM what do you feel are you know a couple of the most important tests that people should be talking to their doctor about ordering to really get a sense of their blood sugar in the context of their their metabolic Health most doctors start with a fasting glucose and with a hemoglobin A1c so those are pretty standard tests that you're going to get when you go see your doctor and you get kind of a

basic blood panel and those can give you a lot of information so when I was working at the health maintenance organization and I didn't have the luxury of doing a lot of functional testing I really found that with a hemoglobin A1c and a fasting glucose I could get a lot of information and I could guide my patients in terms of dietary changes so that's where you start the problem is glucose changes kind of late in the metabolic Health Journey so for people who are maybe eating too many refined carbohydrates maybe they have a sweet tooth

like I did and they're getting too many uh too much sugar what we know is that insulin changes first insulin changes insulin is the is what drives glucose inside cells it's kind of part of the control system for your glucose so insulin can change 7 to 14 years before your glucose changes so most conventional doctors are looking at glucose and you just have to be thinking Upstream that it could be 7 to 14 years of changes in your insulin before it shows up on your glucose so my preference would be that we add on looking

at insulin fasting insulin ideally like a 2hour glucose challenge test where you're measuring glucose and insulin every 30 minutes after you have uh a certain dose of glucose usually 75 grams so those are some of the tests that I find to be helpful and then I would say there's more advanced testing that you can do so I like to use Labs like Cleveland heart lab I like to do an insulin resistance score I track something called a Homa IR for insulin resistance I look at um uric acid so I like that to be less than

five in women less than 5.5 in men I look at um uh lfts like alt uh when you have increased fatty liver related to insulin resistance you may find that your alt goes up so I like to see an ALT in women less than 20 less than 30 in men so those are some of the basic things that I like to measure in terms of metabolism and then it also can relate to inflammation that's sort of another topic related to metabolism but that's that's where I like to start I'd love your thoughts on this do

you feel that it's possible for especially somebody who's in the menopause stage of their life is it possible to feel significantly better without getting your blood sugar in control I don't think so I I don't think so let me just let me think about this so I'm trying to think if I have any patients with pre-diabetes of which there are so many and most don't know they have it I'm trying to think if there are any people I know with pre-diabetes and diabetes who really feel well without addressing their glucose and I think the answer

is no I just think it's so critical to energy production which is you know that's the fuel for your mission it's how you live your life so unless your glucose is under control unless your insulin is on your side I just don't think you can feel well I figured you're going to say that because I know your content pretty well and I think it's an important reminder because when individuals men and women right this conversation we're mostly focusing on women but men and women especially you're in your later 40s you're in your 50s you're in

your 6 or in your 70s and you are starting to learn about the importance of balancing your blood sugar it can feel like a lot if you've been eating a particular way your entire life and you've been on this glucose roller coaster all day long and you're used to eating that way which means that you're probably snacking a lot you're probably hangry a lot yes you have a lot of refined carbohydrates in your diet you might be going to sweet things a little bit more than you know what would be more tolerable for the body

you are uh undereating on fiber that would be there and you probably are relying a little bit too heavy on um processed food whether that's Ultra processed food or whether that's healthy processed food because a lot of healthy processed food can spike your glucose up and down all day long and when you start to zoom out and you think man my entire diet is designed to shoot my buos up and then I crash later on and I don't feel good and then I do it all again and you're used to that it can feel daunting

to think how you're going to break out of that cycle and why I think this is so important to remind people is that you know you've stated in previous interviews that there's no bigger habit change that you have seen in your clinic than putting a patient on a continuous glucose monitor can you explain that a little bit especially in this context of these habit changes being a little daunting for individuals yeah I love that you framed it this way Drew I don't know that I've ever heard someone frame it the way that she just did

because um as you were talking you were taking me back to my 30s and my early 40s when I know that I was so spiky with my glucose I just know I was you know I would I'd be at work I would skip lunch because I'd be doing charts I would grab you know granola bar or something like that and that would spike my glucose and then I would crash I had a lot of stress and that exaggerates the crashes even more and makes you more spiky and it's all about the spikiness like the spikiness

