Live Like a Girl with Dr. Mindy Pelz - Women, Food, and Hormones – With Dr. Sara Gottfried

Episode Date: September 20, 2021

For full show notes, resources mentioned, and transcripts go to: www.drmindypelz.com/ep88/  To enroll in Dr. Mindy's Fasting membership go to: resetacademy.drmindypelz.com This episode is all about what food we should be eating to improve our hormonal balance. Plus, we talk about birth control, the carnivore diet, and psychedelics. Sara Gottfried MD is a board-certified gynecologist and physician scientist. She graduated from Harvard Medical School and the Massachusetts Institute of Technology, and completed residency at the University of California at San Francisco. Dr. Gottfried is a global keynote speaker who practices evidence-based integrative, precision, and functional medicine. She is Clinical Assistant Professor in Dept. of Integrative Medicine and Nutritional Sciences at Sidney Kimmel Medical College, Thomas Jefferson University, and Director of Precision Medicine at the Marcus Institute of Integrative Health. Her three New York Times bestselling books include: The Hormone Cure, The Hormone Reset Diet, and Younger. Her new book coming out in September 2021 AND AVAILABLE NOW FOR PREORDER is called WOMEN, FOOD, AND HORMONES. Pick up your copy of Dr. Gottfried's new book on Amazon, B&N or wherever books are sold. Please see our medical disclaimer. 

Befriend your brain. Don't wait until you have some scary diagnosis of Alzheimer's disease or your memory is declining. Do everything you can take care of your brain and your executive functioning now. I am a woman on a mission that is dedicated to teaching you just how powerful your body was built to be. I like to do that by bringing you the latest science, the greatest thought leaders, and applicable steps that help you tap into your own internal healing power. The purpose of this podcast is to give you the power back and help you believe in yourself again. My name is Dr. Mindy Pels, and I want to thank you for spending part of your day with me. On this episode of The Resetter podcast, I bring you Dr. Sarah Godfrey. Now, if you don't know Dr. Godfrey, you need to get to know her. So there are so many reasons why I love this woman,

I love her work, and I really loved the conversation that you are about to live. listen to. So Dr. Godfrey is a New York Times bestselling author. She is amazing to follow on Instagram, by the way. I would encourage you to go follow her there. And she has a new book coming out called Women, Food, and Hormones, which is a book that women have been dying to get their hands on. So I'm really excited to share our conversation that we had on her new book and specifically on what foods we should be eating to improve our hormonal balance. But here's what's really cool about this conversation, other than she's an amazing human, is we started off the conversation talking about birth control.

Now, you guys have asked us a lot of questions about birth control. And when I look at the topic of birth control, I think there is the topic of what do we actually need to be thinking when we choose birth control. and then there is the part of the discussion about what if we've been on birth control for many, many years, what could we have possibly depleted from being on a consistent birth control method? So we dove into that, and I'm really excited to share that with you. That is the first half of this podcast. The back half is all about food. And we talk everything from, is the carnivore diet good for women?

what kind of nutrients do we need to add back into our life as we move through menopause? And we even had a little surprise discussion about psychedelics. So if you've heard my talk with Dr. Austin Perlmutter, he really was interested in psychedelics for healing emotional trauma. Well, I'm not going to give it away, but Dr. Godfrey had some really interesting insight on how we can use psychedelics for healing past trauma. trauma. Super complex, super deep conversation. I'm so excited to bring it to you. Dr. Sarah Godfrey. One thing that we got so much feedback on after the last time you came on is women are really

struggling with their birth control choice and women who have been on birth control for so many years are finding that their hormones are all messed up. So can we start by just saying, let's look at all the birth control options out there. What do you feel like is the safest if there is one? Yeah, great question. So my favorite form of birth control is vasectomy, like by a mile. I love vasectomy. I mean, women go through so many things in relationships. And I feel like that is one place where a male partner could really step up. And there's so many men that are afraid of, of it, but really it's just the tiniest little incision. So vasectomy is my favorite, but IUDs are not far behind vasectomy. So I'm a big fan of IUDs. I would say that I've been an IUD crusader for

most of my career because it has the highest satisfaction rate of any form of birth control. And yet it is the least used. Now, fortunately, that's changing. I feel like more women are reaching for IUD. They're asking questions about it. but I definitely think that it's the safest and it's definitely incredibly effective. And you just take it out, you know, if you decide that you want to have a baby. Right. So I'm a big fan. I would say the birth control pill is the number one hormone disruptor that we have.

I saw that you said that. I was like, that's powerful. Explain why. Because a lot of women just hop on it because it's the easiest. And then there's a large hormonal. consequence. There is a huge hormonal and also nutritional and inflammatory consequence. So the reason why I think it's such a hormone disruptor is that it does mess with your hormone. So you take synthetic estrogen together with a synthetic progestin. And those two together,

they thicken the cervical mucous. That's the way that it works in terms of helping to prevent the egg from meeting up with sperm. But in the process, of doing that, it tends to reduce your estradial levels, your body's level of estrogen, and it also reduces your testosterone levels, your free testosterone levels. And this is especially important because testosterone is the most abundant hormone that women have. A lot of women don't realize that. No, no. I think it's estrogen. What's that? I want a little more back. Exactly. I mean, we want testosterone because it's what gives. us confidence in agency. It helps us with sex drive. It helps us with risk taking. It helps us with

muscle mass. I've been watching all of your reels on fasting and muscle mass. And we know that testosterone is part of that story. So when you take synthetic estrogen orally, that raises this intermediate biomarker called sex hormone binding globulin. And that's like a sponge that soaks up the free estrodial and also the free testosterone. Now, some women don't notice much of a problem when their testosterone goes down and their estrogen goes down. And if they have the kind of androgen receptor that's super efficient, kind of like a Prius, they may not notice much in the way of a difference.

