Dhru Purohit Show - The Top 3 Mistakes When it Comes to Diet and How it Impacts Our Hormones with Dr. Sara Gottfried

Starting point is 00:00:01 Hi everyone, Drew Prode here on today's mini episode. We're chatting with the one and only Dr. Sarah Godfrey. And we're talking to her about the common hormone imbalances that we've normalized today in society. This mini episode is taken from a full episode that we did with Dr. Sarah Godfrey, but it was so popular and it has so many gems that we're replaying it as a Monday mini episode. A few other things that we talk about with Dr. Godfrey in today's episode. We talk about the signs and symptoms of hormone imbalance. The top three things to prioritize when addressing hormone imbalances. How to uncover the root causes of these hormonal imbalances. It makes when it comes to diet and how our poor mistakes in diet impact our hormones.

Starting point is 00:00:47 And lastly, we're going to talk about the key pillars of Dr. Godfrey's Godfrey protocol, a step-by-step plan that can help you step in the right direction that comes to balancing your hormones and improving your metabolic health. Fascinating conversation, stay tuned. So hormonal imbalances, they'll impact by different estimates up to 85% of women at some point in time in their lifetime. But because, or rather I should say, and because hormonal imbalances are so ubiquitous, there is much of the population, not just women, but men too, that have gotten used to it. It's so common that everybody just thinks that it's normal. So I'd love to start off with a basic question, which is so important for setting the stage for this conversation. What are examples of hormonal imbalances and how are some of them things that people have gotten used to and they just think it's a normal part of life?

Starting point is 00:01:47 Terrific question. I feel like I want to caution people. Don't get used to it because there's so many things that you can do to get these hormones back into balance. starting with your fork. So what are some of the most common ones? I would say cortisol, insulin, estrogen dominance or dysestrogenism, problems with testosterone, problems with growth hormone. These are some of the most common ones that I see.

Starting point is 00:02:14 The way that you know you have these are basically with cortisol, the main stress hormone. You know, what a lot of people describe is that they feel overly stressed. Maybe they've got high perceived stress. High cortisol has all of these consequences in the body, including increased belly fat, can make you feel wired but tired. It can also disrupt some of the other hormones. So another important piece here, Drew, is that these hormones cross talk. So you don't get a hormonal imbalance in isolation.

Starting point is 00:02:48 Often you get sort of a pattern of hormone imbalances. You have a quote, and I want to read this quote here. with our audience because I think it's a it's a great one for my next question. And you say, I can tell you without a doubt, you can not achieve, you cannot achieve true help without achieving hormonal health and balance. Tell us what you mean by that, quote, and help us understand what the hell is going on that hormonal imbalances seem to be increasing year over year. This episode is brought to you by Inside Tracker.

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Starting point is 00:04:19 InsideTracker makes their results easy to understand and provides tips on how to use food first for optimal nutrition. Right now, they're offering my podcast community 20% off. Just go to insidetracker.com slash Drew. That's D-H-R-U to get your discount code and to try it out for yourself. That's InsideTracker.com slash dH-R-U for 20% off. Did you know that the health of your entire body is rooted in that? health of your gut. Hippocrates said this many, many years ago, disease begins in the gut, and so does health. Over the last decade, research on the importance of the gut microbiome has

Starting point is 00:05:00 exploded, which led myself and my business partner, Dr. Mark Hyman, to ask the simple question, is there a way that we can create a daily support system for the individuals in our community to help them transform their gut for the better? Turns out there is. With the help of a few experts and years of research, we created the ultimate multivitamin for your gut microbiome. It's called gut food. Gut food uses the power of three critical gut supporting components, prebiotics, probiotics, and polyphenols, and features five ingredients at clinically validated dosages to support the reduction in overall inflammation, support the growth of beneficial gut bacteria, help support the

Starting point is 00:05:43 reduction in bloating and help support mood and energy. You know, we created this product because it's exactly what we wanted for ourselves and what we wanted to offer to our community because nurturing your gut health can literally transform your life. I'm so excited about gut food and I want you to know that you're going to love it too. If you want to learn more about gut food and what we've been up to go to gutfood.com. That's g-ut-f-o-o-odd.com to learn more. What I see in my practice is that people will chase a certain goal. So that could be their weight, like a number on the scale. In my husband's case, it's how fast he can do a century.

