Dr. Sara Gottfried has elegantly distilled her years of clinical experience and thousands of patient contacts into a user-friendly body of knowledge for physician and layperson alike. She’s truly a functional/systems medicine pioneer, combining the best of scientific data with the art (and heart) of medicine.
An expert in the area of women’s hormones, Dr. Gottfried candidly shares her own personal experience with hormone imbalances. Sara was pivotal on my own journey toward better self-care, as you’ll hear in this podcast.
Pearls from Sara Gottfried, MD
- The 7 main Reset hormones
- Always balance estrogen first
- The estrobolome
- Key causes of weight loss resistance
- Laboratory considerations
- Nature cure & hormone balancing: Dry skin brushing, hydrotherapy
- Lifestyle changes (“Cell to Soul” support): ESSENTIAL to hormone balancing
Dr. Fitzgerald: Hi everybody. Welcome to New Frontiers in Functional Medicine. I’m Dr. Kara Fitzgerald and with me today is a very special guest, in fact, a woman who really spoke to me in such a frank and honest way at an important transition time in my life. It was a tipping point actually. Anyway, it’s Dr. Sara Gottfried.
I’ll tell you a little bit more of my background in a second, but you know her as the author of two New York Times bestselling books including The Hormone Cure, which I have and I use not just personally, but professionally. There are many pearls in that book. It’s highly useful and she’s got 40 pages of references in there too as well. And her new book now out in 2015 is The Hormone Reset Diet and that’s what we will be mostly focusing on today.
After graduating from Harvard Medical School and MIT, Dr. Gottfried completed her residency at the University of California at San Francisco. She’s a board certified gynecologist who teaches natural hormone balancing in her novel online programs so that women can lose weight, detoxify and slow down aging.
Dr. Gottfried lives in Berkeley, California with her husband and her two daughters. Sara, it’s great to have you here.
Dr. Gottfried: Thank you Kara. I’m so happy to be with you.
Dr. Fitzgerald: Yeah. So my background, our first conversation was mid-2013. You were just putting the final touches on The Hormone Cure as I recall. And I called you. We had a scheduled appointment to chat about an interview I was going to do with you and I literally came from a red eye to the office to call you. And you chastised me for that choice. I hadn’t slept at all. I dragged myself into my office and there I was working.
That was really the beginning of a conversation that I started to have with myself around lifestyle changes and what was healthy living. For most of my career, I have traveled. And particularly in the maybe 2010 through 2013 or maybe earlier than that, I was traveling extensively around the world. It was rewarding in some ways, but yeah, I wasn’t practicing what I was preaching and it was taking its toll on myself. So I appreciate you for that candid conversation and your support through the years.
Dr. Gottfried: Thank you for that. I think I’ve been there myself, sister. So I hope it didn’t feel like I was chastising. I hope it felt more like I was nudging you to just acknowledge what happens when we have boundary for the wild things like red eyes.
Dr. Fitzgerald: Yes.
Dr. Gottfried: And we know that when you defy the adrenal demands, the amount of demands that are put on your adrenal glands alone is about three-fold normal and I think most people feel that. I forget how far it has flown, but it was probably across the country.
Dr. Fitzgerald: Yeah.
Dr. Gottfried: And when you work hard the next day, it’s just exhausting. Your cortisol is going to be higher. It’s just a lot of wear and tear on your body.
Dr. Fitzgerald: Yeah, absolutely. And I think I used the word chastise, but I think it wasn’t a conversation that I was having with myself or with anybody else. A lot of our colleagues, a lot of my friends, I mean people are traveling all of the time and we take it as a given. I’ve done so really my entire career. And yet, I absolutely felt the impact on my body.
And I’m so grateful that we started that conversation and it grew and it translated into some pretty big life changes for me and more discernment around my choices.
Dr. Gottfried: That’s beautiful. That’s the goal.
Dr. Fitzgerald: Yeah.
Dr. Gottfried: That’s what I want for our listeners today, to have more discernment at the end of our conversation.
Dr. Fitzgerald: Oh, that’s so wonderful. All right. Let’s jump in and talk about The Hormone Reset Diet. Tell me about it.
Dr. Gottfried: Yeah. This book is such a labor of love. My first book, The Hormone Cure, is about the types of hormone imbalances that women have and I sometimes joke that I have had every single one of them.
But I also struggled with my weight for most of my life and I didn’t talk about it until I published the The Hormone Cure. I gained some weight as a result of publishing that book and I felt like I really needed to take on my own experience with weight gain, having difficult losing weight.
We know that 80% of women are unsatisfied with their body. And I know that that’s true because I used to be one of them.
And if we rewind to when I was in my mid-30s, I had a baby and I just couldn’t lose the weight afterwards. I went to my doctor, my primary care doctor who had that attitude that I think a lot of conventional doctors have. He said, “Eat less and exercise more.”
Dr. Fitzgerald: Right.
Dr. Gottfried: I held on the doubts. I was feeling stressed out and having this new baby and juggling with the job. And he also suggested the antidepressants. And I just had a hunch that he was not giving me the solutions that were getting at the root cause. I had a hunch that my problem with weight was hormonal. And that hunch turned out to be correct. So I had estrogen dominance, insulin resistance, high cortisol, low thyroid, long list.
But I learned through extensive research and then from a lot of personal experimentation that calories matter, but hormones and nutrients matter more. That’s what has changed everything. That’s what led to my new book, The Hormone Reset Diet.
