The Hormone Cure #SANE

Jonathan: Hey, everyone! Jonathan Bailor here & today we have a guest and a topic that I know is really, really, really going to resonate with a lot of you. We have none other than the Harvard trained MD with 20+ years of practical and clinical and actually interacting with people experience. She’s helped over 20,000 men and women achieve their wellness goals. She focuses on hormones, so you know I love her! Her new book is a #1 New York Times Best Seller. It’s called The Hormone Cure. She is none other than Dr. Sara Gottfried. Sara, welcome to the show!

Sara: So happy to be with you!

Jonathan: Well, Sara, let’s just jump right into it. Tell us your story. You’ve been at this for years and years and years and your book just came out. Tell us from little Sara’s first steps in short, to The Hormone Cure and how you arrived at it.

Sara: Well, my story actually begins in a strange place and that is, I grew up with a great-grandmother who was a bit of a radical. So I was raised in suburban Maryland and she would show up at our house not with See’s candy and the latest Barbie, but with kale and Meyer lemons. She was very slim and she was smart about it, but she didn’t believe that you find the answer to health in the bottom of the pill bottle or by giving your power away to your conventional doctors. So I grew up with a radical idea of health and wellness and how to kind of rock your body as you age.

But it wasn’t until I was in my 30s where I really came up against a struggle with weight. I had this experience when I was in my mid-30s, working mom. I was working at my local health maintenance organization, and as you can imagine, it’s a bit like McMedicine over there. I had this experience of being premenstrual, being fat and frazzled, about 25 pounds more than I am right now, and I came up against that same place that I think you described so beautifully, Jonathan, of feeling fat and cranky, exercising a ton, and then coming to that disconnect between what I learned growing up, what I was taught in medical school, and all of this converging in my own body. Where I just found that I was told by my doctors when I was struggling and churning in my 30s and trying to figure out how to lose this weight, I was offered the latest antidepressant and I was told to exercise more and eat less, and that just didn’t feel right to me. That was a defining moment. So that’s what led to me taking on my hormones and becoming a bio-hacker. Ultimately, it led to The Hormone Cure.

Jonathan: Sara, it’s a fascinating and, sadly all too common story I’m hearing. Especially in that decade of 30s, both for men and women, it’s the input stay the same – meaning, an individual continues to eat the way they’ve been eating and continues to be as active as they’ve been active – and then things just start to change and it’s like, “Well, hold on, the inputs didn’t change, so how is the result changing?!” What we’re discovering and what your work deals with as well, the system itself – a.k.a. your body, a.k.a. your hormones – are changing. But no need to fear: You can change the quality of your inputs and then you can change the quality of the system. Right?

Sara: You got it! I love how you describe this! You are an honorary bio-hacker, maybe an official bio-hacker, so I feel like we are soul brothers here. I think it’s so important to realize that beginning in your early 30s, you will fall down a hormonal flight of stairs if you’re not proactive and getting smarter, wiser, about how to approach the aging of your body because metabolism slows down, thyroid starts to sink, cortisol goes up as we get older – that’s the stress hormone – and that causes all kinds of problems in the body, insulin can climb, your estrogen can become dominant and low. So there’s so much going on hormonally and we want to be able to manage this like we manage our 401K.

Jonathan: I love it! Sara, do you think we’re starting to see…? Obviously, with work like yours, we’re starting to see a bit more mainstream attention paid to this and I’m hoping we’re getting close to a tipping point because I remember back in the days of Dr. Barry Sears and the Zone Diet. He said as soon as you start thinking about food as a control system for your hormones rather than a source of calories – not that calories are irrelevant – but once you get your hormones in play, the body is pretty smart. It generally tends to take care of the rest. Do you start to see the mainstream catching on or what else can we do to help there?

Sara: Well, I’m definitely a ‘glass half full’ type of a person, so yes, I would say the mainstream is catching on! I want to re-brand hormones. I feel like hormones have gotten a bad rap. We’ve got to turn that ship around. Hats off to Barry Sears! I’m a huge fan of this idea of ‘food is a control system’, ‘food is information for your body,’ as one of the most important ways to balance your hormones. Barry Sears was famously quoted as saying that you can reverse insulin resistance with the Zone Diet in 48 hours and I have seen that in my last 20 years of taking care of patients. No question. That is true. I think that’s such a hopeful message for listeners, Jonathan, because for many of us, especially if you’ve been struggling with your hormones for a while, if you’ve been feeling cranky pants, or like you’d rather mop the floor than have sex with your husband, and no matter what you do, it seems to fail when it comes to weight loss. I think it’s so important to realize that you can turn these hormones around in a very short amount of time. It’s not some gigantic project that you have to take on.

