Pursuit of Wellness - Fix Your Hormones: PCOS, Fertility, Pregnancy & Autoimmune Conditions w/ Dr. Sara Gottfried

Episode Date: March 11, 2024

Ep. #80 This week we are learning all about hormones with the renowned Dr. Sara Gottfried, who is an expert in women's health and hormonal imbalances. Sharing from our personal experiences, Dr. Gottfried and I navigate the complex world of hormonal issues that many women face post-pregnancy and beyond, challenging conventional medical advice and underscoring the importance of symptom-guided hormone health. Dr. Gottfried passionately advocates for accessible and comprehensive hormone testing, stressing its necessity for all women, not just those facing fertility challenges. For Mari’s Newsletter click here! Leave Me a Message - click here! For Mari’s Instagram click here! For Pursuit of Wellness Podcast’s Instagram click here! For Sara Gottfried instagram click here! To preorder Sara Gottfried’s new book The Autoimmune Cure click here! Show Links: To preorder Sara Gottfried’s new book The Autoimmune Cure click here! The Hormone Reset Diet (Book) The Hormone Cure (Book) Sponsored By: Visit Carawayhome.com/Pursuit to take advantage of this limited-time offer for 10% off your next purchase Right now, Chomps is offering our listeners 20% off your first order and free shipping when you go to Chomps.com/POW Stop wasting money on things you don’t use. Cancel your unwanted subscriptions by going to RocketMoney.com/POW Topics Discussed: 03:38 - Dr. Sara Gottfried’s journey 05:36 - Where to start with your hormones 08:42 - Most prevalent issue in women’s health 10:06 - Autoimmune disease 15:56 - Environmental factors 18:29 - Feminine vs Masculine energy 20:09 - Generational impact on hormonal imbalance 22:48 - Genetic environmental driver 24:45 - PCOS deep dive  31:26 - Insulin resistance 38:53 - Lifestyle redesign 40:02 - Individualized supplements 42:23 - Sugar suggestions 43:53 - Progesterone 47:45 - Testing for ovulation 50:28 - Benefit of psychedelics 52:37 - Connecting the dots 56:10 - Heart Rate Variability 58:56 - Pregnancy and hormone health 01:01:41 - optimal workouts for PCOS girls 01:05:19 - The Autoimmune Cure

There's a way that we've kind of dishonored the rhythms of being female that are backfiring and not working so well for us. And so I think it ends up being this invitation to really show up in the most authentic way possible. This is the Pursuit of Wellness podcast, and I'm your host, Mari Llewellyn. What is up guys? Welcome back to the Pursuit of Wellness podcast. I am so excited for today's episode. I already know you guys are going to love it as much as I did. Dr. Sarah Gottfried was a dream guest of mine. She's an icon. She's a legend. She is such an important voice in women's health online. I really, really believe that.

She's so intelligent, plus such a baddie. She looks so good. I don't know how old she is, but I do know she has two grown children and she looks incredible. So I'm listening to her. She is a physician, researcher, author, and educator. She graduated from Harvard Medical School and MIT,

completed a residency at UCSF, but is more likely to prescribe a CGM, continuous glucose monitor, and a personalized nutrition plan than the latest pharmaceutical. She's all about holistic health. Dr. Gottfried is a global keynote speaker and the author of four-time New York Times best-selling books about hormones, nutrition, and health. Dr. Gottfried is a global keynote speaker and the author of four-time New York Times

bestselling books about hormones, nutrition, and health. Her latest book is called The Autoimmune Cure, which launches this month. She's a clinical assistant professor in Department of Integrative Medicine and Nutritional Sciences at Thomas Jefferson University. She has a long list of credentials, guys, and really is such an important person for us as women we talk about a number of topics including hormone health autoimmune conditions why as women we are dealing with such hormone imbalance and how we need to be living differently than men how our hormones are impacted by generations before us by by our mothers and grandmothers. We talk a ton about PCOS. I saw so many questions from you guys about this topic,

so I made sure to ask a lot, a lot of PCOS questions. I also technically have PCOS and we discuss that. We talk about fertility. We talk about naturally raising progesterone and why progesterone could be stopping you from ovulating. We talk about aura rings. We talk about ovulation tests. We talk about psychedelics for medicine. We talk about endocrine disruption. We talk about trauma. We talk about the microbiome and the impact it has on hormones. This is an amazing episode. I recommend grabbing a pen and taking notes. If you are someone dealing with a hormone imbalance or you just feel like something's off in your body, it probably is. And this would be such a helpful episode for you. I really, really hope you enjoy it, guys. Let's hop in with Dr. Sarah Gottfried. Dr. Sarah Gottfried, welcome to the Pursuit of Wellness.

Thank you, Mari. So happy to be here. I was just telling you I am such a big fan of your content. I've been seeing you for years now and you're a dream guest of mine. We're going to talk hormones, longevity, women's health. I mean, you're such an important voice in the women's health space and the women have a lot of questions. I really feel like there's kind of an epidemic happening with hormones now and it's kind of alarming to me and I'm someone who's super into health and fitness and even I've struggled with my hormones. So I have a lot of questions for you. I would love to start

by hearing your personal story of how you got to where you are today. Well, I sometimes joke that I've had every hormonal problem that a woman can have. And for me, it started in my 30s. I was early 30s. I had one kid and I just hit a wall after that baby. Couldn't lose the baby weight. I was working in what I think of as McMedicine at the time. So I've seen a lot of patients like 30 to 40 a day. And I just, I was cranky. I was irritable. I had premenstrual syndrome. I just felt way too young to feel so like old and just miserable. So it was at that point that I went to my primary care doctor, had my list of, you know, all the things that I was struggling with. And he said a few things that just made me furious. He said, number one, with the weight loss, Sarah, it's simple math.