is the problem what you want is kind of this steady curve with your glucose so that you're body has a reliable source of fuel and it's not going to you know kind of this um alarm setting constantly so as I think about the people that I see you know most of the time people are coming to me because they've got symptoms they feel fatigued they feel depressed they feel anxious their joints hurt you know there's something that brings them to me and often when we start to kind of pull back the the onion layers and

we look at the gut and we look at blood sugar control and we look at how metabolism is operating they're really surprised to find that these things are not optimized and they're surprised that foods that they always thought were healthy are actually spiking their glucose maybe even taking them up to pre-diabetic and diabetic levels so I think unless you're measuring it you really don't know and that's the part that I love about continuous glucose monitoring because it gives you this immediate biof feedback on how your body is dealing with the muffin that you just ate

versus the salmon and broccoli and when you have that data you have to act on it like it's when you realize oh I feel so terrible after the muffin and wow look my glucose didn't change at all when I had the salmon and the broccoli like that is enchanting to get that kind of personalized information about yourself and you just can't ignore it so it sets up this Loop of Integrity that I think otherwise people are missing it's it's almost like what you don't know like you just it's very hard to change Behavior unless you

have the subjective data that's saying to you Sarah gotfried when you eat a banana your glucose goes up to 180 like you can't go out and have the ACA bowl with your daughter every time you come to Los Angeles because your glucose is spiking way too high and then you feel like a hot mess the rest of the day irritable struggling can't go out at Soul cycle like I used to love to do with her and so it allows you to connect the dots in a way that I think is really critical you know to

add to that because I'm a big fan of uh continuous glucose monitors as well I think we're both advisers to levels and we're big fans of them um we'll link to them in the show notes for anybody that wants to check them out it's also too that you can eat in my experience the banana but have it after you know at the end of the meal because I think part of what you're also helping people understand is that you know we don't want to demonize any sort of macronutrient that's there and interestingly enough I found

that you know even when you do things like you go into the sauna your glucose goes up or you do a heavy workout your glucose goes up and those are natural responses that the body has that's there so certain meals I would have I'd go up but what was great about eating a balanced you know like eating a blood sugar balanced forward diet is that when I shifted to that style of eating which is largely the things that you're talking about I would naturally have a up curvature and then it would naturally kind of come

down without like looking like a big yo-yo yes throughout the day and then when I started training a little bit more seriously than I was I actually found that I could eat more car carbohydrates than what I was eating at the time I had pretty much stripped all refin carbohydrates out I was starting to pulse in some white rice especially in the days that that before the day that I would work out and I found that my improvements in the gym were significant and I also found because I was tracking My fasting insulin that my

fasting insulin was staying stable primarily because I was adding lean muscle mass all throughout the process and it's our lean muscle mass that's eating up all this glucose in the first place another reminder that you can actually just get away with eating some more carbs you know was my situation if you're bringing in that strength training piece now I wasn't eating 300 grams of carbs a day I'm just talking about a little bit of add additional carbohydrates in my diet when i' pretty much stripped them out and I generally noticed that I was feeling better

and my glucose was still you know mostly balanced my score at the end of the day you get a score from levels on the app that was there I was still regularly scoring in like the high 80s or or 90s and so that's the interplay of how all these things come in together is that we don't have to worry that we can never eat some of those things it might be that we change the sequence of how we order them eat them and that we're eating less of these sugary spiky Foods on an empty stomach

which is what 99% of people are doing out there that's right I mean you just spoke to the complexity of the system and I think it's so important to realize that yes we don't want to demonize Foods we want to learn what's the best way to package them in your system and that's why I love n of one experiments I mean it's really the primary tool of precision medicine and some people are a little daunted kind of hearing oh it sounds so sciency and of one experiments but really it's it's something that all of us

do kind of intuitively we just don't call it that so I did an N of one experiment when I was in my 30s and I was struggling with my weight and I realized okay I'm eating too many cookies and ice cream I've got too many refined carbohydrates I need to cut back on the carbohydrates that I'm eating and I need to get into food recovery and so that was an N of one experiment that really worked for me and then I've had a similar experience as you where over time as I've done more weightlifting I