Jonathan: And in some ways, I think it’s also very empowering, Sara – and I’m saddened by this and again, our spirits are aligned here as well – I’m saddened that often times we feel like we need to turn to a prescription to try to turn things around when frankly we have the most powerful or one of the most powerful medicinal forces in the world at our disposal – no Ph.D., no M.D., no pharmacy needed! – and that is whole healthy foods.

Sara: Hallelujah! Yes, I totally agree with you. You’re my latest crush, but another crush that I have is Mark Hyman. Mark Hyman, I was chatting with yesterday and I love this idea that he has that you really want to start a revolution with your fork. I would say that even though men and women come to my office, they get to the door of my office because of hormones, and they come in and they say, “Give me some of that testosterone.” Or whatever it is that they want me to treat them with, it’s so important to dial back to the foundation.

I think that about 70% of hormone balance and creating ease around your weight comes from your fork, so I totally agree with that. I also love this point you made about Barry Sears, about amplifying the innate intelligence of the body. We want to find the ways that we can really – just like in positive psychology, where you’re amplifying the good rather than trying to change the bad which almost never works – we want to amplify the innate biology that we have. We want to leverage that beautiful epigenetic effect – that 50-80% of our DNA is expressed based on how you eat, move, think, and supplement. So, let’s go there! Let’s find the needle movers!

Jonathan: Sara, that is so profound and so spot-on! That’s actually why I think this re-focusing on hormones rather than calories is so hopeful and transformational because if your focus is on calories, then you will think you need to avoid food; whereas if your focus is on hormones, actually if you avoid food, you’re avoiding that which can cure you! So if you’re focusing on hormones, it almost forces you to heal your relationship with food and to celebrate food and to pursue eating more, but healthier foods. That, to me, is just such a better way of living.

Sara: Oh, yes! This is the key to creating more pleasure in your life. I’m doing the happy dance over here. I know you can’t see me doing the happy dance, but I totally am because I think so many people feel like to manage their weight, they have to remove all of life’s pleasures and start eating cardboard and less of it. They feel like they’re destined….They sort of see Quinoa as this prison sentence. I think it’s really important to realize if we take on, just for a moment, high cortisol – our stressed out culture that we live in and how many of us are running task to task and cortisol is really high and it’s making a muffin top, it’s laying down belly fat, it’s making you forget why you walked into a room, it’s making you lose your focus or maybe lose your sex drive.

I think it’s so important to realize, even with cortisol, a small amount of dark chocolate lowers your cortisol. So we can have a lot of fun as we shift that focus to hormones – I completely agree with you – in terms of healing your relationship to food and doing it by shifting the focus to your hormones.

Jonathan: The irony, Sara, feels that some of these, let’s call them more conventional and areas we are certainly trying to change these common concepts of health, but the example I always give – and cortisol’s a great hormone to look at. Let’s take an individual who’s already over-stressed and who’s already not sleeping enough and that individual wants to improve their health. How common do we hear the following story, Sara? “Okay, I’m going to get up at 4 a.m. I’m going to get up at 4 a.m. I’m going to get up at 4 a.m. because that’s healthy, I’ve got discipline. Then I’m going to go run outside, on the pavement, on the road, breathe in exhaust from cars. Then I’m going to come home and I’m going to quench my thirst with some power juice and then I’m going to have carb cravings throughout the day because of what I just did. Then I’m going to be rushed throughout the day because now I have to go shower and I’ve got to get the kids over here and…..” What I just did to become ‘healthy’ actually just took my cortisol and just shot it through the roof and set me up for long-term depression, fat gain – all kinds of sadness! I’m trying to be healthy. What’s going on there?