But if you're someone who is really sensitive to testosterone and you have more of the like Hummer receptor where you need a lot of testosterone to feel like you're actually. your best, then you'll notice it. And what shows up is you go to the gym and you don't, you don't get the same benefit from weight training, from strength training, or your sex drive is decreased, or you're losing that confidence, that vitality that testosterone is really known for. So that's one reason. The other reason is the micronutrient gaps that can occur. And there's a long list of these, including vitamin C, vitamin B is the ones that are kind of of the most known include vitamin B12 and B9 or folate.

If you have an MTHFR mutation or gene variant, you may notice that this is even worse. But there's also magnesium. There's a few other micronutrient depletions that I've been writing about. And then the last thing is inflammation. So women that go on the birth control pill, if you look at biomarkers such as high sensitivity, C-reactive protein, it goes up about. two to threefold when you're on the birth control pole. So more inflammation, a lot of women don't realize that.

They just notice that they're more puffy and they can't, you know, their joints ache. The other thing that happens with the low testosterone is you make it vaginal dryness. And, you know, a lot of women who go on it for contraception are just like, what's going on? I mean, I'm in my 20s and I have vaginal dryness. I'm way too early for menopause. So it causes all of these problems. One other thing it does that I think there's less literature on, but I certainly see this in my practice, is that it makes you less flexible in terms of your hormonal control system.

Okay. So I'm going to get a little geeky here for a moment. Go for it. Your listeners can handle it. Yeah, they'll love it. So there's this control system. We kind of think sometimes, I would say, maybe 10, 20 years ago, we would think. think of the control system for hormones as being the hypothalamic pituitary adrenal access.

And now we think of it more broadly. It's the hypothalamic pituitary adrenal thyroid gonatal gut access. So all of these parts are involved in managing your hormones. And when you're on a birth control pill, you just can't kind of flex in terms of your cortisol levels quite the way that you could off of the birth control pill. So for all of those reasons, I'm not a huge fan. Yeah. And when I hear you explain it in that much detail, the first thing I think is,

so why are so many women being told to go on birth control? A lot of times they're told to go on birth control because of some other crazy hormonal symptom, not even for birth control. Is this just like a misnomer that keeps getting perpetuated in the medical community? It is. I mean, I was taught when I went through my medical training and when I went through residency to basically convince women that they should go on the birth control pill. And I think a lot of this is pharmaceutical influence. There's billions and billions of dollars that goes into the latest birth control pill.

So that's one influence. Another is, you know, I would say in my training, I was not given a root cause approach to women's hormone. issues. I was taught to just, you know, stick a band-aid on it, offer birth control pill, and then reach for the door and get out of there. And that does not solve problems for women. So, you know, it's not just used for contraception, of course. As you know, it's used for acne. It's used for painful periods. And I would say those things, acne, painful periods, even PMS and premenstrual dysphoric disorder, those are messages that we need to decode. They're part of the innate intelligence of the body.

And when you just kind of steamroll it with a birth control pill, you're not serving anyone. It's really, you know, you get these micronutrient depletions, you get this issue with hormone balance. And it's not helping the way that you might think. Yeah, yeah, absolutely agree. Let's go back to IUD because I don't want to get off this topic. There are two versions of the IUD that I'm familiar with. And, you know, neither of them, they both have upsides and downsides.

Which do you feel like is the best and or the way I look at it is the least harmful? Which two would you pick or would you recommend? Well, I would say these are second to the septomy once you're finished with childbearing. Right. But first of all, you know, I like the copper IED. So the intrauterine device that releases copper has been shown. to be 99.9% effective. It's as effective as getting your tubes tied. So in terms of the risk of pregnancy, it's as effective as getting your tubes tied. The problem is there are some people who are

sensitive to copper. And so that's something that you want to track and stay on top of. What I like to do is to track micronutrient levels to my patients. So I'm looking at copper. I'm looking at zinc. I'm looking at the ratio between them. I'm also looking at other micronutrients just to see if there's any gaps. The second one that I think you're referring to is the intrauterine system. That's also known as the Levo-Norgestral IUS, Morena. And the way that I use the morana is that once again, it's got a synthetic progestin in it. So some women are really sensitive to that. You know, a lot of the physicians that'll insert a marina will tell patients, oh, you don't get any systemic symptoms because this is just a local effect of the progestion in your uterus. But the truth is, if you

look at the science, somewhere around 10%, sometimes even more, women will feel symptoms of the synthetic progester on the fake estrogen in their body. So they may have mood swings, they may have cysts on their ovaries. There's other consequences related to the intrauterine system. But as always, it kind of depends on the individual. It depends on, you know, what sort of issues are you trying to juggle. I have patients, for instance, who have fibroids. And if they don't use something like a morayna, then they're going to have really heavy bleeding that we can't keep up with in terms of food and supplements. And so their other choice is to go to. to surgery. If you're able to avoid surgery by using a marina, more power to you. You know,

we can manage these other things. You can think of it almost as a bridge, especially for the folks who follow you who are over the age of 40. You can think of it as a bridge to menopause. Because once you go through menopause, things like fibroids tend to shrink about 20% sometimes more. And this can provide you, you know, with a treatment that helps you avoid the knife. Okay. And what do you think with heavy metals in copper? Do you worry that it is a heavy metal that would create heavy metal symptoms? And we do a lot of detoxing of heavy metals. And that's been one of my apprehensions with the copper. Of course. Yes. So this is why I like to track the levels. But, you know, I also personally, I have a genomic risk that makes me very low in copper.

So the copper IED was a really good fit for me. And if I don't have an IUD, I have to take a supplement that contains copper. So this is where I think precision medicine comes in because we want to personalize to the individual. And there is such a thing as copper toxicity, Wilson's disease. We want to certainly be careful about that. You know, Dale Bredesen, for instance, talks about the copper sink ratio. I would refer people to his books for more details about that. that. But I think as long as you're tracking it, it's a very effective form of contraception.