Starting point is 00:06:26 So people chase different goals related to health. But I think what I find is that if your hormones are not in balance, if they're not supporting what those goals are, you're not really going to get there. So we see people, for instance, who are at a normal weight, and yet their hormones are out of balance. They're the so-called, I don't love this term, but skinny fat people. You know, you can have a fasting glucose that's relatively normal and yet have metabolic dysfunction because insulin is not working the way that it should be. Insulin is that hormone that opens up the door to the cell and lets glucose in.

Starting point is 00:07:06 And what happens with a lot of folks is that they have issues with insulin, sometimes a decade, even 13 years before it shows up as a problem like type 2 diabetes. So I think we have to pay attention to a number of different factors and hormones drive which you're interested in. And that's why I got so excited about hormones early in my career. It's why I think it's so pivotal to one's concept of health. Before we go into your personal story, I want to tease out a little bit because I think hormone imbalance is starting to make its way out there a little bit more with the likes of individuals

Starting point is 00:07:46 like yourself, incredible doctors, researchers, putting the spotlight on it. But still, I think there's a lot of people listening that are going through some signs or symptoms and they don't understand that there's a connect to hormonal imbalance. So let's tease this out a little bit more. What are some other things, especially for women, which your new book is really focused in on, that are signs and symptoms that there are hormonal imbalances that are going on? Well, there's a long list of symptoms. It really depends on which hormone you're talking about.

Starting point is 00:08:20 But if we take a hormone such as thyroid, some of the symptoms that people can have include fatigue. You can have hair loss. That's both head hair, also eyelashes, eyebrows. famously hypothyroidism or low thyroid function is associated with loss of the outer third of the eyebrows. You can also have constipation. So gut function is a really important part of this process. Maybe we can talk a little bit later about, you know, I'm an engineer. So I think about the control system for hormones. And when we think about the control system for hormones, it involves the gut. So it involves the brain talking to the adrenal glands, talking to the ovaries or test.

Starting point is 00:09:01 and men talking to the thyroid, but also talking to the gut. So constipation is one of those signs of low thyroid function. You can have rising cholesterol levels, dyslipidemia. You can also have cold intolerance. So those are some classic symptoms of a thyroid that's out of balance. That's something that tends to affect women much more than men. Women are more vulnerable to hormone imbalances. So I think that's part of why we especially need to be. to be educated and empowered about it. But men experience a lot of these symptoms, too. They have issues with cortisol. Cortisol problems can lead to low testosterone, which I think has gotten a lot of press recently. Low testosterone in both men and women is also associated with loss of muscle mass.

Starting point is 00:09:51 So the way that it can show up is that maybe you're going to the gym or you're doing home workouts during the pandemic and you're just not seeing a response, maybe to strength training or to other forms of exercise. Another factor is sex drive. What's happening with your libido? There's a number of different hormones that are involved with that, testosterone being the most common. And then there's mood issues too. So estrogen, testosterone, cortisol are all involved in depression, anxiety. I just had a patient last week who was having these really steep glucose excursions on our continuous glucose monitoring. talk more about this later. Well, one of the things I found was that she would get panic attacks when her glucose was too low. So her insulin wasn't working the way that it should be. So we want to

Starting point is 00:10:43 be thinking about this full scope of symptoms, you know, not just sex drive, not just hair loss, but this fuller scope. You know, we know, for instance, that cortisol is a biomarker for depression and suicide. So about half of people with depression have high cortisol levels. So those are a few examples I could go on. I've written a few books about it because I think it's so common. And unfortunately, this is the part that I think is very frustrating. I believe that mainstream medicine fails people when it comes to hormone imbalances. We don't look for them. We often don't test them unless you're trying to get pregnant and you're having difficult. And the solutions that are often offered are things like, why don't you take this birth control

Starting point is 00:11:32 pill? Sounds like you might have a hormone issue. How about this birth control pill? Or how about this selective serotonin reuptake inhibitor? Because it sounds like you might have some hormone issues, maybe a little depression. So we have to be looking at the root cause. The root cause often maps to hormone imbalance. Help our audience understand contextually what's going on that we are seeing year after year these increases in hormonal imbalances and the severity in symptoms that you described at the beginning of the podcast. Well, there's so many, and I'll probably leave out a few, but I'll hit the highlights that I think are the most important. The first is our food system has completely changed. So, you know, I mentioned my great grandmother earlier. She was born in 1900,

