Podcast Episode #79: The Hormone Cure with Dr. Sara Gottfried, Pt 1

We covered some great topics including:

• All paths lead back to cortisol.
• Dr. Gottfried’s great grandmother who inspired this journey… she was a “Paleoista”
• Women trying to do it all – the major downfall of our health
• There’s a time and a place for caffeine – why/how are you using it? Tuning in to our bodies and realizing if we are using it “medicinally” or not
• Yoga (or other similar activities) – the importance of it in balancing our lives
• Master hormones for women: Cortisol – Thyroid – Estrogen, Men: Cortisol – Testosterone – Thyroid
• Formulate 5 strategies to address your cortisol issues!
• Who needs to hit the pause button
• Ways to work on supporting your own cortisol right now:
• Tiara time (15 mins, 4x/week)
• Sexual stimulation
• Nutrition – kicking sugar out to create a good neighborhood in your body
• Phosphatidylserine
• Omega 3
• When women are more likely to experience low thyroid issues (two specific times in life)
• Go-Go-Go, Androgens, and PCOS
• Catabolic vs anabolic hormones
• Oral contraceptives – how it affects us and for how long
• The importance of testosterone levels in women
• Dr. Gottfried’s recommendations for birth control
• Rogue facial hair on women

Get your copy of Dr. Gottfried's awesome book, The Hormone Cure.

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LIZ WOLFE: Hey everyone, I'm Liz Wolfe. I'm a nutritional therapy practitioner and author of the upcoming book, Modern Cave Girl, available for pre-order on Amazon. And I'm here with Diane Sanfilippo, who is a certified holistic nutrition consultant, the woman behind Balanced Bites and of course, the New York Times Bestselling book, Practical Paleo. Remember our disclaimer: the materials and content within this podcast are intended as general information only, and are not to be considered a substitute for professional medical advice, diagnosis, or treatment. Welcome to episode 79 of the Balanced Bites podcast. We have a very special guest with us today, Dr. Sara Gottfried, author of the new book, The Hormone Cure: Reclaim Balance, Sleep, Sex Drive, and Vitality Naturally with the Gottfried Protocol. We're so excited to have her here, and we're going to jump into chatting with Dr. Gottfried, as well as get questions that you asked via Facebook and social media. But real quick, we'll just do a little bit of housekeeping. Diane, is there anything we need to share with our listeners?

DIANE SANFILIPPO: Can you hear me?

LIZ WOLFE: I can hear you.

DIANE SANFILIPPO: Okay, great.

LIZ WOLFE: Unfortunately. Ha ha ha ha.

DIANE SANFILIPPO: [laughs] So yeah, moved into the new place and I have to mute to make sure that the outside traffic. Once again, I have loud traffic outside. This happened, I think, when we first started podcasting when I was in San Francisco.

LIZ WOLFE: Yup.

DIANE SANFILIPPO: Living on busy streets. Anyway, I'll be doing some time travel, going back to the future as I like to call it, into another time zone where it will also be a whole other season. Liz, you and I joked about that over the winter when we hit So Cal, and we were just laughing that we had gone to summer. But anyway, so I'll be in Austin next week at PaleoFX, so once again, back in time and back to summer, which is crazy because it somehow managed to become winter again here when it was just about to be spring, so if anybody's looking for me next weekend, I will be in Austin at PaleoFX. Come out to the event. I think there's probably still some tickets for sale. So you can definitely find me there. I'll be speaking on a panel about women's health, so it's actually pretty great that we're doing this podcast today. And I think I'll also be doing a little bit of a Paleo 101 sort of basics talk and a cooking demo, which I’m really excited about.

LIZ WOLFE: Uh oh.

DIANE SANFILIPPO: Yeah. I'm really excited about that. So…

LIZ WOLFE: One day, they're going to let me do a cooking demo…

DIANE SANFILIPPO: No, they're not.

LIZ WOLFE: No, they're not. [laughs]

DIANE SANFILIPPO: So you just said a second ago, you were like messaging me that I was echoing. That's because I’m in an empty house.

LIZ WOLFE: You need some rugs in there, covering

DIANE SANFILIPPO: And I was talking really loudly. I need some more furniture. The other note I just wanted to make about last week's episode. You were away last week, I think. We're both in like these transitional moving times here.

LIZ WOLFE: Yeah.

DIANE SANFILIPPO: So last week's episode on simplifying the transition to Paleo, we've heard some feedback from a lot of folks that Dr. Scott's audio was cutting out, and I think…I thought that it was only for the first 10 minutes, but a couple of people said it was really kind of the whole time. Internet in western Pennsylvania will do that, so we're going to re-record that episode and post it up soon. We'll hopefully do that within the week or so. So look for that. You know, once this episode is live, I'm sure, that episode will have a new version, and we'll cover the same questions and all that, but there may be some more information that we get to, so even if you already listened, you may want to listen again. And thanks for the feedback on that one.

LIZ WOLFE: Yes, well, I…Diane, I will not be at PaleoFX this year.

DIANE SANFILIPPO: Boo.

LIZ WOLFE: Yeah. I know. Last year was fun. So yeah, I won't be at PaleoFX. Some people may know. One of the roles I take most seriously, much more seriously than say, my podcasting role, or, you know, my obscure movie quotes expert role is my role as supporter of and spouse to my military man. We have some changes coming up, as happens when you're living the military life. And these changes just happen to coincide with PaleoFX, so as much as I wish I could be there, last year was a blast, it's just not in the cards for this year. So miss everybody, but I know you'll all have a terrible time without me. So…

DIANE SANFILIPPO: I created a cardboard cutout of you to bring and kind of…

LIZ WOLFE: [laughs] A flat Stanley? ][laughs]

DIANE SANFILIPPO: [laughs] A flat Stanley of Liz Wolfe, and it's about 8 feet tall. I think it's pretty much like life-size.