went from being pretty low carb and mostly ketogenic kind of eating in and out of ketosis to now having more carbohydrates and it doesn't Spike my glucose like it used to so yes I eat them kind of at the tail end of a meal but my glucose disposal which is really your muscle yeah has changed so I've got more lean body mass I've got um yeah I just don't get as spiky and so with the continuous glucose monitoring one of the most important things that I think it's done for my health and I think it's

something that others might want to consider is that it's rever vers my pre-diabetes so I was on this path during my 30s toward type 2 diabetes no question and no one no doctor that I was seeing was really tracking it or telling me you know you got to do something about this you're fasting glucose is 105 oh this year you're fasting glucose is 110 no one was tracking this for me and so you know there's a lot of ways that um conventional medicine offers us so much for acute care you know if you've got a

broken bone if you need your appendix out I love conventional medicine but when it comes to chronic disease like the way that your metabolism is working or not working the development of pre-diabetes the development of type 2 diabetes it's a place where conventional medicine really falls down on the job so you got to track these things and with glucose monitoring with doing these NF1 experiments I was able to reverse my pre-diabetes and it wasn't just that my fasting glucose was elevated I went and did some Advanced testing with uh one of my mentors Mark Houston

and he demonstrated that with that fasting glucose kind of in the 105 to 110 range I had Downstream consequences to my blood vessels my blood vessels were showing damage even though I didn't have diabetes yet and that's something we see in women that the cut offs we use for diabetes were mostly defined in men and women at lower glucoses in the pre-diabetes range have more adverse consequences than men do so it's another really important sex difference so for the women who are listening to it us I really want you to understand this may or may

not be trapped for you you really want to take it on yourself look at your fasting glucose over time ask for fasting insulin maybe do a two-hour glucose challenge test if you can afford it do some continuous glucose monitoring so that you can see if this is a problem for you fantastic um important reminder if if somebody wanted to go get started on a um continuous glucose monitor do you want to just mention it and then we can put your link in the show notes so I usually advise people to start start with their clinician

so the first glucose monitor that I got was as a research subject um and I it was a a lab that was looking at different food plans and now it affects glucose so that was about five years ago but after that when I saw you know I was tracking my pre-diabetes I went to my primary care doctor different one than when I was in my 30s and said hey I've got pre-diabetes I really want to keep this from developing into diabetes could we get a continuous glucose monitor and my insurance paid for it with the

diagnosis of pre-diabetes so that's not true for all insurance but I'd say start with your doctor and if your doctor is unwilling or your insurance won't pay for it that's when you would consider more a direct consumer approach but you still need a prescription so I usually don't recommend just one different direct to Consumer lab I usually suggest you know Nutri sense levels health.com uh there's Zoe Health there's lots of different companies that offer this direct to Consumer that's fantastic I want to ask you something which is that there's been a few people that have

come on this podcast and said that cortisol in particular High cortisol is one of the number one drivers of belly fat in adults do you believe that statement to be true and the context of me asking is that would you say that that is even more of a driver of belly fat and abdominal fat and maybe contribution to Total visceral fat than even um excess calories from ultr processed foods it's hard to know the relative contribution I haven't seen that studied I'm going to put my science hat on here as I answer this so the

data I looked at with cortisol when I did the hormone cure I found one study that suggested that the fat cells in your belly have more cortisol receptors than fat elsewhere so it makes sense to me that high cortisol would stimulate belly fat and there's a lot of evidence basic science as well as clinical evidence that supports it so people who have high cortisol we already talked about how It's associated with depression it's also a suicide marker we know that it's associated with a greater risk of developing diabetes maybe pre-diabetes I don't know if that's

been proven but knowing that the fat in your belly has more receptors that can be stimulated by high cortisol makes sense as we think about this network effect the other thing I think about is the role of um trauma so people who have more adverse childhood experiences when they're before they're 18 so you can maybe we could link to an ace questionnaire they're free and available online so it's a questionnaire that just tracks your experience of trauma when you're a kid things like um whether you were neglected whether you were physically abused or sexually abused