Starting point is 00:12:22 So it's really easy to do the math on her. She's no longer with us. But she died in her sleep with no chronic disease very peacefully at 97 after coming to my wedding and dancing and flirting shamelessly with every man that was, you know, at the ceremony. So she's a great model for me. But when she was growing up, you know, apples were these small little tart green things. They weren't these big huge, you know, high, altered apples that are associated with higher fructose and kind of a change in the physiology

Starting point is 00:13:00 that they create in the body. She was not eating processed foods. She was eating whole foods. We know that a whole foods diet is the healthiest that we have. If we look at the data, we know that a Mediterranean diet is the most proven in terms of health. And she was eating a Mediterranean diet. It was altered a little bit because, for instance, she used. found that alcohol didn't agree with her, so she didn't drink alcohol. So our food system has completely changed. And in many ways, I think you and Mark have done such a stellar job talking about this, about, you know, how we have lost the small farmer. We've lost, you know, the number of fields that are organic is so tiny. We're using glyphosate, which has all of these downstream

Starting point is 00:13:49 consequences is one of the most important disruptors of the integrity of the gut lining. So food is completely changed. And we also have more of it. So we live in this time of abundance. I'm someone who struggled with disordered eating when I was in high school and in my 20s. And so, you know, when you're faced with this bountiful amount of food, it can be very tricky to make decisions about what to eat and what not to eat. especially if you're the way that I was in my teenage years, where you use food for emotional reasons.

Starting point is 00:14:28 So we've seen this rise of eating disorders. We've seen these changes in terms of the food system. We've seen the rise of pollutants, herbicides, pesticides, things like glyphosate. And then in terms of stress, we know that stress is increasing. We also know from the annual survey by the American Cyclone, psychological association that women are more affected by stress than men. We know that during the pandemic, stress levels, numbers of depression, incidents of depression has dramatically increased in some reports 3x. So I think we're faced with a lot of environmental unknowns. Some people

Starting point is 00:15:09 are able to manage that and have found, you know, sort of the gifts of the pandemic. Other people are really strongly affected by it. I think there's also economic. economic forces here too in terms of both the richer getting richer, the poorer, getting poorer, as well as racial trauma. I think trauma in some ways has either increased or our awareness of it and some of the downstream consequences has increased. You know, we look at, for instance, the adverse childhood experiences study that was done at Kaiser 20 years ago. We know that women experience more trauma than men. We know that trauma in childhood is associated with more adverse effects later in life, whether that's heart disease or alcoholism or even early

Starting point is 00:15:59 mortality. And as you can imagine, trauma is one of the most important disruptors of hormone imbalance. Because when you're growing up and these caretakers who are supposed to be looking out for your best interest aren't doing their job, you're neglected, maybe there's some abuse, maybe your parent went to prison or your parents got divorced, often that leads to dysregulation of the control system of your hormones. So here we're talking mostly about the hypothalamic pituitary adrenal axis and the release of cortisol. And we're also talking about post-traumatic stress disorder and even what I see more often in my practice sub-threshold post-traumatic stress disorder, which doesn't meet criteria for PTSD, but it's something that I see

Starting point is 00:16:52 pretty commonly. So I think trauma is a big piece here under the rubric of stress. There's these gigantic changes in our food system. And then there's also the way that this affects sleep. So you look at sleep, you look at sleep debt, how sleep debt is increasing, even with all the things we know about how sleep is so important for your cortisol level the next day. your insulin level the next day. If you get short sleep, which for most of us is less than 7 to 8.5 hours, that leads to more carbohydrate cravings the next day. So I think sleep is another really important piece. And once again, women are differentially affected. So women have about twice the rate of insomnia as men. I think some of that gets kicked up postpartum during pregnancy

Starting point is 00:17:40 and also postpartum, and then it also becomes an issue in perimenopause and menopause. That's a great lay of a land, and it's a perfect segue into our next chunk that I want to dive into. The new book is called Women, Food, and Hormones. And on top of everything that you shared here about the high-level statistics of how women are more impacted by especially stress in their lives, what is it that fundamentally you want, Again, hormone imbalances, they impact men, they impact women, but there's something that uniquely is there for women.