Dr. Fitzgerald: I appreciate how frank you are with your own experience through both your books. All right, so let’s talk about the seven hormones that are so paramount to understand from your perspective. I know we know as clinicians a lot about this and we’re doing balancing in our office every day, but you have a really unique take.
And I might add, there are just thousands of patient encounters where you have really distilled this knowledge beautifully. So tell me about them.
Dr. Gottfried: Yeah, thank you. The seven hormones that I found to be the most important when it comes to women and weight are estrogen, insulin, leptin, cortisol, thyroid, growth hormone and testosterone. So those are the big seven that I pay a lot of attention.
There are other hormones as well, ghrelin. There’s a long list of other hormones. But those are the seven that I really found to be key.
Dr. Fitzgerald: Yeah. And you always start with and return to estrogen. So talk about that.
Dr. Gottfried: Yeah. I feel like estrogen is the devil we know. It’s the quintessential female hormone. It gives us breasts and hips and in my case, a little too much breasts and hips.
So estrogen is important for both men and women. When men have estrogen dominance, it can lead to an imbalance in testosterone to estradiol ratio and that is a marker for an increased risk for heart disease. It can give you a man can. I am trying to think of a more clinical term for that.
Dr. Fitzgerald: Gynecomastia.
Dr. Gottfried: [Inaudible 00:07:40]
Dr. Fitzgerald: Right.
Dr. Gottfried: So I start with estrogen because it’s actually one of the hormones that are harder to reset. For the past 10 years, I’ve been teaching a detox, a way of resetting these seven hormones in three day burst. And I found that estrogen was the hardest. So that’s the one I like to start with.
It’s also an easy win to reset estrogen. And once you start to change the way that estrogen is trafficked in your body, it makes such a difference in terms of how you feel, your mood, your fluid retention. So it’s the one I like to start with and it’s the one I like for people to crack the longest. So that’s the reason why it’s first in the sequence.
Dr. Fitzgerald: Yeah, it makes absolute sense. In fact, I just finished your detox myself and I feel the estrogen shift. There’s just no doubt about it. I’m with you in tending towards estrogen dominance. Absolutely. I do think that we have a good toolkit and you’ve outlined a really nice one in your book.
So you’re looking at genetic and epigenetics these days. Actually you have as long as I have known you. And you talked about the estrobalome.
Dr. Gottfried: Yeah. When people have heard of the microbiome, we have this collection of bacteria and other microbes that we run around with. They outnumber our human cells, 10:1. And when you look at their DNA [inaudible 00:09:17] again, it’s called the microbiome. So, most of us have heard of the microbiome.
There’s a subset of the microbiome that is a major factor in determining your estrogen level and that subset is called the estrobalome. So it’s the collection of mostly bacteria that modulate your estrogen levels in your body. And these bacteria determine whether estrogen keeps getting re-circulated in your body over and over again instead of getting pooped and peed out.
An analogy I like to use here is that estrogen is meant to be used and then disposed of. It’s not supposed to re-circulate. If it re-circulates, it’s like karma.
Dr. Fitzgerald: Right. Right. Actually, I want to just jump to another question I was going to ask you on this topic because we are here now. And that is the gut endocrine brain axis. You’ve just said quite a bit. Is there anything you want to add thinking about the gut HPA, or endocrine brain axis?
Dr. Gottfried: I think this is fundamental functional medicine. You and I love to talk about functional medicine and when you’re looking at root cause analysis and you are approaching the body as a system instead of taking the gut and leading it to the gastroenterologist and taking the endocrine system and leading it to the endocrinologist or the gynecologist. When you look at the whole system and the interconnections, I think that’s so key.
So I think the estrobalome and the way that you manage estrogen in the body is a great example of that. So if you are someone who’s like me, I’m a bit of a recovering type A personality and I get stressed pretty easily. Medically, I’m considered a corporate warrior, so I tend to be too stressed.
Dr. Fitzgerald: Yeah, I got it.
Dr. Gottfried: So when you are like that and you run around with high cortisol, you also tend to have high estrogen. You tend to have an estrobalome, that kind of favors, having more estrogen in your body and less progesterone. So in women, the ratio that you are trying to pay attention to here is progesterone and estradiol.
And if you’re a high cortisol person, your control system, the hypothalamic pituitary adrenal thyroid gonodal axis, when you are making too much cortisol, you’re going to block the progesterone receptor. And when that happens, high cortisol can also [inaudible 00:12:02] in the gut and lead to leaky gut syndrome. And you can have problems with dysbiosis, with SIBO small intestinal bacteria overgrowth.
So these are just quick little hints about the importance of the interconnection of the gut, the control system for the hormone, the HPATG and the brain.
Dr. Fitzgerald: Right, absolutely. So you are thinking about – I can see in both of your books and I am sure you did this in clinical practice, addressing the gut concurrently. I mean that’s just a thread that’s woven through all of the stages of the reset diet.
Dr. Gottfried: Oh, for sure. I think if we dial back to how we work in functional medicine and the protocols that we built, the way that I was taught to address the problem is to formulate a differential diagnosis, to have a list of why somebody has the symptoms that they have when they’re sitting across from me on my office and then ideally find one drug to probably address the most common problems they have or run some labs and see what is the one problem that they have.
And I think what we’ve learned overtime, some of us come to functional medicine a little later in life, it doesn’t work, that whole idea of one drug, one disease. It’s just not effective. It doesn’t get the root cause. It leads to partial solutions at best. And your greatest hope of a cure is to address upstream, to go upstream if possible, to address the root cause and often that root cause is related to the gut or it’s related to the way that your brain perceives threat in the environment.