LIZ WOLFE: Yes, life size. Exactly. The hair goes down…the hair is 4 feet long…

DIANE SANFILIPPO: Right.

LIZ WOLFE: And the flat Stanley is 8 feet tall. Okay. All right, well, let's…without any further ado, let's introduce our guest, who has been patiently waiting through all this jibber jabber, Dr. Sara Gottfried. Hi, Dr. Gottfried, how are you?

SARA GOTTFRIED: Hey, I'm really good, and it's not jibber jabber. I'm having a great time listening to you guys.

LIZ WOLFE: We're all girlfriends here on the Balanced Bites podcast. Well, I wrote a little bio for you, if that's okay.

SARA GOTTFRIED: Right on.

LIZ WOLFE: Yeah. All right, Dr. Sara Gottfried is an integrative gynecologist and a firm believer in treating the root cause of problems, not just the symptoms. We love that. 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 where she still serves on the faculty. She's board certified in obstetrics and gynecology, a teacher of the adjunct faculty at Touro University College of Osteopathic Medicine and a mentor to medical students in her integrative medicine practice, the Gottfried Center for Organic Gynecology. Dr. Gottfried delivers cutting edge women's health information to as many women as possible by using technology including teleseminars, group coaching, webinars and Facebook. Women today are incredibly busy, so delivering information in this convenient and easy manner also serves to raise oxytocin and reduce stress, which of course, is incredibly important, and the information Dr. Gottfried provides teaches women how to balance their hormones naturally, regardless of age and location. As a result, her innovative methods for sharing medical information make her a popular keynote speaker and podcast guest. Also a nationally recognized yoga instructor, Dr. Gottfried teaches workshops and online courses such as her Mission Ignition Sex Drive, an online program she developed to help women cultivate their vitality. Dr. Gottfried also conducts mentoring and Mastermind programs for practitioners to learn the Gottfried Protocol, her proprietary 3 step evidence based method for natural hormone balancing.

DIANE SANFILIPPO: Wow, when does she sleep?

LIZ WOLFE: Yeah, you're not busy at all.

SARA GOTTFRIED: [laughs]

LIZ WOLFE: That is awesome.

SARA GOTTFRIED: In between bites of Paleo, I have some sleeping.

LIZ WOLFE: Yes. What's like the number one thing that you are working to communicate to folks with your book? Or can it even be broken down that way? Is it just…there's so much information there, so much valuable information, especially for women. So, but what's your ultimate goal with this book?

SARA GOTTFRIED: Hmm, if you had to pick just one thing, I would probably say, that all paths lead back to cortisol. So I find that we've got that's epidemic of women and men who feel overwhelmed, and I really feel that much of this is hormone imbalance. And yet, we've got all these women who are running around blaming themselves for feeling overwhelmed, fat, anxious, bitchy, you know. They'd rather mop the floor than have sex with their husbands, and I want to change that. I want change that. So this book is about changing it. Stop blaming yourself. Let's see what's going on hormonally. Let's start there.

DIANE SANFILIPPO: Well, we're glad that we're able to talk with you about this today because we've got tons of listeners who have so many questions about this stuff, and we get these questions all the time, you know, asked of us, and we're not experts on this specific topic the same way that you are, so we're thrilled to be able to have this conversation. And I think, you know, what we'd first like to do is give a little bit of your journey, and you know, sort of your background about why this topic was just at the forefront in terms of just putting this in people's hands. I mean, the way I’m looking at this book right now is that it's going to empower women. It's going to give them the tools they need to figure out what's going on with themselves.

LIZ WOLFE: Not having to rely on one appointment with one doc going forward, just being able to use the information and be their own practitioner once they know of this.

SARA GOTTFRIED: Yeah, I agree with you. I really believe that we're our own best doctor, and I'm not saying that we should, you know, self-diagnose and deliver your own medical care, but I think we've got to step away from turning our power over to our physicians, and as you just described, you know, waiting for that one appointment. I think empowerment is a big part of the message of my book, The Hormone Cure. But you asked about what sort of drove this for me, and there's a couple things that drove it. I actually grew up with a great-grandmother who was a bit of a radical. In fact I might even say that she was an early Paleolista.

LIZ WOLFE: Ah!

SARA GOTTFRIED: Because she would show up at our house. I grew up in Maryland, and she would show up at our house, not with Barbies or candy, but with kale.

LIZ WOLFE: [laughs]

SARA GOTTFRIED: And, you know, she was an early yogini. She practiced yoga way before we had a yoga studio on every street corner, and she really believed that you don't find the answer to health in the bottom of a prescription pill bottle. She thought that she really find it in the way that you eat, move, think, and supplement. But honestly, I didn't understand her legacy until I was in my 30s. I'm 46 now. When I was in my 30s as a working mom, I was seeing patients as a gynecologist in what I would call McMedicine, and I think you know what I mean by that.

LIZ WOLFE: Wow, yeah.

SARA GOTTFRIED: I was seeing, you know, the 7 minute appointment, 40 of those a day. It was not fun. And I was a bit of a train wreck. I had a lot of belly fat, even though I felt like I was doing everything right with my food, and I was a runner. I had PMS and low sex drive. I would come home from a busy day at work, like many moms, and pour myself a glass of wine or two, and I just was really struggling with how I felt. I was 34 years old at the time, and I just felt like I was pushing a rock up the hill. And I felt too young to feel so old. I went to my doctor, and he offered me what I called vitamin P. He offered me Prozac, and that was a defining moment for me because I looked at that prescription, and he also said to me, you know, you need to exercise more and eat less. And that just made me feel so bad. You know, I was already blaming myself, and it just made me feel like, he was saying, you need more willpower and oh, by the way, why don't you take this nice antidepressant? So that was this moment where I flipped, and I said, okay, I'm not depressed. Like I don't think the answer is this prescription. Let me take a look at my hormones because I'm certainly feeling hormonal. And at that point, I realized that I had hormones that were out of whack. I had a high cortisol level that was dragging down my thyroid function, which is the master of metabolism, how you burn calories, and when I figured that out, I was able to turn it around. So I was able to fix my cortisol within 4 weeks, and when I did that, it also fixed my thyroid because these hormones talk to each other. And then I turned this way of working, kind of natural hormone balance with how you eat, move, think, and supplement. I turned that towards my clients. The next 10,000 women that I saw in my practice. And the results were extraordinary. So that's what led to me writing this book. You know, I was able to climb out of this hormonal hole that I was in, and then I wanted to share that with women, and have them, as you said, have more tools, not less, and to be empowered around this.

