The Sabrina Zohar Show - 167: Why Your Body Can't Just Calm Down: The Science of Anxiety ft. Dr. Sara Szal

Episode Date: October 17, 2025

In this episode, Sabrina Zohar sits down with Dr. Sara Szal to uncover the hidden physical roots of anxiety. From hormones and gut health to mold, blood sugar, and cortisol, they break down how your body can fuel emotional chaos even when your life feels “fine.” Sabrina opens up about her own misdiagnosis journey, being told her anxiety was just mental before discovering deeper physiological causes. Together, they explore how the nervous system, hormones, and environment intertwine, and how healing often starts in the body, not the mind. If you’ve ever asked yourself, “Why do I feel anxious when nothing’s wrong?”, this episode will change the way you understand yourself.Get a mold test: https://www.survivingmold.com/The Institute for Functional Medicine: https://www.ifm.org/Work with Dr. Torrie Thompson!Visit www.functionhealth.com/SABRINA or use gift code SABRINA100 at sign-up to own your health.Stuck After the Podcast? Master Implementation in 8 Weeks with Sabrina's Foundation Course HERE!Enrollment for The Self Love Course, The Nervous System Course, and The Break Up Course is now closed. For your continued education and growth, please explore The Foundation Course, which is currently available.Get Ad free HERE!Want to work with Sabrina? HERE!Get merch for The Sabrina Zohar Show HERE!Don't forget to follow Sabrina and The Sabrina Zohar Show on Instagram and Sabrina on TikTok! Video now available on YOUTUBE! Disclaimer: The Sabrina Zohar Show, formerly known as Do The Work, is not affiliated with A.Z & associates LLC in any capacity. Learn more about your ad choices. Visit podcastchoices.com/adchoices

Dr. Sarah. Hey, Sabrina. I am so excited to have you. Welcome to the studio. Thank you. Happy to be here. I'm excited because we talk about everything that I've talked to this point up on the show, besides personal experience, has been about the mental health of anxiety.

Yeah, mental health. The mental health, which is, as we know, incredibly important. But I'll be honest, it wasn't until, like, I always associated with, like, I need to do the mental health stuff and completely said fuck all to my health, like physical health. And I had my sister for years being like, you know, Eating sugar like that at night is going to cause you to be more anxious or Sabrina, you're eating this when you shouldn't. It's causing inflammation.

And I thought it was for the birds. I was like, that is nonsense. Birth control is not doing anything, right? All those things. Until I started really doing the work going through my own stuff, which we'll talk about, and realizing the impact that the like physiological anxiety, right, that we have different things that it's not just mental health. So I am stoked because we have so much to talk about.

Before we dive in, could you please tell us more about you, how you got to where you are? because that why people understand, like, why we have you here because you're a fucking legend. Well, thank you so much. I am a physician. I've been taking care of women for about 30 plus years. I'm a board certified obstetrician gynecologist. But I do a lot more than that. My focus is really what's called precision medicine. So I really help people looking at their physiology, as you described. Their biomarkers, like blood testing, that sort of thing. So that we understand. root cause of why they have symptoms like anxiety or maybe mold toxicity or, you know, struggle with depression or ADHD. So that's my work. I've written a few books, The Hormone Cure, women food and hormones. Those are my favorite topics. Well, I'm glad you're here today because we're going to dive in because I think so much of it's important, like I said, whether it'd be all of those variables. But I'm curious to even start, as you've done all of this work for years,

What is the one or maybe a couple of things that you have noticed that contribute to anxiety, depression, things like that that are underrated, that we might not even realize? The things I see the most are drinking too much caffeine or even any caffeine, if you're really sensitive to it, like I'm super sensitive. And I can tell that you probably had some caffeine this morning. I did not. And then what I see a lot of people do, men and women, is that they crank themselves up on caffeine. And then at night, to be able to decompress, they then drink. And the thing about drinking is that the next day, it often increases anxiety, just as your body is detoxing and withdrawing from it. And it affects your sleep.

And so many of these factors then map to symptoms like anxiety. So with anxiety, I would say those are the first two. The third thing is nervous system regulation. And that's something you and I dish about a lot. I would say it's even broader than nervous system dysregulation, which I hope we'll dive into. It's also dysregulation of your immune system leading to autoimmune disease like Hashimoto's thyroiditis. It's dysregulation of your endocrine system so that you might be making too much cortisol or not enough cortisol, which then can map to anxiety. So those are the things I see the most commonly.

Does tea count? I had a tea this morning. Is it that minute? Like, is it that when we talk even, like, is it that when we talk even, start with caffeine, something like that, because I wanted to talk about sugar, gluten, dairy, all of the usual suspects, but caffeine, alcohol, things like that. Could you go a little bit more to explain how do those things interrupt all of these different aspects? Because it is feeling like a perfect storm that they all kind of come together to cause to start shit. Well, with tea, what kind of tea did you have today? Green tea. Yeah. So green tea is pretty good. The thing about green tea is that it tends to increase your sympathetic nervous system, but in a way that's kind of smooth. It's not quite as jagged as coffee can be. It depends on how sensitive you are

to caffeine. So I'm someone who's really sensitive. I can occasionally have some green tea because it doesn't crank up my sympathetic nervous system, that on button that raises your heart rate. It makes you feel sort of jittery. So the thing about green tea is it raises L-thianing. It's got L-thian in it. And that's kind of a smooth ride. It's a way that increases arousal and alertness without jacking you. So I like tea. These other things that you talked about, like gluten and dairy, sugar, those tend to, for people who are sensitive, it tends to mess with your nervous system. It can raise your cortisol, especially if you're intolerant. So I've done testing. I know that I'm gluten intolerant. I don't have celiac. Okay. But I get more cortisol in my system if I get exposed to