That’s certainly true for me because I am one of those people who are always searching for threat. I’ve got what I sometimes call very fondly a hot amygdala. I am always looking for danger.
Dr. Fitzgerald: Right. That’s so interesting. That’s a great connection. And of course, we can turn that on readily. I mean a dysbiotic imbalance could participate in triggering that and vice versa and then the cortisol into the mix will continue the progression of that. But yeah, I understand what you mean.
Okay, so just talking about labs in this systems workup, my first question, thinking about estrogen and getting rid of it is beta-glucuronidase. Are you looking at that on a stool test? So that’s an enzyme that when in high presence is going to allow for the re-circulation of estrogen from the gut back into circulation, beta-glucuronidase. And it’s available on certain stool tests. Is that something that you consider?
Dr. Gottfried: I do. But I have to tell you and I want to hear your experience as well. When I suspect that someone has estrogen dominance and after taking care of 20,000 women in the past 25 years, I have a pretty good sense of what hormones are out of balance just from talking to them for about 15 minutes.
Dr. Fitzgerald: Yeah.
Dr. Gottfried: So when I am looking at someone and I think that they have estrogen dominance, I’m going to order some tests to confirm it. But I can tell you, I ordered a lot more stool tests at the beginning where I would look at beta-glucuronidase and it was high pretty much in everyone that I suspected had high estrogen dominance.
So I do think it’s helpful, especially towards the beginning of your career in functional medicine to order it. And it’s good as a confirmation that there’s a confusing story.
Dr. Fitzgerald: Yes.
Dr. Gottfried: What about you? Do you order it often?
Dr. Fitzgerald: Well, when I use the panel of GIFx, it comes standard on that panel. I’d look at it and I certainly consider it, but if it were a standalone offering, I agree with you, estrogen dominance is pretty straightforward and I am going to be measuring hormones. So it’s not something that I would as a standalone order if it were offered.
Incidentally, going back to The Hormone Cure, you compiled some self-assessments that you based on all of your clinical time and working with so many women with these hormone imbalances. And then you also looked at John Lee’s work.
Those are very useful. I mean they are really nicely honed self-assessment tools that I use with the patients. And I also recommend them when I’m teaching just as good down and dirty assessments to differentiate the different clusters of imbalances that we can see.
Dr. Gottfried: Absolutely. And I think there are a lot of folks who have some overlap between the different sets of symptoms. But for our listeners, if you are interested in checking out some of these questions that we’re talking about, you can certainly go to either of my books or you can go to TheHormoneCureBook.com/quiz. And that will take you to a version of this quiz.
But yeah, I think these quizzes are really helpful. I tend to use the quizzes. I do more of a gestalt when I’m seeing a patient. And I also use the quizzes when I’m teaching a workshop. So I teach a lot of hormone balancing yoga workshops. And I’m also a yoga teacher. I had to become a yoga teacher because of this crazy personality of mine and [inaudible 00:17:51].
But I will use that so that people can self-diagnose. I think it’s so helpful to engage that collaboration with the patients and so having that power so that you are not turning the real power to a patriarchal physician and putting all the power in their hands. I think it’s helpful to have that analysis and have a sense of, “Oh, I have a tendency towards estrogen dominance. Oh, it looks like insulin might be out of whack. And I think I may have some problems with testosterone.” So I think it’s very helpful to guide the next steps.
Dr. Fitzgerald: Yeah, absolutely, absolutely. I’m low in cortisol in the morning and then I shoot up at 3 PM, 4 PM, 6 PM, 7 PM and I can’t sleep. Yeah, it is. I think it’s really a useful tool and folks coming into functional medicine should check them out. We will put the website with this podcast transcript.
So going back to laboratory, what do you think is essential workup for women?
Dr. Gottfried: Yeah, it’s interesting because for me, this has changed overtime. When I first started out, I always did a blood test when I first saw patients. And that panel would include if they were cycling a day 21 or day 22 progesterone. I would look at extradiol, I would check free and total testosterone. I’d look at cortisol ideally around 8 AM. I’d look at fasting leptin.
The panel that I would run on someone who had weight gain was a little bit different than someone who had other hormonal problems. But I started with blood testing because I really found that it was the universal language of conventional medicine and it was the way that I can develop buy in with a lot of the conventional physicians that were referring to me, starting 10, 15 or 20 years ago.
And then overtime, what usually happened on a second visit is I would look at diurnal cortisol. And now, I’m actually really interested in diurnal urine testing so that you can look at the metabolism of cortisol and you can look at estrogen metabolism.
So the panel that I run has really changed overtime. I still do blood testing, especially with someone who’s trying to lose weight. And I also look at fasting glucose and hemoglobin A1C. I like to look at liver function just looking for fatty liver. And I’m sure I’m leaving things out here, but that’s the basic panel.
Dr. Fitzgerald: Okay. And so what urine panel are you using? Can you share that?
Dr. Gottfried: Yeah. I tend to use the Precision Hormone Panel. It’s the one that I found to be the most accurate. It’s a lab that’s based in Oregon. And the guy that was the head of the urine testing and CRT went off on a zone, Mark Newman and developed this assay that I just find to be incredibly helpful.
Dr. Fitzgerald: Okay, all right. It’s good too. Are you looking at nutrients and micronutrients as well?
Dr. Gottfried: I do look at nutrients because I think micronutrient deficiencies are really important to look at. And as we get into the topic of weight loss resistance, I think it’s important to look at things from the overgrowth.
Dr. Fitzgerald: Yeah.
Dr. Gottfried: So I changed overtime, but I started off doing a lot of nutraceuticals. I still like the nutraceuticals like Genova. And I also do some organic acid testing with Metametrix. So that’s what I tend to do.