DIANE SANFILIPPO: I love what you said about having the prescription, but not actually wanting to fill it because I actually went through the same thing years ago, and I don't know…yeah, I was actually struggling with some weight loss resistance as well and had a prescription for some kind of anti-depressant, and I just remember…I don't think the doctor said to me, you should do x, y, and z with your exercise and nutrition, but I remember saying to myself, I knew enough for myself at that point, and this is years ago, that there was another way, and I should really look at what I was doing outside of that before I really turned to that as kind of the last resort, and it was kind of that realization that I really…I wasn't doing everything I could be doing, and I don't mean that in a “do more” the way that most women are trying to do it all, right? And I think it's really fascinating that you dug yourself out of that in about 4 weeks. That sounds amazing, and we have a lot of women who ask questions and one of the things we say is that they need to be patient because most of us are trying to hurry up and fix everything, or, you know, even with supplements, it's like they want things to happen in a week or two. And sometimes it's going to take longer. How can we get women to realize that, you know, the way that we're always trying to sort of do it all and just like kind of keep going and keep up with the Joneses is really doing more harm than good?

SARA GOTTFRIED: Well, I would say that's a central tenet of my book, and I'm really glad that you called that out because we know that women right now are busier than at any other time in the history of the world, and we're also the least happy. And I'm on a mission to change that because it's almost as if we've turned our power over to the iPhone, the connectedness, the rushing from task to task, and honestly, the cortisol…cortisol is that main stress hormone, and it rises when you're in a situation of feeling so stressed out, feeling so much in a hurry, and I think of cortisol as being the bad boyfriend hormone. And what I mean by that is, it's like the guy you dated in high school or college. You knew it was going to end badly. You knew it was going to, you know, blow up in your face, and you went there anyway.

LIZ WOLFE: Hahaha. Yup.

SARA GOTTFRIED: Yeah, cortisol's a lot like that. And this is one of those situations…you know, I know we've got some guys who are listening to us today, too. It's one of those situations where cortisol favors men. It makes me really sad to say that because I'm a feminist, but it turns out that cortisol really drags down the other hormones that really allow women to be able to rock their mission. So the problem here, the gap, is that in conventional medicine, you're not going to hear a lot about cortisol because conventional doctors look at cortisol as being a hormone that you should ignore unless you have one of two extremes. You either have complete adrenal failure, and your adrenals are these cute little glands in your mid-back that secrete cortisol as well as other sex hormones. They're about the size of a pencil eraser on top of your kidneys. You either have complete adrenal failure where you're not making any cortisol at all, or you have the other extreme, which is Cushing's Syndrome, where you have way too much. But the truth is, 98.5% of us are somewhere in the middle where cortisol is not in that ideal hormonal specimen place where, you know, you're either too high or too low or sometimes even both within the same day.

LIZ WOLFE: So I have to ask a question about this, and it's making me very sad. [laughs]

SARA GOTTFRIED: Yes, Ma'am. I'm prepared.

LIZ WOLFE: Okay, this kind of…I'm kind of joking, not really. It made me kind of terrified to keep reading when I saw the section title, High and/or Low CortisoLiz Wolfe: Stress Case? Is Life Without Caffeine Not Worth Living?

SARA GOTTFRIED: [laughs]

LIZ WOLFE: So please give it to me straight. Do I have to quit drinking my coffee? [laughs]

DIANE SANFILIPPO: That's Liz, by the way. I quit last summer, for the record.

SARA GOTTFRIED: [laughs]

DIANE SANFILIPPO: It's probably a topic every single podcast, we probably talk about it every week.

LIZ WOLFE: Probably.

SARA GOTTFRIED: Well, this is such a good question, and short version is, probably not. But let me unpack this a little bit. And Liz, you're working on your book, right? I mean, it's on pre-order right now on Amazon.

LIZ WOLFE: Yeah, I have about negative two months to finish it. [laughs]

SARA GOTTFRIED: Got it. I got it. I just went through that, so I know it well. So there's a time and a place for caffeine, and I'm not taking caffeine away from anyone who's trying to launch their book.

LIZ WOLFE: [laughs]

SARA GOTTFRIED: So probably you're going to be safe here. But here's what I think about when it comes to caffeine. Are you using it medicinally? Are you using it because you wake up in the morning from not having enough sleep and all you can think about is pouring a cup of joe? Or are you using it to kind of enhance your focus and to augment what is already working well in your body? You know, you're amplifying the positive. So there's plenty of biohackers out there. Sorry, I just let that slip because I'm here in Northern California, Silicon Valley is so full of biohackers.

LIZ WOLFE: I like it. Yup.

SARA GOTTFRIED: Yeah, there's plenty of biohackers out there who are using caffeine in a very effective, medicinal way. But then, I also find that many of the men and women who come to see me or work with me online are using it as a high interest loan, and by that, I mean, you know, they get up in the morning as I was describing. They don't feel restored. They didn't do that whole repair conversation that we want to be having every night. And they are so depleted that they need a cup of coffee just to remember who they are, and then maybe there's another cup of coffee, and that's the situation where you're taking out a high interest loan against your adrenal glands. And you're going to have to pay it back at some point. It does raise your cortisol although I think there's some debate right now about whether the rise in cortisol that happens when you drink caffeine, whether that is from the caffeine itself or is it from some of the other components of drinking coffee or tea. So with coffee, for instance, there's mold and mycotoxins that can actually raise your cortisol level. So that's the more nuanced answer. The short version is Liz, probably not. You can probably keep going, as long as you're not using it as a high interest loan.