Starting point is 00:18:16 So when you sit down with your patients, which I would say you see both men and women, but for the ones that are women, what do you want them to understand about a lot of the solutions that are out there, well-intentioned, well-meaning solutions that work for a lot of people? what do you want them to understand about those solutions in the context of their unique biology and hormones? Yeah, there's a lot that I want them to understand. And I think the subtext of your question is really great, which is how do we prioritize this? Like, how do we not overwhelm somebody? How do we really figure out, okay, here are the three things I want you to focus on initially?

Starting point is 00:18:58 So the way that I rank order what to focus on, what to understand, I would say, say metabolism is first. Because metabolism is not just your weight on, you know, the bathroom scale. It's not just belly fat or how much fat mass you have. I think a lot of people think of it in that more narrow context. Metabolism is much bigger, broader, deeper than that. It is the aggregate of all of the biochemical pathways in your body. And that includes your hormones. So I like to start first with metabolism, I want to make it come alive for my patients. And the way that I do that is through precision medicine. So I really believe that we have to democratize data. We can't take, you know, that annual test for fasting glucose and hemoglobin A1C and have that just be owned by the

Starting point is 00:19:55 clinicians that are taking care of the patient. I think it's important that we use any means possible to really help people understand where they are on the continuum of health. So I'll start with blood testing. I'll do some genomic testing to look at metabolism. I'll look at particular biomarkers. I'll look for micronutrient deficiencies so that we can really customize and personalize a food plan. But one of the things I love to do is to really solicit from the patient, what are your values? what is most important for you?

Starting point is 00:20:35 And then how can I tie what we're learning about you, about your metabolism, about your metabolic health, to those values? So I'll give you an example. You know, for me, I want to live a long life. I've got a couple of daughters. I want to be, if I could, like my great-grandmother and dance at their weddings, you know, to really see how they turn out, to be part of their lives, to have that feeling of connection and love and intimacy.

Starting point is 00:21:05 So that's a really high value for me. And, you know, if I'm still able to dance reasonably when I'm in my 90s, that would be like, that would be really awesome. You have the dance part, but don't forget, your grandmother was also flirting with other men that was there. So you got to have both of them. Yeah, we got it. We got to have both.

Starting point is 00:21:23 You know, for other people, my husband jokes that one of the reasons why he wants his health is because he loves lemon ricotta pancakes, gluten-free. And so he wants to eat as many of those as possible as he gets older. So we all have different values. And for some people, it's a particular mission. One of his missions is to reverse climate change. So mission can pull us forward too. But then let's connect it to metabolism.

Starting point is 00:21:48 Because that's the way I think that you get the best buy-in. And when you can democratize the data, So that's with, you know, I share every single lab that I collect on a patient. We talk about it because this is owned by the patient. This is the patient's physiology. And there's something incredibly enchanting about looking at and understanding your own physiology. Instead of outsourcing it to somebody else, the way that, you know, more patriarchal medicine is practiced. But really understanding, okay, when I eat sweet potatoes makes my glucose spike.

Starting point is 00:22:26 When I am in a fight with my husband, it raises my cortisol. And once again, it makes my glucose go up. So understanding kind of those moment by moment changes that can happen in your physiology, I think is very helpful. The last thing I'll finish with on this particular question is that I'm a bioengineer. So I think a lot about systems biology. And if you can bear with me for a nerd moment here. One of the things I think about is how do you define health? Because in medicine, we've done a really lousy job of defining health. We define it in a circular fashion as the absence of disease. And that really is not a gold standard. That just centers our inquiry around disease. So if you really look at health and you really understand what the drivers of health are, and I'm saying metabolism is one of the most important. It's not the only one, but it's to me the most important.

Starting point is 00:23:24 And then you look at these transitions that can occur along a continuum, from health to pre-dise. So, for instance, insulin resistance or pre-diabetes. And then another transition later to maybe type 2 diabetes. When you understand where you are on that line, it gives you this feeling of, oh, my gosh, I can do something about this. And one of the cool things when it comes to metabolism is that the most proven way to correct your metabolism to reverse metabolic inflexibility or metabolic dysregulation is through diet and lifestyle change. So that's been proven over and over again, even though our medical training system does not show physicians how to do this. So this is where I really invite our