But you raise a good point, which is we don't have enough choices. No, we don't have more choices that are safer. Yep. I know you're a mother of one daughter, two daughters? Two daughters. So I have one daughter and I feel like I have analyzed this from as many different angles as I can and I come up short and it's like, okay, pick the lesser of all the evils is the way I see it. So is there like, and we don't, we have a lot of women over 40 listening, but if they have daughters that are in their 20s, you know, what would you, what did you recommend to your daughters? What would you recommend to someone who's trying to make this choice right now?

Well, it's the same recommendation. You know, a woman in her 20s is going to be less like. to choose vasectomy, but I think IVs are really the way to go. And then to track the micronutrients, to track heavy metals and make sure that it's not an issue. So I still have the same recommendation. But you, you know, there's also plenty of patients who come to me who are on the birth control pill, whether they're younger and they're taking it for contraception or for acne, or they're older and they're taking it for perimenopause. and it's not necessarily that you have to come off the birth control bill at all costs. It's more that we want to manage it.

We want to make sure that those micronutrient gaps are filled. We want to make sure that the inflammation is not elevated. We want to make sure that testosterone is in that Goldilocks position where it's not too high and not too low. Same thing with estrogen. So I have the same recommendation kind of across the age span. When you have not had a baby, it can be a little more painful to put an IED in. That's certainly true.

but women do it all the time. And I think once again, we need some more options. I used to be a big fan, for instance, of kind of layering up natural family planning together with, you know, maybe a diaphragm. Yeah, what happened to the diaphragm? When we were in, you know, high school, that was the thing. I know.

I love the diaphragm. I was very, right? I mean, it was like a barrier method. I could control it. I could just put more goop in there if I needed to. Yeah, a huge fan of the diaphragm. I don't know. I imagine there's some sort of profit motive that has gotten in the way. They didn't consult me, Mindy, about keeping the diaphragm available. Well, they should. It's like the diva cup. The first time I used a diva cup, I'm like, this is brilliant. Wait, this is like the diaphragm. They're the same thing. Totally. And what I love about the diaphragm, too, is it got women to, you know, kind of understand. stand their own physiology and their own anatomy.

You know, I used to, I've said this so many thousands of times with my patients. I'm like, okay, you put your finger inside the vagina. You feel your cheek, like your vagina feels like your cheek and your cervix feels like your nose. It's more firm. Make sure the diaphragm is over the cervix. And, you know, I just think that kind of education and information is really helpful so that it's not, you know, like a down there thing.

Yeah. like this dark area that nobody knows about. I want it to, you know, see the light of day and sort of understand which they have. Yeah. Have you, you have to read the book if you haven't read it. Come as you are by Emily Nagowski. Come as you are. I'm writing it down. Oh, Sarah, you're going to love it. You know Dr. Carrie Jones. Oh, yes. Carrie. She, when I asked her what book she thought every woman should read, she said that one. And so I brought Emily on to the, um, on to my podcast to chat with her. And the whole book is about exactly what you just said,

about women understanding themselves. She actually says the first part of having great sex is to grab a mirror and put it down there so you know what you're looking at, get familiar with it, understand it. And, you know, when you start to go into that level of detail, you realize how many women not only don't know their hormones, don't know how to eat for their hormones, on the hormones, which we're going to talk about, but haven't even looked down there or touched down there to understand this incredible body part. Totally agree. I mean, I feel like if you want to have fantastic sex for the rest of your life, you've got to know yourself. And you also have to

be able to teach your partner. And that's not just, you know, I've been married almost 20 years. Like this is an ongoing conversation, right? I mean, you want to keep getting to know yourself, understand at different life stages, what works for you. You don't want to outsource that to someone else. You want to know. Well said. So, okay, one of my other thoughts on birth control that I've heard is if you get on it early, like, let's say, 15, 16, that the hypothalamus pituitary ovary

connection isn't well established. And now you're putting an exogenous, whatever. you know, hormone substance into you. And so you've thrown your whole innate hormonal production off. Is that true? And if you take it off these birth control types, you can bring that back very quickly? Well, this is an area where I would say we have less science to back us up. But definitely the point I was making before that being on the birth control pill makes you

less flexible, like makes your hypothalamic pituitary adrenal, gonadal axis less flexible, that's part of the problem with going on it too young. So when you're an adolescent, and I'm told now that adolescence lasts until like 26, I thought I was almost done with raising children, but turns out I'm not. So with adolescents, you know, they often they don't mature their system, their control system for hormones until well into their 20s. So when you disrupt it by giving these synthetic hormones, we don't really know how safe that is. So, you know, we have the safety data that's been used to get FDA approval for one birth control pill after another.

But we also know that, you know, there was a study in the New England Journal of Medicine a couple of years ago showing that there's a greater risk of breast cancer. associated with birth control pills. So we're changing the hormonal, the natural hormonal balance in women. And I know that there's some downstream consequences from that. Yeah. I really like your approach of testing the nutrient value and just testing. Are you doing that like once a year for women? Is that what you would recommend? I do. So it depends on what I find. Typically, when I see a patient, I do a lot of consultation, case review, second opinion. So I'll do either a Nutraval or a metabolomics test or like a vibrant lab looking at micronutrients.

And if it's not terrible, you know, if there's just a few gaps that we need to fill in that I'll check it once a year. If there's a lot of issues that we need to address, you know, like with methylation, with the B vitamins, with antioxidants, with minerals, then sometimes, I'll retest sooner, such as at four months or six months. Okay. And what do you say to a woman who's been on it? This is one that, like, shocks me. How many women, when I ask, how long have you been on the birth control pill? They're like, I'm decades.