whether your parents got divorced whether you had someone in your family that was an alcoholic had alcohol use disorder so it's a way of measuring adverse childhood experiences and people who have more adverse childhood experiences have a greater risk of developing problems with cortisol and they also have a greater risk of problems with their metabolism and developing type 2 diabetes so that doesn't get specifically to your question about belly fat or visceral fat but I do believe there's a link and I still think we're we're trying to sus out some of the details of it

going back to your sequencing where you started off with cortisol and then you talked about thyroid and the importance of that and you talked about some of the uh interplay of bioidentical hormones where those can be helpful we did a little interlude about diet were there other things that you looked at on your journey as you were starting to get your own hormonal life in order there's a lot of things so if we go back to thyroid for a moment I found that there were number number of micronutrients that I was missing that hugely affect

thyroid function so I think it might be helpful just to sketch those out so I mentioned already that my high cortisol was affecting my thyroid was affecting the conversion of T4 to T3 so I had low T3 and that's something I see very commonly in terms of micronutrients you know that's something that we tend to measure in functional medicine we look at things like vitamin D copper zinc selenium even iodine and all of those things can affect your production of thyroid hormone so you want to be thinking about that I did my first neutraal I

think in somewhere around 2005 on myself and I found that my copper was really low and when I started taking a multivitamin that had copper and I also found my vitamin D was low when I started taking vitamin D and I got my cortisol to come down it corrected all of my thyroid issues so it's an example of how you want to be thinking about kind of the bigger ecosystem including micronutrients and how your body processes some of those sometimes it's related to the food quality in the diet that you're eating but it can also

be genetic so if you think about genetic drivers related to the thyroid I have a problem with my vitamin D receptor so I need higher doses of Vitamin D to keep my levels where I want them to be and vitamin D is kind of like estrogen it's got like 400 chops in the body and you want to make sure that your vitamin D is sufficient especially for gut function along with thyroid function the other piece that I'll mention and we can go there if you want or not is that as I corrected my cortisol issues

and I got my hormones into a better place I would reach kind of a new Plateau I would feel really good I'd have a lot of energy I would launch another couple of books and then I would kind of easily backslide I noticed this pattern over about 10 12 15 years and I realized that trauma was a big part of the backstory for me in terms of chronic cortisol problems so I could optimize my cortisol I could do it you know with daily meditation and yoga and taking some of these supplements that we've talked about

but I really needed to excavate and reprocess some of the trauma that I experienced to get my hormones back into balance so that's not usually where I start with somebody you know when we're trying to address hormon I really start with cortisol I start with the hormonal Charlie Angels but it's something that you want to be thinking about especially if you're someone who's been working on your hormones for a while and they get better and then they backslide they get better and then they backslide you want to be thinking about trauma were there tools methodologies

Therapeutics courses books that were significant for you to the extent that you feel comfortable to share absolutely well I wrote a book about it so it's about to be very public so and we're going to for those that are listening we're gonna have you back on the book comes out in March of next year 2024 and we're going to do a whole Deep dive on that book so stay tuned for that yes thank you Dre yeah so for me there was a huge shift that came with the their early research on MDMA assisted therapy for

post-traumatic stress disorder so I'm someone who's got a pretty high Ace score um my Ace is about six and basically if you have an a score of one or higher that's considered elevated so about 60% of Americans have an elevated a score and so mine's six and it just puts me at risk for 40 plus different chronic conditions including diabetes including problems with blood sugar and um and again for those issues for those that are following that could be anything from growing up in a situation where somebody was uh impoverished right it could be growing

up and living with a parent who had substance abuse yes so there's a whole list of things you check them off and that leads to the totality of the score and in your instance you're saying yours was six mine was six and so as I started to look at this literature I just was kind of stunned at how effective MDMA is for resolving trauma so if you look at the initial studies the phase two studies and then the phase three studies the first study was published uh the first phase 3 study was published in nature

in 2021 and what we knew going into that study is that if you've got significant trauma if you've got post-traumatic stress disorder so you can think of you know maybe depictions that you've seen in movies or on TV you know like a veteran who's come back from the Gulf War who's got um hypervigilance maybe has nightmares is reenacting some of the trauma that he or she experienced so post-traumatic stress disorder is usually diagnosed by um a psychological expert like a psychiatrist or a psychologist and when you look at the kind of medical interventions that are