You just need to exercise more and eat less. And it sounds like you've got hormonal issues. How about a birth control pill? And then the best of all was maybe you're depressed. How about a little selective serotonin reuptake inhibitor? So at first I was kind of ashamed and upset. And then I got angry because I realized if I'm being told this and I'm a physician, then there are millions of women who are being told this very same thing and it's wrong. So that's really what got me to kind of turn left. I left his office, went to the lab, started checking my hormones,

and that's what got me started with all of this. Even now, when a woman is struggling with hormones and maybe doesn't have the resources for a naturopath or a holistic practitioner, what would you say is the option? Like, where do you go when you want to figure out your hormones? I would say start with your symptoms because your symptoms are really a map. They can guide you toward what the root causes of your hormonal challenges. And so in my first book, The Hormone Cure, I've got a questionnaire on pages 24 through 31. And those are questions that I ask my patients every time I take history. So if you don't have the resources to pay to come see me or some other practitioner, I would say start there. If you can do some laboratory testing, I think that's ideal. You want to put your symptoms

together with some objective information. And, you know, start with your clinician, because if you can get your insurance to pay for it, that's really ideal. But I also see a lot of clinicians who say, oh oh no, your hormones vary too much. We can't measure them. And that is not true. I mean, if you are trying to get pregnant and you're having a challenge with it and you go to your clinician and you want some help, suddenly they're measuring every hormone. They're looking at your thyroid, your DHEA, your testosterone, your estradiol, your FSH level. Why is it in one situation, it's reliable and dependable and in another situation when you're not trying to get pregnant, it's not? So I would say let's even the playing field, we all deserve to get our hormones measured.

Absolutely. What is your preferred form of testing do you like dutch tests blood tests both i like all of the above is that an option because there's a time and a place for each one i start with blood testing because it's the universal language of physicians so i get a lot of referrals that you know and i want to I want to build bridges with conventional physicians. I don't want to, you know, alienate them. So I do blood testing. And a lot of the outcomes, you know, especially testosterone, estradiol, FSH, thyroid, are based on blood testing. But it's not very comprehensive. It doesn't tell us, unless you specifically order it, free levels of hormones, like with cortisol or with testosterone.

And so I like the Dutch. I ordered the Dutch Plus in pretty much every patient, whether that's a man or a woman, because it gives me so much information about the cortisol pattern during the day, sex hormones, even some organic acid testing, which I find to be really helpful, metabolites. A lot of people think with estrogen, it's just one single measurement, but it's actually an entire family and all of their progeny, right? They're metabolites and measuring them can give you a really good snapshot of a more comprehensive picture of what's happening in your body. From your experience, what do you feel like is the most prevalent issue right now with women's health? Is it the hormones? Is it autoimmune? All of the above? Well, these are all interdependent.

So I started with hormones because I was a hormonal hot mess and I had to solve it. And I think that somewhere around 85 to 90% of women struggle with a hormone imbalance at some point in their lives, whether that's insulin or estrogenism or polycystic ovary syndrome. So all of those things are common. And, you know, the people who come to see me are a special population because they're struggling in some way. And I've had maybe like five patients who were perfect hormonally, but the other, you know, 40,000 had things that we needed to address together. So autoimmune disease is a really common problem. dramatically increased, not just over the past few decades and since I started my training, but even post-pandemic, the rates have increased like ninefold, like huge increases recently. But I would still say hormone imbalances are the primary issue that I see.

What classifies an autoimmune condition? Because I hear the term a lot, but I'm actually not quite sure what it is. It's a great question. So the way I think of it is that there's this spectrum from totally normal immune system to autoimmune disease. And those are things like Hashimoto's thyroiditis and multiple sclerosis, inflammatory bowel disease, like ulcerative colitis and Crohn's disease, type 1 diabetes. There's 100 of them. But there's also this really broad range in between before you get a diagnosis of an autoimmune disease

that I think of as autoimmunity. And so it's a process that occurs, we think, over about 7 to 14 years where you start to have difficulty telling the difference between your normal tissues and something that's abnormal that you should attack, like a virus. And so your immune system, which has this army that's meant to protect you, becomes confused. And there's certain things that drive you in that direction. But that's the basic definition of autoimmunity. And the way that we tend to measure it, at least with classic autoimmune disease, is by measuring antibodies. So in the case of

Hashimoto's thyroiditis, we're talking about thyroid peroxidase antibodies or antithyroglobulin antibodies. With rheumatoid arthritis, it's rheumatoid factor. So you can measure kind of this level of weapons that your immune system is releasing to attack your own tissues. And that's part of the definition. But I would say, Maury, the definition is becoming broader because there are also other conditions where your body is attacking itself, normal tissues, and we may or may not be able to measure an antibody, like with endometriosis.

With coronary heart disease, the number one killer, the way that we attack our blood vessels with coronary heart disease, the number one killer. The way that we attack our blood vessels with coronary heart disease, a lot of experts think that's autoimmune, even irritable bowel syndrome. So there's lots of conditions, fibromyalgia, that aren't classic autoimmune diseases, but your immune system is still attacking itself. We talk a lot about the importance of protein on this show and I'm always giving you guys ideas for recipes but I know snacks can be so challenging and Chomps makes snacking simple. Their tasty meat sticks are packed with mouth-watering flavor and only the best ingredients each stick has up to 12 grams of protein without any of the unhealthy additives and zero grams of sugar they are low carb keto friendly allergy friendly and don't contain

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going to rocketmoney.com slash pow. That's rocketmoney.com slash pow, rocketmoney.com slash pow. I've heard someone say that acne could be autoimmune because I kind of have a reoccurring acne that I've been dealing with for 10 years plus. Would you consider that autoimmune? I'd need to look at the data on acne. But I think when you see these chronic inflammatory conditions like acne, there could be a case made for it. So I'd have to look further into that, but I would be open to the possibility. Do you think there's anything in the environment or our lifestyles that's contributing to the rise of autoimmune conditions? Like why are they popping up so much? I think there's a lot of different reasons. You know, if you just start with the way that we eat, you know, our food supply has completely changed.