Like now they're 45. They're moving through menopause, and they've been on this for decades. Is there a very good chance that they've got some nutrient deficiencies that need to be addressed? I would say there's a very good chance of micronutrient deficiencies, especially if that's someone who's relatively stressed and has issues anyway with B vitamins. And then you layer on kind of the genetic issues like MTHR. And of course, it's not just MTHR. There's a whole list of single nucleotide polymorphisms that are part of the methylation pathway. So yes, I would say that's one of the issues.

Now, it's not all doom and gloom with the birth control pill to be balanced. What I can also say is that when you're on the birth control pill for more than five years, that's associated with the reduction in ovarian cancer because it's, you know, helping to reduce the risk associated with estrogen dominance and with what I was always taught was incessant ovulation, that we have too much ovulation. And so the birth control pill can help with that. but it is associated with a greater risk of breast cancer. So we have to kind of put all of these risks and benefits together to make a good decision.

And what makes me crazy, Mindy, is that a lot of women don't get full informed consent. Yeah. Yeah. Right. So their doctor doesn't tell them about the micronutrient depletions, doesn't tell them about the copper risk with the IUD, doesn't tell them about, you know, how testosterone can decline. You may have vaginal dryness or decreased libido, which is.

is the greatest irony when you're on this for context. So I think the important piece here is informed consent and then to move forward so that we're trying to reduce these risks that are associated with it. I love that. And you and I talked about this last time. Women I just feel are being so left out of the healthcare conversation, you know, that we have a system that's very one size fits all. And functional medicine has really revealed that that's, that there's a different way to

do that. Do you feel like the, I call it the sick care system, do you feel like the sick care system is going to eventually move more towards functional medicine, or is it just a dinosaur that's sitting there going to keep saying the same thing over and over again for women? Yeah, it's a good question. I mean, I work at an academic medical center where the way that we've positioned the work that we do, I call what I do functional, integrative, and precision medicine. We've positioned it as adding value to mainstream medicine. So I think in some ways that's a way to not offend and to, you know, kind of bring the allopathic physicians into the fold.

So I think positioning it in that way is very helpful. I agree with you about the sick care system. We still need it, right? I mean, we need it when we break a bone. or, you know, I just tore my labrum and my right shoulder and I was flirting with whether I needed surgery. So, you know, we certainly need the sick care system. But what I hope we do is to move more toward health as the objective and the goal. I would say medicine in many ways, I heard this quote from the guy who used to be the physician-in-chief at Massachusetts General Hospital. He said,

medicine is the only industry that does not use health as its gold standard. Like, we don't have a gold standard. You know, health is defined as the absence of disease, which is sort of a circular conversation that doesn't get us to the point where we really understand, okay, for you, Mindy, for, you know, the patient that I saw earlier today, what is health for you? Like, what do you want to use it for? What does it mean to you? How do we architect wellness specifically for?

you. Yeah. Because it could be different person to person. For me, it has more to do with glucose and insulin because I used to be a pre-diabetic. For other people, it may have more to do with methylation or detoxification. So we have to figure out, you know, what is that personal concept of health? Do you think that that lack of focus on what health looks like for each person is because what we've been taught is if you do not have a symptom, you're healthy. So we've learned early on, I don't have any symptoms, then I'm working perfectly. Do you think we need to change that paradigm? I think that's part of it. I think there's, you know, there's this, it's almost like benign neglect where, how are you? I'm fine. I'm fine. You know, like, often we don't start to pay attention

to health until we get a scary diagnosis. And a big part of this, of course, is the failure of prevention. A lot of people just don't care that much about prevention until you hold their feet to the fire, until they have a heart attack or they have a laboral terror or they have, you know, something else that forces them to change their behavior in some way with food, with lifestyle, with supplements, with relationships. So I think that's part of it. I think that, uh, we have this, we have a hard time defining health. Yeah, that's true.

Yeah. I mean, you know, you know why though? I think because it's a verb. It's not a noun. It's a daily action. It's not like an event. It's not a place to get to. It's an action you're doing on a daily basis. Yeah, I love that. I totally love that. I agree with that 100% because a lot of people think health is some destination. Yeah. And the truth is it's this process, right? It's the active daily pursuit of the choices that create us. you know, to be able to do the things that we most want to do, to be able to live our life as deeply and fully as we possibly can. And that can change, you know, year to year, decade. One thing I'm really into right now is trauma and healing trauma. I think that's another really important hormone disruptor. And my concept of health is starting to include, you know, what kind of trauma have you been exposed to? We've all gone through this trauma of COVID over the

past months, right? And now we have some really effective methods of treating it. And I know this is like yet another podcast, like psychedelic assisted psychotherapy in the use of INA. Are you into psychedelics? Oh, totally. Oh, my God. I brought Austin Perlmutter on. And I was like, okay, tell me about this. I see this. And he had a really fascinating explanation of it. So why are you in favor of it? Well, because taking care of men and women for the past 25, 30 years, I know that trauma disrupts hormones in a really powerful way. So whether that's adverse childhood experiences or it's more recent occurrences like women trying to survive in COVID while they're homeschooling their kids and like also trying to work. what we know is that it's a huge hormone disruptor. And, you know, the kind of tools that I've been given to deal with trauma,

things like therapy, talk therapy, EMDR, you know, some of the things that are in when your body keeps the score. I've been underwhelmed, honestly. Like, I think some people are able to find a path of healing their trauma. But when I see patients go through. MDMA assisted psychotherapy. When you look at the randomized trials, like the one that was just published in nature a few months ago, we know that this is so much more effective than anything that we've ever used before in terms of using this medicine that can help you kind of change

