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By far one of my most wide-ranging conversations on New Frontiers, Dr. Sara Gottfried and I set out to talk about her new book Brain, Body Diet and quickly headed north. Listen to our lively, personal, smart, heart-felt conversation as we dive into her experience using a continuous glucose monitor to address fairly severe nocturnal hypoglycemia, her thoughts on addictions and genetics, taming the dopamine-deprived COMTer, and lots of women’s health.
You know that Sara is, of course, extraordinarily bright, but she’s also an open book in a lovely, inspiring way. For instance: How would a concussion, obtained through a dearth of self-care plus wine, lead to the Brain Body Diet? Besides the obvious connection, Sara describes a personal reckoning and rebirth that I can certainly relate to.
If you are enjoying what you hear on NFFM, PLEASE leave a review wherever you’re accessing this podcast.
~DrKF
The gut-brain axis has become a prominent area of interest in recent years, with research suggesting both direct and indirect connections between the gut and the brain.
For Sara Gottfried, a board-certified physician-scientist and a three-time New York Times best-selling author, the gut-brain axis became the central focus in her life and in her practice after she experienced the psychological aftereffects of a course of antibiotics.
Her latest book Brain, Body Diet offers a deep dive on this subject with specific protocols for healing the gut and improving cognitive health depending on a patient’s unique circumstances. In this podcast, Dr. Gottfried talks with Dr. Fitzgerald about her own personal experience, as well as the latest research on the gut-brain axis.
In this New Frontiers in Functional Medicine podcast, you’ll hear:
- Relationship between antibiotic use and depression, anxiety, and other cognitive issues
- Relationship between antibiotic use and insulin resistance
- Importance of the gut-brain axis and how tending gut health may become especially critical for women (and men) over age 40
- Why alcohol is harder for the body to process as we get older (it relates to more than just the process of liver detoxification)
- Limits in our current understanding of the microbiome
- Treating patients with refractory gut issues
- Dr. Gottfried’s preferred lab tests
- Benefits of continuous glucose monitors and preferred brands
- Men’s and women’s unique responses to the ketogenic diet
- Genetic factors involved in blood sugar control
- Different phenotypes of blood sugar regulation
- Nuances and limitations of using HbA1c as a measure of long-term blood sugar control
- Why fasting insulin trumps fasting blood glucose as a measure of overall blood sugar stability and metabolic health
- Importance of prebiotics in building a healthy microbiome
- How addictive tendencies manifest in women
- Concept of behaviorceuticals
[embed_popupally_pro popup_id=”28″]
Sara Gottfried, M.D., is the New York Times bestselling author of The Hormone Cure, The Hormone Reset Diet, and brand new, Brain-Body Diet.
After graduating from the physician-scientist training program at 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 feel great. Dr. Gottfried lives in Berkeley, CA with her husband and two daughters.
Connect with Dr. Sara Gottfried on Twitter, Facebook, and at SaraGottfriedMD.com.
Gottfried Institute
2625 Alcatraz Avenue
Suite 369
Berkeley, CA 94705
(888) 893-6586
Dr. Kara Fitzgerald: Hi, everybody. Welcome to New Frontiers in Functional Medicine, where we are interviewing the best minds in functional medicine, and sometimes, the most amazingly superb minds are back with us. And, such is the case today, where I’m just really, really delighted to be talking to just a wonderful woman who’s become a dear friend of mine, and also whip smart inspiration for so many of us.
I’m talking about none other than Dr. Sara Gottfried. As you know, she’s a board-certified physician-scientist, and a three-time New York Times best-selling author. She graduated from Harvard Medical School and MIT. She completed a residency at University of California at San Francisco.
Over the past three decades, Dr. Gottfried has seen more than 25 thousand patients, and specializes in identifying the underlying cause of her patients’ condition to achieve true and lasting health transformation. Not just symptom management. She’s a wife, a mom, a researcher, a certified yoga teacher, and so much more. Her books, as I know you’re familiar with. In fact, go into our podcast archives and listen to where I’ve talked to Sara before. She’s written The Hormone Cure, The Hormone Reset Diet, Younger, and her latest book that we’re going to be talking about today is Brain, Body Diet.
Dr. Sara Gottfried, welcome, and a big virtual hug to you.
Dr. Sara Gottfried: Hey, Kara. So happy to be here.
Dr. Kara Fitzgerald: First of all, you know, you and I were just talking. You’re a real, authentic human. You know, our very first conversation was going on six years ago. And, I was actually interviewing you a long time ago, and as I was just … It was a pivotal conversation. Part of it was because you were so authentic. And, you actually kind of shared some truths with me. I mean, I had just done a red0eye flight, and I was just lying on the desk slumped over, attempting to pull out a cheery self for this interview, and you called me on it.
You’re like, “What are you … ” Like, “Why are you even in your office, Kara?” But, it was this conversation, I had just met you, and it was your authenticity that drew me to you, and continues to just really make me love and appreciate this brain-heart of yours. So anyway, on that note, talking about Brain, Body, Diet, you share an incredibly authentic story that kind of led you to the book. And I just, I want you to talk to me about it here.
Dr. Sara Gottfried: You got it. And thank you for that. I mean, I feel like too often, as physicians, as practitioners, we set up this front of kind of having it all together. You know, like, here’s the seven steps to burn your belly fat. And, I think the truth is that, so many of us struggle with many things, whether that’s a relationship, or the way that we’re feeding ourselves. Not just nutritionally, but emotionally. And so, I do think that sharing our vulnerability is such an important part of transformation.
So yes, this book was very interesting, because in 2015, I set myself up for a fall.
Dr. Kara Fitzgerald: Yeah.
Dr. Sara Gottfried: And, I wonder for our listeners, if maybe you’re doing this to yourself. So, I set myself up for the concussion that I had. I had hardly paid attention to my body. I’m much more, or at least, I was, much more like a dictator, like a drill sergeant. Like, okay, you’re going to do this 10-hour live stream in San Diego. You’re just going to march through it. Even if it’s a death march, and you don’t get to eat and you don’t get to pee, like, you’re just going to do it. And, you’re going to show up, and you’re going to give 110 percent. That’s just my style. It’s kind of my personality.
Dr. Kara Fitzgerald: Yeah.
Dr. Sara Gottfried: So, what happened was, I was standing in the kitchen at 10:00 p.m. with a group of friends that I did this live stream with, and they’re many people that you know. Alan Christianson, Srini Pillay, Dave Asprey was there, J.J. Virgin. There was a group of people, and I hadn’t eaten all day long.
Now, I know that I have dysregulation of the HPATG, hypothalamic-pituitary-adrenal-thyroid-gonadal axis. I know that I have issues with the way that cortisol and insulin talk to each other. I know that I have a tendency toward hypoglycemia. In fact, I’ll just foreshadow that. I keep texting you photos of my continuous glucose monitor, and these episodes of hypoglycemia that I have, that can dip below 50.