Starting point is 00:24:16 listeners to step into that place of not outsourcing the assessment of your metabolism to someone else. Really understand it yourself because it's as important as your savings account. It's as important as your retirement account. You know, in many ways, it doesn't matter how much you have in your 401k or defined benefits. What matters is your metabolism because that is such a key driver of health span, that period of time that you feel fantastic and you're relatively disease-free. What are some other things in the context of getting to the root causes of hormonal imbalances that you want people to know are within their power to make a change and a difference on. There's a long list once again. I think cortisol is probably the low-hanging fruit when it comes

Starting point is 00:25:07 to the way that your physiology is behaving. And the reason why I say that next after talking about metabolism is because cortisol is a priority hormone, meaning that you, you, you, you need it to live. You can live without estrogen, you can live without testosterone, you can live without many hormones. But cortisol is essential to life. It's involved in so many different things. It is involved in regulating glucose. It works together with insulin. It's also involved in immune function. It's part of your circadian rhythm. So it's got this really foundational role in your health. And I think what's interesting about cortisol is how much you can modulate it with mindset, with food. So reducing food stress, for instance, not eating foods that you're

Starting point is 00:26:05 intolerant to. I happen to be intolerant to gluten and dairy. So it raises my cortisol if I get exposed to those foods. So cortisol, I would say, is really a low-hanging fruit, understanding where you are with perceived stress, I'll give an example of how you can test this. There's a perceived stress deal that I think is very helpful that was published by Cohen. And you can Google the perceived stress scale to take this really simple test, takes about five minutes, and see where you are. Especially when you're under a fair amount of stress and you're not sure how resilient you are, I think measuring can be very helpful.

Starting point is 00:26:46 So cortisol, I would say, is one of those low-hanging fruits. I've had someone on a podcast before say, oh, it's like Michael Cortisol Leone. Like it's a little bit of a like the godfather in the body. And that's true because it's such a high priority. It's also so involved in this interdependence with other hormones that it's good to know about. So once again, lifestyle factors can modulate cortisol so readily, whether that's practicing yoga, which we know reduces cortisol and by consequence, it also affects interleukin six and other biomarkers associated with inflammation.

Starting point is 00:27:25 You can, you know, meditation, I think is a very powerful way to change cortisol levels. And can I jump in for a second? I saw a really great video that you made on Instagram not too long ago talking about also, again, I love simple, practical solutions that anybody can do. And it was about a breathing technique that was there. Would you mind sharing about that? Of course. So this is Batako breathing.

Starting point is 00:27:50 There's a Ukrainian physician who developed this way of breathing. And it was so interesting to me when I first learned about it because I have a voice disorder, which you can probably hear. It's just as a result of doing so much public speaking and not breathing properly for many decades. So Batako breathing is one of the recommendations that came from my voice therapist who said, you seem like an over-breather. And what I was doing, Drew, is what I think a lot of yogis do in that I'm a certified yoga teacher.

Starting point is 00:28:24 I take these deep inhales. I extend the exhale. And that can create some inefficiencies in terms of gas exchange. So the work of Batako, Dr. Batako, is to change your breathing pattern, to do this for about 20 minutes twice a day to make your your breathing more efficient. So the way that I do it is I use an app breathing zone and it counts out the breath and kind of guides me. So I just did my 20 minutes this morning before we got together. And I start off with about five breaths per minute and then I get down to about four breasts per minute. You get a little bit of air hunger, but you learn how to

Starting point is 00:29:06 tolerate it. You learn how to tolerate especially the retention. So I use this with my athletes. I work with an MBA team back east. I use it with, you know, people who struggle with cortisol issues. It's a very efficient way of improving your breath pattern. And it's been mostly studied in asthma. It's been shown to help quite a bit with asthmatics. It doesn't have a ton of research behind it, but lack of proof is not proof against. This is one of those interventions that I think doesn't require some complex randomized trial to show that it's useful. Give us three top things that are mistakes. Again, they could be well-intentioned that people have when it comes to their diet and how that impacts hormonal imbalance.

Starting point is 00:29:57 Love those too. So I would say number one is juice. A lot of us think that juice is healthy. We think it's an efficient way to get, you know, maybe a green juice with celery and apple and spinach is so healthy for you. But we're really designed to eat those foods together with the fiber. So juice is not the panacea that a lot of people think it is. I think that's really essential to know. And one of the things that I was doing back in my 30s was that I would do these juice vass and then I would refeed and I would gain all the way back.