your narrative, change sort of the attachment that we have to the facts that occurred, but also the story that we tell ourselves about what occurred, not to gaslight people, but to change. our reaction to it. So to me, that's really exciting. That's why I'm excited about psychedelic-assisted psychotherapy. Yeah. Yeah. When I brought it up to Austin, he said, well, what do you think of it? And I said, well, I'll just be honest. I'm researching it. And a part of me really feels like, is it just an excuse to do like this mind-altering drug? And he came in really strong. And he said, I would encourage you to think about that differently. And we had a beautiful discussion about it after that. So it's getting so much attention right now. It's really fascinating and exciting at the same

time. It's very exciting. I would say probably about three quarters of the psychiatrist friends I have are just racing toward this work. Wow. Because they're burned out. Yeah. They're tired of, you know, just trying one new antidepressant after another or like layering them on top for patients with depression and anxiety. And now they have a new tool in their toolkit that is really effective. So yes, I agree with Austin. It sounds like that was a lovely moment where you really open to him poking you a little. It was beautiful. I loved it. I love it too. And it's, you know, I think this is yet another place where we want to listen to the science. And the science is telling us, okay, this is not just some.

chemistry lab in Berkeley, you know, where MDMA was for synthesized. It's not like an excuse to use a party drug. When it's used in a medical setting where, you know, you're in a very safe setting, you have to pay a lot of attention to this thing called set and setting. So mindset and also the safe container for being able to do this type of work, very different than like taking ecstasy in college in a dorm without, you know, safety. parameters around you. It can really be effective, especially when you have a trained psychotherapist who can guide you through this process where you can, you know, like jump on those lily pads and go back to some of these traumas and re-experience them in a different way. Wow. I love that.

This topic, I could go down a very long path with you, but I don't, I want to leave time for food. This is your new book that's coming out, food and hormones. And one thing that I learned is, in my own fasting journey was I got so excited about what fasting was doing for my mental clarity, my energy, my weight, that I just started fasting more and more. And then one day I ran a Dutch test on myself and my hormones were horrific, like sex hormones totally tanked. And I started to realize, oh, wait, maybe I'm not supposed to fast the same way all month long. And it just like opened up Pandora's box.

And all of a sudden, here I was 45 years old at the time. And I was thinking, wait, I'm not supposed to exercise the same way all month long. I'm not supposed to eat the same way. Like, why am I 45 in learning this now? So I'm so excited for your new book and talk a little bit about what women need to know around food and their hormones and how do we match that to their cycle. Yeah, great question. So, you know, I get asked a lot, what should I eat?

And to me, the answer is, eat for your hormones. So eat for your insulin, your cortisol, your estrogen, your progesterone, your testosterone, your testosterone, your thyroid, your growth hormone. All of these are incredibly important. A lot of folks don't realize that fat, healthy fat, is the backbone of the hormones that you make, especially the sex hormones. So that includes, you know, the testosterone, estrogen, progesterone, cortisol. But, you know, cholesterol gets converted to pregnin alone, the mother hormone of all the sex

hormones, that then goes down the pathways to progesterone, cortisol, DHA, testosterone, testosterone, and estrogen. And what we want to do is even a way that regulates these hormones. A lot of people don't realize that your food is the most important factor when it comes to being able to manage these hormones. So this book in particular is about the metabolic hormones. the ones that you talk about a lot that are involved in switching from burning glucose, burning carbs versus burning fat, how we want to be metabolically flexible. And so this is a four-week pulse

to change the way that your hormones are made and regulated. It involves detoxification first, especially people who have more of an apple shape. It also involves fasting. So layers, in fasting, not so high that it tanks your sex hormones, but is adjusted for you. And it's also got nutritional ketosis using clean keto, not just, you know, bacon and fat bombs, but using a lot of those prebiotic fibers, the vegetables that help you with making glutathione, with all those things that are involved in detoxification. You know, we were talking earlier about how I was up in Tahoe. and I we get there. We have an electric car, so we're always trying to figure out where to plug it in.

Yes. You have that same problem. Totally. We have only electric cars. So it's always about, okay, where's the station? Yeah. Like any road trip requires that you do a little forethought. So we, we park the car, we're charging it.

We go into this traditional grocery store in Lake Tahoe. And I'm going down one aisle. And I see this separate aisle that says it was oral wheat and that we're, was keto bread. And I was like, what? Let me see what these ingredients are. And so I went over, I turned it over, and it was just bad oils, bad ingredients, toxic synthetic chemicals. And I thought to myself, this breaks my heart because people are going to look at that and go keto. Keto, that's healthy. I'm going to go ahead and buy that. Give us a little understanding for women. what part of keto should we be looking out for as far as like pre-made packaging products?

And the second half of that question is when is there a time ever we need to not be in ketosis? Yeah, love those questions. So first of all, I think I was at the same grocery store as you because, yeah, when I see oral wheat is making keto bread, I immediately am suspicious, right? I mean, industrial seed oils, it's processed food. And I think a lot of people have that feeling of, oh, I could do keto and eat bread. And yeah, you could. You could make your own bread that has really healthy oils and has, you know, good nutrients.

But I wouldn't advise buying processed food as a way of doing the ketogenic diet. So I think it's much better to go with a Whole Foods based food plan that's really rich in vegetables, it's vegetables forward, especially for that detoxification. And if I take a step back for a moment, you know, part of the problem is that men, because they have so much more testosterone than women, even though it's the most abundant hormone that both of us have, they are much more successful on keto. Yeah. And part of the reason is most of the research on keto was done in men and assumed to apply to

women. Women often don't do as well on the ketogenic diet as men do. that's known as the testosterone advantage. So there's these things that women need to do to adapt the ketogenic diet. And I would say the oral wheat keto bread is not one of them. It's more about, you know, really getting those whole foods, making sure that you've got a plate that has plenty of vegetables. I recommend about a pound a day and use net carbs, not total carbs.