gluten. Same thing with dairy. There's a type of protein called casein. and dairy that can activate your immune system and then also activate your cortisol. So those are some of the things that can map to problems with anxiety. Let's talk about cortisol because I wanted to talk about all those different things. But if we're talking specifically about cortisol, I see this especially in the early stages of dating, the spark and the, oh my God, I was sweating while I was with them or I was really nervous, which must mean I really like them. What's the other side of the coin of feeling that intensity or the high cortisol. Like, how can we start to differentiate? Like, is that healthy or not? What does it look like? Yeah. It's such a good point. So teasing it apart, you know, often,

you and I have talked about our childhoods. And there's a way that you can have this pattern from childhood, especially if you had a parent that was narcissistic or you had a lot of chaos in your home where your body is like adjusted to a certain level of cortisol, often a little higher than is healthy. And so that high cortisol then sets, it's like a set point. It's like a set point. point that you have in your body. And you feel kind of bored unless you're at that higher level of cortisol. And so for some of us, when we're in a relationship and we feel that kind of rev and we feel that high cortisol feeling, we mistake it as feeling alive when actually it's jacking up that sympathetic nervous system that, you know, raising your heart rate, causing to breathe faster

and leading to potentially some dysregulation. So, how do you tell the difference? I think there's there's a way that we can mistake high cortisol for chemistry. All the time. Right? So I want to dive into that. Please. And what we want to do is look for a sense of regulation. Like I just witness you with tech guy and I can see this co-regulation that happens between the two of you. You know, just like a mother with a infant who holds a baby against her chest and the baby's crying and then the baby hears the heartbeat and like the soft contact with the mother, smells the mother, calms down, regulates the nervous system. It's like the baby is borrowing from the mother. Yeah. And that same network in the body still exists when you're

dating. And you want that co-regulation of, you know, the care of another person. Like I see tech eye just caring for you so deeply. And I see how. that creates the co-regulation in you. And that's cortisol in its right place where it's on that Goldilocks position, not too high and not too low. And is cortisol something, do you advise getting it tested? Like, is that something? Oh, hell yeah. Okay. So that isn't accurate. Because I know some of that's, you know, depending on what you test, like, that's kind of nonsense. But like, so cortisol is a yes to get tested? Cortisol is a huge yes. Because, you know, I actually think that a lot of us are measuring the wrong things. Cortisol is something you want to measure.

So you can start just with a blood test in the morning. It's something you can actually order on your own. You don't have to go through a doctor because a lot of doctors like, oh, no, we don't test hormones. They change too much. Yeah. Unless you're trying to get pregnant and then they test everything. The only time they told me they were willing to test my hormones was, well, you have a normal period. We don't need to test. And so my journey was total, right? I had, and I've actually the first time I've talked about this journey. So I'm excited that you're here and I get to do that. I've mentioned my mold journey, but I didn't go into details. For me, it was that I was so manic. I couldn't sleep. I was waking up multiple times a night. I, and this is like I was working out. I was eating. I was eating, like, gushers and fruit roll-ups at night anymore, which I did. I'm not, like, I don't drink alcohol. So I knew there were certain things I couldn't move out in dairy and gluten shore. But it was like, man, I'm, I'm manic. I can't sit still. Like, it goes beyond where you're like, okay, there's nothing going on in my life right now. It's not like I have a really inconsistent partner that's treating me like trash. Okay, maybe that's triggering something. There was nothing. And I still couldn't just be. And so I was going to all my doctors and here's what I heard.

And again, let me preface before we go any fucking further. Nothing that we are talking about is to replace your medical advice. If medication, if things let that work, please good luck, Godspeed. I wish you all the best. I am giving you my personal experience. There's more to life than finding the perfect car. But finding the perfect car can help you get the most out of life. Like the SUV that handles everything from drop off to off road, and the car that hulls groceries and hockey teams, or the van that's gone from just practical to practically family. Whatever you want, wherever you're going, start your search at ototrater.ca. Canada's car marketplace. They kept telling me, take Prozac, take an antidepressant, you can't sleep because you're depressed and I kept saying, but I'm not. I don't have depression.

So I find, okay, fine, traditional doctor, got my blood work. done. Everything's fine. Everything's fine. And it wasn't until I found a functional medicine doctor who I said, Dr. Tori, shout out, love her. And she was like, okay, there's something else here. She took my blood work and she's like, functionally, you're not at the levels. You need to be. You're not. You're being compared to people all around the country and the world. She's like, but I'm looking at you. Then it was, let's check out your mold. I am riddled. Not only did I have mold, but I also had a parasite and something like a plastic that was mimicking estrogen. So my adrenals thought I had enough, but I didn't. And it was the perfect storm of all of these aspects. Now, detox, fucking sucks. Like, let's not pretend. But I'm so grateful. So now, now knowing my

journey, I want to know the science and what's going on. How did all of those things compound? Like, what does mold and parasites and plastic? How does that impact? Because I think so many of us are like, oh, whatever, that's just BS, microplastics. That's just hella, balloon, bub. But it's actually real. And I'd love to know how does that impact our body? Because I think a lot of us probably think we're crazy, but we're not. There's more to it. And no, you don't just need an antidepressant. Oh, for sure. I mean, that's part of what makes me crazy about mainstream medicine. And I don't want to throw mainstream medicine under the bus because, you know, if you break a leg or you've got an infection, we need mainstream medicine. But it fails a lot of us and it fails you in that situation. So I've been practicing functional medicine for about 20 years. And what we know is that if you're someone who's got anxiety, if you've got that mania that you're describing, have difficulty with sleep. Maybe you're noticing that your hormones are just, you know, not as balanced as they used to be, like PMS is worse or even premenstrual disorder. You want to start thinking about mold because mold is