And then the question is where does the stool analysis fit in? I tend to do that as well. I tend to focus first on hormone balancing because I just find that that helps people feel better so fast. And sometimes when you clean up the food by addressing hormones, some of the gastrointestinal symptoms can resolve.
Dr. Fitzgerald: Yes.
Dr. Gottfried: You might have a different path and I want to hear about that. I mentioned you look at maybe gut function and immune function a little sooner than I do.
Dr. Fitzgerald: Yeah, I have to honestly say I tend to bang it out immediately. I look at the whole, I look at the gut and I am looking at nutrients and doing a nutri-eval and ion. And I am looking at hormones. These days, I’ve actually been using blood. I was using urine for a while but I wasn’t quite satisfied with the results that I was seeing, so I am interested in this lab that you mentioned.
So I do my assessment early and it’s really pretty thorough and then I build out the matrix. So I am using the functional medicine tools to map out where I need to start. Often, it’s the gut. Obviously the gut is a huge player.
But when you’ve got a woman come to you who’s got hot flashes and not sleeping, kids, working, that whole picture that you talk about, you articulate from your own experience and also the women that you write about in your book, there are some urgent things that need to be addressed immediately. And in a 30 to 50, 60-something woman, that’s giving them some relief from hormone overload. And I absolutely agree with you that dietary intervention is a huge leverage point for us.
And then I pinpointed micronutrients. In The Hormone Cure, you had a nice appendix of some of the herbs and nutrients and nutraceuticals that you recommend, which work. They work.
I also appreciate the fact that you are not a mega doser at all. I think that really identifying those areas that you can gently push with a few interventions or with diet and lifestyle can have profound and far-reaching effects. So I appreciate it.
Dr. Gottfried: Thank you.
Dr. Fitzgerald: Yeah.
Dr. Gottfried: And I love to fill out the matrix as well and that profile that you described, which is pretty much 95% of my patients. They come in and their eyes are wide and they’re like, “You want me to do what?”
Dr. Fitzgerald: Yes.
Dr. Gottfried: And so sometimes, I’ll triage the testing that they do so that we start off with, “Okay, we’re going to look at a case of where you are with your hormones. We’re going to start with these easy wins and then we’re going to move on to this other testing if you still have symptoms that aren’t resolved.”
And part of this comes from a very functional medicine way of thinking about protocols where you start first with the lifestyle changes, filling micronutrient gaps, figuring out, “Okay, you hardly have any vitamin C and if you take two grams of vitamin C a day, it’s going to raise your progesterone level.”
Sometimes, these small tweaks can really swing big doors. And then I like to move on to herbal therapies. And if those aren’t resolving symptoms, I’ll do some more testing and then we’ll do some bioidentical hormone therapy.
But I agree with you, in conventional medicine, their approach has always been one dose for everyone and it’s a pretty whopping dose. And I find that the human body, especially the female body does a lot better with the gentle coaxing and nudging, especially of herbs and the more tonifying approach rather than a sledgehammer of big dose of the Wiley protocol for estrogen and progesterone for instance.
Dr. Fitzgerald: Yeah, absolutely. Absolutely. I’ve inherited former Wiley people into my practice and that’s a whole other podcast, but when you’ve been mega-dosing…
Dr. Gottfried: The Wiley protocol refugees, we will have a separate conversation.
Dr. Fitzgerald: Right. I mean there are some varying important cleanup work with such hormone overload and just definitely detoxification and attention.
While we are talking about this, I just wanted to point out when I was reading Hormone Reset – and it was really woven to The Hormone Cure and you really practice what you are preaching – is that lifestyle medicine is always in there in every one of the hormone reset stages, there’s something about mind and body and I greatly appreciate that, be it love and kindness or using heart map tools. It’s very nice.
Dr. Gottfried: Thank you. I feel like this is such an important piece. And I’ve had the experience of women coming to see me in my office and they will just say at the top of their head, “I know you’re a yoga teacher. Don’t talk to me about yoga or meditation. I will shoot myself if you make me to do yoga and meditation.” So I really appreciate that a lot of people who are feeling overwhelmed, they’re just like, “No, no, no. You don’t understand.”
Dr. Fitzgerald: Yeah.
Dr. Gottfried: So I think it’s really crucial, especially if you have this particular pattern of the high rev that you actively reset your nervous system. And I learned it through trial and error. Believe, I’ve tried to get away with not meditating and not doing yoga on a regular basis. It just doesn’t work as well.
And as you move through the protocol of “Let’s do this to your diet and let’s add these micronutrients and how about this herb for your adrenals,” those are going to be so much more effective if you got the lifestyle dialed in.
Dr. Fitzgerald: Absolutely. There was a pretty cool paper that came out of University of Oregon. I think it was last year about grounding. I don’t know if you saw it. I will send it to you if you didn’t.
They did this interesting study of lowering cortisol. A grounding activity could be as simple as taking your shoes off and standing on clean grass. That’s it. And I do think that when we get our hot amygdala like that, women in our office of which I am one, we do need to initially meet them where they are at and show them that this works. So something simple as just getting outside in the dewy grass without your shoes and breathing for a few minutes as your starting point I think can be really powerful.
So that’s one of the things I think about with my patients who come in and say, “Don’t talk to me about yoga or meditation.” That cracks me up because I can certainly identify and I can see that woman in front of me. “Okay, what are you willing to do or where can we meet to start this journey?” There is a fundamental shift as I myself had to make a few years ago around this and this movement into the recognition that lifestyle medicine or some kind of a practice, we don’t need to call it lifestyle medicine, is so essential to the whole on this process.