So, I’m standing there in the kitchen. We’re trying to decide what to eat after 10 hours of filming. And I fell. I passed out. I hit my head on the back of a stove, and then on the floor, a cold tile floor. And, what was scary about that, there were many things that were scary. But, what was really scary was that, I woke up, and then I had what looked to the doctors in the room to be seizures. So, I had these tonic- clonic movements. And so, that’s when they called an ambulance.
And so, I ended up in the ER. They attributed this to hypoglycemia. And, I then had a pretty moderate to severe post-concussion syndrome afterwards, where I had trouble with balance. I had … You know, what mainstream medicine told me to do was to lie in a dark room and not get stressed. Which, you know, is what they tell you when they have no idea what else to tell you.
And so, I talked to various functional neurologists who gave me some more helpful information about how to deal with the neuro-inflammation that I had. And, that’s what really got me started with looking beyond the portal that I have where, I look at functional medicine starting through the lens of hormones—hormone disruption, hormone dysregulation—and it got me to look beyond that and to really understand, okay, what’s going on with neuro-inflammation? What could I be doing to prevent it? How could I stop it in its tracks? And, that’s what led to this book, Brain Body Diet.
Dr. Kara Fitzgerald: That’s extraordinary. What are the … I mean, what are the nuggets that you want us to glean?
Dr. Sara Gottfried: Well, there’s a few nuggets. I would start first with, let’s connect the dots between brain and body, because mainstream medicine is not going to do it for you.
Dr. Kara Fitzgerald: Yeah.
Dr. Sara Gottfried: So, I’ll give you a quick example. In 2017, I went through surgery for the first time. I took a course of antibiotics for this surgery. And, when I finished the course of antibiotics, what I noticed were two big changes. The first was that I felt anxious for the first time in my life. And, you know me. I’m not an anxious person. I’m pretty calm.
Dr. Kara Fitzgerald: Yeah, yeah.
Dr. Sara Gottfried: And then, I had fat gain. And, I track my body composition pretty carefully. So, this was, like, 15 pounds of fat that kind of showed up in a short amount of time.
Dr. Kara Fitzgerald: Wow.
Dr. Sara Gottfried: So, I had insulin resistance. I had an elevated hemoglobin A1C. My fasting glucose was higher. My insulin was higher. And so, this got me to connect the dots for myself between brain and body, and realize that oh, when you look at the literature, one or more courses of antibiotics is associated with a 15 to 44 percent increased risk of anxiety. One course of antibiotics or more is associated with a 23 to 50 plus percent increased risk of depression. It’s associated with insulin resistance, auto immunity, issues with learning and memory. And so, that was the way that I connected the dots between brain and body.
And then, as I started to look at it in my patients, I could see it everywhere I looked. And I know, Kara, you actually do this. I would presume, this is the lens from which you practice functional medicine. But for me, as a gynecologist, it wasn’t really the first place I looked. It’s more the second and the third place that I looked. Like, what’s going on in the gut? What’s the gut microbiome, brain axis?
Dr. Kara Fitzgerald: Yeah.
Dr. Sara Gottfried: So, that’s one of the main points of the book. I mean, ultimately, this kicked off an N of 1 experiment I had. I was diagnosed with SIBO. I did microbial testing, looking at the microbiome before and after the course of antibiotics. And, I had a loss of about 87 percent of my microbial diversity. I had increased intestinal permeability. I had all the hallmarks of a disrupted gut-brain axis.
But, I would say, a second point is that, the female brain is really, completely different from the male brain. We’ve got a different set of biological imperatives in order to feel our best, especially as we get older. Estrogen is the master regulator of the female body. And, I think in some ways, women need a wake-up call about this. Because after the age of 40, the gut brain-axis really is in trouble.
Dr. Kara Fitzgerald: Yeah.
Dr. Sara Gottfried: And so, I think we have to pay attention to this. And, we know that if you just look at images of the male versus female brain, you can tell with about 85 percent certainty whether one is male or female. Now, I live in San Francisco, so I’m a little cautious about saying this with gender non-binary terms that we use now, but this is at least what we know from the literature.
And then the last point is that, and I think you’re already on board with this, if you want to correct the gut-brain axis, or brain-body disconnection, you have to use personalized lifestyle medicine. No prescription pill is going to do it for you.
So, I would say, those are the three main points of this new book.
Dr. Kara Fitzgerald: It’s extraordinary, Sara. And well, and also, you know, just thinking about what you’ve just said where, you’re widening your lens … You know, our original conversation, which, incidentally, folks, if you’re interested in hearing Sara’s therapeutics, and I think we have it in our show notes, around how she does address hormone imbalances, it’s a really clinically friendly podcast. But, in this case, you know, you couldn’t get here from there. And, you widened your lens into this extraordinarily foundational conversation, which, although you paint it with really good evidence. You know, talking about the change in the blood brain barrier as we age. And that, actually, that was kind of an aha for me in the book.
So, you know, it’s a little bit more permeable, and that is the mechanism around not tolerating alcohol, which, as I was telling you, that’s kind of ironic, I told you I don’t drink anymore. I haven’t for years. And that was the … I used to like to drink quite a bit. But, I couldn’t handle it.
Dr. Sara Gottfried: Yeah, alcohol hits a lot harder after 40.
Dr. Kara Fitzgerald: Yeah, it sure does.
Dr. Sara Gottfried: And, I think a lot of people don’t understand the rationale behind it. It’s not just your liver enzymes and what’s going on with liver detoxification. It’s also this more permeable blood-brain barrier. So yeah, I think that’s such an important part of this conversation. And, as I’m sure our listeners know, those tight junctions that we have, that maintain our intestinal integrity are very similar to the tight junctions that we have in the blood-brain barrier.
Dr. Kara Fitzgerald: And, addressing this very foundational piece, the body brain, I like that. Are you calling it … Excuse me, the brain body. I guess you could go either way, brain … Well, no. Maybe, I’m sure you chose brain body specifically, that this term that you coined is going to obviously and profoundly impact the HPA axis without question.
So, Sara, you and I have been dialoguing about blood sugar. It’s been a good conversation. It’s pretty profound to me. And, I know you’re just a data hound, so you track carefully. And, I have also experienced anxiety induced, antibiotics induced anxiety. But, the fallout that you’ve observed over time is just tremendous with the increase in insulin and … So, I think you already had that bias. You have a … And really, honestly, we all are biased towards marching down the metabolic continuum towards diabetes, if we’re not, if we live in this culture. But, I think you would probably say that even before that antibiotic experience, you might have been biased towards met syn.