Sara: And you think you’re doing it all right. That’s the part that makes me crazy. I so love that you just made that sketch because this is 91% of the people who come to see me have exactly that situation! They’re saying to me, “Okay, look at this body. I’m 30 pounds overweight and yet I feel like I’m doing everything right.” So I think it’s really important to realize this very sacred important role – kind of the central story – of hormones. Even that example you gave – getting up at 4 a.m., going for a run. I’ve always been a runner and when I was in my 30s and I started this bio-hacking process and looking at hormones and how they influence all different aspects of our life, but of course I was motivated, first, by weight. What I found is that my cortisol was about three times normal first thing in the morning – and that’s not a good thing. Just as you described, 50% of people with depression have high cortisol, 20% of people with depression have low thyroid. I was offered Prozac as a way of dealing with my emotions then and yet I didn’t have depression; I had a problem with cortisol. Every time I would go running – this doctor that I saw told me to exercise more and starve myself – so when I did that, when I went running, it raised my cortisol even further because that’s what running does. It was much better for me to go to a Pilates class or to… I actually became a yoga teacher because I had to. I did it of necessity.

Jonathan: Well, Sara, you’re hitting on the key thing here, which again, it seems commonsensical, but we’re just bombarded with so much nonsense that sometimes we need to just shout the common sense, which is if we want to heal our body, which is what we’re really talking about – we’ve got to heal our body – the body and components of the body heal when we reduce stress, not when we increase stress. You don’t heal a broken ankle by jumping rope; you heal a broken ankle by elevating it, by taking pressure off it, by applying ice to it, by caring for it, not by punishing it.

Sara: Well, you’re right. Maybe we could go deeper with this ‘reduce stress’ idea because you’re right. I feel like what you’re saying – maybe how I would translate that is, let’s reduce the inflammation in the body. When it comes to injury, like an ankle injury that you were describing, we want to reduce inflammation. To put this in an astonishingly simple context, what I would say is, we want to make a good neighborhood, not a bad neighborhood. When you get up at 4 – and that raises your cortisol because you didn’t sleep restoratively or for enough hours – and you go running – and that raises your cortisol even further – and then you come home and you have that carb-laden drink, you raise cortisol even further. So you get into almost like a series of drive-by shootings in the body with behaving that way. You’re right – it is creating more stress on the body. But I also think that some people have their eyes glaze over when we talk about reducing stress. I mean, honestly, my eyes sort of glaze over when the doctor says that to me. So I want to be careful about talking about these hormones and saying, “Okay, these hormones are not demons.” We just want to work with this innate intelligence. We want to get these hormones working for us; not against us. We want insulin in that Goldilocks’ position of not too high, not too low. Same thing with cortisol. Same thing with thryroid.

Jonathan: Oh, absolutely! Maybe on the side of over-simplifying that example where there is certainly eustress and distress and certainly, for example, the types of exercise which has been shown to have dramatically positive hormonal benefits is ‘stressful’, but in just a different, more productive way.

Sara: Yes, yes, yes! I sometimes joke, “You stress, I stress…” I agree with you. Just like with cortisol and estrogen and the dance that it has with progesterone and women and the dance that it has with testosterone and men, we want to have that sweet spot. So when it comes to stress, we’re not talking about removing all stress from one’s life because then you would be an apathetic blob, totally not of service to the world, and we want people to be of service; we want you to rock your mission! You do that by getting the right dose of stress and that’s what you mean, I believe, with the eustress.

Jonathan: Exactly. And picking and being intentional about your sources of stress and not having sources of stress, which should be positive, end up being negative, like we were talking about with the excessive exercise earlier.