LIZ WOLFE: I can't promise you that that's the case. [laughs]

DIANE SANFILIPPO: I think when you're finishing a book. I mean, everyone who listens to this podcast heard me talk about when I finished mine last year. I felt like I was going to die for about 3 months last year. Like I was really in a lot of pain. Just I couldn't even explain it, but I was taking out that loan. I mean, I was drinking coffee until 10 PM at night to be up until 2, 3, 4 in the morning working. And it was very shortly thereafter that I realized, it was time to just absolutely quit. Like cold turkey, probably a month after I finished the book. It was quitting time. So I think you might be onto something too about the difference between the coffee and the tea and some other components of the coffee because when I feel weird and jittery from coffee, I don't get that from tea, and I know there's obviously a lot more caffeine in the coffee, but I think there’s a lot of other components in the coffee that leave that kind of strange feeling. But yeah, Liz, did you have another question up here?

LIZ WOLFE: Well, this one was about yoga, and I guess it's the right place to throw it in here just because, you know, we're talking a little bit about cortisol, but yoga is clearly very important to you, Dr. Gottfried, and the cover of your book, you're holding a yoga mat.

SARA GOTTFRIED: [laughs]

LIZ WOLFE: So I wanted to get you talking a little bit about the importance of yoga in your life, and you know, a balancing protocol that involves more than just kind of focusing on what you're eating and what's going on inside your body, but the tasks that you're actually undertaking to stay safe, fit, and healthy like yoga.

SARA GOTTFRIED: Sure. Well, I…and I wanted to say, just very quickly, to Diane, you know, I just published this book, The Hormone Cure on Tuesday, so I hear you, and you, you know, you launched a New York Times Bestseller. You launched a revolution with Practical Paleo, so hooray for you…

DIANE SANFILIPPO: Thank you.

SARA GOTTFRIED: And I think, you know, you also did a beautiful thing that I just wanted to honor for a moment, and then I'll talk about yoga. You did a beautiful thing where you recognized, it sounds like a month out from after publishing your book, that you weren't using caffeine medicinally and so you made this decision to detox, which I think is exactly what we're talking about here. We're talking about attuning to your body, amplifying the innate intelligence, and what I heard embedded in what you just described is that you were able to do that once you had this book launched. So I just wanted to honor you for that.
So back to yoga. I had to become a yoga teacher about 11 years ago because I just couldn’t live with myself, and it was part of this whole program to get my hormones into balance. I mentioned that I got cortisol and thyroid back into that Goldilocks position within a month of not too high, not too low. And for women, I think about these hormones as being three main hormones. I like to keep this astonishingly simple. Three main hormones that you want to be working for you, not against you. And those are cortisol, thyroid, and estrogen. And for the guys who are listening, I actually call it your Hormonal Three AmigoSara Gottfried: cortisol, testosterone, and thyroid. But what I found was that yoga was a very helpful way for me to get cortisol into that Goldilocks position, and then to hang out there most of the time. So I also acknowledge that I have a lot of men and women who come to see me in my integrative medicine practice or work with me online, who are not going to go to a yoga class. You know, I'll start to mention yo-and they'll be like, oh, no, no, no. Like I get the bug eyes and so I think it's important for all of our listeners to come away today maybe with five strategies, sort of your top 5 strategies of how to dance differently with cortisol. So it doesn't have to be yoga, but yes, I'm a big fan of yoga. It's a system that really works well for me, but I can tell you, I'm not sitting on a cushion for an hour for each morning, chanting OM. Like that's not how I practice yoga. I do it in the afternoon, while my kids are climbing on top of me. I do it within my life, and I really get it to work within my life. But there's about 97 plus ways that you can get cortisol to work for you, not against you. And yoga's just one of them.

DIANE SANFILIPPO: I actually just wanted to kind of slip this one quick, I don't know if it's a question or really more of a comment, but in one of your 97 ways, I’m sure, as you've mentioned in your multi-factorial approach, are supplements. And I literally today just decided to reach back into my cabinet of supplements and reach for my adrenal complex that I took last summer after working on the book because I've got this…I wake up very alert, and then about 2 hours later, I feel like I could go right back to sleep, and It's just crazy, so you know, and because I like to make super practical and easy for people who are just at home right now. They might not have a cabinet of adrenal supplements the way I do to be able to reach into. But, you know, what would you say are your top5 easiest, you know, sort of quick start to calming down. You know, quick start to addressing the cortisol. Most important perhaps, but also just stuff that people can do starting now. You know, that they don't need to go anywhere or buy anything or do anything else for.