Dr. Gottfried: Totally. And with that woman sitting across from me, I feel like one of my jobs is to break the bad news. And actually, some sort of contemplative practice is part of the process here. It’s non-negotiable.
Dr. Fitzgerald: Right.
Dr. Gottfried: And even though a lot of women come to me and they say, “No, give me a prescription for testosterone and I’ll be on my way,” the body doesn’t work that way. You can’t just throw testosterone into the hypothalamic pituitary adrenal thyroid gonodal axis and hope for the best. It’s a very complicated feedback loop and you have to dial it in and figure out, “Okay, what’s going to make the most sense here?”
And I’m glad that you brought a grounding. I think this is one of the reasons why when you go to the beach and you walk on the beach every morning for an hour, you just feel so much better.
Dr. Fitzgerald: Yes.
Dr. Gottfried: It’s the reason why gardeners feel better. I just think there already these solutions that nature offers us that we often don’t take because we’re running around with insulated tubes.
Dr. Fitzgerald: Yeah. And it’s so simple. Okay, that was a nice divergence and an important one. Now, I know that you have encountered in your practice significant weight loss resistance. We all have. And I want to back that up by first saying that functional medicine works for weight loss all of the time.
I have cases after cases after cases where women and men, kids if they need to, they shed pounds naturally through the process of balancing and dialing in the diet and micronutrients, et cetera.
But there is a subset of women. I don’t think that I’ve seen this in a man or at least certainly not to the degree that are extremely resistant to many different interventions and diets and even with all the analyses. We are still hitting a wall. It’s very slow. And I just wanted to get your idea on that, pretty refractory weight loss resistance.
Dr. Gottfried: Well, I see this a lot. I have a lot of women who do my detox and they are getting their hormones to a place where they are almost a poster child, but they are still struggling with their weight.
I think the tendency in the past has been to say, “You must not be doing it right or there must be something psychological.” I just think that’s total BS.
So what we know about weight loss resistance, I think it would be fun to discuss with you a little bit on this. I think of eight different categories with weight loss resistance and we can maybe talk about some of these.
One is the timing of foods. I address this quite a bit in The Hormone Reset Diet. This is especially important with insulin and with leptin that you have a period of time before you go to bed where you digest. What I generally recommend is that you finish eating by 7:00 and that you go 46 hours between your foods. And if you’re someone who feels like you have to snack, that is the sign that either your insulin or leptin or both are out of whack and need to be addressed.
The second category is inflammation. I know you deal with this a ton, chronic immune activation, mold exposure if it’s in here. I’ve been learning more recently about mold exposure and how about 50% of buildings are exposing people to mold either at the workplace or at home, schools too. And about 24% of population has genes that make them really susceptible to chronic immune activation after being exposed to mold.
So that’s another common problem about medications. You and I were talking offline a little bit about this, especially I think you are about antidepressant and SSRIs, they affect the serotonin receptor and there are some genes in particular where when you block that receptor, when you take Lexapro or Paxil, it can lead to metabolic syndrome. We have that consolation of weight gain and diabetes and increased blood pressure and problems with your cholesterol profile.
But also some of the old ones, the old antidepressants like the tricyclics, which we sometimes use in gynecology for people with urinary incontinence. And the [inaudible 00:34:15] inhibitors can do it too.
This is one of those places where we know that SSRIs cause weight gain in up to 25% of the people who take them. And this is usually 10 lbs or more. It affects your appetite and metabolism. So this is a common one. I know you have encountered this too, Kara.
Dr. Fitzgerald: Yeah, absolutely. And there are also interesting data around I think what will emerge rather as a profound dysregulation of the microbiome with the psychotropics. Yes, I have.
When you and I were talking about it, you wanted me to mention or you asked me how I dealt with it and I would say thus far in my practice, I have not been successful at supporting an individual who has psychotropic related weight gain. I have not been able to support them in any profound weight loss while they are on the medications.
So in my experience thus far unfortunately – see, I say unfortunately. I know it does seem there are small subsets who really benefit from these meds, but really by and large, you can at least start to taper. We’ve got a great arsenal of tools in functional medicine for all of these things that we’re talking about that for the majority of folks seemed to be quite useful in improving them sufficiently where they no longer need any of these medications that they’re on.
So for those folks who can taper off, some people do it really quickly and then the weight loss happens. Unfortunately thus far in my experience for the most part, it’s hard to work through the drug with our tools as far as weight loss goes.
Dr. Gottfried: With the good news being that when you are working upstream and you’re changing diet and you’re healing the gut, often you don’t need the medications.
Dr. Fitzgerald: Absolutely. Absolutely.
Dr. Gottfried: As a hormone expert, I have to say that a lot of people get started unnecessarily on these psychotropics.
Dr. Fitzgerald: Yes.
Dr. Gottfried: We know that SSRIs for instance can be life-saving in someone who’s got severe depression. But what I see is I see so many women who come in who have got that high cortisol, low cortisol story and they’ve got thyroid that’s out of whack and estrogen dominance.
We know that 50% of people with depression have high cortisol. And 20% of people with depression have low thyroid function and they get started on exactly the wrong thing. They get started on an SSRI instead of addressing the root cause.
Dr. Fitzgerald: Absolutely.
Dr. Gottfried: So often the hormone balancing and dialing in the rest of the matrix can help people get off.
Dr. Fitzgerald: That is the good news.
Dr. Gottfried: That’s a very important solution.