I have a great grandmother who was born in 1900. And the way that she ate is just very different from how we eat now. So I think our food has made our immune system more likely to attack normal tissues. There's certain foods that, you know, just trigger, more likely to trigger response and trigger inflammation. And that includes gluten, dairy, nightshades. You know, there's a long list of common food reactions. So food is one piece. I think we've got more toxic stress than ever before. When you look at, you know, kind of post pandemic, what's happened with mental and physical health, there's a way in which very few of us don't have an experience of trauma at this point.

It's just so widespread kind of wherever you are in the world. There's hormonal disruption. There's endocrine disruption from chemicals in the environment. And some of it also is the way that we architect our lives, some lifestyle factors, the way that we, not just the way we eat, but the way we sleep, the way that we move, you know, even sitting in this chair. I kind of wish I could go on a walk with you or go to the gym and lift weights with you while we record a podcast because we're meant to be moving. And there are ways that we have this mismatch with our environment. And the whole point is, you know, if I had to summarize kind of what I think health is, health is homeostasis. It's the state of balance that you feel internally, But a lot of us are really sensitive to the environment and it just

causes this level of dysregulation that leads to, you know, jacked up rates of autoimmune disease. Yeah. We talk a lot about women's health and I feel like I've seen you mention the systematic stress we feel as women. And it kind of feels like nowadays we take on this masculine role in society. I know I have for many years because I have a business, I'm hustling, I have a team. And I've kind of reached this point with my health journey where I feel a little bit misaligned with the way that I've been living my life. And you just mentioned going on a walk for the podcast. I have begun walking for my meetings, for my therapy, and ideas are coming out so much more fluidly and it's making me rethink how I live my day. I think it's a really powerful tool we can use. Yeah, I love that you've come to this understanding because,

you know, I was taught to be masculine in order to achieve, right? Like I was taught to kind of deny my needs. Oh, you've got your period, doesn't matter. You show up for the meeting, doesn't matter that you've got menstrual cramps, It doesn't matter that you are ovulating and you'd rather be at the gym than in some business meeting. And there's a way that we've kind of dishonored the rhythms of being female that are backfiring and not working so well for us. And so I think it ends up being this invitation to really show up in the most authentic way possible and to find these ways like you're describing, walking while you're doing therapy and while you're doing meetings, finding these ways that we can really show up as fully ourselves and not someone else's version of what we're supposed to be doing. How are our hormones impacted by generations before us, by our mothers, by our grandmothers?

Are we born with hormonal imbalances? Did they develop over time? Like what's the history there? Another great question. I would say we don't totally understand this. What we can understand is that there are certain hormonal tendencies that can be inherited. So how do we know this? We know it from looking at the survivors of 9-11. We know that the women who are pregnant in 9-11 had some changes with their cortisol levels that their babies then inherited. And we've also seen that in genocide. So the work of Rachel Yehuda looking at Holocaust survivors and their offspring, the way that they signal cortisol is changed.

So there are these epigenetic changes. They're not genetic. They're kind of above the genes. They're almost like little paperclips that go into your DNA that you can then pass on almost like soul wounds. And then we also know from this research project called the ice storm that when you look at women who are pregnant who go through a significant traumatic experience like this huge ice storm that happened near Montreal and in Canada, that the sets of genes that become paper clipped, become changed in terms of what offspring inherit, are in two different categories. The metabolic system, so like how you traffic in glucose and insulin, and then your immune system.

So soul wounds definitely affect your immune system, your metabolic system, as well as your endocrine system. I'm just thinking from a personal lens. I come from a family of very high stress, high strung women. And I feel like I'm that way. I'm very, you know, type A, I'm very anxious all the time, it takes a lot of work for me to calm down. And I lean on the side of having higher testosterone. And I struggle with acne, and a little bit more of PCOS like symptoms. Is that connected in some way? So you're asking about kind of the genetic and environmental drivers of polycystic ovary syndrome or whatever phenotype of PCOS you might have. So yes, we know

that there are genetic drivers and, you know, it'd be so easy if there was just one gene that we could identify and we could test you for the gene, yes or no, you have it. It's more complex than that because there's a lot of different genes that kind of work in a pathway to affect your metabolism, to affect your, you know, kind of the state of balance between estrogen, progesterone, and testosterone because PCOS is not just testosterone. And so, yes, I feel like it definitely runs in families. I don't have PCOS, but I certainly have insulin resistance and I've got a lot of people in my family with PCOS. And I feel like, you know, for some of us, I'm a higher testosterone person as well. You know, there's a gift in that. And then there's also a way that it creates vulnerability. And so on the one hand, I think my higher testosterone levels helped me

achieve, I wouldn't say testosterone levels helped me achieve. I wouldn't say I'm a type A anymore. I'm more like an A minus. But I was a type A certainly through college and through medical school. And I think that higher testosterone was helpful. Yeah. It builds confidence and agency and it helps you, you know, just kind of put yourself out in the world in a way that you may not be able to if testosterone levels are lower. So there is a gift side and then there's

more shadow side. I agree. I feel like I'm very driven and I think a lot of that comes from my high testosterone, but I have the acne on the jawline and that's where it gets frustrating. I want to dive into PCOS. I'm sure you've heard this from a few interviewers, but PCOS is by far the most asked question I get every time. And truthfully, I'm a little bit confused about PCOS. I have some symptoms of it, but don't have cysts on my ovaries. Like I'm not even, it's a weird diagnosis because I feel like it's kind of just a cluster of symptoms. And it's like, is the diagnosis even really helpful? Like, should we just focus on the symptoms? Like, how do you define PCOS? You're asking just kind of the most brilliant question when it comes to PCOS because it's polycystic ovary syndrome, not a disease. And syndromes tend to be this constellation of symptoms where you might have one or two, but not like all five.