something that is present in about 50% of buildings in the United States. Oh, shit. So 50% of buildings are water damage and that can lead to mold and mold exposure. But this is where things get interesting, Sabrina, because some of us are exquisitely sensitive to mold toxins. I'm one of them. And it sounds like you are too. And you can test for that. It's genetic test just to see if you're, if you've got the sensitivity. But once you connect the dots and you realize that some of your symptoms like anxiety are driven by mold, then it allows you to map the solutions a lot differently than your one or two take Xanax. Because that's, that's basically a way of masking symptoms instead of addressing the root cause. And we always want to address the root cause.

And again, let me preface because I've had people that yell at me. I'm like, I'm not advising. There are so many people I know that are on those that work beautifully. And I am so grateful. But if you've tried it and you're like, hey, this isn't this isn't helping me. Like for me, I have the MTHFR gene mutation. So found out, that's why when I was talking to the doctor, he's like, No wonder you were feeling worse when you took them. You didn't need more serotonin your brain. It was dropping off. And it's not that that doesn't help people. It wasn't helping me. And okay, I wanted to get deeper. Again, I preface this. Because for some people, people think I'm anti-meds and I'm absolutely not. I just am, let's think about another thing. But I'm curious. How does mold, like, what does mold do to your body that causes the anxiety? I'd love to understand a little bit more about that. Yeah. Yeah. So mold works in a lot of different ways. And I'll just hit some of the top mechanisms. So, Mold is basically, it's known as biotoxin illness. So just like you were describing with forever chemicals, now microplastics can change your hormones. They act like endocrine disruptors.

Mold is an endocrine disruptor. And so it changes some of the pathways, especially in the brain and the nervous system. It changes GABA. It changes some of these mechanisms that are involved in kind of calming you down and self-soothing. So you can't. get those to work for you the way that they once did. The other thing that does is cause inflammation in the nervous system. So that's known as neuroinflammation. Inflammation, I think of as, you know, this normal process, like you get a splinter in your finger, and your immune system rushes in to fight the splinter and help you not get infected. So normally, inflammation should last about three days. But if you've got chronic inflammation, especially that affects

the brain, then you've got this frat party that never stops. You know, sometimes the beginning of a frat party is pretty good. But when it goes on for more than three days, there's nothing good that comes out of that. No, thank you. So neuroinflammation is when your brain is having this frat party and is causing symptoms in your case of mania, anxiety, sleep disruption. And everyone's a little bit different in terms of what type of symptoms that they have. You know, some people with mold that I've taken care of, have this like sharp kind of stabbing pain in their body. That's another symptom that people have. There's lots of different symptoms. I think the key for people who are concerned about mold is to do a visual inspection at your home to see if you see any black mold or other types of mold, like especially

where water damage could occur like near the dishwasher or the washing machine or under the sink. But also to do something called a visual contrast test. And maybe we'd, could link to it in the show notes. It's a cheap test. You can go to surviving mold.com and run this test for like $1520. And it's a good way to see if your vision is starting to be affected by mold toxicity. Oh, I find that stuff fascinating. I know when I did the, even just go, I had my mom do a mold test because we even knew I was like, mom, something doesn't make sense. I'm like, you're just always, she fuzzy headed, not clear brain fog. And is that what causes is that the brain? And is that the brain? fog. Is it because you have... So that's the inflammation. So neuroinflammation causes brain fog. The other thing I think about with brain fog is that when you've got these boundaries in the body. And I love these moments where you and I can talk about like mental health, emotional health, and then how it translates to physical health. So you've got these boundaries, you know, emotional boundaries is what you mostly talk about. But you've got these physical boundaries too. And the physical boundaries are ways that you interact with the outer world. The primary one is in your gut. So that's... It's, you know, this in some places in your gut, it's only one cell thick. So it's a really tenuous boundary. And people who drink, you know, not you, but people who get exposed to glyphosate, this boundary gets disrupted. And that can trigger inflammation because 70% of your immune system is underneath that cell lining. The other place where you have a boundary is a blood-brain barrier.

And just like the, you can think of it like, the, you can think of it like, these tight junctions that you have in the gut between the cells of your gut, those tight junctions get loose, almost like Swiss cheese. Same thing can happen in the blood-brain barrier because the tight junctions are very similar. And when you lose that integrity of the boundary, that's when you get inflammation in the brain. So that's the mechanism for how brain fog occurs. So if I hear brain fog, the thing I'm thinking is what's going on with the gut lining. Do you have leaky gut, increased intestinal permeability. And we can test for that. I just assume that people have it. And then we don't have a way to test commercially for disruption of the bullet brain barrier. But if you've got brain fog, I just assume you do. For the gut, can we talk about that? Yes. I hear that all the time. The gut, the gut, the gut, I trust my gut. I don't know. I feel it in my gut. So we have that. But could we actually talk about the correlation? Because I know that there is the, what they were saying, like the umbilical cord comes there. And so it's a straight line. You have your vagus nerve and your right here as we go up. And I would love to understand because I feel like we throw that around of like, my gut is this or my gut is unhealthy, leaky gut. I feel like most people probably have that.