Starting point is 00:30:37 So it just wasn't a helpful thing for me. It set me up for yo-yo dieting and really, in some ways, ruined my metabolic health. So that's number one. Number two, I would say is villainizing carbs. So I think we've gotten to a place where people hear about low-carb diet. they hear about the ketogenic diet and they think, oh my gosh, I just need to cut carbs out of my life. I don't need carbs. I need protein. I need fat. Maybe they go on a classic ketogenic diet. And I think we have to be really careful about that because the data looking at folks who follow

Starting point is 00:31:18 a classic ketogenic diet, we know that there's some significant changes that can occur to the gut microbes. So to the microbes themselves plus their DNA, which, just known as the microbiome. There can be a decrease in diversity, alpha diversity in particular. There can be a decrease in stool volume. And so we want to figure out, okay, it's not that carbs are the villain. It's actually metabolic inflexibility. That's the villain.

Starting point is 00:31:50 So that's what we want to address. Maybe we could talk a little bit about metabolic flexibility versus inflexibility. The third thing is, oh, if I have to pick a third, I would say, villainizing fat. So I grew up with Dean Ornish. I remember reading his books in high school. And when I went off to college and medical school, I would make these pasta dishes with tons of vegetables and zero oil.

Starting point is 00:32:25 And I remember in anatomy and medical school, so this is 1989, I was so disturbed and freaked out about working with a cadaver that I just couldn't imagine eating meat. So I stopped eating meat. I was continuing with this low-fat plan. And what I found was that my hormones just became a total mess. I remember my breast size went down by about two cups because my cholesterol, I remember measuring it right around then after I went on this.

Starting point is 00:33:00 a vegan food plan with very little fat, what happened for me was that my total cholesterol went down to like 120. And cholesterol is the backbone of all the sex hormones that you make. If you look at the sex hormone pathway, it goes from cholesterol to pregninolone, the mother hormone of all of your sex hormones. And it goes on to progesterone and cortisol and DHA and testosterone and estrogen. So fat is not the villain. We went through that low fat phase, which I,

Starting point is 00:33:30 I think did more harm than good, and we're still recovering from it. So healthy fat is really important for you. It's the way that you make a healthy balance of hormones. So those are the three that I think are the most important. Let's come back to the Godfrey protocol. While we have a little bit of time here towards the end of our interview, what is it, who is it designed for, and can you walk us through what are the key pillars that are part of it?

Starting point is 00:33:59 The key pillars start first with detoxification. So I want to talk, maybe I'll give an overview and then we'll circle back to why I designed it in this particular sequence. So step one is detoxification, opening up your detox pathways. That includes methylation. It includes cruciferous vegetables. It includes paying attention to antioxidants. The second part is the ketogenic diet. So really following a ketogenic diet, in a particular way, using net carbs. So I was told when I first started on keto not to use net carbs, but I think we have to, especially for women. And then the third part is to layer in intermittent fasting. But to do it in a particular way that doesn't cause hormone imbalances like

Starting point is 00:34:48 disrupted cortisol. So if I take a step back now, what I found Drew was that about seven or so years ago, I suddenly had all of these patients who came to me who were struggling with the ketogenic diet. So they were early adopters. They were following different thought leaders. They were trying keto. They were doing the macronutrients. They were eating the fat bombs and the bacon, and they just weren't getting the results that they were hoping for. Often they would do it. They do keto with a colleague from work, like a male colleague, and the male colleague would get all the benefits, and they were struggling. These were mostly women. So I saw this sex difference. I saw that my male patients were doing a lot better on keto. They were becoming metabolically

Starting point is 00:35:36 flexible, and the women were really struggling. And I called them my keto refugees because they were so frustrated and they felt like I'm doing everything right. What is wrong? Why is this not happening? So as I was struggling on my own with the ketogenic diet, I realized one of the first pieces that's so important for women is to make sure that those detox pathways are open. So I see a lot of women who struggle with constipation who are not pooping every single morning with that feeling of utter relief, like you have evacuated completely and you are ready to start your day. So we need that in place before you can really be successful on a ketogenic diet. You have to be eliminating. that is priority number one when it comes to many of these metabolic hormones, especially the

Starting point is 00:36:27 estrogens, because the gut is so involved in estrogen balance, especially estradile. So detox, getting that dialed in is so essential that I put it first. And also getting the vegetables that you need, the alum vegetables that raise glutathione, the dark green leafies that help you with the B vitamins, that help you with methylation. really important to have that in place. Then the ketogenic diet itself, again, I said before that I used net carbs because I find that women who restrict total carbs too much often end up having menstrual irregularity. We see that in up to 45% of people on classic keto.