So it can be tricky to diagnose. You know, the average woman with PCOS can go to a lot of different clinicians and suffer for like seven years before she gets any clear answers. So the way that I diagnose it is to look at a woman's history. You know, if she tells me and she's got acne and she's got maybe some increased hair growth in places where she doesn't want it, like on her chin or nipples. And you put that together with sometimes some irregular menstrual cycles, but not always. You put it together with cysts on the ovaries, but not always. You put it together with a particular blood panel, like biomarker panel with higher testosterone levels, but not always. Maybe some insulin resistance, but not always. Like there's a way that it's maddening and frustrating that you don't get a yes, no answer. There's more like, oh, you have a touch of PCOS. Okay, what am I supposed

to do with that? And the problem there is that in conventional medicine, they ask one question, which is, okay, we think you've got PCOS. Do you want to get pregnant? Yes or no? Yeah. And if you want to get pregnant, then typically they give metformin, maybe some Clomid, try to get you ovulating so that you can get pregnant. If you don't want to get pregnant, you get told, here's a birth control pill. It'll give you a regular cycle, which is a total myth. And so to me, that really is the problem. So the diagnosis is a problem. The treatment approach is a problem

because there's so many things that you can do to go upstream and look at the root causes and work with them there. Bering is coming and it is time to reset the house. I just spent my last Saturday cleaning the whole kitchen, getting everything organized and looking amazing in our new house. And I also was organizing my Caraway cookware set. I love my new stainless steel pans. I really try to use as much stainless steel as possible because it really is the cleanest thing that you can cook on. But I also have this stunning bakeware set from Caraway.

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That's how I like to approach it. Yes, it's a good way to approach it. You mentioned the fertility piece. I'm trying to get pregnant right now. So I'm very interested in this. Congratulations. Well, it has been a emotional roller coaster. I did not anticipate how obsessive I would be four months in.

It's crazy how it takes over your whole. It does take over your life. I did not anticipate that. I really thought that I would be very chill about the whole thing and I'm not. So that's nice. If you have a PCOS diagnosis or you have the symptoms of PCOS, is it just a for sure thing that you're having, you're going to have a hard time conceiving? No. Okay. How does that work?

Well, it depends on ovulation. It depends on a lot of different factors. I mean, when you, when you look at PCOS, I wish it were simpler in some ways, but it's one of the most complex conditions that women face. And if you take away the hormonal imbalance that the birth control pill causes, PCOS is the number one hormone imbalance that women face. So not everyone with PCOS struggles with fertility. But if you're not ovulating every cycle or if there's some irregularity to how you ovulate, that's what tends to make it more difficult to get pregnant. And then for women like us who've got higher testosterone levels, the higher testosterone can be directly sometimes toxic to the ovarian tissue.

And you combine that maybe with some insulin resistance, which is something I also have, and it can make it harder for the normal healthy processes to be happening in the ovary. Now that typically shows up as cysts in the ovaries, but not always. How do you know if you're insulin resistant the main way you know is to look at your insulin levels and your glucose levels so for some of my patients i put a continuous glucose monitor and pretty much everyone and so sometimes you can tell just from their glucose levels that someone is insulin resistant. But we also know from studies in the UK, like the Whitehall study, that problems with insulin can predate problems with glucose by 7 to 13 years. So the way that I like to look at it is I like to do a two-hour glucose challenge test

where I'm looking at fasting glucose and insulin, and then we give a specific amount of carbohydrates, so usually a 75 or 100 gram load. And then you look at your glucose and insulin at intervals after that, like every 30 minutes, every hour, And then you look a total of two hours out. I like to do that with a continuous glucose monitor, but you still have to draw the insulin. Because typically what happens with insulin resistance, you know, what's happening on a cellular level is that your cells become numb to the insulin signal. So you can think of it as insulin is like the lock on the door of your cells and it goes in, opens, unlocks the door, lets glucose inside of your cells. So if you're someone who's insulin resistance, it's like the lock in the door is jammed.

So you can try with insulin to open the lock to the door to get glucose to go into inside the cell and it's just not happening and so in that situation your insulin levels in your bloodstream are getting higher and higher trying to drive that glucose inside your cells and it's not working so typically you want to look at the postprandial insulin first, like what happens in response to food, because that's what changes first in the sequence. Can you feel that physically? I feel it because I'm pretty sensitive to it. Yeah. So I started, I was insulin resistant when I left that doctor's office in my 30s. And I went to the lab and I checked my cortisol,

which was like three times what it should have been. I checked testosterone. I looked at estrogen, progesterone, thyroid, and I looked at insulin and glucose. And I remember my fasting insulin was like in the 20s and my glucose was in the pre-diabetes range it was like 105 and I was like what is that did I eat some food or like was that my mouthwash or my toothpaste like why is that and I checked it again and it was still elevated so I was insulin resistant probably through my pregnancy like I had a borderline glucose test in my pregnancy. I find that when I eat, so I eat very high fat, high protein, low carb. I don't feel good when I have a lot of carbs.