But like, could you give us an understanding of what does that actually mean? Like what is the gut actually with the brain gut barrier, which I learned. I'll tell you this. I was doing my mold detox and she gave me candy back team. Oh, yes. And she was like, okay, overgrowth. We had to kill it. And I went bananas. Like manic. I was depressed. I was crying. And when I called her and she's like, stop them immediately. That is the first. first time I realized the brain to gut access. I was like, holy smokes, look at the correlation. So I'd love you to take it from here. Yeah. So, you know, in functional medicine, the gut is really the foundation of everything. So you can't have a healthy body if your gut is not working properly.

And, you know, there's a lot of ways that the gut maps to your hormones bi-directionally. And I'll explain that in a minute. But what you just mentioned, the gut brain access, I think, is critical here, especially if we're talking about anxiety or mania or whatever symptom. So the first myth is that a lot of people think that if they don't have any gut symptoms, they don't have constipation or diarrhea or reflux, that their gut is fine. And that's not necessarily the case because your gut can be a problem and you may not have any symptoms from it. So it's always worthwhile is where we start in functional medicine is to look at your gut health. So when it comes to the gut brain axis, there's a lot. There's a lot of There's a way that the bacteria, the microbes that you have in your gut are producing neurochemicals, serotonin, GABA, dopamine, and they're acting throughout the body. A lot of people think all those brain chemicals are up here, but they're actually throughout the body. And the gut is the primary source of them.

If you have an imbalance between the good bacteria and the not-so-good bacteria, I think of them as like the Homer Simpson bacteria in your gut, then that can also lead to problems. The term that we use in functional medicine for that is dysbiosis. And it sounds like with the candabactin that you had, you might have had some die-off or like you might have killed off some of those Homer-Simpson bacteria. And what did you feel? Did you feel like flu symptoms or mood symptoms? mood. I was overthinking. I was spiraling. I was crying. And she was like, yeah, your body doesn't want to get rich. You have overgrowth of good. She's like, your body's holding on to it. Yes. Can you explain, too, there's the biofilm and like your gut, because I know things get stuck in all of these little places. And I really want the audience to hear and understand the nuance and complexity of the gut and the lining because I've been learning about it and I'm fascinated by it. Yeah. Yeah. Biofilms are super interesting. And this is a super active field in terms of research. So it seems that some of us create these biofilms in our gut as well as other places. I just was hearing about it with like breast implant illness.

Biofilms develop there too, where these bacteria or even fungi like yeast can get stuck. And so if you've got a functional medicine doctor who's treating you the way we treated the gut issues, you know, like 10, 20 years ago and isn't addressing the biofilm, you could. get better and then backslide. Okay. So addressing biofilms is also a really important part of this process. I've been doing my coffee animals for that. Yeah. I mean, there's a lot of different ways to do. Some more proven than others. Yeah. I'll say that I just enjoy. It's more of just like, I just enjoy it. It's not even for, if there's no benefits, I'm like, I just like. I love the two of saying this. I just enjoy. I enjoy how I feel after. I'm big on the body and sensations and feeling like, wow, okay, if this is helping me, like, Even if it's placebo, I'm like, great.

But I, okay, so I have one audience member. If I don't ask you about this, I know she's going to shoot me because she has asked me about this for like six months. And I've been saying that you're coming on. Birth Control. Oh, yes. Is the elephant in the room. As yours truly was on birth control for 10 fucking years. And no one ever warned me.

I took the pill and then I went IUD and then I went copper IUD, which was not fun because of my stuff. But I would love to know. Can we open this can of worms? Like, what does birth control do to you? What are the long term effects? How does this impact when you're dating, like, lay it on me? Gosh, yes. Okay, so first, what does it do?

So you take this synthetic form of hormones and it suppresses your body's own menstrual cycle. So you take ethanol esteradial together with a type of progestin, which is a fake progesterone, and that basically overrides the way that your ovary produces estrogen and progesterone. Okay. So you're suppressing your natural cycle. Now, when the pill first came out, we thought this was a huge feminist invention because it allowed us to control our fertility. And I don't want to take away from that. It's really important.

But the problem is so many women, like you, get started on the birth control bill and don't get told about some of the consequences. So what are the consequences? Number one, we're just talking about the gut and the microbiome. It can disrupt your microbiome. It even has been associated with a greater risk of Crohn's disease, which is a type of autoimmune disease that starts in the gut. It increases inflammation in the body. So not that short-term good inflammation, but the long-term chronic. And not by a small amount, but like doubles or triples your level of inflammation.

Now, you can measure this. You can measure a blood test called high-sensitivity C. reactive protein. That's what we see in the studies. The third thing is, it can shrink your clinton. clitoris by up to 20%. No shit. Yeah.

No woman I know wants to shrink her clitoris. So, you know, if I've got a woman who's kind of on the fence, like, I don't know, I'm kind of liking the pill. Usually that's the one that kind of seals the deal and gets people to be like, I think I want to try something else. So how does that happen? Yeah. The pill basically raises this intermediate blood test called sex hormone binding globulin. And sex hormone binding globulin. And sex hormone binding globuline is kind of like a sponge or a carrier protein in the body. And so when you go on the pill, it raises sex hormone binding globuline. And then that lowers your free testosterone. Now, we need testosterone. You know, we think of it as a male hormone, but it's actually so critical for women. It's the most abundant sex hormone that women have. Didn't know that. Even though it's about one-tenth of what men have, it's involved in age and

confidence, libido, it's certainly involved in preserving the clitoris. And so when you go on the pill and it shrinks your level of free testosterone, that's where the clitoris can shrink. And even 20 to 25% of women on the pill have vaginal dryness because of this drop. Yeah, yeah. And that's, I mean, they also have decreased libido, which is like the greatest irony. You know, you go on the pill, usually for contraception. And then you don't want to have sex because it's changing your hormones. That was my issue.