Sara: Absolutely! Absolutely! I think we want to figure out… One of the ways I think about this is I put on my ‘functional medicine’ hat – occasionally I wear this kind of cute ‘functional medicine’ hat – and this hat is designed to really look at ‘what are the nutritional gaps that you have?’ Each of us is a little bit different in this regard. One of my nutritional gaps, for instance, is that I have a genetic tendency to be low in copper. So when I eat some oysters, for instance – I know, Jonathan, you live in Washington, so you probably have some really good oysters up there. When I eat an oyster which is very rich in copper, I just don’t extract much of the copper from it and copper is so important for your thyroid function. Both men and women are affected by thyroid problems. It’s a huge part of metabolism and how fast you burn calories or how slowly you burn calories. What was happening for me in my 30s was that I was running around for three decades not knowing this about my copper and so when I filled that copper gap, it really helped my thyroid start to function properly. For those of you who are listening, who are just like, “Yeah, whatever. What is she talking about?” The thyroid is the biggest endocrine gland that you have – second only to your fat, which is another important endocrine gland, but we can get into that in a moment. With your thyroid, I find that so many women especially, starting around age 40, will go through ‘thyropause’. I’m hoping we have time to talk about all the pauses; we may have to do that at another time. There’s andropause, sexopause, menopause, perimenopause, and then thyropause. So, thyropause is when you start to get fat even with the same input, as you were describing. You get cranky, usually depression, sometimes anxiety, and you get tired. You just wake up in the morning thinking, “Meh!” It’s just ugh! Sometimes it’s as simple as making sure you’re taking a potent multivitamin that’s filling those gaps like copper, zinc, and selenium. That’s step 1 of the Gottfried Protocol that I have in my book, The Hormone Cure.

Jonathan: And, Dr. Sara, what are your thoughts on… you talked about as you age, you get these ‘meh’ moments. One thing that I hear so much from women – it’s specific to women and it’s specific to postmenopausal women – as they are putting their heart and soul into eating smarter and exercising smarter and they are seeing results, but the thing that’s frustrating them is their husband, who actually really doesn’t care at all about any of this stuff, but is in some ways having a little bit of a blowback because maybe she is the health CEO of the household, so as she decides, the rest of the family decides as well, and the husband is just… his pants are falling off, like he’s like, “Oh my God! Look at me, honey! The weight is just melting off me!” Whereas she’s taking a much more intentional and deliberate approach and not seeing as compelling of results. Is there hope there?

Sara: Oh, yes! And I am so there with you! You just want to punch your husband in that situation. No matter how much you love your husband, you just want to punch him! Of course, I’m not advocating violence, but here’s how you get very strategic and sort of get into warrior mode around this, around closing that gap – the gender gap – of men who have their pants falling off even though they don’t need to lose weight. One of the advantages that men have – they have many, actually – is that stress favors men. We know that women are a lot more vulnerable when it comes to managing stress – and of course I’m generalizing – but if you look at the control system for stress in women versus men, women are way more vulnerable. That’s why we have double the rate of insomnia, it’s why we have 15 times the rate of slow thyroid function, it’s why we have double the rate of anxiety and depression. So one of the major differences is that men have about ten times as much testosterone and there’s a pretty big range there. Testosterone is that lovely hormone responsible not just for sex drive, but also very important for your sense of vitality, for your metabolism, and maybe most importantly, in my mind, as I look at the job description of all these hormones, is that it’s in charge of your growth and repair. So, DHEA and testosterone – you want these two hormones to really be supporting you in your relationship to your weight and to food. We know that testosterone is really effective at helping you see a response to exercise. It’s really effective in your confidence, which I think, helps people with creating new positive habits as they step into a different relationship with food. So, men have the advantage when it comes to testosterone. Testosterone starts to wane for men between the ages of 40 and 70 – that’s classic andropause, or what I call the ‘grumpy old man syndrome’. When it comes to women, I think, as these postmenopausal women, who are looking at their husbands who need a new pair of jeans, they want to be looking especially at their hormonal ‘Charlie’s Angels’. I like to keep this super simple. The hormonal ‘Charlie’s Angels’ you want to be watching are cortisol, estrogen, and thyroid. The list is quite a bit longer of the hormones that influence your weight – it includes insulin and leptin and many others – but I think these three hormones are where women should focus because that’s part of the reason why your husband is having so much wild success. If you can get those hormones working for you, not against you, it’ll make a big difference in your relationship to weight.

Jonathan: I love it, I love it! Sara, I don’t want to give away the farm here, but if I were trying to do this – I wanted to get my ‘Charlie’s Angels’ smiling and working on my behalf – what are some things, let’s say, three things I could start doing today to help getting them on my side?