I've noticed I'm very sensitive to sugars. I don't know what that means about insulin resistance. I don't think it's ever been. I do a lot of lab work and it's never been mentioned to me. So I don't know. Oh, you have some lab work there. I listen. I printed it out. I wasn't going to ask, but I was like, let me just see if she notices it on the table. Okay. Yes. I can't wait to show you. Happy to look. Yeah, because I'm really just trying to hone in on this and figure out my situation. I mean, I've improved my lab work since the beginning of last year, but now I'm on this fertility journey and I'm kind of looking at it from a new

lens. When it comes to PCOS or symptoms of PCOS, how can we live in the most optimal way? Live, eat, supplement, what do you recommend? So generally for women who are trying to get pregnant, the recommendation is a little bit different than someone who's not trying to get pregnant. So what I talk about in the hormone cure is that a low carb diet reduces testosterone within seven days, reduces acne within seven days. So low-carb can be super helpful. The thing that's a little bit tricky is that when you're trying to get pregnant, carbs can sometimes be your friend. I know. And I find this somewhat frustrating because I'm pretty carb intolerant.

Like I just can't tolerate that much in the way of carbs. And I know you have been lifting heavy for quite a long time. There are ways to work around that. So you can do carb cycling. You can work on kind of both sides of the equation. If you think about the input side which is the amount of carbs that you consume how you combine them with protein and with fats and then you look on the output side you look at how much you exercise how much you lift how much muscle mass you have so there's ways to become more carb tolerant but generally when you're trying to get pregnant, what I've found taking care of patients is that low carb, even, you know, almost like a ketogenic diet can be kind

of stressful on the female body. I know. I love my keto lifestyle. I know. I hear you. I'm the same. But I'm eating more. Okay. So here's what I do. I have more potato. I feel good on potato. So I do sweet potato, Japanese, and I'll do them at night. So I kind of like backload my carbs at dinner. How do you feel about that? So I think you can debate that. I mean, part of, if I were taking care of you, I would want to see continuous glucose data to see what happens when you have carbs at night. I actually wore one kind of recently. The only time I saw it spike was when I had two dark cherries.

Yeah, so certain fruits can really spike you. So it sounds like Japanese sweet potato, white potatoes, sweet potatoes were not spanking you. Is that right? No, I felt fine. So that's good news. And it might be related to the lifting that you do. It might allow you to be more carb tolerant. When I have sweet potatoes or white potatoes, my glucose goes through the roof. Interesting. So it's really individualized. It's important to recognize that. So then the question is also, you know, one of the consequences of a ketogenic diet or low-carb diet is that you might be feeding your benevolent bacteria in your gut less of the prebiotic fibers that they need. So that's another thing that I like to test in my patients just to see if,

you know, is there some optimization that we could do here? With PCOS, the symptoms, the hair growth, the acne, is the diet helpful for those symptoms? Or do you feel like there's certain supplements that need to be introduced? I think diet can go a long way and I've got a food first philosophy. So I definitely think lifestyle redesign, starting with food is the place you begin.

For most women who've got PCOS, I would say they need more than just a dietary change. But that said, you know, it's pretty impressive to me. I think it's pretty empowering that inside of seven days, you can significantly change the biochemistry of your body. You can significantly change your testosterone. So there's a lot that you can do. It's a heavy lift with food,

but you also have to be really consistent about it. And it's one of those behavior changes that's not that easy for people. So I would say start there. The thing about supplements is that they can give you kind of more dynamic range. They can give you, you know, like I'm down in Los Angeles, I'm away from my kitchen, I'm not weighing my protein, I'm not getting my 30 grams five times

a day. Like I'm not on my game the way that I usually am. And so supplements kind of let me have a little more buffer. And I think the same is true with PCOS. What specific supplements do you like for PCOS? So this is where I individualize and I love that you sort of said, you know, why do we think of it as PCOS? Maybe we should just look at the individual components that someone is facing and address those. So that's how I work with patients. And so I do genetic testing and I'm looking, you know, not just at your PCO pathways, I'm looking at your cellular processes, like how well do you detoxify? What's going on with your methylation? What's happening with your inflammatory tone? What about oxidative stress, kind of the rust in the body from aging? How are those pathways doing? What's going on with your blood vessels and your lipids

and also nutrigenomics? Like how do you do with vitamin D? What's going on with choline? Sounds like you probably get enough from the way that you eat. So I like to look at genetics. I like to look at biomarkers to guide the recommendations of supplements. But there are certain supplements that have been shown to be really helpful. So that includes the myonositol, d-chironositol.

Those are probably the most proven. But vitamin D also has a huge role with PCOS. Things that I help as insulin sensitizers like berberine, chromium, those things can be helpful. Alpha lipoic acid. And so with my patients, I'm doing the genetic testing. I'm doing biomarker testing. I'm doing hormone testing, Dutch Plus. With the biomarker testing, I'm looking at micronutrients. Like what is your level of alpha lipoic acid? What's going on in your gut? Do you have the right levels of, you know, short chain fatty acids?