SARA GOTTFRIED: Sure. Well, just like I learned from my great-grandmother, what we're talking about here is how to get cortisol into the Goldilocks position, not too high, not too low, with how you eat, move, think, and supplement. That's really the basics of the Gottfried Protocol, which the book is about. So the first I would say is we got to figure out how to hit the pause button, and not everyone's going to want to do yoga. So I'll give you a couple of other strategies. The idea here is that most of us are quite good at pushing the pedal to the metal, and I think of that as being your sympathetic nervous system. It’s that part of your nervous system that is fight or flight. And when you're launching a book, for instance, you know, hats off to both of you. I think it sounds like, Liz, you're in that fight or flight space of pushing hard and Diane, you've recovered after launching Practical Paleo. But what I think about here is a race car driver, and how a race car driver just doesn't develop mastery from pushing the pedal to the metal. A race car driver actually develops mastery by figuring out when to hit the pause button, when to get the strategic pit stop, so that then they can win the race, but they're also pulling the car to the side to, you know, get the tires change before one of the tires blows out. So that's what we're talking about here. We're talking about how to hit the pause button, and the irony is that, so many women, men too, but women especially are wired to give until they drop, and the women who most need this, who most need to hit at the pause button and take a pit stop are the ones who feel like they absolutely do not have time.
So let me give you a couple of strategies here. One is what I call Tiara Time, and I think your listeners might like this one. So the idea is that you get a tiara. It can be a cheap plastic one. It can be, you know, rhinestones and super ornate. And you announce to your family. You know, I've got two kids and a wonderful husband, but I need a physical boundary where I put this tiara on my head, and I say, okay, I'm taking Tiara Time. I can't help you with your homework for the next 15 minutes. I'm going to go call a girlfriend. I'm going to take a hot bath. I’m going to just sit my butt down and look at a candle for ten minutes because I need that. I need that. So the prescription here is Tiara Time, 15 minutes, 4 times a week. Another strategy, and I hope this is okay with your listeners, is orgasm. Orgasm is one of the most effective ways to get cortisol into balance again. It also, by the way, bonus prize, helps make your thyroid more efficient. So I'm a big fan of orgasm. There's even a practice called Orgasmic Meditation, which is a 13 minute practice, you can get more into that if you want. I'm just going to give you a few headlines here.

LIZ WOLFE: Hold on. [laughs]

SARA GOTTFRIED: [laughs]

LIZ WOLFE: I just got to finish writing this note. Okay, go ahead, yes. Orgasms, yes.

DIANE SANFILIPPO: Liz is taking notes. It's like, I don't think that's like explicit, so we're good. We're good.

LIZ WOLFE: No, love it.

SARA GOTTFRIED: Okay, good.

DIANE SANFILIPPO: Go ahead.

SARA GOTTFRIED: Yes. I haven't said vagina yet, but I am a gynecologist.

LIZ WOLFE: Woo!

SARA GOTTFRIED: So another one…I'll give you a couple of food things. You know, one of the reasons why I love Paleo so much is that I really think it helps to balance your hormones and I hope we get a chance to talk about that a little bit. But I consider sugar to be one of those food components that is almost like a drive by shooting in the body. I want us to create a good neighborhood in the body, not a bad neighborhood, and I really consider sugar to be like a drive by shooting. So another idea here is just to cut out the sugar. If you're eating Paleo, then you probably have done this already, but we know that sugar raises your cortisol level, and then it raises your insulin, and then you're off to the races. You're in that vicious cycle of higher insulin spikes, cortisol spikes, you're laying down fat, especially at your belly where you have 4 times the number of cortisol receptors compared to fat elsewhere.
Another headline here, I'll give you a supplement, is one of my favorites, which is phosphatidylserine, PS, phosphatidylserine. It's one of those components of a cell membrane, and it's very effective at lowering cortisol levels. One other supplement I love is omega-3 for those of you who eat fish or you could also get a vegetarian source of omega-3. This has been shown to lower cortisol levels and also to raise lean body mass. That's been shown in both men and women. So I'm a big fan of those. Those are maybe my top 5.

LIZ WOLFE: So let's jump into then…you mentioned at the beginning of talking about how Paleo actually is helpful in balancing hormones. We have, you know, kind of the safe supplemental side, and then we have the food side. How what we eat is actually able to help us balance those hormones, which I suspect would be kind of the foundation of what you work from. Let's talk about how you use this Paleo idea in your practice to help people balance their hormones.

SARA GOTTFRIED: Absolutely. Well, I…you're right. I have been looking at men and women and how they balance their hormones for 2 decades now, and what I found is that the food is the most important piece, and yet it's also the piece that many folks want to bypass. And what I find is that you're far less likely to get a cure for your hormones if you bypass the food. So I think this is a really important part, and in fact, I would even say it's probably 60 to 70% of the whole hormone balancing equation. I have to agree with my great-grandmother there. So a couple things that I think are really important. One is I find that most of the men and women that I’m working with are under dosing on protein. They’re not getting sufficient protein. And the people that I take care of who are actually eating a Paleo diet are getting sufficient protein. And they're getting really beautiful sources of protein. So that, I think, is really important. I also think you got to have sufficient fat. I mean, I feel like we're still undoing the damage of the myth of the low fat diet.

LIZ WOLFE: Mm-hmm.

SARA GOTTFRIED: And so I'm grateful for the work that both of you do to kind of spread this message of getting healthy fats, getting a sufficient amount of protein, and really limiting those refined carbohydrates. So those are some of the ways that you can balance your hormones. You know the more that you stay away from gluten, that also helps you with hormone balance, especially with your thyroid.

LIZ WOLFE: And as far as the, you know, the thyroid stuff goes, I want to jump in and say, I've learned so much from your book. In particular, that an underactive thyroid affects women, I think you say, 15 times more often than men.

SARA GOTTFRIED: That's right. Yeah, this is one of those situations where stress definitely does not favor women. And there's a lot of different reasons for why women are more affected by thyroid problems than men are, and there's also a ton of differences with other health issues. But women are especially vulnerable to thyroid issues at two main times in their life. Number one, when they get pregnant and in that post-partum period. That's a time where a lot of women have thyroid issues, and sometimes it gets misdiagnosed as post-partum depression, which is another thing that makes me crazy.

LIZ WOLFE: Mmm.