So my book goes through these details as well as, you know, how to define your carb limit because some of us, when I first tried keto, I had a really low carb limit. So I was carb intolerant. I couldn't eat much in the way of carbs without my glucose, you know, just spiking through the roof. And so I needed to really dial in the macronutrients at that point. Now I'm at a point where I go in and out of ketosis, which is, you know, the way that our DNA evolved, as you well know. And I think in general, what I've arrived out is that this type of variation where you go in and out of ketosis, when you use fasting as kind of the back door to ketosis and use that

to augment ketogenesis, when you use detoxification to really augment the benefits of ketosis, that's where you get the greatest success. Yeah. But there's not a lot of long-term data on keto. I don't believe in going on keto and then, you know, doing that for the rest of your life. Yeah. You know, it really depletes the microbiome. The microbiome need those prebiotic fibers for the benevolent microbes to really thrive.

A lot of people become constipated if they're not paying attention to getting the vegetables that they need. So I think coming in and out of keto is the best way. My recommendation in the book is a four-week pulse. with keto. And you could even say it's similar to a medical therapy where, you know, there are some people who raise their bad cholesterol, their LDL, their LDLP, a few other biomarkers that we like to track. And so you want to be aware of what some of these risks are and not just stay in ketosis

for the rest of your life. Yeah. And do you think recently I was geeking out with some other functional medicine practitioners. and we were talking about why the week before your period starts that you tend to be innately more insulin resistant. And my brain always goes to, okay, what's the body trying to do? If it is intuitively more insulin resistant the week before, there must be a reason for that. And that doesn't mean go deeper into keto.

That means honoring what the body needs. So do you buy into this thought that we need to do something different the week before? for our cycle. I buy into the fact that I think you have to adjust what you're eating as well as the way that you're exercising throughout the menstrual cycle. Okay. So that we're synced up with the innate intelligence of the body. Yeah.

So the week before your period, what we know is that a lot of people actually come out of ketosis, like women can pop out of ketosis that week because of some of the hormonal changes. Now, I haven't seen a lot of data on insulin. resistance, but what we know is that carb cravings, especially for women who have PMS, they go up about 260 percent the week before your period. Now, some of those carbs I think you need for adrenal function, for thyroid function, for making serotonin.

And so to get to your point, which is the body is trying to tell you something, I think part of this is getting the right dose of carbohydrates that work for your body. It's also the time during your cycle where you don't want to be going for a personal best with your running or with, you know, doing high intensity interval training. The best time to do that is right at ovulation or a few days before ovulation. So testosterone peaks around day 12, somewhere between day 9 and day 12. Estradial also peaks. Progesterone is relatively low.

That's where you really want to go for it in terms of gains, muscle gains or speed gains with your exercise regime. Would you say that then estrogen wants you to be, is going to respond better if you're in ketosis, whereas when progesterone is coming on the scene, it's a little bit more of a time to step out of ketosis? Can we make it that simple? I don't know if we can make it that simple. I mean, the body, what I see with my patients is a lot of people, as I said, pop out of

ketosis when progesterone rises. So that's typically around D-21, 22 with a hypothetical 28-day cycle. What we know with estrogen, estrogen has about 400 jobs. One of those jobs, what's that? She's busy. It's really busy, right? It's keeping my shoulder lubricated. Yeah, right. It's, uh, it does so many different things. It's involved in appetite. So, you know, But the other thing that happens around day 21, 22 is that estrogen does have another little peak, not quite as high as day 12, but it has another little peak along with the rising progesterum. So I think, you know, what some people notice as estrogen starts to decline the week before their period is that their appetite increases.

So you just want to pay attention to that and sort of notice what's happening. It's not a time, and I say this with so much love and respect, it's not a time to be binging on refined sugar. because I used to do that. I had a disordered eating when I was in high school and through my 20s. So we just want to watch that. And the thing with progesterone, you know, it starts to decline. We don't make as much of it.

Typically, yeah, it does. It does. It does. So getting vitamin C, that's one of the ways that you can raise it naturally. We also know that Chase Tree, BITACs can be helpful for raising serum progesterone levels. So I don't think it's quite as simple as, you know, cycle in and out of keto based on your estrogen and progester levels. I think you have to look at the bigger picture.

And then there's also the role of estrogen and insulin, which I know you've written about and you've made some videos on. Yeah. So talk about that. Do you think, so like let's use menopausal women. You know, as our estrogen goes down, the research I've seen shows that we become more insulin resistant once we start to lose estrogen. So is that a time we may want to use keto more to make ourselves insulin sensitive? I think it is a really good time to do a keto pulse. The thing that you

have to be careful of is some of these downstream consequences. So especially paying attention to lipid metabolism, looking at your cholesterol. In my women who are perimenopausal and menopausal, what I like to do is baseline labs before and after they do a four-week pulse, just to make sure that it's a good fit for them. We can also do some genetic testing to look at how people respond to different types of fat, like saturated fat versus more plant-based fat. And with, you know, the other point that I think is essential here is that in perimenopause, as estrogen starts to decline in the second half of perimenopause, the first half of perimenopause, I think of this low progesterone.

But in the second half of perimenopause, the estrogen declines, you get this redistribution of body fat, right? So what typically happens is women store more fat, kind of depending on their baseline through their pre-menopausal years. I store it at my buttocks and my hips and my breasts. So I'm a little bit more pear-shaped.

And what happens for me in perimenopause and happens to a lot of other women is that we redistribute. So there's more fat deposited at the viscera, so at the abdomen, and less at the subcutaneous space. And that is related to a drop in estrogen and also this increased insulin resistance that you're speaking to. So how do we, is there a way to, I mean, if it's naturally happening, is there a way

to make that ride a little smoother? And I like your idea of the keto pulse, but. But are there some, like, key things we need to do to make sure that that redistribution isn't traumatic and that we just sort of ride it as smoothly as we can? Yeah, absolutely. So, you know, one solution is definitely to do this four-week pulse where it's not just keto, it's detoxification, which I think helps with that redistribution as well as fasting. we know I saw that you had a YouTube on alternate day fasting.