So I'm treating, I'm personalizing based on what's in front of me with the patient that I'm working with. And with diet, with PCOS, is the recommendation whole foods, lower carb? Should we be avoiding sugar completely? That's where I start. Okay. So I like to meet people where they are. You know, someone like you sounds like you've been off of sugar for a fair amount of time. Yeah, I'm not really a good example. You're not the best example. Yeah, so a more normal human who is, you know, maybe having dessert a couple times a week and has, you know, often there's a layer of some emotional eating with PCOS. And I say that as someone who's recovered from emotional eating. So I have a lot of compassion for people who, and I think this often relates to trauma, you know, that

the way that we eat and the soothing that we experience with food, the serotonin increase that we experience with eating carbohydrates, that can sometimes set up these pathways that can become dysfunctional. And so, yes, my preference is to get a continuous glucose monitor in my patients to start tracking their food intake to see what are the healthy foods that are really a good fit for them. How does, you know, some macronutrient modulation, how does that help them? But generally, I'm starting with a low-carb approach and we're trying to get rid of refined carbohydrates. We're trying to reduce sugars significantly, but I like to meet someone where they are. I'm not going to tell them, okay,

no more sugar ever again, or else I'm not going to talk to you. Like that's, that's no way to take care of somebody. I want to ask you about progesterone. I see a lot of questions about progesterone. I discovered that I had extremely low progesterone. It was at like a 0.1. And as I mentioned, I run very stressed, a little bit more on the kind of negative side. So I introduced bioidentical progesterone. I take slow release progesterone every day. And when I was researching it before I started taking it, there's kind of like a little bit of bad PR around progesterone. Why is that? And like, do you think that hormone replacement therapy can be useful? So this is somewhat complex, this particular topic.

What we know is that if your ovaries are not producing an egg and going through the cycle that raises your progesterone level so that on, you know, ideally day 21 or 22, you've got a progesterone in your serum of 10 to 15. If that's not happening, then what we want to do is try to nudge your body into ovulating and producing those progesterone levels on their own. So typically the place that I start is with Chase Tree. So Chase Tree, I don't know if you've taken it before, but it's been shown to raise serum progesterone levels. There was a randomized trial that was published at Stanford a while ago showing this. So back when I was working at McMedicine, I had this woman who came in and she was trying to get pregnant. She was like 34, 35, and she had really low progesterone levels. And so she was starting to go down this path toward reproductive endocrinology,

where they were going to start using increasingly stronger medications to try to get her to ovulate and to get her pregnant. Meaning like metformin, Clomid. Metformin, Clomid. And she somehow found out about Chase Tree. And so she started taking it. It's also called Vitex, Chaseberry. She started taking it and she got pregnant. So it raised her progesterone levels. She got pregnant. And this is what we call in medicine, an anecdotal report. Like it's not the best evidence, but she told me this and I was like, that's really interesting. Like I was never taught about that. And'm board certified as snow beach UIN. So I go and I look at the data and lo and behold, it's shown to be like this gentle nudge to the

ovary and to the endocrine system that helps women ovulate and helps to raise their progesterone level. So that would be my preference as a way of, you know, kind of managing ovulation and maybe, you know, working on insulin resistance and some other things. The thing about bioidentical progesterone is that in some women, it can block ovulation. So that's where you have to be kind of careful. So what I sometimes do with patients is if they need progesterone, I'm going to try to have them make their own endogenous progesterone by whatever means necessary. And they might need metformin, you know, Chase Tree might not do it, but I'm pretty reluctant to start bioidentical progesterone. If I've got someone in whom metformin or clomid

doesn't work or taste tree doesn't work, then at that point, I'm going to refer them to a reproductive endocrinologist. Sometimes I'll use bioidentical progesterone after someone ovulates, but I really want to do everything I can so that your ovaries can do that for you. What do you feel like is the best way to test if we're ovulating? I'm using the strips, the pee sticks, but the lines are a little confusing and my temperature with my aura ring. Yeah. And do you use an app together like natural cycles with aura? Yeah. And it says confirmed ovulation based on the temperature. But can I trust that or should I be doing double checks? Double checks, I think, are helpful when you're trying to get pregnant.

Yeah. So I really, I mean, I wear an Aura as well. I think their data is really accurate. So I like a backup method such as the peesticks where you're looking for luteinizing hormone. Are you ovulating when you expect to? Like, is it, what day is it? Day 21, around day 21. So a little late, a longer cycle. Wait, no, I tested progesterone on day 21. So that was after ovulation. Yes. I don't exactly know the day,

but I do know that my luteal phase is too short. So it was around the six day mark. And on this past cycle, it was actually closer to 12. So it's starting to increase. Gotcha. Yeah. So luteal phase and a shortened luteal phase is something that we see really commonly. Oh, okay. And one of the kind of easy solutions for that is vitamin C. So vitamin C at small doses like 750 to 1,000 milligrams has been shown in women with shortened luteal phase to normalize their luteal phase and to increase their progesterone levels. So I'm always looking for what are some of the natural ways? Are there any micronutrients that might be low that we could adjust and get to the Goldilocks position so that we allow the intelligence of your body to come through? Yeah. Do you think bioidentical progesterone is something that I could like wean myself off of? Yes. Okay. That's good to know. Because now

I'm not, am I stuck on it? You're not stuck on it. You're not stuck on it. And it's, you know, let me first say that it makes sense that you tried it. Yeah. It totally makes sense. You saw low progesterone. You're thinking, well, it's over the counter. Like you can get progesterone from Whole Foods. So it makes sense to try it. What I've seen, again, anecdotally, is that it blocks ovulation and pregnancy in women. Got it. Okay.

I'm glad I asked about that. I'm glad you did too. I saw on your website that you have, and tell me if you're okay with talking about this, psychedelics listed as a treatment. Yes. How can psychedelics benefit us physically with our health? Like that kind of took me aback. Yeah, psychedelic medicine is undergoing a revolution right now. It's pretty amazing to see the amount of data that we have showing its benefits. A lot of the research on trauma and kind of the role of psychedelic medicine or with treatment-resistant depression and the role of ketamine and psilocybin as treatment has centered around mental health issues. So when you think about people who've experienced trauma or just have, you know,

kind of these longstanding mental health challenges that they're faced with, to me, that's only part of the puzzle. It's like the tip of the iceberg. There are so many physical issues that people face like problems with cortisol, problems with what I think of as the pine network. So pine is psychoimmunoneuroendocrine network. And the psychological part is just one small piece. So it's important. But when you think about the chronic dysregulation that people have that lead to things like insomnia, difficulty sleeping, blood sugar dysregulation, an increased risk of diabetes, autoimmune conditions, chronic endocrine problems, like problems with the control system for cortisol and other sex hormones, the hypothalamic pituitary adrenal axis, even problems with thyroid and other endocrine abnormalities.