But then, adding the antibiotics and doing the tracking that you’ve done, you really saw it take off.
Dr. Sara Gottfried: I saw it take off, and I could actually watch it take off, because yes, I was attuned to this. I mean, especially at that time, I was, I think, 49. And what I knew was that, I had a tendency toward blood sugar dysregulation, not so much due to my food, because I’m so careful about my food. But because of stress and just, I’m like, programmed to be a sentry. I’m programmed to survey the horizon and look for danger and threat. So, I think I probably got a pretty big amygdala.
I know that I’m just really sensitive to environmental ques. So yes, I knew that before I took the course of antibiotics. And you know, one of the studies, I think it was Lurie, L-U-R-I-E, 2015, that showed this association between one or more courses of antibiotics and the diagnosis of anxiety, the diagnosis of depression, multiple courses being associated with the higher range that I gave you, 44 percent with anxiety, 53 percent or something with depression.
But, what I saw as I turned this into an N of 1 experiment, which is something that all of our listeners could be doing with their patients. What I saw is, I did my base case microbiome testing before the surgery, before the antibiotics. And then, I did it after I completed the antibiotics, is that, there were certain bacteria that just disappeared.
I lost all Akkermansia.
Dr. Kara Fitzgerald: Wow, interesting.
Dr. Sara Gottfried: I lost all B. Longum I mean, like, nothing, zero.
Dr. Kara Fitzgerald: Oh, no, wow.
Dr. Sara Gottfried: So, I can’t say that those are the cause, you know, that the antibiotics wiped them out. But, it’s sure an interesting result to be tracking. So, yes, I think it’s important to be tracking the science. I wish we were at a place where we could say A causes B, causes C when it comes to the microbiome. I don’t think we’re anywhere near to that point. I think we’re still at the learning to crawl stage.
But, when you do N of 1 experiments, you can start to see, okay, here’s where I turn the corner when I took that course of antibiotics. And, it just got me … To me, this is not some huge problem that I had. It’s more that, it’s kind of the next sacred message that I’m meant to decode, and to really understand it, kind of bring my best original mind and thinking to it, and then write about it and share it and teach it.
Dr. Kara Fitzgerald: Yes, that’s right. So, and that’s what this book is. This is your decoding journey.
Dr. Sara Gottfried: This was my decoding journey. But, it’s also, you know, it’s not just me. Because, I’m not so great. It’s also the rising prevalence that I’m seeing in my practice of patients with anxiety. And, noticing the way that I was taught in my mainstream medical training was that, you take patients with anxiety and depression, you know, you give them a few lifestyle tools, and then you ship them off to mental health.
And, I think that paradigm is completely broken. And, we have to be thinking about how the brain-body is talking to each other. Like, what can we do to support the microbiome? To support the gut-brain axis, and to help our patients who have, would have been designated in the past as mental health issues. Alongside, in parallel, integrated with our treatment of their SIBO or their hyperpermeability of the intestinal lining, or even their disruption of the hypothalamic pituitary adrenal axis.
Dr. Kara Fitzgerald: Mm-hmm (affirmative). I guess, the other piece I want to, you know … You mentioned anxiety, and it’s one of the fundamental motivations behind this book, or you know, just the massive incidence of it, particularly among women. But really, anything that … I mean, we can cast the wide net with the chronic issues that we see in our culture germinating from this fundamental piece that you’ve outlined in your experience of taking the antibiotics.
Like, for instance, the fact that your diet is impeccable, and I know it is, because you and I have talked about it quite a bit. And, you have some pretty profound blood sugar dysregulation if you’re not exquisitely dialed in. We see that more and more in our practice. And, we also see these really refractory guts. And, it’s beyond, it is quite beyond, even though the habit and the push of our culture is towards what are you actually eating, I think … And certainly, that is playing a role in some of our patients, but more and more, we’re seeing it … Like, for you, the stress role is the big piece. And then, layer into that antibiotics and disrupting your microbiome and so forth, and your barriers, your brain and your gut barrier.
But these so secondary pieces, these other pieces of the puzzle are as profound. I mean, I shouldn’t say that they’re secondary, but we’ve always thought of them, historically, as secondary, when in fact, now, they’re much more front and center.
Dr. Sara Gottfried: They are front and center. So, I like that you’re kind of broadening the perspective here, and I agree with you. I think so many of the chronic issues that you and I are facing, and our listeners are facing, need to be considered in this context. So, I’ll just maybe, get a little bit more contextualized here.
So, when it comes to neuroinflammation, what I could see those pointing to was not just anxiety, depression, maybe some early memory loss issues with learning. It’s also brain fog. I think brain fog is one of the first symptoms of neuroinflammation.
It also maps to addiction. Addiction is something I’ve struggled with. I’ve talked about it in my books, especially my issues with food addiction, and then kind of borderline orthorexia. I think it maps, certainly, to early subjective cognitive decline. And then later, to the scarier diseases, like Alzheimer’s disease, like diabetes and so forth.
Dr. Kara Fitzgerald: Mm-hmm (affirmative).
Dr. Sara Gottfried: And, I like that you brought up this point about refractory guts, because as someone who is trained as a surgeon, as someone who has … You know, I spent the first half of my career treating women who had things like endometriosis and polycystic ovarian syndrome, and infertility. And, generally, what I found is, I could make a few tweaks and my patients would get better.
When it comes to the refractory gut issues, oh my gosh, like, this is the bigger project. Like, this is the project that takes a few years. It’s not a matter of throwing some glutamine at the problem and hoping in six or 12 weeks time, that the patient’s better.
It’s a much more complex interplay in that role between patient and collaborative clinician.
Dr. Kara Fitzgerald: Yeah. First of all, I just know that people are going to be wondering what lab you used. That’s kind of pedestrian in our conversation, but people are going to want to know. What microbiome test did you use?
Dr. Sara Gottfried: Yeah, so I’m always a little cautious about this, because I don’t like to go with just one lab. I can tell you, I’ve ordered a lot of different labs over the two years since I had … Well, actually, it’s longer now. Two plus years since I had the course of antibiotics. When I took a look at where we were in 2017, I sent off a few different labs. First, I used the American Gut Project, so I think that Rob Knight is probably the leader in this field. I think he really understands the limitations of microbiome testing, and he’s honest about them, and I appreciate that.
Dr. Kara Fitzgerald: Yeah, yeah.
Dr. Sara Gottfried: I also did a series of viome testing, and I don’t want to speak badly about viome, but I would say there’s less scientific validity behind at least, the results that I got from viome.
Dr. Kara Fitzgerald: Okay.
Dr. Sara Gottfried: I did a lot of different OAT testing. I found that to be really helpful, especially with diagnosing my small intestinal fungal overgrowth.