SARA GOTTFRIED: You know, if you are having mood issues or you can't lose the baby fat after you have a baby, think of the biology. Don’t just immediately go to the anti-depressant. Make sure that your clinician is ordering thyroid tests, and I've got which tests you want to order in the book. The other time is women of a certain age, so starting around 40, there’s what my friend Mary Shomon calls, Thyropause. So this is sort of before menopause, this idea that your thyroid starts to slow down. It's one of the reasons your metabolism slows down when you're in your 40s, and the symptoms are weight gain, fatigue, and moodiness, especially kind of a low grade depression, but it can show up as kind of a low grade anxiety, too. It can also show up as hair loss. There's, you know, like a list of 150 symptoms, and I'm just hitting a few of the top ones. So yes, you're right, 15 times more common to see an underactive thyroid in women vs. men, and oh, by the way, 1 in 4 women between the ages of 40 and 55 are taking an anti-depressant. And we know that 20% of women with depression have a thyroid problem. We know that 50% of women with depression have a cortisol problem. So I just want to change that conversation about hormones and start thinking about, okay, you may have a hormone problem and not know it. Let's start there.

DIANE SANFILIPPO: I think it's funny, just this one sort of idea I'm getting from everything that you're saying, and I sort of picturing my mom because she's definitely one of those women who…she will fill her day with helping other people with a million things, you know, and then every now and then we'll kind of step back and kind of take a break or take a day for herself, and you know, I try and learn a lesson about how to manage myself and my time and my tasks, you know. It was very nice of you to commend me on my work and for taking a break, and then I very ridiculously signed up to write 2 more book before the end of this year. Then I really plan on taking a break after that. But I think it is really important that women, and I don't know why this has happened. I think part of it, I always end up talking about this, just the fact that like women have careers and we’re all those women, and we love that, and we have the career and we have the kids and we have everything else, and we're trying to do it all. And we just don't realize that, you know, I’m kind of coming back to the same topic, but we just don't realize how much rest and how much mental downtime we need. And just how much that really affects us. I think, like even, Liz going into this kind of homestretch of finishing up her book. I kept saying to her, you know, I know how you feel. This is…this is the tough part, you know, and it becomes this thing where you don't even understand why you're tired or why you're anxious or why something happens because it's almost like this lifestyle stressor just crept in, that issue with the cortisol. It's so…it just compounds, right? It's not like one day you did too much. It's like every day it's a little bit too much. And then all of a sudden, people are like, why am I not able to exercise anymore? Why can I not…why do I not have any energy whatsoever? Why am I drinking 8 cups of coffee now, you know, all day long? And you know, this is the kind of person that we're dealing with so often, right?

SARA GOTTFRIED: Yeah.

DIANE SANFILIPPO: Is that, you know, like this is what we're seeing. Women who come to us with issues with menstruation. They're not menstruating regularly or they have PCOS. Huge, huge issues with PCOS, and you know, we don't have every answer for them, so you know, what other kind of…just to wrap up this section before we get on to some more questions, just some other thoughts for women about how much we're trying to tackle all the time.

SARA GOTTFRIED: Oh my gosh, I wish I had like 3 hours with you guys this morning.

LIZ WOLFE: Same here.

SARA GOTTFRIED: Yeah, so let me…I'll just hit a few highlights of…

DIANE SANFILIPPO: Part 2.

SARA GOTTFRIED: Yeah, exactly. Part 2 later. So I've got an entire chapter on excess androgens. And the androgen family, if you don't know them, are testosterone and DHEA, also DHT, dihydrotestosterone, and that is the root cause of Polycystic Ovarian Syndrome. So I've got an entire chapter, it's chapter 8, on Polycystic Ovarian Syndrome and how you turn that ship around. But I think you're absolutely right about this insidious effect of cortisol and stress. And how it's not, okay, you shot your wad that one day when you did a total marathon, it's more this every day you do a little too much. Like your output is more than your input, and it does wear you down. You know, your hormones just fit into one of two camps. One camp is the cortisol camp, which is the wear and tear camp, and these are called catabolic hormones. Don't let your eyes glaze over. It just means that you know, they're breaking down things in your body to be able to help you function, especially when you do a little too much each day. And then you have the anabolic hormones, which have gotten kind of a bad rap from body builders who abuse steroids, but the anabolic hormones you make naturally in your body, and they are things like testosterone and DHEA. They are the growth and repair hormones. And you want to have an even balance between the wear and tear and the growth and repair. And I alluded to earlier how when you sleep at night, you want to have that whole repair conversation. You know, there's this healing response that happens at night, and that conversation has a beginning, a middle, and an end. I see a lot of women and men who have like the beginning, maybe the middle conversation, but they never finish the conversation at night when they're sleeping.
So I think it's so important to really take a look at and be brutally honest about whether you're doing a little too much each day. I also think here about elite athletes. I mean, if we just have a moment here of awe around Olympic athletes, for instance. Just like those race car drivers, they are not pushing the pedal to the metal all day long every day. They are very clear about when they work hard and train, you know, for some people maybe that's sprinting. And when they recover. Like they're really clear about the importance of the recovery. And what I find is that so many men and women, women especially, don't spend enough time on that recovery. You know, women are also more than double the rate of men when it comes to difficulty with sleeping. It's like we wake up at 2 o'clock in the morning thinking about the deadlines that we either hit or didn't hit. That's hypervilgilance, and there's definitely a cost to it. What it does is it makes you whittle down those growth and repair hormones, so that you don't make as much. And this is not something that just happens at menopause. You know, there's a myth that I believed when I was in my 20s. I kind of thought of menopause as being this cliff I was going to fall off of when I was 50 plus, and I just didn't need to worry about it until then. And it turns out your hormones start to change in your 20s. Like at 28, you're starting to lose your testosterone and your DHEA, and those are really important for helping you stay vital and stay, you know, in a place where you really are feeling like you've got all the energy you need, and it's consistent, and you can count on it. You don't know kind of what's going to happen day to day. Diane, I think it was you that mentioned how you would get up in the morning and after you finished your first book, and you'd feel pretty good for awhile, and then 2 hours later, you felt like you could go back to bed. And that's an example of inconsistent energy. I see that in 91%…

DIANE SANFILIPPO: This is right now.