Dr. Fitzgerald: Yes, and it is the good news. And you’re right, yes, I think we’re enormously successful in that arena. I also wanted to add to the mix that inflammation is such a fundamental player in mood disorders of all ilks.
Dr. Gottfried: Yeah.
Dr. Fitzgerald: And just simply reducing the inflammatory burden in whatever way is indicated in a patient will be sufficient to turn them around. Sometimes certain appropriate nutrients are needed to support. Yeah, it works.
Talking about some of these nutrients, you do make, as I said earlier, a lot of nice recommendations in The Hormone Cure and I know you’re thinking about some new ones. I was checking out your blog recently.
What are some of the supplements that are go-tos for you these days?
Dr. Gottfried: Yeah. Well, I think omega-3 is one of the most proven supplements. And what I love about omega-3s is that they make such a big difference in healing the gut. They also have been shown to lower cortisol, they’ve been shown to raise lean body mass in randomized trials. So that’s certainly a go-to.
In The Hormone Reset Diet, I talked quite a bit about berberine. It’s one of my favorite supplements. I’m looking at some new data that show you need to take them for about two months as a pulse and come off of it and then restart it again. But I really love the berberine data, especially when it comes to regulating blood sugar.
It seems to work, as you know Kara, as well as not better than metformin. And this is especially good for women who have that polycystic ovarian type of phenotype that kind of picture. It’s been shown to really be helpful for them.
So those are some of my favorites. I could go on. I have a supplement graveyard at my house. I think I got thousands of supplements. I’m just constantly trying to learn more and find the one that makes the difference for the most people.
Dr. Fitzgerald: Right. That’s so funny. I think I do too. We’ll have to compare closets.
Dr. Gottfried: We can each other photos. Yeah.
Dr. Fitzgerald: Right.
Dr. Gottfried: You can post it on Instagram. We’ll start trending the supplement graveyard, “#supplement graveyard.”
Dr. Fitzgerald: Right. That’s so funny. Yeah, I know, I look at myself. Yeah, I have too many.
And yes, I am a big fan of berberine. And incidentally of course, it was first recognized with antimicrobial properties. So it’s certainly some of that modulating that we’re doing with blood sugar and lipids and so forth using berberine through gut, balancing the gut microbiome. So it is quite a remarkable botanical.
Dr. Gottfried: It is. Yeah, I love berberine. And what can I tell you? I’m always trying new things. Maybe you and I could talk a little bit about some of the supplements that we’re taking now.
Dr. Fitzgerald: Okay.
Dr. Gottfried: Do you want to go first? What’s one that you’re really into right now?
Dr. Fitzgerald: I am just scanning my cabinet. I take extra potassium always. I like that quite a bit. I use magnesium. I think I have a lot of work courses in my supplement cabinet. I recently did an ion like the nutri-eval. So based on the ion, I needed B12, a little bit of extra folate. I’m doing phosphatidylserine.
Dr. Gottfried: Right. I love that.
Dr. Fitzgerald: Yeah. I take fish oil always. What else? I’ve been taking some extra liver support these days? So I do a little milk thistle or a combination product, milk thistle, a little bit of N-acetylcysteine, some alpha lipoic acid, artichoke. All right, I am still scanning the cabinet.
I do DIM. I use DIM. I’m taking black cohosh because I am definitely prone to getting hot flashes if I am not balanced. And oh, gamma linolenic acid as well, I take GLA. I tend towards a little bit of eczema. I think I do have one of the Filaggrin mutations, which will allow eczema.
I have winter eczema. I don’t have severe eczema. It runs in my family, but I am fortunately heterozygote. So I tend towards the dry skin and GLA seems to knock that out with fish oil.
Well, that’s what I can think of right now. I know there’s more. I’m sorry. What are you expecting? There’s got to be more.
Dr. Gottfried: No, that’s a great look. That’s a great look. I just come off of a protocol to get rid of mercury. So I’m in a more zen state of fewer supplements right now.
Dr. Fitzgerald: Oh, nice.
Dr. Gottfried: I would take extra fiber because fiber is so important especially for resetting your estrogen levels. So I get somewhere around 75 to 100 grams of fiber a day. So I have to take them as a supplement.
I take vitamin D. I got a faulty vitamin D receptor. So I take about 10,000 international units a day with some broccoli seed. I also take fish oil, I think about 4000 milligrams a day.
Dr. Fitzgerald: Yeah.
Dr. Gottfried: I take magnesium as well. It really helps me with my estrogen methylation pathway. So I’m a big fan of magnesium and butein. And I also take N-acetylcysteine. I love NAC. I feel like it’s got one of the best profiles proven to help reduce mercury and just to help the liver with detoxification. So those are some of my top.
Dr. Fitzgerald: Right. Yeah, it sounds like a good protocol. I have to say that I am also taking D and fiber as well although I have never calculated the numbers. So I want to pay attention and do a little tracking for that.
Dr. Gottfried: Awesome.
Dr. Fitzgerald: Okay, let’s move away from the cabinets. Again, in The Hormone Reset, you are employing some nature cure treatments, which as an enteropath, I very much appreciated seeing. And again, I think they’re time-proven a couple of the things that you’re doing.
First of all, you have dry skin brushing, which I absolutely love. I can feel the tingling just seeing it. And I know you do hydrotherapy. You’re recommending Epsom salt baths and so forth. So talk about that.
Dr. Gottfried: Sure. These are things that I found to be so helpful in my body. I think we all have a set of standards, an evidential hierarchy for protocols or recommendations that we make to clients. And then there are certain, as you said, nature cures that have such a low risk that we don’t need to have randomized trials. So I think they’re helpful. You can do the end of one trial and just see if it makes a difference for you.