Dr. Kara Fitzgerald: Interesting, organic acid testing, when you say …
Dr. Sara Gottfried: That’s right. And, I did GI Maps. I found that really helpful, especially with quantifying some of the Homer Simpson type of bacteria, like Pseudomonas, E. Coli, and others. So, those are some examples. And then, there’s some really basic tests here, too. The foundational tests that I used to do when I was seeing 30 to 40 patients a day, and that includes just simple measures of inflammation.
Dr. Kara Fitzgerald: Mm-hmm (affirmative), yeah.
Dr. Sara Gottfried: Looking at glucose metabolism, fasting insulin, fasting glucose, hemoglobin, A1C, although after wearing a continuous glucose monitor for the past year, I have to say, I think those tests are in the dark ages. And then, looking at kind of basic hormone profile, I tend to do a lot of dried urine testing, but I still do some serum testing, too.
Dr. Kara Fitzgerald: Yeah.
Dr. Sara Gottfried: And so, that’s looking at various points in the HPA pathway, as well as thyroid function and gonadal function.
Dr. Kara Fitzgerald: And, what continuous glucose monitor are you using? I know you’ve added those, as well.
Dr. Sara Gottfried: Yeah, so there’s three different companies that make continuous glucose monitors. There’s Dexcom, there’s Abbott, and there’s Medtronics. I haven’t used that one. And, I’ve always used Abbott. I’ve heard, at least when I started wearing these about a year ago, the calibration was the easiest with Abbott. Dexcom has since come up with a couple of versions like the Dexcom. I think it’s a G6. I think they even have a G8 now, which doesn’t require as much calibration. And, it’s the one that Peter Attia swears by. In fact, he’s got a podcast where he interviews the CEO of Dexcom that I think is outstanding.
Dr. Kara Fitzgerald: Wow.
Dr. Sara Gottfried: So, I tend to use Abbott. There’s some disadvantages there, too. One disadvantage is the cost. The economics of this doesn’t make a lot of sense. It’s used by a lot of bio hackers, but mostly, it’s only paid for when it comes to insurance for Type I diabetics, and occasionally, a Type II diabetic can get it paid for. I wish we could use it more broadly, such as gestational diabetes, or with people who are just trying to understand how their body is responding to the food they’re …
Dr. Kara Fitzgerald: Well, yeah, absolutely. I mean, I think the whole night imbalance with you that we uncovered was, or you uncovered, is profoundly important. And, I think, I totally agree with you, Sara. Sara has some hypoglycemic episodes, and I think particularly at night. And, I think that’s just going to be a game changer, that we’re going to see something like this. Perhaps it’s a cortisol or adrenalin-driven kind of hypoglycemic incidence. We’re going to just see these way more routinely. And, you know, as really big deals that need addressing. And, you don’t have metabolic syndrome or diabetes. So, I think we’re going to be ideally, using this in a much more broad way. Would you agree?
Dr. Sara Gottfried: I would totally agree with that. I mean, I think there’s so many places I want to go with this. I get excited.
Dr. Kara Fitzgerald: I know, I know. And, I hope it’s okay that I mentioned that.
Dr. Sara Gottfried: Oh, of course, yeah. I’m an open book. Anything I talk about with you, Kara, you’re welcome to bring up. So, there’s a few different points here that I think are interesting. One is, I did my continuous glucose monitoring, and I had a mainstream physician that prescribed it for me. At the time, I was going to Forward, which is one of the kind of clinics of the future that’s opened up around the U.S. And, the one that’s based in San Francisco has a lot of Silicone Valley funding. And so, it’s supposed to be doing some functional medicine, as well as integrating tech.
And, it was so interesting talking about my CGM results with my mainstream internist. Bless him, but he was basically looking at the way that I was dipping below 50 at night. And, his only question was, “Well, were you symptomatic?”
And, I’m like, “Do you mean was I in a coma? I don’t think so.” You know, don’t worry about it if you’re not symptomatic. And I just, I’m not going to buy that. I just don’t think that it’s healthy for our system to have such hypoglycemic dips.
Dr. Kara Fitzgerald: Right.
Dr. Sara Gottfried: Like, I think there’s something that could be done about it. And, as I dug a little deeper and talked to you about it, and sent you some screen shots, you were suggesting that I start experimenting with a meal or a snack before I go to bed.
Dr. Kara Fitzgerald: Yes.
Dr. Sara Gottfried: And, what I discovered was that, I did have some issues with the time-restricted feeding that I was doing. So, at the time that I had these episodes of nocturnal hypoglycemia, which were happening every single night, usually like clockwork at midnight and 3:00 a.m., I was following a 16/8 time-restricted feeding protocol, mostly pretty low carb.
Dr. Kara Fitzgerald: Mm-hmm (affirmative).
Dr. Sara Gottfried: But, I was finishing eating at, like, 4:00 p.m.
Dr. Kara Fitzgerald: Yeah.
Dr. Sara Gottfried: And what I did was, I did a two-week liver detoxification. I stopped kind of high-balling the pea protein that I was having every day. I did an elimination diet where I got off of nightshades and a few other things. And low and behold, the nocturnal hypoglycemia completely disappeared.
So, I liberalized my time-restricted feeding window. I’m now eating more like a 14-hour overnight fast, 10 hour eating window. And, that seems to agree with me better. And, there’s some data that Valter Longo talks about where, he thinks that that’s less stressful on the body.
Dr. Kara Fitzgerald: Yes.
Dr. Sara Gottfried: And, this gets back to kind of that drill sergeant personality of mine where, you know, I read 16/8 looks good. I looked at some of the randomized trials. And, I was like, “I’m in.”
Dr. Kara Fitzgerald: Yes, it’s … Yes.
Dr. Sara Gottfried: Sign me up for the early time-restricted feeding.
Dr. Kara Fitzgerald: Right, that’s right. Well, and you know, he talks about stress data. And, your body was. You were in like, you were in a hypoglycemic crisis at night from that. I mean, we’ll also see, we can actually see sort of, you know, cortisol liver, breaking down muscle at night. And then, causing these spikes in cortisol/adrenaline, breaking down muscle and see … Well, and you were actually going through this. So, a fasting blood sugar in you, if you didn’t have your continuous monitor, your morning fasting blood sugars were actually on the higher side, considering what you were doing dietarily.
Dr. Sara Gottfried: Oh yeah, pre-diabetes range. Like, consistently 105 to 115.
Dr. Kara Fitzgerald: Yeah, which is insane, unless you have the piece of information of what’s happening at night with your body. And, you were, if you were tracking super carefully, maybe you would see that you were losing a little bit of muscle, and da, da, da.
Dr. Sara Gottfried: Oh, I was. I was.