SARA GOTTFRIED: Oh, you have it right now? Okay, all right. Well, so one of the things we would want to do is to see what's going on, you know, two hours after you get up. Like you could measure your blood cortisol level, for instance. You could do that at home with a home test. You could do it with your local doctor. And if it's low cortisol, we'd have a specific strategy for that. That's chapter 4 of my book. And if it's high cortisol, you know, high cortisol tends to make you feel more tired but wired. Kind of a weird paradoxical combination whereas low cortisol just makes you tired.

DIANE SANFILIPPO: Well, this is…I mean, it's very interesting. I have a salivary test I was ready to take, which maybe I'll figure out a way to do a blood test instead.

SARA GOTTFRIED: Oh, you could do a saliva test. I think that would be very worthwhile.

DIANE SANFILIPPO: It's just so funny because, you know, here we are, writing books about health, and I think everyone I know. I seem to have a lot of friends now who are authors on topics of health, and every one of us, you know, when we're finished with it, we're like, wow. I'm pretty tired now. And I've been kind of digging out of that hole for awhile and yeah, definitely it's tough. The sleep is a tough thing, and anyway, so enough about me. [laughs]

LIZ WOLFE: My next book, Diane, is going to be called How to Bury Your Head in the Sand and Not Ever Worry About Yourself Ever. Yeah.

DIANE SANFILIPPO: Let's get to some of the questions we have from our readers and listeners. They're just kind of basic questions on hormones. Obviously people don't have your book in their hands quite yet, but I think this is definitely going to be a really fantastic resource for everyone to read through and kind of see because I feel like all of us are dealing with this in some way or another, or we will face it or may face it, so, you know, you mentioned our hormones changing as early as our 20s, and, you know, that was kind of like, a little bit of an eye-opener. You know, I think, much like you, I was…I've been thinking about the idea of menopause in however many years, 15 years, and just like, okay, things will change then, but you're obviously correct in that they're already changing. So we've got women who are asking several questions about birth control.

SARA GOTTFRIED: Mmm.

DIANE SANFILIPPO: And I think, one is asking about how to achieve healthy hormone balance if you are taking hormonal contraceptives, oral contraceptives, and another is kind of asking about how much they may alter your regular hormonal balance once you come off of them. So any thoughts there?

SARA GOTTFRIED: Oh, so many thoughts. Okay, let me try to give you the short version because this is one of those things that I get very excited about. So I actually think the number one hormone imbalance that women have in the US is hormonal contraception. So here's the deal. When you go on the birth control pill, and honestly, I don't know a single woman who hasn't gone on the Pill. I’ve been on it. You know, I think I started when I was 19, and I was on it through a lot of my 20s. So you know, don't freak out if you're hearing what I'm about to say and it worries you. You can turn this around. So when it comes to the birth control pill, what happens is, it makes your free testosterone go down significantly. So by virtue of taking oral estrogen, oral synthetic estrogen and the Pill also has oral progestin, which is a synthetic progesterone, that will lower your free testosterone. Testosterone is really important in women. You know, we think about it as being this male hormone in that it's responsible for sex drive, but it turns out that, yes, men have ten times the level of testosterone that we have, but we have it, too. In fact, we have ten times the amount of testosterone as we do estrogen in our bodies as women, and we need that testosterone. And just like with cortisol, you want it in that Goldilocks position, of not too high, not too low. Not only is testosterone in charge of sex drive, it's also in charge of your confidence, your agency, like your ability to be effective in the world. It’s in charge of feeling lubricated, especially at the opening of the vagina. And we know that somewhere around 20 to 25% of women when they go on the Pill, when they drop their testosterone so significantly, it makes them have vaginal dryness or it robs them of their sex drive, which is, you know, what a drag that is. You go on the Pill because you want to have sex and not get pregnant, and then you don’t want to have sex.

LIZ WOLFE: Mm-hmm.

DIANE SANFILIPPO: So I'm not a big fan of the birth control pill, and even when you stop it, one of your questions was about, you know, getting into hormone balance when you stop it. It turns out that up to a year after you stop the birth control pill, there's still this effect on your testosterone where it lowers your testosterone. It does it through, if we could have just a quick biochemistry moment. Bear with me here. I promise it won't be too painful. What the birth control does is it raises something called sex hormone binding globulin. SHBG. And what that does, it's kind of like a sponge that soaks up your free testosterone. It turns out that your SHBG stays high up to a year after you stop the Pill. It's not as high as when you were on the Pill, but it's still significant, and I can tell you, most doctors are not warning their clients about the effects of these hormonal contraceptives, like the birth control pill. One other thing that it does that I think is important to mention is that when it lowers your testosterone, that can actually shrink your clitoris by up to 20%. There, I said another anatomical term.

LIZ WOLFE: This is fabulous.

SARA GOTTFRIED: [laughs] Yeah, so I don't want to lose any part of my clitoris, nor do I want any of my clients to lose 20% of their clitoris, so I'm not a big fan of the birth control pill. I do think that non-hormonal contraception is a better choice. I'm a fan of the copper IUD. I also think that condoms and the diaphragm is very effective if you use them right. You know, some people if they're super fertile need to combine it with natural family planning if they're not wanting to get pregnant. The Mirena is something that's used quite a bit, and that has synthetic progesterone in it. And that I think is a little bit better than the birth control pill, but some women are still sensitive to the synthetic hormones, and I just think synthetic hormones have no business in the female body.

DIANE SANFILIPPO: Hear, hear.

SARA GOTTFRIED: [laughs]

DIANE SANFILIPPO: Yeah, I was probably on it, like very poorly because I'm terrible at remembering to take anything. I was taking it from a very young age because I had very painful periods. That was really the reason I went on it in the beginning and how interesting that, you know, I was also completely addicted to sugar.

SARA GOTTFRIED: Yes, yes, yes.

DIANE SANFILIPPO: Mm-hmm.

SARA GOTTFRIED: A big reason why women have trouble with acne…you know that one in three women takes the birth control pill because of acne or because of painful periods, and I would say, okay, why don't we go to using food and supplements as a way of…

DIANE SANFILIPPO: Yup.