So I find, especially when I am asking people to get off of caffeine and I’m going to break that bad news right now, that if you do the Hormone Reset Diet, it’s a 21 day program to reset your set of hormones. I’m going to ask you to get off of caffeine because we know that 51% of the population has the slow metabolism gene for caffeine and if you’re like me, that means that I’m going to sleep one to two hours or less even if I have a cup of coffee at 6:00 in the morning.
So I like for people to get off of caffeine. One of the ways that I think is really helpful to swap the caffeine for something that stimulates you in the morning is to do dry brushing. It’s so lymphatic. It just gives you that zingy feeling that I think you were just trying to articulate and I’m a huge fan.
And then with hydro therapy, this is interesting. We could drill a little deeper into this because there are some new data, especially on saunas and how they turn on longevity genes such as FOX03 gene.
But the ideal hydro therapy is that you have cold exposure. One way to do it is to get in your shower. You dry brush first and then get in your shower and do a minute of cold water, as cold as you can stand and then a minute of hot water, as hot as you can stand and just alternate.
And this is really interesting for the body. It’s like I’m an engineer and I think of the body as being like this harmonic operation that you induce.
One way to think of it is this term hormesis where you have a mild stressor like hot water or cold water or alternating. It just stimulates these endorphins and it stimulates this healing response in the body that can be quite profound.
Dr. Fitzgerald: Yeah, absolutely. And just physiologically, it’s the dilation and constriction of your vessels and getting things moving. And I think going into the shower after you’ve done dry brushing, which also gets the lymphatics moving is a great combination.
Dr. Gottfried: It’s a great combination. There was a study that was just published in JAMA looking at the Fins. So my grandmother is Finnish and I grew up visiting her family in Minnesota and one thing we would do there in the summer and we can be able to do this on the winter is you go have a sauna with the family.
So you’re sitting around in your towels and getting to know people on a very intimate level. And then you go dive in the lake. And then you go back to the sauna and then you go dive in the freezing cold lake. And so it’s the same sort of process.
But in the study that was published in JAMA, there was a group of Finnish men that were followed for about 20 years and they found 40% reduced mortality in the men who have saunas four to seven times a week versus people who have saunas once a week or less. There’s 40% reduced mortality, 50% reduced mentality or cardiovascular disease.
Dr. Fitzgerald: That’s great.
Dr. Gottfried: That’s quite profound. And that’s thought to be the heat shock proteins that get activated. And that turns on the FOX03 gene, which is one of your longevity genes. It helps clear out the gunky proteins that you have in your bodies. So this is a really good thing.
Dr. Fitzgerald: That’s a nice study. And I’m sure that we’ll see more as attention is brought to these concepts and which was yet another reason I appreciated seeing them because certainly we’ve been aware of these things and traditional medicine, natural medicine for time immemorial.
I just want to throw in this little cool factoid around the whole hydro therapy piece. I remember in med school learning about using warm water on burns. I don’t know if you’ve ever heard that.
About a month ago, I was frantically cleaning the kitchen and just tidying up before I left for work. And I picked up a metal lid off of a burner and it really scolded my hand. And I remember this idea that was introduced to me back in school to use warm water.
I decided to try it and I never blistered. I picked up an extremely hot metal lid and I expected a profound burn. I wasn’t sure if I would be able to actually type or to do any of the work that I needed to get done that day. I thought that my right hand would be out of commission. But there was no blistering and it healed almost immediately. So I thought I really need to do a literature search on this.
And sure enough, there it was. There was a much higher rate or faster rate of healing when they burned little mice unfortunately when they exposed them to warm water. I wanted to do cold. We immediately want to do cold. I want to stick my hand on the freezer, but just the vassal constriction effect, the long term. The pulsing hot and cold as you described is very different than just shutting circulation down completely by freezing one’s hand.
So it was something that I wanted to blog about. And I took a picture of my hand and maybe I will get to it, but it’s a little bit tangential, but interesting.
Dr. Gottfried: It’s very interesting. I didn’t know about that. So you are teaching me something new. I love it.
Dr. Fitzgerald: Yeah. And they’ve actually studied it. Okay, so toxins, let’s just circle back to toxins. You covered a lot of them in the book. And you emphasized clean source alternatives frequently. Are there any particular bad actors that come to mind as what you’re going to be addressing in your patients immediately?
Dr. Gottfried: Oh my gosh.
Dr. Fitzgerald: I know.
Dr. Gottfried: We haven’t talked that much about endocrine disruptors and I feel like this is the elephant in the room when it comes to hormone imbalance whether you have weight loss resistance or not.
A common problem that I see and this is in the literature as well is that you go on a diet and you lose weight maybe 10 lbs and then you just hit a wall and you hit a plateau. And it’s very common that in that situation, you started to burn fat and you released all these endocrine disruptors that are stored in your fat tissues.
Dr. Fitzgerald: Right, that’s right.
Dr. Gottfried: So you have to have a method for getting rid of these endocrine disruptors. So what are some of the worst players? I think the average woman applies about 515 synthetic chemicals on her skin every day and I think the skin is a really important place to be thinking about where you might be exposing yourself. Most people have bought the message that they need to eat organic food so they have less of pesticide and herbicide pollution, but they are still putting toxic shampoos or nail polish on.
There was just a study released from Duquesne University a short while ago in collaboration with the environmental working group where they found that when you apply nail polish to your fingernails and this is the standard nail polish like Orby or Orly, you got a sevenfold increased level within 14 hours of metabolizing certain toxins that are in the nail polish. And the one that they studied in particular is called TPHP, triphenyl phosphate.