Dr. Kara Fitzgerald: Okay, well, there you go. I mean, and I see this in patients who are doing a ketogenic diet, which is fabulous. And then, layering in time-restricted eating. All good, but we’re just stacking on these interventions. And, until metabolically, we really struggle with it. Some of us do. Some of us do.
I mean, I think the take home in looking at the data and kind of chewing it over with you is that, it’s really individualized.
Dr. Sara Gottfried: It’s so individualized. And it’s also, I would say women are more vulnerable than men.
Dr. Kara Fitzgerald: Yes, that’s right.
Dr. Sara Gottfried: I see men who can get away with the ketogenic diet. They can get away with time-restricted feeding. They have the testosterone advantage. And, women are just more vulnerable. Like, they lose the luteinizing hormone signal.
Dr. Kara Fitzgerald: Yeah.
Dr. Sara Gottfried: If they’re not getting adequate calories, they switch into fat oxidation much more slowly than men do when it comes to the ketogenic diet. And, Jeff Volek has known this since 2004. Like, this is not news.
Dr. Kara Fitzgerald: Right, right, that’s absolutely right. Yeah, and if you’re prescribing the ketogenic diet as we are in practice, and you are, you’ll see this with women. Particularly post-menopausal or perimenopausal women. But I do want to say, Sara, and I think this is important, that it was a man that I was just talking about who layered in intermittent fasting on a kind of a keto leaning, Paleo diet. And, you know, he’s been impeccable. He’s been a patient of mine for years, and his A1C was up to six, and his blood sugar was high. I mean, this is a guy, he’s an athlete. So, it’s pretty extraordinary.
I think the duration of manipulating metabolism eventually causes anyone to face plant. So, you’re absolutely right. With women, we’re the canaries. You see it with us much, much quicker. But in that case, it was a man. And, I do think in our male patients, we will encounter that. They just may be able to be in that kind of a metabolically stressful place for a longer period of time before they crash.
Dr. Sara Gottfried: That’s right.
Dr. Kara Fitzgerald: And, the same thing for him. His prescription again was like, hey, you know, some nighttime sweet potatoes for you, buddy.
Dr. Sara Gottfried: What could be better?
Dr. Kara Fitzgerald: Yeah, right.
Dr. Sara Gottfried: Well, I think this is such an important point. I think you’re talking about sort of, those metabolic stress load. And, I agree with you. I think women have sort of a lower threshold than men do, but I think we all have a threshold. And, I used to … You know, I remember thinking about the gene environment interface, and I remember going back to 1989 to 1994 when I was at Harvard Medical School. And, we were so excited about the human genome project. We were hoping that okay, you know, with height, it’ll just be one gene that controls your height. When it comes to blood sugar, maybe it’s just five or six genes that control your blood sugar. We just have to figure out how to work around them.
Dr. Kara Fitzgerald: Right.
Dr. Sara Gottfried: No. You know, the truth is, there’s something like six thousands genes, gene/gene interaction.
Dr. Kara Fitzgerald: Yes.
Dr. Sara Gottfried: Transcription factors. This process is so complex, and we’re still in the early stages of trying to understand it. And, this approach of just kind of a simple, “Well, when I should just add some Omega 3’s, that’s an insulin sensitizers. That just doesn’t work for a lot of people.
Dr. Kara Fitzgerald: Right, right. I do appreciate, though, that we’re in extraordinary times. And, it’s absolutely thrilling to sort of, as Richard Lord says, my mentor, the PhD biochemist at the lab that I did my post-doctorate at, you know, embrace the uncertainty. You know, and we are. And, we’re just gathering so much data. And, I love it and appreciate it.
I just want to circle back. I’m curious, you guys we will link to the Forward Clinic that Sara mentioned earlier, because I’m sure some of you are wondering about it. And, the cost of your continuous glucose monitor. You probably, you had to pay out of pocket, I’m assuming.
Dr. Sara Gottfried: Well, so far, I got insurance to pay for it. I’m not sure how long that’s going to last.
Dr. Kara Fitzgerald: Wow.
Dr. Sara Gottfried: So, I love this idea of embrace the uncertainty, because I heard a talk at Jeff Bland’s Personalized Lifestyle Medicine Institute last October by Joel Dudley, and he’s got a great institution up at Mt. Sinai, Lab 100, that I really recommend for people in terms of quantifying health. And, he’s got some really interesting data on three different phenotypes of blood sugar dysregulation. And then, I’ve heard a talk more recently by Jessica Mega, whereas, she talks about five different phenotypes of blood sugar dysregulation.
So, I think you’re right, embrace the uncertainty. Like, this is the path that we’re on. We’re going to keep going. With your question about cost, we know that the cost of continuous glucose monitoring is probably somewhere around about seven to nine dollars a day. My monitor costs me about 35 dollars each, and if my insurance company is listening to me right now, they’ll probably cut me off. But, I was able to get it paid for by insurance because of these episodes of hypoglycemia. So, for whatever reason, Forward was able to get those through on my insurance.
Dr. Kara Fitzgerald: Oh, great, great. Well, it’s worth a shot, then, for us.
Dr. Sara Gottfried: It’s worth a shot. And you know, what a lot of biohacker clinicians do is, they just buy from Dexcom or from Abbott. They buy these CGM’s in bulk, and then they use them with their patients. You insert it yourself. As a patient, it’s actually pretty easy to do. It’s got a little applicator with a needle that sticks about a little less than a centimeter into your arm, and it’s … And then, the needle is withdrawn, so then, you just have this tube that’s about the size of a hair, that sticks in your subcutaneous, interstitial space. And, that’s where it’s measuring continuously your glucose level.
Now, let me say one other quick thing about Abbott. So, Abbott’s measuring glucose about every 15 minutes. Dexcom is measuring glucose about every five minutes. And, if you look at the work, say, of Michael Snyder at Stanford, he has open-sourced an algorithm that he’s used in his N of 1 studies.
Dr. Kara Fitzgerald: Right.
Dr. Sara Gottfried: He’s got 50 plus people that are in his N of 1 study where, he tracks 14 different ohms. And, he has a way of measuring glucotype where, he can divide you into normal, moderately disrupted, and severely disrupted. And, he can take the Dexcom data, which is every five minutes, and give you your gluco type. So, that’s also very interesting. I wish I had an algorithm that I could use with Abbott. I end up kind of roughing it. So, that’s another potential consideration between these different labs.
Dr. Kara Fitzgerald: Right, oh, it’s just so fascinating. And I just, I really appreciate you doing it. I was talking to the docs here in my clinic about it. In fact, you’re going to join us in our virtual clinic in a little while here and share some of your experience. And you know, we haven’t started using them in practice. And, I just, we’re sort of, we’re a little bit backwoods here, but I …
Dr. Sara Gottfried: It’s not back woods.