Those are all affected by trauma. And so when I think about psychedelic medicine, I'm excited about the mental health benefits of it, but I'm especially excited about the physical health benefits. That's a crazy connection because I think for a long time I mentally separated my trauma journey and my mental healing journey and my hormone problems and my stress problems. And it's so connected. And I think it's so connected and I think it's difficult to like wrap our heads around that concept I'm so glad you're making this point

because most people don't connect the dots it's hard to because like if you can follow all the rules and take the supplements and eat a certain way and exercise a certain way that's that makes you feel better about what you're going through but if you can't tap into the mental side of it there's almost this like obstacle yes and I feel like I've hit that wall so many times and I'm sure a lot of people listening have had the same experience because at the end of the day if your mind is buzzing and something's wrong up there, it's difficult to connect with the body. Well, they're so interdependent. Yeah. You know, we think of them as kind of these separate systems like, oh, here's my mental health over here. Here's my physical health over here. But

they are embedded. And so, you know, when I was struggling in my 30s with my cortisol levels, and I would get them to a much better place, I would normalize my cortisol levels. And I, you know, could tell you exactly the supplements that worked and the meditation and the yoga practices that were so helpful. But they also kept coming back, showing me that there was some vulnerability with the way that I traffic in cortisol. And that vulnerability, I believe, is related to childhood trauma. And so I think that's a common thread, you know, especially for people who are really focused on their wellness journey. And they take two steps forward and then they backslide a little bit and then three steps forward, two steps back. Often the reason for the stepping backward is trauma and the way that the signature of trauma is still living in your body.

Do you feel like you've ultimately cured your cortisol problem or is it still reoccurring I still have a vulnerability but I would say for the most part my relationships are completely different the way that I work is completely different the way that I launch a new book is completely different like I don't run myself ragged

the way that I used to and I still have to be attentive to it. And it's one of the reasons why I wear an aura ring because I'm also an unreliable historian. So I'm so cognitive that it's sometimes hard for me to feel when cortisol is, you know, kind of running the show inside my body. And so I can use heart rate variability. I can use daytime stress. I can use my sleep score, my deep sleep and the number of interruptions I have to be able to track how that maps to my stress response system. So I wouldn't say I'm cured. I would say I've done so much work to try to resolve trauma in my system and try to change that signature that

trauma has in my body. But I'm also still vulnerable. I'm more aware of my vulnerabilities and how to work around them. But I would say it's a lifelong project, one that I totally embrace. Do you find that you have a higher heart rate variability or a lower one? Oh, I tend toward low. Okay. So heart rate variability, you know, I can tell you when I'm on my game. Like last weekend, I was in Big Sur and it's just such a beautiful, wild, rugged place. And I was eating amazing food and I was sleeping so well. My HRV was just like rock star level, like super.

It was high and it was beautiful and it was good. And then I went to a tequila tasting at the place where I was staying. Yeah, that'll do it. Oh my gosh. That'll do it. My HRV was like a third of what it should be. What do you consider rockstar level? I'd love to know. Well, this is where I think it's important to track yourself over time and not necessarily compare yourself to others. Okay. So I'm pretty happy with a level of like 50 to 70.

I'm so confused by HRV. So mine is usually 150 plus. Oh, wow. But what does that mean? Like, am I okay? And every time I post about it, everyone's like, what? Why? Like, what I okay? And every time I post about it, everyone's like, what, why? Like, what's, are you, like, what's going on?

Do you have any sort of cardiovascular issues? No, I don't think so. Okay. Well, I would have to look at it more deeply. So the aura gives you a summary. It doesn't give you a lot of the details. Yeah. A chest strap, which is what I used to do, gives you a lot more information and you can run that through filters and you can get a better sense of what's going on.

So I can tell you with the professional athletes that I take care of, like I take care of the Philadelphia 76ers, they have HRVs that are really high. You know, they're professional athletes. They're in their 20s and 30s and they're pretty impressive how high their HRVs are. I feel like I could compete with them. I think you might be able to. Why am I a professional athlete status HRV? That's so strange.

I mean, apparently you are. That's so odd. I would say let's dive into it more deeply. Yeah. And what matters is, you know, do you notice much variation depending on your travel and lifestyle and stress? If I have a drink, it's usually under 100.

Yes. I've never seen it lower than a 50, ever. Okay, that's good. So you're younger. Yeah. Younger tends to be higher. Okay. And you're super fit.

Do you know what it was before you went on your weight loss journey? Oh no, I would have had no idea. So that would be super interesting. I know, I wish I had tracked that information. Okay, good to know. For my ladies listening who are pregnant, how should they be managing hormone health during that? And how should their diet be looking?