I think we’ve got to really demand these consumers that we have safer alternatives. I love finger nail polish and I actually always have a pedicure. And I use Zoya. Zoya is one of my favorites because it doesn’t have this particular toxin.
Another common source of toxins is conventional meat, especially from [inaudible 00:52:56] farms. And a lot of people are pretty aware of this. They are eating wild meats or they are eating grass-fed beef for instance, but they will go out to restaurant or they’ll travel and they will have a hamburger and just look the other way. So you got to think about that, about the conventional meat and how that is associated with an increased level of estrogen in the body because we’re constantly fighting this estrogen pollution and I want people to be aware of that.
Dr. Fitzgerald: Right. Right. There’s a study that I always site when I’m talking about toxins. I think it’s 2006, Lee et al. And they showed a dose relationship between diabetes and persistent organic pollutants. And the odds ratio in that particular study was 38, actually greater than 38.
Dr. Gottfried: Yeah.
Dr. Fitzgerald: So the association is just massive. And just like you said, when we start to lose weight, we liberate. So persistent organic pollutants, folks, we don’t move them out of our body, hence the name.
In fact, I always imagine it as our liver really. These are synthetic chemicals and our body looks at them and says, “What the heck do I do with this?” And so we immediately sequester them, “Put them in the fat. Just get them out of circulation because our liver just stumbles with this.”
However, we can move them from our body. Detoxification does work, but as you point out, weight loss liberates them, the so called second half life. And they have profound endocrine disruption capacity.
Dr. Gottfried: Yeah. I am glad you raised that study because I feel like that’s the one that really got the attention of the conventional physicians who have ignored the mounting data that we had on endocrine disruption and whatever problem it is, even in the diseases that they are seeing every day like diabetes.
Dr. Fitzgerald: Yes.
Dr. Gottfried: So for sure, you can disrupt your estrogen. You can disrupt insulin, leptin, androgens. We got a serious problem with the endocrine disruptors that we’re getting exposed to including the POPs, the persistent organic pollutants.
Dr. Fitzgerald: Right. But I was hardened. I don’t think that there had been – there hasn’t been enough good solid research around the detox part of cost that we employ and removing POPs. But just having worked at the lab for so long when we started to look at the toxins and we certainly looked at persistent organic pollutants, we would employ our own detox profiles and get baselines and follow up. And I’ve seen that our protocols work in expediting the removal of certain compounds that have decade or longer half life. So it’s time for us to hopefully – we will – organize and get this data out there.
So Sara, it’s been really wonderful talking to you and I could continue. It’s been such a pleasure. But we need to circle back. If clinicians are interested in learning more about your approach, obviously the first thing to do would be to get your books and to probably try what you’re recommending on themselves and with some patience.
But is there any way that they might learn your protocol, anything you would advice?
Dr. Gottfried: Honestly, I write my books with practitioners in mind. So I think there’s a lot for the clinician in my book. That’s certainly the reason why I’ve gone through about 2500 studies for each of my book so that they have the resources they need at their fingertips to go to the original data.
And that came from having patients bring books to me when I was first starting out and realizing that often this is the main place where you see these conceptual models that maybe were not seen in conventional medicine. So that’s one way.
If you’re on my list at SaraGottfriedMD.com, you’ll get information about our clinicians’ training. We’ve got training for hormone, natural hormone balancing that we teach usually every other year. We’ll probably teach it again in 2016. My third book is about epigenetics and how to slow down the aging process, so we’ll definitely have some teaching for clinicians there. So if you’re on my list, you’ll get information about it. I think that’s probably the best resource.
Dr. Fitzgerald: Great. And again, we will give you the various links that you need on the podcast page. All right, I hate to wrap up. It’s just been such a nice time chatting with you, but any final words of inspiration to clinicians or just people interested in living well.
Dr. Gottfried: Well, I think I can speak from having lived in a female body for 48 years. Yes, women are more sensitive to the environment. We’re more likely to have hormone imbalance. It is easier for us to gain weight. It’s harder for us to lose weight compared to men.
But it also presents us amazing opportunity when you understand the differences between men and women and to leverage that sensitivity, that high sensitivity that we have so that it can serve you better. And another way to put that is it’s so much easier to get your hormones back into balance than to live with the misery of them being out of balance. So I think that’s my last piece of wisdom to share with people.
Another last piece that I’m working on right now is the power of community and collaboration and accountability. So if you are interested in the Hormone Reset Diet whether you’re a clinician or a consumer, come join us. Come do the detox with us. Come do the Hormone Reset Diet with us. You can learn more at HormoneReset.com/detox.
So we teach it a few times a year and we just know that the results are twofold to threefold better when you do it in a group with a start date.
So those are my last words of inspiration. It’s been so fun with you. I just really appreciate you so much.
Dr. Fitzgerald: I can’t wait until our paths cross in person again as they will. Your detox will be, as you say, addressing cell to cell. Thanks, Sara.
Dr. Gottfried: Yeah. We all need to do that.
Sara Gottfried, MD is the New York Times bestselling author of The Hormone Cure and The Hormone Reset Diet. After graduating from Harvard Medical School and MIT, Dr. Gottfried completed her residency at the University of California at San Francisco. She is a board-certified gynecologist who teaches natural hormone balancing in her novel online programs so that women can lose weight, detoxify, and slow down aging. Dr. Gottfried lives in Berkeley, CA with her husband and two daughters.
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