Dr. Kara Fitzgerald: Well, you’re …
Dr. Sara Gottfried: You have a reasonable amount of skepticism about how to use this. And, I think that’s a good process. You know, there’s the earlier adopters, people like Peter Attia and crazy people like me who are going to be trying to figure out how to use this.
Dr. Kara Fitzgerald: Yeah, yeah.
Dr. Sara Gottfried: But, I can tell you, even if I had to pay 200, 300 dollars for this device, I would. I would pay that every two months, because it gives me real-time feedback that is really hard to come by. And, it changes my behavior.
Dr. Kara Fitzgerald: Yeah.
Dr. Sara Gottfried: So, I’ll give you a quick example. My kids love acai bowls. We all know that acai bowls have way too many carbs. But, I figured, okay, I’ve got the continuous glucose monitor. I’m just going to go with my daughters and have one of these bowls. I ordered one that seemed reasonable. It had a lot of nuts in it, so I thought that would reduce the glycemic load. And, my glucose went from my base, which is about 80 to 90, up to above 200. And, it stayed there for a couple of hours.
Dr. Kara Fitzgerald: Right.
Dr. Sara Gottfried: But, that is not normal. I went on a trip to Dallas. I gave a seminar in Dallas earlier this month. And, there were some grapes in the room. You know, like, the hotel office left some grapes. And, I don’t eat grapes. And I said, “Well, whatever, species diversity, I’ll have some grapes.” So, I ate maybe, like, 10 grapes, and my glucose went up to like, 190.
Dr. Kara Fitzgerald: Wow.
Dr. Sara Gottfried: And so, it gives me feedback that is just so incredibly helpful, and it allows me to understand how it is the matrix of my body is responding to these environmental inputs.
Dr. Kara Fitzgerald: Yeah, that’s extraordinary. It’s very interesting. It’s very interesting to me. Well, let’s talk about … This has been kind of a fun, unexpectedly diverging conversation.
Dr. Sara Gottfried: As usual.
Dr. Kara Fitzgerald: Right, I know. It’s really, really, really interesting. And, I would love to use it myself, and I will. And then, kind of think about how we might bring it into our patient model. However, if you’re paying attention clinically, I mean, we can pick up on these clues. So, folks out there who may not be, who are not using it in practice yet, we are able to … You know, you could infer from Sara’s first morning glucose being really high, if you’ve got a good diet diary on her, that something amiss is happening at night.
Now for you, the fact that you dropped so low is profound. But, we can already be thinking about like, a dawn phenomenon. You know, there’s other pieces that we could think about and tweak, which we have, even without the continuous glucose monitor. So, there’s much much that we can do, even if we’re …
Dr. Sara Gottfried: That’s right, and we know … You know, I’ve been checking my cortisol for 20 years. We know that my a.m. cortisol is pretty high. Like, that’s a hard one for me to control. I can meditate it down to a reasonable level, and I take different adaptogens at night. But, I know my tendency is to have high cortisol in the morning. So, that fits with this picture.
Dr. Kara Fitzgerald: Yes.
Dr. Sara Gottfried: What doesn’t fit with the picture, what I want to kind of warn our listeners about is that, my hemoglobin A1C is 5.0.
Dr. Kara Fitzgerald: Yes, yes, yes, yes.
Dr. Sara Gottfried: Or less.
Dr. Kara Fitzgerald: Right.
Dr. Sara Gottfried: And so, that doesn’t capture. You know, what happens there is that, I’ve got these hypoglycemic swings that draw the hemoglobin A1C down. So, I think that’s a place where some people misinterpret.
Dr. Kara Fitzgerald: Ah, isn’t that interesting. Well, you know what? I see fabulous A1C’s frequently in … This is so interesting. I was talking to David Perlmutter actually, about this on the podcast I did with him not too long ago. I see fabulous A1C’s in women who are on the PCOS continuum for some reason. But, when you look at insulin, it’s off the chart.
Dr. Sara Gottfried: Yeah.
Dr. Kara Fitzgerald: Like, A1C in my experience … And, it’s probably not limited. I just, I have noticed a pattern, though. And, I don’t know why. It’s just something I’ve observed in practice. So, I always get a fasting insulin. And, I think, actually, a fasting insulin is, in my experience, really, more useful in addition to a fasting blood sugar and a handful of other markers. But, yeah, you can see a real clean A1C. But, is it? Could it be a surrogate marker for these serious hypoglycemic dips? I mean, that’s an interesting thought, Sara.
Dr. Sara Gottfried: That, and if you look at my insulin over time, another thing that I’ve seen is that, my insulin can swing up, and it can swing down.
Dr. Kara Fitzgerald: Yes, yes, that’s right. Yep.
Dr. Sara Gottfried: So, you know, I try to keep it … I don’t know what your goal is, but I try to keep it between three and five.
Dr. Kara Fitzgerald: Yeah, I think that’s a reasonable goal. I think the data suggests that’s reasonable. Yeah, for sure. Yeah, so, right, if you’ve got, if your body’s able to just dump a boatload of insulin out, you’re going to be tending to your A1C, and it’s going to be less reliable. Your A1C is going to look better. That’s right, yeah.
Well, let’s talk, I want to talk about, kind of in our closing minutes here, I want to talk a little bit about your book. The program that you’re recommending for folks. Some of the thoughts on rebuilding. And, you talk about this being a 40-day turnaround. Now, you mentioned to us earlier in this conversation how, it’s a journey. It’s a long-term journey of kind of nourishing your gut back to health and so on and so forth.
But, we know in practicing functional medicine that yes, it is this long, it is a long-term journey, and an enjoyable long-term journey, actually, because you feel pretty darn good doing it. But, we can make significant differences pretty quickly.
Dr. Sara Gottfried: Yes.
Dr. Kara Fitzgerald: And so, I think your suggestion of 40 days is entirely reasonable for somebody to anticipate noticing some differences. So, talk a little bit about what you’re recommending in Brain Body.
Dr. Sara Gottfried: Sure, yeah. I love that idea, because I think the turnaround actually has to be pretty fast, or else people are going to give up.
Dr. Kara Fitzgerald: That’s right.
Dr. Sara Gottfried: Especially if they’re not feeling well. So, there’s data showing that you can turn around hyperinsulinemia in 72 hours if you approach it correctly. I would say when it comes to estrogen as the master regulator of the female body, you can turn around estrogen signaling pretty rapidly. I don’t think it’s 72 hours, I think the studies say it’s probably four to six weeks. So, 40 days is a better fit there.
But, in terms of protocols, you know, you and I always have debates about protocols because functional medicine in some ways is anti-protocol. You know, the ideas that we personalize and that there’s not a cookbook method. But, I also think that we have to start with some sort of ….