We know that that actually works better for women who are in menopause than it does for pre-menopausal women. And we almost never hear that, Mindy. I mean, when you hear that like you have an advantage after you go through menopause. No. The only advantage we have is we go through menopause is our wisdom. That's the only advantage, I think we have. There's another advantage. Christian Northrop taught me this.

She said, you know, when you're in your reproductive years and you, like, are changing your estrogen, progesterone, testosterone, every day, you become so accommodating. And when you go through menopause, that hormonal veil is lifted and you start to speak your truth. And you just don't accommodate anymore. So I am looking forward to that, didn't he? Look out for the people that are around you for sure. That's right.

I've been training my husband, so he's ready for this. Definitely needed. Okay, the other thing I was thinking as you were talking, I don't know if you read about this in your book, where does the carnivore diet fit into this? Yeah. I think the carnivore diet probably works better for men than women. I mean, we see that with pretty much every diet. Yeah.

You know, I don't know that I have enough experience with it to really be able to speak to it fully. I know that it's very popular right now. and it's in some cases kind of put together with the ketogenic diet. Once again, I think that women need more vegetables. They need more detoxification. They need adaptation so that they're not just eating like a carnivore. But what do you think? You probably know more about this than I do.

Well, I've researched a lot on the carnivore. I think that if you have like an autoimmune condition, there's some really excellent research showing that it can really uprogram. T regulatory cells and that it can really calm that autoimmune condition down. I have tried it myself and only for like little five day periods and I feel a bit euphoric. I do not like not eating vegetables. I feel like when my hormones are off, if I go and eat vegetables, life just gets better. So I don't, I'm conflicted, which is part why I ask you, I think maybe if we go in with spurts

of it and use it every once in a while, I think that's amazing and can be really helpful. But I worry with women going on it long term. I do too. You know, the main thing I worry about is the microbiome. Yeah. So I haven't, you know, even with keto, I would say the data on keto, most of which is in men, about 90% of the data, the data on the microbiome and how it's affected by going on a ketogenic diet makes me quite concerned. And it's part of the reason why I think detoxication,

pooping every day, feeling like you fully evacuate, making sure that you're getting rid of those estrogens once they're used and they're not endlessly recirculating like bad karma. I think that's really important. And with the carnivore diet, I haven't seen a lot of data looking in a rigorous way at the microbiome and how it's affected by it. So I'm encouraged by what you said about autoimmune disease. but, you know, I think a big part of autoimmune disease is gut rehab and making sure that we've got adequate diversity. We've got plenty of those benevolent microbes and not too many of those, you know, like Homer Simpson problem microbes. Yeah. Yeah. I love your analogies. The way I look at it is like we need to be walking around with a toolbox and then we've got to figure

out when to pull out which tool. So I don't, you know, here's the science behind the carnivore diet. is that it actually increases a species of bacteria called your bacteriides. And I have heard, I don't know if you've heard this, but I've heard that if Firmacutes get higher than Bctorides, that ratio, that FB ratio makes it so that you actually will store calories more as fat. And if anybody's, any woman's been on lots of antibiotics and has brought the bacteriotes down, brought Firmacutes up really high, she's going to eat the same thing as maybe her other, You know, her sister does, but doesn't have that same ratio and she will store fat more.

So her calories is fat. So back to varieties can really be replenished with the carnivore diet. That's what I've heard. But I'm going to- Well, it's, you know, when you look at the microbiome data, I think part of the problem here is having a consistent way of analyzing it. And I feel like we're still in the early days of being able to make generalizations. In some ways, I think one of the best researchers in this area is Rob Knight at the University of California, San Diego, his work with the Human Gut Project. And what he's found is that species diversity is probably the most proven way, especially with vegetables and even fruits, is probably the most proven way to improve diversity.

So I understand what you're saying about pharmacutes versus bacteroidities. And I think I wish we were at a place where we could make really clear recommendations about diet and how it changes the microbiome. I still think we're in the early days of it. Yeah. And I will tell you that those studies were mouse studies. They weren't female studies. So it does, you know, I always say, I don't know how you feel about this, but I always say that male studies and mouse studies, they kind of get us in the ballpark, but they are definitely not analogous to what a woman needs. They just get us sort of an awareness.

And now we've got to, because we, like you've said, multiple times, we don't have enough female studies. So we got to sort of make some connections until we get those studies. That's right. I mean, I think it's a start. It points us in a particular direction. So it gives us directionality, but it doesn't give us answers. It gives us some hypotheses that we can then test.

Yeah. But we got to test them to be able to answer this question. Yeah. Agreed. Agreed. And then what do you think? I got to ask this last question and then I've got a handful of rapid fire questions for you. What are your thoughts on fasting, a specifically longer fast? So when I look at the fasting research,

which I feel like I've spent so much time diving into, that as we fast longer, there's some incredible benefits, you know, 24 hours, we see that the gut microbiome in mice again will totally reboot itself. I'm seeing some really cool literature on, uh, 24 to 48 hours can really help with dopamine receptor sites. Do you feel like, and feel free to disagree with me, but do you feel like that is safe for women to do? Is there anything we need to mind when we go into these longer fasts? Yeah, it's a great question. I feel like what I, what I see with fasting is that it's one of the most incredible tools that we have to reset the body, You know, to trigger autophagy, as you've talked about so beautifully, and to get the body to kind of go back to its factory settings.