SARA GOTTFRIED: treating that. Let's go to the root cause because you're much more likely to get a cure. You know, if you're off sugar. Sugar raises your cortisol level that's going to make you have more painful periods. If you use omega-3, if you follow a Paleo diet, you know, those things are very effective at helping you.

DIANE SANFILIPPO: Yeah, it's amazing. None of this stuff was kind of, you know, on the radar back then, and it just seems like an easy, an easy great answer and now it's one of the things that, you know, whenever Liz and I answer questions on the podcast about hormonal issues or stress or any of that, and the person, you know, the woman mentions she's taking oral contraceptives, we kind of always say, the exogenous hormones are putting you at a place. You don't have an even horizon. We don't know what your body really wants to be doing because these oral contraceptives are putting you basically out of your body's normal balance. It's really hard for us to kind of direct women even with dietary choices when they're taking this exogenous hormone in. It seems to be driving things and also making it tough for women to lose weight.

SARA GOTTFRIED: Definitely. I mean, I am a big fan of trying to get people off of synthetic hormones. I think, you know, we use them for 57 years in this country without a good trial to support them. And then we learn they were dangerous and provocative, so I think it's really important to get off of synthetic hormones and to find, you know, another fit that's more natural. That's not going to be true for everybody. I'm not saying, you know, blanket statement for absolutely everyone because there are some people who find the birth control pill is lifesaving. Like if you have endometriosis, and the choice is, do you have a hysterectomy or be on the birth control pill, there may be a time and place to be on the birth control pill. But I would say, if you're having any of these problems, like vaginal dryness or no sex drive, see your doctor to get some of those things addressed. But I think the way you described it as not knowing what your true horizon is is very true. I really believe that we want to be attuned to the native intelligence of the body and it's very hard to be attuned to that when you're kind of blowing right through the natural hormone balance by being on synthetic hormones.

DIANE SANFILIPPO: Yeah, I, you know, to kind of go back to our little talk about coffee. I almost think that's what happens when people are drinking coffee as well. They have no idea what their normal circadian rhythm would be like without it, and it's such a painful, stressful thing to even think about not having it for one day. Like how you were saying, you know, people, you know, they need to have an honest conversation with themselves about how they're using it, whether it's medicinally or not, and I think a lot of us are just really out of touch with what our bodies' natural cycles are like or natural rhythms, and how we feel that with all of these exogenous inputs, whether it’s the hormones or the caffeine or the sugar. Any of those stimulants.
Do we have time for maybe one more question now, and maybe we can wrangle you back on the show another time because we've got so many questions from our listeners?

SARA GOTTFRIED: You got it. I'm happy to answer another question.

DIANE SANFILIPPO: Okay, cool.

SARA GOTTFRIED: And I'm happy to come back!

DIANE SANFILIPPO: That would be great. We love this stuff. Okay. Liz, do you want to grab one more question here?

LIZ WOLFE: Yes. In talking, going back to a little bit of this talk about androgens and such, we have a question from Andrada. She asks, “Why do I have chin hairs since the birth of my daughter 6 years ago? ” And I also wanted to ask in general, why do women sprout these whiskery like hairs?

SARA GOTTFRIED: Yes, yes, yes. Well, I call these rogue hairs.

LIZ WOLFE: Mm-hmm.

SARA GOTTFRIED: You know, the…we want to have the thick glossy hair on our head, and not have these rogue hairs on our chin or elsewhere. And it's very common after having a kid for your hormones to go through a major shift. Right? Like once you push a small basketball through your vagina or have a c-section and you deliver that placenta, and your hormones go from sky-high down to almost nothing, you actually go into reversible menopause, depending on whether you breastfeed and if so, how long. And so some women get a preview of coming attractions, even with this woman, whose daughter was born 6 years ago. When you go through that change and you have almost no hormones at all, like no estrogen, no progesterone for a piece of time, it can make you get into a place where testosterone's more dominant compared to estrogen, for instance. So when you're breastfeeding, it also suppresses your estrogen label, and when you have more testosterone compared to estrogen, that's when you tend to sprout those chin hairs.
It can also be genetic. It can be related to, you know, does your mom have chin hairs? There are certain ethnic predispositions to have more rogue hairs or even, you know, be more hairy than other ethnic populations. So those are some of the reasons why I think about the rogue hairs. The question that we had before about polycystic ovarian syndrome..one of the features of polycystic ovarian syndrome is having increased rogue hairs or having more hair growth on your arms or on your chest. You know, kind of in places where it's maybe not where you want to be having hair. So that can be a sign with polycystic ovarian syndrome of having excess androgens, like high testosterone or high DHEA. So that's what I would say there. I could go on and on, but the main idea is that you want to have a balance between these hormones. You want to have a balance with your hormonal Charlie’s Angels with cortisol, estrogen, and thyroid. And then there's some other hormones too that are important with women. In your adrenals where you make cortisol, that's where you're also making testosterone and DHEA. For women, you also make those in your ovaries, and you want to have the right balance between these hormones. So my book is about this. It sounds like for this woman, part of the issue was that she became somewhat testosterone dominant after she had her baby, which is very common.

LIZ WOLFE: Perfect. Well, we’re rounding out on an hour, and I guess we should probably go ahead and close this one down, and get you scheduled for part 2 of The Hormone Cure with Dr. Sara Gottfried. Everyone, the book is The Hormone Cure. It’s by Dr. Sara Gottfried. It's an incredible book. It is so dense in information. I don't know how you got it all in there, but the website is www.saragottfriedmd.com. You can go to the podcast post for this episode to link there, and to find the book as well. That's it for us this week. We will be back next week with more questions. Until then, you can find Diane at www.blog.balancedbites.com. And you can find me, Liz, at www.cavegirleats.com. Thanks for listening. We'll be back next week.

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