It was like I didn't want to do anything, but I was able to now. I have the freedom and the agency. It's a freedom. But then I don't want to. Yeah. So that's, I mean, this especially troubles me deeply

when you see teenagers started on the birth control bill. 18. Yeah. I was started when I was 16. Yeah. And, you know, most 16-year-olds,

you might have been the exception, aren't speaking up for themselves. They're not going back to the gynecologist and being like, hey, I don't want to have sex anymore. Like, do you have something better for me? So I feel like women don't get full informed consent about these things. The list goes on in terms of some of the problems with the pill. I think you asked, how does it change dating or who you're attracted to? This is also super interesting.

So we know that women on the pill are attracted to a different type of guy. When you're on the pill? Ryan and I were talking about that last night because I was like, we were going over what I wanted to talk with you. And he was like, did you know? He was like, if you're dating someone and then you start birth control, it can change versus if you've been with them and you met them while you were on birth control. Can you please tell us more about that? Because that is fucking interesting. And maybe something that most people don't realize is happening. Yeah, it changes your pheromones. Do you know about pheromones? They're these, they're like hormones, but they're released in a way that you can smell. But usually it's kind of below consciousness. So you may not be aware that you actually smell something different. So the type of person that you're attracted. to the pheromones that you produce and the type of pheromones you're attracted to change on the pill because you're changing your hormones. And so typically you are attracted to a guy that's more like you, as opposed to someone who is less like you, which tends to be better in terms of the immune system. So the type of person you're attracted to changes when you're on the pill.

And now what about like long term ramifications of the pill? You know, 10 plus years. And I think for a lot of people that are writing in, whether you're in your 20s, 30s, 40s, it doesn't really matter, right? After a certain while, you're not going to use the pill when you're, whatever age you are. But what are the long-term ramifications that we're seeing and how quickly, like, is it that you have to be on it for five plus years to really see it? Or is it like an immediate thing? Curious to see how that falls off and then, like, is there a detox from it? Like, does it change you forever? Like, what does it do to you?

Yeah. So long-term, there's some positive things, some negative things. So I feel like I should say a few positive things, even though I pretty much never pursue. guy birth control bills anymore. There's time and the place for it, just like the Xanax. Yeah. There are some people who really love it and they don't have any side effects. So bless you, but that is not the majority of women. Right. So one of their consequence of being on it long term is that it can deplete you in certain nutrients. Okay. So there's five different ways the body communicates with itself. And that is your hormones, peptides, proteins, the genome. and nutrients. So when you're on the pill, pretty much any pharmaceutical is changing some of your

biochemical pathways, and it might be blogging you from certain micronutrients. So on the pill, you tend to run low in magnesium. CoQ10, which you really need for mitochondria energy. It can affect your B vitamins, especially vitamin B2, B6, B9, B12, which you need for a stress response. We know. We know. that women on the pill have a blunted stress response. So they don't have kind of the full range that you have when you're not on the pill. Now, I said I would say some positive things. So here's a few positive things. You're like that you could take a pill. That's the positive. It's the same time every day. Yeah. So it does reduce the risk of ovarian cancer. So with you being on it for 10 years, we think once you're on it for five years, that decreases your chance of ovarian cancer up to, like,

80 to 90%. So that's pretty good. Wow. Yeah. We like that. Because basically it's suppressing ovulation. Right. So you're not having this constant ovulation, which is associated with more ovarian cancer. It also, for some people, the pill can help with PMS. Yeah. Now, that tends to be the one with just perinone, which also is associated with about a six-fold increased risk of blood clots. So, you know, it's like you take the pill with the poison. So those are. some of the positive things. Long term, what we know is that when you go on the pill and it raises sex hormone binding globulin, that sponge that soaks up pre-testosterone, and then you come off the bill, the rise in sex hormone binding globulin persists up to a year after you stop the bill. It's wild. So we don't even know how long your system is persisting in having this high sex hormone biting glabulant. It's not quite as high as when you're on the pill. But it's affecting your hormones long term. So for people, you were talking about detox, you know, what I generally suggest is that if you're coming off of it because you want to get pregnant, in that situation, you want to give yourself some time

to go back to like a normal ovulatory cycle. Because the pill not only changes your estrogen, progesterone and testosterone, it also can affect your fertility and your cervical mucous for months to, potentially a year after you stop. So it's good to build a bridge if you want to be fertile. I prefer the IED in that situation or switch to a barrier method like condoms. That combined with natural family planning can be really effective. I've had luck with that personally. Yeah, I've a lot of friends. They're doing the natural thing. And one friend, she's like, I've not had any issues. And it's like, whether that means more about her reproductive system, who knows? I think one thing that actually was subtle for me that I didn't really realize because I see

you have your glucose monitor on was, which I'm not diabetic, right? So it's not just for people right. As a kid you think you saw it. Then you're like, oh, no. But blood sugar had such a bigger impact on me than I ever thought. And it wasn't until that in histamines. I wanted to talk to you about because that's the buzzword now. I'm hearing everyone other fucking mother is talking about histamine.