FDA approved for post-traumatic stress disorder talk therapy as an example the efficacy for resolving PTSD is on the order of about 30% that's pretty abysmal not great it's not great so for someone who's got trauma who's been in therapy for for like decades and we all know that it costs a lot and it's slow and it takes a long time if I knew that it was 30% effective I don't know that I would have done it and then if you look at some of the medications that are FDA proof for PTSD some of the selective

serotonin reuptake Inhibitors they have an efficacy of about 30% so this is what a lot of veterans are being offered some of them are getting trauma-informed care fortunately were getting better at this but if you look at MDMA assisted therapy in someone with post-traumatic stress disorder the resolution of PTSD is on the order of about 67 to 71% so more than double what is currently FDA approved so when I saw that it got me really interested and I felt like if there are some behaviors that I have that are showing up as this chronic cortisol

problem and I have the opportunity to resolve them with MDMA assisted therapy I'm going to do it so I think the promise of psychedelic assisted therapy is really enormous and my hope is that MDMA becomes the first FDA approved treatment for trauma for post-traumatic stress disorder and keep in mind here you know for our listeners you may not have post-traumatic stress disorder or maybe do and you want to pay attention to this but there are a lot of people running around who are more like me who have what I think of as partial PTSD or

the medical term for it is sub threshold PTSD and we can be super functional but we may not be able to really serve our mission in the biggest way possible because of this trauma that's still lurking in our system so that's the thing that probably got me the most excited in terms of how you can rebalance the endocrine system to consider some of these novel therapies like psychedelic assisted treatment what did you notice in your body after going through whether it was your first or a series of these treatments I'm so glad you asked that

question because really that that's the main question with trauma because people who've experienced trauma often are not at home in their body and so you ask him what did you notice in your body what I noticed immediately with the first MDMA assist therapy that I tried was that I was back in my body the entire time that I was on the medication and it was durable and I realized how much I dissociated as a way of coping with the trauma as a way of coping with you know a career choice that exposes me to a

lot of trauma and I think this is something that a lot of people may do as well I would dissociate to a cognitive processing place where if I was feeling stressed I would just immediately go upstairs to my brain and just try to problem solve and it was a form of dissociation where I would just feel like I was up here and everything kind of below the neck I would just ignore and Medicine in many ways selects for that right I mean Gabor mate talks about this about how you go into medicine they give you

this weird uniform right you start wearing scrubs all the time they isolate you from your you're like in the hospital I was working 120 hours a week it's almost like a cult and it's sort of selects for this dissociation so that you are in the emergency room a car accident comes in and you're able to just go cognitive and like go through this process of doing everything that needs to happen but when it comes to living your life and really feeling what's happening in your body the emotions that are happening you can become kind of

a nerd to it you can become dissociated so it got me really interested in okay how do we actually get embodied again because that's what I felt with these medicines I felt embodied again Drew that's powerful on a day-to-day level did you also notice no matter how small I mean first of all being in boded being back in your body is so big for anybody that has not had that on a data level did you notice um shifts in your health that would show up as a byproduct of being back in your body yeah it's

such a good question and as I was you know I was first prompted by all these patients that were coming to me with autoimmune disease and then I started to do Ace questionnaires on all of my patients and I noticed that the a scores were higher in the people that I had with autoimmune dis disease and that's what got me to kind of look at this process and look under the hood like why is this happening and I realized okay the system that gets disrupted by trauma is the pine system your Psycho immuno neuroendocrine System

and for some people it might just be one of those four maybe their psychological system gets disrupted they've got depression anxiety post-traumatic stress disorder but usually it's more than one system that gets disrupted and there are some who have this vulnerability with their immune system and their immune system becomes overactivated and that's oversimplified but that leads to autoimmune disease and we know that for most autoimmune disease you have to have this combination of genetic predisposition together with increased intestinal permeability and then a trigger and sometimes that trigger is trauma so I can't remember what your

original question was but I was asking did you notice you know immediately there was a shift being back in your body did you notice any um areas of your health oh yeah that you would have said had improved which already being in your body and I'm sure if there was some history of sort of HRV scoring that you had you'd immediately have seen a major shift in sort of background stress that was there yeah like did you notice that you were you know holding your breath less often that's something that I've heard from individuals that