So when you're pregnant, I would say eat for your microbiome. You know, there's this idea that you eat for your fetus. Your fetus is, you know, we all love the fetus, but your fetus will extract any nutrients that it needs. Like it's pretty amazing how a fetus can do that. I mean, it's just sort of the start of motherhood, the way that your baby will take what it needs. So what I really advise, I mean, if you have disposable income, I really advise people to do some nutritional testing to make sure that you're not low in B vitamins as a result of being stressed for years. Make sure that your vitamin D is in a good level. Look at your homocysteine. Look at your inflammation. Look at your glucose and insulin. If you can afford a

continuous glucose monitor, I think that's really helpful. Use that to personalize your food. In pregnancy, generally, we say we want you to have a pretty balanced diet. The most proven diet in the world is the Mediterranean diet. So that's really medicine for the average. So it's a population-based way of looking at diet and we have to personalize. So the Mediterranean diet, when I follow the Mediterranean diet, I gain weight. It's way too many carbohydrates for me. And unless I've got, you know, like a pretty, like I'm doing some kind of build with like the way I'm lifting and the way that I'm

consuming carbohydrates, I will guarantee gain weight and have blood sugar problems if I follow a Mediterranean diet. So what I tend to do with women who are trying to get pregnant or are pregnant is use a continuous glucose monitor. Start with a Mediterranean diet. Maybe try to alter the carbs a little bit. Not severe, low carb. Make sure that you're getting enough carbs to feed your microbiome. maybe having 25 to 35 different species of fruits and vegetables each week is critical because we know that that's what creates the kind of diversity in the microbiome

that really sets you up for health and then sets your baby up for health. You mentioned something and I realized I forgot to ask for PCOS girls, the most optimal workout that you would recommend? Because we're seeing trends of low cortisol workouts now with Pilates and walking. Are you a fan of lifting weights with PCOS? So with PCOS, especially if you've got insulin resistance, I think you have to do resistance training. I think it's critical. But I think you maybe are asking about something else, which is a lot of people with PCOS have stress dysregulation. So their control system, their hypothalamic pituitary adrenal axis, and if you want to get a little more technical,

it's a bigger control system. It's the hypothalamic pituitary adrenal thyroid gonadal gut axis. So all those things are involved in controlling your hormones. And so when you've got adrenal dysregulation and a lot of fatigue and you've been stressed for years, maybe decades, and you've got PCOS, you want to be somewhat careful. Like you don't want to start lifting heavy, you know, tomorrow. But I also think that more adaptive exercise like walking and Pilates may not serve you either. So I think trying to find what works for you personally, I mean, obviously I want to hear more about your story. But what I've seen on social media is that you changed the way you ate, you started lifting heavy. And I've seen

some of the workouts that you do. I think that's really critical for building muscle mass and maintaining it as you get older. Yeah. And you've had the queen gabrielle lyon on your show yeah and so you know i really agree with her that muscle is the organ of health span yeah and so it's never too early to pay attention to that and you know on the one hand i want people to attune to what their body needs and to not push themselves too hard, especially someone who's an overachiever and pushes themselves too hard in every other part of their life. I don't want this to be another place where they feel like they're failing. But when I've shied away from lifting heavy, when I've done more adaptive exercise and, you know, I'm like yoga girl a queen you two are such powerhouses together but I personally feel like there's a way to approach weight lifting that isn't super high cortisol like I'm taking my rest days I'm not always doing it in a hit manner I went through a phase of doing

hit style weight training every day and that fried me and I look back and I kind of cringe because I definitely went too hard but now I have slower days I have back and I kind of cringe because I definitely went too hard. But now I have slower days. I have faster days. I take my rest days. So I really think that there is a way to go about it that's optimal for where you're at. That's right. And it's not yes, no. It's not heavy lifting, yes, no. There's a whole spectrum here of ways to do resistance training and strength training. And you want to find the way that works for you. And maybe variety and mixing it up as you described.

So I know you're launching a new book. Am I allowed to talk about it? Oh, please. March 12th, The Autoimmune Cure. Why did you decide to write this book? I wrote this book because I was seeing this exponential rise in autoimmunity. And I'm someone who is measuring antibodies looking for autoimmunity way before a diagnosis of autoimmune disease. So I saw this exponential rise, especially in my female patients.

But not just in my female patients. Men do this too. And I just felt like, wow, why is this being shown to me? I really believe in divine timing. And I felt like there was a way that there was something happening in our culture that I wanted to understand. And as I started to look further at it, once again, I measured my own labs and lo and behold, I had positive anti-nuclear antibodies, not just like a little bit, but like high levels of antibodies against the nucleus of my cells. So that got me really interested in looking at, okay, why is this happening? Why are we seeing such a dramatic rise? And when you look

at the root cause, which is genetic predisposition, together with increased intestinal permeability or leaky gut, and then some kind of trigger, I realized, wow, we've got more triggers than ever before, like the way that we're eating, pregnancy, postpartum, perimenopause, infection, trauma, toxic stress. And I just felt like there weren't enough physicians who were looking at autoimmune disease from this perspective and thinking about, okay, if you can't change your genetic predisposition, you can change your leaky gut. Like there's a lot you can do. L-glutamine, aloe vera,

and there's a lot you can do about triggers. So that's what got me excited to write this book. I am going to be purchasing this book for my husband who has awful leaky gut. He's a bodybuilder, so he's been through it. Yes. So I will be getting the book. Where can everyone find you and the book online?

So the book is available anywhere books are sold online. I'm at sarahgoffreadmd.com and mostly I hang out on Instagram, which is at sarahgoffreadmd. Thank you so much for coming on. We'll have to do a part two at some point because I have so many questions for you. I really appreciate it. My pleasure. see my favorites at marilowelland.com. It will be linked in the show notes. This is a Wellness Out Loud production produced by Drake Peterson, Fiona Attucks, and Kelly Kyle. This show is edited by Mike Fry and our video is recorded by Louise Vargas. You can also watch the full video of each episode on our YouTube channel at Mari Fitness. Love you, Power Girls and Power Boys. See you next time. The content of this show is for educational and informational

purposes only. It is not a substitute for individual medical and mental health advice and does not constitute a provider patient relationship. As always, talk to your doctor or health team.