Dr. Kara Fitzgerald: Yeah, yeah.
Dr. Sara Gottfried: So, when it comes to protocols, it depends on the symptoms that a patient has. If the issue is body weight set point or adiposity, there’s an approach that I have for that in terms of helping with neuroinflammation and with the hormones that regulate body weight set point.
When it comes to brain fog, especially mommy brain that happens after having a baby, when it comes to the hyper arousal associated with the steps that lead up to addictive tendencies, I’ve got a protocol to approach that. We talked about anxiety and depression, but I would say … and also, memory. Now that I’m over 50, that’s especially interesting to me. I never cared about it until …
Dr. Kara Fitzgerald: Yeah.
Dr. Sara Gottfried: … I turned 50.
Dr. Kara Fitzgerald: Right, I know.
Dr. Sara Gottfried: So, you know, it depends on what the condition is, but I would say there’s some basic functional medicine tenants here. It always starts with food. You know, and with what we know with great scientific rigor about how we might be able to positively influence the microbiome. And, I would say when it comes to the microbiome, what we know is that the best data is probably with prebiotics. With resistant starch. You know, the way that I used to think about probiotics when I first started to prescribe them 20 years ago was that, I used them as a replacement dose when people had a course of antibiotics. And then, I used them for various causes. And, there’s a lot of proven benefits to taking probiotics, but they’re not colonizing. We know that they’re probably modulating the activity of the microbiome.
And so, I think our understanding of how these protocols are impacting the body has really evolved over time. And then, sleep is such a foundational piece of all of these different factors. I think it’s so important for, especially disrupted blood-brain barrier. We know that melatonin is probably, the greatest salve that we have when it comes to hyper permeable blood brain barrier.
Dr. Kara Fitzgerald: Interesting, wow. Okay.
Dr. Sara Gottfried: And then, there’s lots of nutraceuticals. I’m happy to talk about those, but I also think that, just as a mainstream pill is not going to reconnect your brain and body, I think we have to be judicious about nutraceuticals.
Dr. Kara Fitzgerald: Mm-hmm (affirmative).
Dr. Sara Gottfried: And then, of course, exercise or what I think of as behaviorceuticals, and some of these mind body techniques that I usually won’t shut up about.
Dr. Kara Fitzgerald: Behaviorceuticals, I like that. So, people can grab … I recommend you look at, actually, all of your books. I think are incredibly useful, and there’s a lot of easy reference tables. And, you’re good at highlighting some of the really important statistics that we need to just be aware of. I want you … So, you’ve touched on addiction today. You’ve brought that up. And then, you just mentioned your approach to it. I guess, just in your final moments, we were talking about sort of food addiction, orthorexia.
How are you, or … Well, let’s say food addiction like a binge eating disorder, and then the flip side of that coin, orthorexia. But, just talk about that in the final minutes. Like, how you might address it.
Dr. Sara Gottfried: Sure. Well, I would say I had 40 years of food addiction before I got into recovery. So, I have a lot of personal experience with this. But, I think this maps to something bigger, which I’ve heard described by others as the pleasure trap. And that is, the way that you traffic dopamine in the body. And, I know from a number of different SNP’s that I have, for instance, the COMT SNP, that I have very little dopamine. Like, I chew through catacholamines really fast. And, that translates into not just addictive tendencies, but excessive thoughts, compulsive behaviors, a tendency towards self-harm, such as when I had my concussion, as well as what’s been diagnosed formally as attention deficit disorder.
But I would say, from a functional medicine perspective, we know that there’s micronutrient deficiencies that are really common and can lead to the pleasure trap. We know that it’s not just a psychological solution. We know that hyperarousal is a stress state of increased biological and psychological tension, and that’s what tends to lead to the obsessive thoughts of compulsive behavior, which leads to self-harm, which leads to addictive behavior.
So, the hyperarousal, things like agitation, anger, anxiety or panic, being easily startled, difficulty concentrating, fight/flight/freeze reactions, feeling overly sensitive or even numbed out emotionally. Feeling guilty or shame, flashbacks, gastrointestinal symptoms, diarrhea, constipation, irritable bowel syndrome, irritability, insomnia, lower pain threshold. And then, self-destructive behaviors, all of those things map to hyperarousal. And, I think there is a micronutrient pattern that we can see with that. You know, low B vitamins, probably issues with methylation, since I’m talking to the methylation queen.
And then, there’s a genomic component, too. So, I mentioned COMT, but there’s many others. There’s the serotonin transporter gene, SLC6A4. There’s FKA506 binding protein five, which has been associated with PTSD, especially in people who went through the 9/11 terrorist attacks, as well as the holocaust. There’s various dopamine genes, and even alcohol processing genes.
Dr. Sara Gottfried: So, I think we have to … When it comes to addiction, we’ve got such a crisis of, especially, opiate addiction right now, but other addictions as well, we need to look at it in this larger context. Like, how do we really have an integrative approach, and that was even the theme of our meeting at IFM just six weeks ago.
Dr. Kara Fitzgerald: Yeah, right.
Dr. Sara Gottfried: So, it’s hard to do it justice. Especially the 40 years of struggle that I’ve had and then 12 years of recovery. But what I know from taking care of mostly women over the past 25 years is that, yes, the literature tells us that something like five to twenty percent of women struggle with addictive tendencies with food. Whether that’s sugar cravings or can’t give up the cheese, or whatever it is.
Dr. Kara Fitzgerald: Mm-hmm (affirmative).
Dr. Sara Gottfried: And, I think that there’s a spectrum here, and there are people who struggle with okay, I know what to eat. And, I just can’t do it. You know, I get that 3:00 p.m. craving, or I want to pour a glass of wine at 6:00 p.m. Or, I just have to get that pint of ice cream out of the refrigerator, out of the freezer.
So, I think those are a few comments about addiction. I think you start again with your food so that you eat to cut cravings. You make sure that you’re getting the protein and the fat that you need. You have to rewrite your model for wholeness. I talk about this conversation I had with Bethany Hayes about wholeness. In fact, could I finish with a quote from Christiane Northrup?
Dr. Kara Fitzgerald: Yeah.
Dr. Sara Gottfried: Because I think she really speaks to this in a way that kind of stopped me in my tracks.
Dr. Kara Fitzgerald: Yeah, please do.
Dr. Sara Gottfried: So, here’s the quote from Chris Northrup.
“Women today are asked to be wholly in one place, and then go home and be wholly in another, with no model for wholeness. Unless there’s an ego strong enough to integrate the two, it leaves a hole in the center. And into that hole falls addictive behavior.”