That's really, I think, the intention behind fasting, and it's been used for time and memorial, right? So religious traditions, regardless of your religion, you know, there are religious traditions that do this. I think that for women, the key part is stress. So there are some women who don't have a lot of stress in their lives and they can do experiments with fasting. They can do 24 hours. They can do 48 hours and see what happens. See what's true for them. I happen to like a little continuous glucose monitor.

I feel like I know all your numbers. I watch them all on Instagram. Yeah. Well, I like to, I really like to watch the CGM data. I mean, you know, usually it's just kind of a flat line. line that gets sort of lower and lower as people fast. But it gives us a lot of information. So to me, the problem is women who maybe have a history of trauma and they can't tune into stress very well. So when they were growing up, for instance, their ability to kind of know

themselves and tune into what's true for them was either taken from them or they got mixed messages about autonomy, I think those people often have a hard time with fasting because they can't sense how stressful it is. Yeah. Interesting. So, you know, with fasting, what I found more anecdotally is that when I fast for 24 hours or longer, I feel really good. But I also know that because of my history of eating disorders, and I think that is so prevalent, you have to be kind of careful in this territory. So you really have to see, you know, what's true for you. Is this making you reset your relationship to food in a healthy way, or is it getting you to restrict yourself unnecessarily? And I love how you talk about, you know, the refeating process, how to make that

as clean and as healthy as possible. I think that's a really important part of this conversation. The data from, you know, looking at Volter Longo and some of the fasting, I've gone to fasting conference and heard a lot of people talk about these more extended fasts. And he even thinks that 16 to 18 hours might be too long. Yeah, I know he does. stressful for some people. Yeah. So I think we have to be cautious.

We have to see what happens with cortisol. I do best with like a 14 to 18 hour fasting window. And, you know, maybe when I'm older and my kids are like launched, they're out of adolescence. Is that ever going to happen? Does that happen? I hope it happens at some point. I mean, during COVID, all bets are off, right? That's true. Very true. But I feel like at some point I can experiment more with fasting right now with the way my life is configured. It just doesn't fit in very well. Yeah. Awesome. I love that. Well, someday, well, I'll pull out my studies and we can like geek out on it when both our sets of kids are launched.

I love it. Let's do it. Okay, really quick. And I want to respect your time, but I have five questions for you. rapid fire. The first one, we're creating a book club. We love books and read them all the time. What is the one book that you would say every woman needs to read? So I would say women's bodies, women's wisdom by Christian Northrop. That's the book that changed my life made me want to go into women's health. Awesome. Okay. If you could go back to your 20-year-old self and give her advice, what would you tell her? I would tell her, break up with the guy sooner than you think. Like, don't hang in there for months to years when you know it's not working. This is a boundary issue. Oh, my gosh. It's like what they tell you when you're a boss,

like hire slow and fire fast. Exactly. Fire that guy. I love it. Okay. Women's hormones in general, if there was only one thing we could do right now as a, as women, let's just say, to change our hormonal picture, what do you think that that would be? Tend and befriend. Tend and befriend. So the data on the sympathetic nervous system fight, fight, flight, was developed on men by Walter Canada at Harvard. And it doesn't apply to women the way that we once thought. So women do best with managing cortisol when they tend and befriend. So I think the more that we have tend and befriend in our lives, whether that's hiking with a girlfriend, you and I need to go hiking. So I would love it. I would love it too. So go hiking, go walking in the stream like you did in your

reels, you know, do the things that really help you with tending and befriending. That's how women manage their stress so much better than that. I love that. That was well said. Okay. Last thing. or no, I got two more. What's one of the greatest gifts that you got from the pandemic so far? We're still in it. But what has been one of the greatest gifts you've received? I have to say the conversations with my family. So I went from traveling about 50% time to traveling not at all. And yesterday I was at a beer garden. I was not drinking beer, but I was with my husband who was drinking beer. and we had this adventure packet that we were,

there are these little cards that you pick a card and then you kind of talk and share about something about adventure. And that for me is emblematic of what the pandemic has done for me. It's gotten me to slow down to really treasure these moments with my family and friends and to really, you know, kind of go deeper and give of myself more. So huge gift. Yeah. I would agree, you know, our son is going into a,

freshman year at Santa Clara University. And he was home all last year. And he ended up doing a little cooking Monday night cooking club where his friends would come over. And I literally would go into my kitchen and there would be like this like pounding music with these guys with their shirts off, like cooking in the kitchen. And I thought there's no way if this pandemic hadn't happened that these boys, these high school boys would be doing this. I love it. Okay. I want to come to your house. Are they still doing it? We have a lot of fun. We have a lot of fun.

Okay, last one. If you had one message for the world right now, what would that be? Befriend your brain. Like especially for those of you who are 40 and older, don't wait until you have some scary diagnosis of Alzheimer's disease or your memory is declining. Do everything you can take care of your brain and your executive functioning. Now, before it's too late.

Hey, resetters. I just want to start off by saying thank you so much for all your wonderful reviews and those of you that have left me comments on iTunes. I just greatly appreciate your thoughtfulness and how much you guys are enjoying these episodes. And it seems like you're enjoying them as much as I am enjoying doing them. One of the things that I've learned in just interacting with so many people is that we've really lost the art of deep conversations. And for me, the Resetter podcast stands for having meaningful conversations with people who are thinking about health, about life, about mindset in a way that we may not be getting on social media or in mainstream media. And so I just want to say, give you guys a shout out and just say thank you for participating in this process with me.

because as much as I absolutely love delivering the information to you, I love even more knowing that it's impacting your life. So please let us know if there's anything we can do to make this podcast more customized to you, to make it better. We are now officially in season two and we are working to bring you the best conversations that health influencers have, that mindset changers can give and to really deliver you something that you're not able to get any. anywhere else. So from the bottom of my heart, as I always say my YouTube, from the bottom of my heart, I am deeply appreciative of you. I am deeply grateful to be on this journey with you and let's get healthy together.