have gone through MDMA assisted therapy that they're not always bracing for some sort of impact yeah because their body was used to doing that as a survival mechanism of the trauma that they went through so no matter how big or small and it's okay if you there wasn't anything no there's a ton there's a ton thank you for red directing me I noticed so many things when I started trying these therapies and I did it you know in the context of um having experts guide me through and you know we have to be a little

bit careful about what's legal there's some differences state by state the one psychedelic and some even debate whether it is a psychedelic that is legal is ketamine so if we take ketamine from for a moment I did ketamine assisted treatment and I also you know I'm a nerd and so I would wear my continuous glucose monitor I would look at my aura ring I would kind of see what happens prepost these treatments and what I found with ketamine for instance is that my heart rate variability would double after I did a camine session so I'd

look at it for a week before and then I'd look at get it for a week afterwards and my HRV would double wow my sleep was better my deep sleep was better and I'm not saying that's going to be true for everyone but for my n of one experiments that's what I found so I find it super regulating there are other people I think you've talked about this as well that there are people who notice that oh I'm breathing more deeply I'm noticing the sense of calm calm I'm tuning into the signals of my body

in a different way maybe I'm talking more slowly maybe I'm pausing and I'm listening more so I think there's so many different things that you can track what I found with my HRV was that it just felt so good in my body you know it's not that I'm like yay my HRV doubled it's more oh my gosh I just noticed I felt so much more regulated I felt like you know that feeling I have when I do meditation or a 90minut yoga class I felt it more of the time and so I think we're we're

really at a a time in history where we need this we really need it you know on the topic of needing this and you're so on the Forefront of this and I'm so excited about your book that's going to be coming out out next year to contextualize it for the conversation today do you feel that there's something in particular about these tools being available now for women if we talk about a cohort of 50 plus where that demographic of individuals if we think about the time that they grew up in the tools that weren't available

to them the conversation that weren't happening at the time and how much of the burden of often many of those women would have raised families and so much sacrifice was placed on their plate the sacrificing of their health it seems like a really powerful time period in our society that these tools are now being available for especially that demographic of women any thoughts on that well it's making me Misty as you talk about this you know as someone who has served women for the past 30 years I would say there's nothing more promising than healing

states of consciousness of which psychedelic assisted therapy is one part and you're right I mean what I feel personally is that I'm not just kind of selfishly going in and Excavating and resolving my own trauma I feel that I'm actually going to past generations and healing some of those epigenetic changes that were passed on to me and so when you call out women especially women that are in this age group you know kind of the 35 to 55 65 age group there is so much promise here for you know the struggle with patriarchy the struggle

with sacrifice the struggle with glass ceilings the struggle with how women disappear over the age of 40 and just become dismissed and and don't feel as relevant as they once were so we have to do everything everything within our power to help women be the fullest expression of themselves and I really believe that healing States Of Consciousness can do that true so there's so many different ways to do that you know certainly yoga and meditation holotropic breath work which is something I've done for the past two years there's so many different ways to access these

healing States Of Consciousness you know someone might do chiong or taichi or some other contemplative practice I would say psychedelic assisted treatment my understanding of of the science and also my personal experience and the three certifications that I've done professionally has shown me that there is more promise here than I've seen with any other intervention in my 30 years of taking care of patients a super hopeful full and promising message about what's available to everyone men women everybody people in different countries maybe uh if the entire world had access to this one day the world

would just be a a little bit more of a loving place if we can learn how to love ourselves a little bit more that's what I would hope that's what I would hope and you know the one of the things that you reminded me of is when we look at soul wounds we look at epigenetic change that gets passed on you know from for instance my great-grandmother to my grandmother to my mother to me what we know from quite rigorous scientific studies is that the genes that tend to get the paper clips put on them

that tend to get changed in terms of their expression are genes of metabolism and genes of the the immune system those are the ones that change the most and so we want to be thinking about okay what do we have at our disposal to work with some of these epigenetic changes and that's part of why I think psychedelic assisted medicine or more generally healing States Of Consciousness are so promising but they also have to be superimposed on all of these lifestyle changes that we've been talking about yeah that's when they not either or yes the