Starting point is 00:37:08 They often have thyroid issues because reverse T3 can be raised by restricting carbohydrates successively. And I also see that they have issues with cortisol. so too much food stress. So if you adapt the ketogenic diet, you focus on net carbs. I have people begin with 20 to 25 net carbs each day. I find that that is so much better in terms of keeping the gut component of the control system for your hormones really working. And then I like to layer in intermittent fasting.

Starting point is 00:37:40 And the evidence right now, you know, there's a lot of different people giving conflicting information about intermittent fasting. my review of the literature is that 14 hours is probably the right number in terms of an overnight fast for women. That's not associated with too much cortisol or other hormone disruption. So this comes from UCSD, the work of Barbara Patterson. She's done some work looking at breast cancer risk and a few other hormonal factors. And I think 14 hours is probably the best way to go. And I recommend that people kind of ramp up slowly to intermittent fasting. I like to combine it with the well-formulated ketogenic diet because it's a backdoor to ketosis.

Starting point is 00:38:30 So most people can get into ketosis after some period of an overnight fast, typically 14 to 18 hours. So that's basically the protocol. And then when you come off the protocol, it's really important, almost like an elimination diet, to very gradually add. those net carbs back in. So five grams of net carbs per day is what I recommend, where you're tracking metabolic flexibility. So you're looking at glucose, you're looking at your weight, you're looking at inflammatory fluid. You're also looking, if you want to test a little further, you're looking at glucose ketone index. So that's a quick overview of the four-week protocol. That's great. And what are some signs, you know, especially for somebody who comes from this background of, you know,

Starting point is 00:39:16 pretty major hormonal imbalances. What are some of the leading indicators that they should notice during the program and especially afterwards that they're headed in the right direction? What should they pay attention to? Well, the first reaction is satiety, which is a very lovely reaction where you just don't feel as hungry. You know, if I take a step back, if you look at the literature on glucose and insulin. Probably the most proven diet is a whole foods diet with no animal protein or fat. So this is very well proven to help with glucose control. My problem is when I eat that way, I actually gain weight. So it doesn't work for me personally. And so I have to find a way to eat clean, but to follow a ketogenic diet.

Starting point is 00:40:11 The main issue when I eat a whole foods, plant-based, 100% plant-based diet is that I'm hungry. I'm really hungry. And so I end up eating excessive calories. So for me, the satiety that you get from producing ketones as a result of burning fat really helps me with creating that metabolic flexibility that I'm after. And of course, it's not about me. it's about other people, when they follow a low carbohydrate, high fat food plan, moderate protein, they have this feeling of satiety that comes from the ketones that are produced,

Starting point is 00:40:53 mostly beta-hydroxybutyrate. So that's one example, the feeling of being satisfied, not being hungry. I haven't eaten yet today because my ketones are relatively high. I cycle in and out of ketosis, kind of as needed. Another benefit is there should be some weight loss. So especially for people who are overweight or obese, we expect as you start to burn more fat, we expect that you're going to have some fat loss. So technically it's fat loss.

Starting point is 00:41:26 I don't want people to lose muscle. I want them to lose fat. And if you have fat to lose, that's one of the benefits that you should see from this type of program. Another one is relationship health. Since we talked about this earlier, I think this is a really key concept. I was just, I was filling out a functional medicine matrix. And under relationship and community, which is something we pay a lot of attention to at

Starting point is 00:41:55 the Institute for Functional Medicine, I was thinking about how relationships are affected by someone becoming metabolically flexible. So when you're metabolically flexible, your blood sugar is kind of where it should be and not like spiking high after you have, I don't know, an assyibo and then crashing down low right afterwards, you know, that's the kind of situation where you are just a setup for a fight

Starting point is 00:42:22 with the people that you love. And so I think another benefit is that you feel more even, your mood is better, you might find that anxiety is improved, and that the quality of your relationships gets better. So those are a few examples. There's a long list in the book, but those are the three that I'm thinking about right now.

Dhru Purohit Show - The Top 3 Mistakes When it Comes to Diet and How it Impacts Our Hormones with Dr. Sara Gottfried

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