So I'm like, let's talk about it. But I noticed for me, like, might as well be therapist, my doctor. When we were noticing, right around my period, like leading up to it, for me five or six days before, I turn into a different person. I am crying on the floor. I am very down. It's a black cloud. There's nothing that can help. I can't sleep. I wake up every single night at two between two to three and then maybe again at four. I'm dysregulated. You can look on my glucose monitor. Blood sugar is dropping all night. What the flying fuck is going on? Why does that happen? Like before is, and I don't think it's just me, but is like, is that common for women to have these fluctuations pre-period? Like, what is going on with blood sugar and histamines and all this stuff? Yeah. I mean, this is an area that's pretty complex, so I'll do my best to simplify without oversimplifying. I always have in the back of my mind, you know, some of these more, the things that are less common as drivers of behavior and symptoms. So I'm always thinking about histamine. I'm thinking about blood sugar dysregulation. That's actually common. I mean,

We see that 93% of Americans. So it's incredibly common. Not surprised. Look at the food we're eating. Right. And well, let's talk about blood sugar for a moment because it is such a common thing. And I think a lot of folks, just like when you've got panic attacks or anxiety, you assume that it's a mental health issue, that you just need to regulate your nervous system. But the truth is sometimes there's physiology that's driving it.

So mold is one example. the more common example is blood sugar dysregulation. So especially if you're someone who's kind of a high stress person, like, you know, had a lot of stress you're exposed to as a kid. And you've got that high set point and your stress response system, you know, isn't quite as crisp as it once was. You could have burned out kind of the connection between your cortisol levels and how that talks to your insulin. And then you can get glucose issues as. a result of that. So what I see, for instance, when I put a continuous glucose monitor in my patients, is that sometimes an episode of panic is related to low glucose. So I see that pretty commonly.

And people who have glucose issues, you know, my story is that I'm really spiky, probably related to cortisol. And it sounds like you might have been too. Now, when you do some blood testing, you may not pick it up. Yeah. So if you do like a blood test once you. You know, with your family doc and you see that you've got a fasting glucose of like 87 and your hemoglobin A1C is 5.4%. If you're going up and down and you've got a lot of the spikiness, you're not picking it up with that static blood test. And so often you need a continuous glucose monitor to look under the hood and see, okay, am I in this type of signal with insulin in the body? Is that actually driving my anxiety? So that's common.

Histamine's less common, but we're becoming a lot more aware of it. Yeah. And the science is still kind of new in this area, but the gut once again is involved. Your immune system is involved. Mass cells in your immune system are what release histamine. Some of us traffic in histamine a lot more aggressively than others. Okay. When I sell my business, I want the best tax and investment advice.

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deal with, you know, if you have like an allergic reaction. But we can overdo it. We can have MCAS. We can have problems with releasing histamine too readily. One of the things I encourage people to do, I tend to do gene testing and also biomarker testing with my patients. Gene testing can identify if you're making too much histamine. If you've got histamine sensitivity. I didn't know that. Histamine's new. Histemeans new because everyone was a do bone broth, have fermented stuff. And then you're like, wait a minute, I'm not supposed to, but you told me that was good for my gut, but it's not good for my gut. And the histamines, it is a new conversation. My doctor had me. She was like, I want you to try band and drill for a couple of nights. Let me know how

you sleep. And then I was like, I'm sleeping great. And she's like, okay, let's like play with this. And I know everyone's going to be different. For me, it was like, I have to take this at this time. If I take it too close to bed, it makes it higher. It has been a whirlwind. But what I have noticed is more consistency and imbalance on the blood sugar, right? Looking at it, What was wild and humbling as all fucking hell was we went out to dinner and blood sugar was normal. I had like three bites of patai, something that I have all the time. It's a little sweet, spiked all the way up and then came crashing down. And having the glucose monitor, I was able to stop and I was like, ooh, I feel lightheaded.

I looked and I'm like, okay, I'm back down. You become more aware of like, ooh, this feeling. I'm like, there it is. I'm off. My blood sugar is low. And so it helped me kind of maintain that. But I don't think people understand how blood sugar. sugar plays a huge part, especially with waking up sad. Waking up really sad and depressed. I'm curious. Like, could you explain even just how does that impact? Because one of my friends was telling me about that. And now that I've worked on my blood sugar, I take a specific night. Like, I take glycine at night. I have my snack at night. I do my egg and my stuff. I have my protein and my fats. But it's changed. I don't wake up sad and crying anymore. But can you explain a little bit about like how does that even impact your mood? Because I think a lot of us wake up like that don't even realize. Yeah, it's such a good point because I feel like what I see.

see in my medical practice over and over again is people who have, as you described, waking up sad and feeling like it's their own fault, like it's a moral failing. And the message I have is, let's test you first. Yeah. Like before we go there, let's just, why don't we assume that it's something physical and check you out for that before we go working on, you know, the cognitive therapy or whatever else we're thinking about. So insulin, the way of it's, the way of think of insulin is it's kind of like a bouncer at a club where it's sitting outside the club and people are trying to get into the club, kind of like glucose is trying to get into the cells. Because you need glucose inside your cells, especially the cells of your brain, to create fuel.