So, I heard that quote many years ago. This is from page 175 of Brain Body Diet. And, it just, I felt like she had a webcam on me. Like, I felt like she just understood something kind of baffling and shadowy about me. I felt exposed. I felt understood. In terms of what women are up against when it comes to work and taking care of family and financial pressure, and raising children, and attending to spouses, and supporting aging parents, and you know, somehow we’re supposed to do that and fit into our skinny jeans and take time for self-care. It’s impossible.
Dr. Kara Fitzgerald: Right, right.
Dr. Sara Gottfried: We’re expected to be perfect at work and perfect at home. And, few of us are wise enough to see the conundrum, or even better, to refuse to buy into it.
Dr. Kara Fitzgerald: Right. Wow, that’s … Yeah, it’s extraordinary. I guess, so really, what you’re saying is, I mean, it’s first, just sort of witnessing. Like, that’s the beginning.
Dr. Sara Gottfried: Yes.
Dr. Kara Fitzgerald: And then, I think what you describe as this craving for dopamine, all of these addictive behaviors are like, “Let me get the brain dopamined up so that I can have some, so I can fill this hole.”
Dr. Sara Gottfried: Yes.
Dr. Kara Fitzgerald: You know, and so, that’s all of the behavior. And, I think the first step in this is this conversation, is just recognizing it.
Dr. Sara Gottfried: It is. It’s awareness.
Dr. Kara Fitzgerald: Yeah.
Dr. Sara Gottfried: It’s awareness of the social contract and how it’s screwing us.
Dr. Kara Fitzgerald: Wow.
Dr. Sara Gottfried: But, it’s also awareness of okay, I’ve got this … My DNA evolved on the Savanna, and it evolved to respond quickly and to make quick decisions, and to not have a lot of dopamine around.
Dr. Kara Fitzgerald: Yeah, right.
Dr. Sara Gottfried: And so, the fallout in our modern culture with abundant food is that, I’m going to eat to try to satisfy that dopamine hit.
Dr. Kara Fitzgerald: Yeah.
Dr. Sara Gottfried: So, I have to work around it. That’s awareness, acceptance of what I need to accept in terms of biological imperatives. And then, action. What’s the action?
Dr. Kara Fitzgerald: So extraordinary. I mean, honestly, now, being a new mom, you know, after I’ve been in a career for a long time and sort of just juxtaposing what you articulated. And, I guess, I know what you’re talking about. I mean, I’m facing that now. But, one of the most extraordinary things that I’ve observed in my short time as Mom is this, like, wellspring of guilt that didn’t … Sara, like, I didn’t even, that was a nonexistent entity in my life.
Yeah, you laugh because you know it. Like, every parent just knows it. It’s like, where the hell is this irrational guilt towards everything? I mean, coming up, it’s all around my child and what I’m not doing. It’s just such an extraordinary thing, but anyway …
Dr. Sara Gottfried: That’s right. Well, I’m laughing at the truth of it.
Dr. Kara Fitzgerald: I know you are. No, I know you are. I know.
Dr. Sara Gottfried: It’s so familiar. It’s so familiar.
Dr. Kara Fitzgerald: No, it’s so nuts. And, it’s just this strange thing that happened. I mean, I didn’t have it before. It was nonexistent.
Dr. Sara Gottfried: Yeah, kids do that. But, kids are also, they’re holding up a mirror that maybe you didn’t have before in your life.
Dr. Kara Fitzgerald: Yeah.
Dr. Sara Gottfried: Before we started recording, we were talking about our relationship, you and me, to food.
Dr. Kara Fitzgerald: Mm-hmm (affirmative).
Dr. Sara Gottfried: And how we don’t, like, we want to pass on a really congruent relationship to food to our daughters. And, I heard something else that I really liked which, I think, takes a little while to suss out, which is, regarding your wellspring of guilt and how it just comes from all sides and springs up from inside of you, I was told that when I have to choose between feeling guilty, or choosing to feel resentful, like, making a choice that’s going to make me resentful, I should choose guilt. Like, I should befriend guilt. And, I really like that. It’s served me well.
It doesn’t always work in terms of my choices, but for the most part, choosing resentment instead, like, making a choice that makes you just, like, stew and feel angry about it is what disrupts the hypothalamic-pituitary-adrenal axis. It’s what ultimately, leads to neuroinflammation. It pokes holes in the integrity of the gut lining.
Dr. Kara Fitzgerald: That’s extraordinary, yeah.
Dr. Sara Gottfried: So, I think that’s another way to deal with the guilt.
Dr. Kara Fitzgerald: That’s interesting. It is, it’s so toxic, resentment.
Dr. Sara Gottfried: Yeah.
Dr. Kara Fitzgerald: It’s such an interesting way to put it, Sara. You know, we just started upon a conversation that we’re going to continue. I just think it’s … Well, maybe because it’s high time for me to begin to unpack this authentic conversation around all of these emotions. You know, the drive towards dopamine, the whole addiction conversation. I mean, we’ve been living in more and more of a orthorexic world in some ways. And then, there’s the flip side of the coin where, it’s not. Where we see these epic addictions happening, the opioid crisis and so forth, as you brought up earlier.
Dr. Kara Fitzgerald: Anyway, it’s just time for … It’s just time for the conversation, and I’m glad that you’re such a courageous woman and spearheading it. And also, coloring it with your brilliance. And incidentally, I think that that’s another piece of the COMT mutation.
Dr. Sara Gottfried: You mean, that I have no filter?
Dr. Kara Fitzgerald: Well, you have no filter, but that you’re just, you’re smart and you’re thinking about stuff. And, you’re connecting the dots and bringing the literature into it. So, it’s just, you know, it’s like, it’s a kaleidoscopic kind of experience.
Dr. Sara Gottfried: Well, thank you. And, a lot of that is in partnership with you. And, this is all in the service of transformation. We’ve got to figure out, how do we serve our patients better?
Dr. Kara Fitzgerald: Yeah, yeah, that’s right.
Dr. Sara Gottfried: The way that we’ve approached addiction to this point has totally failed our people.
Dr. Kara Fitzgerald: Yeah.
Dr. Sara Gottfried: So, this is in the service of transformation. And, I’m always happy to be in conversation with you, Kara.
Dr. Kara Fitzgerald: Well, to be continued, Sara. As always, great talking to you as well. Thanks for joining me today.
Dr. Sara Gottfried: Thank you.
Dr. Kara Fitzgerald: And that wraps up another amazing conversation with a great mind in functional medicine. I am so glad that you could join me. None of this would be possible, through the years, without our generous, wonderful sponsors, including Integrative Therapeutics, Metagenics, and Biotics. These are companies that I trust, and I use with my patients, every single day. Visit them at IntegativePro.com, BioticsResearch.com, and Metagenics.com. Please tell them that I sent you and thank them for making New Frontiers in Functional Medicine possible.
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