two together Dr Godfrey this has been fantastic and I was hoping that as we wind down here you might be open for a little bit of a a recap in a way of some of the key sort of themes that we talked about and I think that uh one of the first ones that I'd love to start off with and you know feel free to get on your soap box and take us through the rest or I'm happy to guide you through them is just this core idea that it doesn't have to be this way

can you start there yeah you know I when I think back to how much I struggled when I was in my 30s and I just drew I felt like I was pushing a rock up the hill and I was just like why is this so hard like why I'm too young to feel like this is so difficult and I was missing this piece about how hormones drive what you're interested in hormones really Drive what you're excited about they are such an important signaling molecule in your body and even though some of the things we've talked

about today might seem daunting or seem like a lot to do it's easier to get your hormones back into balance than to live in that state of hormonal misery so I think that's a really critical place to recap everything is hard but one hard has the pathway of feeling better yes so choose your hard that's right could you share a little bit of a recap on your top lifestyle interventions that you feel are crucial if somebody wants to feel better especially when it comes to this category of hormones well I would say for this group

that we're talking about so women who are in menopause and menopause I would say the top lifestyle interventions are number one food food first so really getting clear about n of one experiments doing some of the things that we've talked about eat more vegetables make sure that you're getting adequate protein so that you're maintaining or maybe even growing your lean body mass eating in a way that supports your hormones number two is managing cortisol because it's not a democracy so cortisol is so critical IAL insulin's critical too but start with cortisol get cortisol supporting you

instead of working against you and there's so many ways to do that we talked about things like yoga and meditation supplements like phosphole sering riola so you might want to measure your cortisol and then develop a plan to address it and then I think it's important to look at thyroid because women in this age group are at risk of thyroid pause you really want to know what's going on with your thyroid so track your panels and then estrogen is the primary regulator it St with progesterone you really want to pay attention to then we also

talked about testosterone because I think testosterone is the most important the most testosterone is the most abundant hormone and so we want to make sure that it's in that Goldilocks position not too high and not too low and there's so many lifestyle things that you can can do to address that things like reducing refined carbohydrates cutting sugar out of your diet and ultr processed foods getting adequate protein and strength training fantastic those are all available and largely the vast majority of those are either things that people are doing so we're just shifting habits and if

you're not doing them a lot of them are either lowcost or free interventions that you could do like sleeping on a regular time time to try to improve your Sleep Quality you know uh lowering your stress level through things like meditation there's plenty of guidance on YouTube and other things that are available that are out there so I love that it's the reminder for everybody here that all of these tools are available and you can set up it reminds me of this quote from uh the financial author Dave Ramsey he says you know if being

broke is normal then be wealthy which is weird so be a little weird and when it comes to your health the same thing is true be a little weird be in your optimal feel good be a different version of Aging that's out there to the degree that people are asking you what do you do and all of a sudden you're an example and a catalyst for change thank you again for being on the podcast I think this is your third appearance my favorite appearance because it was in person and I feel like it's a whole

different conversation that's there for those that are listening today and want to go deeper down the rabbit hole of Dr Sarah godfried how can they keep in touch with you and where should they start when it comes to your books I'd recommend starting with the hormone cure that's really the kind of the original and it lays the foundation for the functional medicine Paradigm that I use when it comes to hormone balancing you can also go to Sarah freed md.com that's where I publish blogs and I have a lot of information about my new book for

instance and the social media where I hang out the most is Instagram as you know I love watching your stuff over there Drew so that's probably the best place to have a conversation fantastic we'll have links to all those in the show notes Dr Sarah Godfrey thank you again for being the voice of women who are looking for a different way to go about things um it's been an honor to host you on the podcast today thank you Dre hey YouTube If you enjoyed what you just saw keep watching for more great content on how

to improve your brain and your life she had type two diabetes for 10 years on insulin she had heart failure she had kidneys were failing her liver was fatty she had high blood pressure she was on a pile of meds in 3 days she was off her insulin in 3 months off of all her medications or