It's a source of fuel. So if you have a problem with your insulin, the bouncer of the club, and it's not letting the glucose get in the club, then you've got all this glucose kind of running around the street. and it's raising the glucose in your blood. That's your bloodstream. So what we know is that once you have a problem with your glucose going up and down, you definitely have a problem with your insulin. So you develop this thing called insulin resistance where your cells become numb to insulin. And that can be from the food that you're eating. If you're someone who binges on stress, if you've got the stress response system that's not working. That was my story in my 30s. So there's lots of different reasons. for it if you're not exercising enough or getting the right exercise because that's the way that you

decrease your glucose levels. So if you're someone who has a problem with your insulin, which usually develops over about 7 to 14 years, and then that leads to a problem with your glucose, the high, your body, as it becomes numb to insulin, insulin starts increasing a level. So you get a higher and higher insulin levels. And you can measure this. You can do a blood test fast, Look at your fasting glucose. You want it 70 to 85 milligrams per deciliter. And you want your insulin between about four and seven. And if it's above that, if you've got high insulin, that can affect your mood. And it can make you feel sad and depressed in the morning. God, it's so fucking crazy. Now I'm curious, because after all of these different variables, nope, that wasn't it? Cut that. Last thing that I really want to hit on fasting. Because we hear all this of like, do, you know, wake up and, you know, fast. And I had sent my doctor. Recently, I'd sent my doctor. I said, so interesting. I said, I'm one o'clock. I'm finally eating. I was like, sorry, don't yell at me. And I said, but it's interesting. My blood sugar was stable all morning. And she's like, yeah, it's called adrenaline and

cortisol. She was like, I don't know that you were actually balanced. I need you to go eat. Someone had actually written in and asked, is it safe if you have a more anxiety, if that's like your baseline? Is fasting a good idea? Because we hear, you know, you should fast in the morning and not eat until and only have a four-hour window or whatever bullshit the fitness world gives us. But what does it actually mean for us as women and our bodies working differently than men? I don't have the same workout routine as guys do because they don't go through the cycle that we do. Their 28 days is very different than hours. Their single day is our 28.

So what does that actually, like how does that all kind of play together when we talk about should you, like not giving them, you know, telling anyone what to do, but how does that impact if you fast and don't eat until fucking three or four in the afternoon? So this is where we have to individualize and see what's best for you. There are some women who can fast like a guy and get all the benefits. What I see in probably 60 to 70 percent of women is that it's too stressful. So you have to think about this. Most of the data looking at intermittent fasting or fasting for more than 16 to 18 hours at night, most of that data is in men. And women are designed to be more sensitive.

sensitive to environmental cues, including when you eat. So what I see in women who fast is that sometimes it's causing cortisol spike first thing in the morning, like your functional medicine doctor was talking about. Sometimes it is leading to a change in ovulation, like especially if you're not getting sufficient calories to keep the control system for your hormones working. What I see with women is that we want to individualize and sometimes come up with a compromise. So for instance, what's working really well for me is to have a protein snack first thing in the morning. So I don't have a ton of protein first thing in the morning, but I'll have 15 to 20 grams. So I'll have that in the morning. I did that this morning before coming to meet you. And that for me really stabilizes my

glucose without jacking up my cortisol. So there's a few ways that you could track this. You could do some blood testing and look, what does it show when you're fasting versus not fasting? You could also look at your heart rate variability, that time between each of your heartbeats. So I track that in a few different ways. I track it with a ring. I track it with eight sleep, a mattress cover on my bed. I fucking love eight sleep. Love eight sleep. Shout out to eight sleep. They sponsored a podcast many moons ago, and I will continue to promote them. It's the best. It's the best thing. I've ever used. And I think it's super accurate in terms of telling you about HRV. Okay, good to know. And this is another piece related to anxiety, which we started with.

For those of us who've got anxiety, typically what happens is you've got this overactive synthetic nervous system. So fight, fight, freeze, fawn. You've got this underactive parasympathetic nervous system, which is stay and play, rest and digest, feed and breed. And so you've got too much of the on position, raises heart rate, makes you feel hypervigilant, not enough of that break that helps you to calm down. And you can measure that with your HRV. So people with anxiety tend to have low HRV. And so you can look if you're fasting, see what's happening with your HRV. Is it improving your HRV? Is it making it go down? And it's not like one night that you want to look at. You want to look at a trend over like three to seven days. So if anybody's listening, if

going, okay, I don't know what I have. Where do you recommend people to start if it's like, like, for me, I knew I was like there's something more than just it being daddy issues. Like, it can't just be, right? Because it would be to the point where like, I couldn't eat, I couldn't sleep. And it's like, while I understand I might be dysregulated, which we have talked about or we can continue to. And I know for me, like, sometimes Ron will be like force feeding me of chicken, just like, please eat protein. He's like, babe, I need you to at least eat something because I can. I can't be so anxious that I can't sit still or I can't eat or I'm right. But I think for anybody that's dealing with that, that's going, okay, well, it's not just my mental health. Where do you start? What do you do? How do you actually start to understand what it could be? Like, what do you recommend? So I recommend first working with a clinician who's knowledgeable about these things, someone really collaborative. And it sounds like this person you found was quite good. So to do that, you go to the Institute for Functional Medicine and find someone who's in your area. It's IFM. Awesome. Another thing you could do is use wearables. So we were talking about tracking your heart rate variability. So just start measuring your HRV. Look at your sleep at night. There's lots different ways you can do it. Wooop, Fitbit. I like ORA ring. I like eight sleep. Do you think the Apple watch is accurate on the doubt? I don't personally find it. I think it's less accurate than some of these others. Okay. I was going to say I was like, I'm not going to recommend that because I have found it not to be. I'll be like that's not how many calories are perjured. There's some head-to-head comparisons. And it seems like ORA and Ate's Sleep and Garmin tend to outperform some of the

others. Okay. And then others swear by whoop kind of depends on what your goals are. That's right. He's whoop and Garman. So I'd go after him for that. Okay. So doing that and then would you recommend like blood work? Like I, so I like blood work. I mean, I think just like if your car isn't working, you want to do a diagnostic. And sometimes if you've got a doctor that's less collaborative, they may not be willing to order some of these tests. Like look at your cortisol. What's going on with your histamine? And so in that case, you might need to do some testing outside of your practitioner. Like, you can go to Functional Health. There's lots different ways. And Function Health is a sponsor. So go support. We love. I love Function. I just made just got my brother to do it. And he

texted me and I was like, this is all easy. Like, we can definitely work on this. It just, peace of mind. I don't want to have to guess. I like to know 160 biomarkers delivered to my door. Okay. So it sounds like doing some research first to understand if there's anything off and then kind of going from there would be the best course of action. That's what I suggest. I mean, even with functional health, it's a great. place to begin, but long-term, what you want is a clinician that's helping to guide you. 100%. And I would also say, this is where you get to do end-of-one experiments. So it's the main tool of precision medicine, the type of medicine that I practice, where you look at something like glycine.

You mentioned glycine to help you with sleep. So you can do an experiment where you've got a period of time looking at your heart rate variability and your stress levels. And then you use glycine and then you see what happens. How does it improve your sleep? What happens in terms of HRV? So I think N of one experiments are also a really good tool to use to personalize what's going to work. And what I'm hearing as well is like there's also a patience component as well. Like there's a few things.

At least what I learned is one, don't overlook anything. That was my, like the Candy Backman, for instance. I remember looking at Ryan going, I'm not going to bother her with this. I couldn't be that supplement. And I had in passing on my call with her said, yeah, I've been feeling a little nutty and she's like, no, no, no, no. Whoa, what could you explain that? And she's like, you need to tell me anytime something happens because we are so sensitive. So I've learned that. Like, don't overlook things. Don't try to dust another rug. It's like, oh, everyone feels this

right. No, they might not. And even if they do, that doesn't mean it's okay. And really, to learn some patients that like, this is a process, just like our mental health takes time. So does your physical body. But man, it's worth it. It's worth it. I mean, there's a few reasons why it's worth it. First of all, it's enchanting to really understand your own physiology. Agreed. And second, I really like the sound of the doctor that you're seeing. And what you're modeling for your many, many viewers is the way that you collaborate and talk to your clinician, that's really the model of Medicine 3.0, which is what we need going forward. And then I also think it's critical to understand that what works for your girlfriend, what works for your mother,

may not work for you. 100%. And so that's where you want to personalize. You know, the way that medicine 1.0 and 2.0 is set up is that you go in, you say you have anxiety. And inside of seven minutes of a typical appointment, you get a prescription for Xanax. That's not helping you with your root cause. No. And to be able to realize that, okay, you spend less than 1% of your time in a doctor's office, that other 99%, you want to be

collecting the information about yourself that allows you to feel fully expressed in all. I'll say the reason I found Tori was because the doctor I went to, I said, could we do blood work? And he said, why? And he said, you don't need blood work until you're in menopause. And I was like, wait a minute, you're talking about I don't need blood work for another 15 years. And I said, but I can't sleep. And he said, okay, hear me out. And he said, this is the best tip I have. And I was like, okay, talk to me. He said, have you tried therapy? And I looked at him. I was like, this is a joke, right? And then he said, here's what I want you to do. Every night before bed, I want you to tell yourself, I'm going to sleep tonight because that's that positive reinforcement that you're lacking.

And I just looked and I was like, oh, that's it. And he goes outside of that. And so Ryan said, what about getting a sleep study? And he said, what are we going to do with the information? And I said, I don't know, fucking do something about it. That was where I said, this is not for me. And I had years of that. Now, are there some amazing doctors? Of course, absolutely. But if you get that, if you're getting told, like you said, if your doctor is not willing to call you blood work, you're telling them there's something. And they just keep trying to say, you're just a prescription. that's when I would say maybe talk to somebody else because it doesn't sound like you're being seen or heard. Well, this is such a classic experience in mainstream medicine.

And it makes me sad because I trained along with people like this guy that she saw. It's dismissive. It's patronizing. And it's not honoring these messages that you're getting from your body, like about your sleep, that you're trying to share with this collaborative person. And they are not collaborating back. And it's even borderline gaslighting to basically say, tell yourself before you go to bed that you are going to sleep. Like, this is not a mindset issue.

It was a glucose issue. It was a mold issue. It was a gut issue. Like, all of those things could have been addressed in that moment. And very real. And I'll be honest with you, since I've been working on that, I'm sleeping from 8.30 to 5 a.m. Every morning I'm waking up significantly more alert. I need a lot less in the days to get me through.

And it's like, but it took me a few years to get here. But it's, and it'll continue. It's always an ever-ending journey. And Sarah, I'm just so grateful. Thank you for being here and sharing so much fucking wisdom. Can you please tell people where can they find you? They can listen to you have a podcast too that I was on. Can you plug yourself a little bit and like can people work with you?

Like, what does that look like? Sure. So the website is sarahzalmd.com. That'll be linked. Great. Yeah. Check me out on Instagram. I hang out there a lot.

I'm still in the process of the. this name change I went through a divorce two years ago. But at Sarah Goughfried, MD, we're slowly getting meta to switch that over to at Sarah Zoll, MD. And yes, I still work with some people. I write books. I've got my next book coming out on women and why we're so dysregulated in a world that's built for men. Those are the places staying out. And yes, my podcast is treated with Dr. Sarah. And it was such a pleasure to have you on it. I'm so excited, Sarah. Thank you for everything. Thank you for being here. And for everybody listening, thank you for getting curious about your health in a different way because I think I've been very honest with my audience. Like, we are evolving the conversations. We cannot just keep

talking about the same three things. And this to me is the perfect place to really kick that off because there's so much more to anxiety than just you're not being positive enough. So I'm so grateful for you to be here and part of the community. So thank you. Thank you, Sabrina.