Sara: Well, I probably would give away the farm because, as I mentioned, I’m crushing on you. Just to be clear, for men, I actually call it the ‘three amigos’. Your ‘three amigos’ are your cortisol, your testosterone, and your thyroid. Estrogen is also important, but it’s the ratio of your testosterone to estrogen. What do we do about this? In my book, I probably have about 97 ways that you can get these working for you, all supported by the best evidence – by randomized trials – because, frankly, we have a shameful past especially when it comes to women and hormones and we must be evidence-based about this, but let’s just take on each of these ‘Charlie’s Angels’. A really important part of cortisol is figuring out how to hit the pause button. I know a lot of people just want to stop the recording when they hear somebody say that, so I’m not saying ‘deep breathing every day, twice a day’. That’s really valuable – I think it’s important – but it’s also important for our listeners to craft their own top 3 list of how they really get cortisol back into that Goldilocks’ position of not too high, not too low.

Jonathan: Just to make sure that listeners understand it, cortisol, in some ways – again, it’s much more complicated than this – but can we think of it as really the thermometer for stress? Like, if cortisol is high, you’re really stressed and if cortisol is low, you’re not stressed at all basically.

Sara: I think that’s a good basic way to approach it. I mean, of course, it’s oversimplified and the issue is, if you’re like I was in my 30s – total stress case, like pushing a rock up a hill – then the more longstanding your chronic stress, the more likely you’re going to have both high and low cortisol even within the same day. So it can get more complicated, but it’s really the high cortisol that more contributes to burning through your happy brain chemicals, making you fat and angry, making you repellant, honestly, and then causing problems with your weight because your belly fat has four times the number of cortisol receptors as fat elsewhere. So I think you’re pretty close, but it gets a little bit more complicated, so I want to honor Robert Sapolsky here and just make that one quick comment. So, let’s just talk about these three strategies and how you eat, move, think, and supplement, and your ‘Charlie’s Angels’. With cortisol, hit the pause button. One of my favorite ways is orgasm. I prescribe that all the time. It lowers your cortisol, raises oxytocin – love it! – and we also know that a hot bath, calling a girlfriend – those things are really effective. It’s more effective to call a woman than to call a man in terms of getting your hormones into balance.

Jonathan: Sara, when you say ‘call a girlfriend’, I’m assuming you’re not referring as that as a strategy for the married men out there.

Sara: Yeah, probably not. Well, it might be effective for them but I don’t want to advocate that.

Jonathan: I just wanted to clarify it with the listeners in case, “Well, Dr. Sara said I needed to call a girlfriend.”

Sara: Yeah. “She said I need a new girlfriend and I need to call her.” Yeah, I can just see the letters coming in. So, we actually know that, rather than ‘flight or fight’, women do best when they ‘tend and befriend’, so I’m quite serious about prescribing for you that you call a girlfriend for 15 minutes. Yes, so this is mostly for women. ‘Girl friend’ – maybe two separate words for men. What works across the board, regardless of whether you’re married or male or female, is phosphatidylserine. I’m just like the biggest cheerleader in the world for phosphatidylserine. Are you a fan?

Jonathan: I actually have a T-shirt printed on the front of it.

Sara: You do not!

Jonathan: Well, it’s actually a sleeveless T-shirt. It’s a halter top, actually. No, I’m just kidding.

Sara: I love it! I do, too!

Jonathan: Oh, you’re the other person that ordered it! Okay!

Sara: Exactly! So, phosphatidylserine is this lovely extract from a cell membrane. Who knew? 400 mg a day – it helps you get cortisol into that neutralized place, whether you’re male or female. Omega-3s are also super-effective whether you’re male or female. Most of us know that omega-3s are a good idea. We get the fish oil and then we stick it in the fridge and take it maybe one day a week. I want you to get religious about these two supplements because they really help you with cortisol.

Jonathan: Sara, what would be your recommendation? For example, I am a fish addict. I literally eat salmon twice a day regularly. If we’re really into fish, does that modify the recommendation here or is it just… Of course, there’s an upper bounds, but what are your thoughts on limits?

Sara: So, Jonathan, indeed you and I were separated at birth because I eat wild Alaskan salmon a couple of times a day. In fact, I had the most blissful summer of my life. I grew up in suburban Maryland but then I moved to Anchorage, Alaska when I was 13 and I spent a summer out in the bush where I was counting salmon with sonar and we used to have to draw a net across the river and we would eat salmon for breakfast, lunch and dinner and I’ve never had a more easy relationship with my weight, I’ve never had such glossy locks, I’ve never had such strong nails as that particular summer. So, yes, my preference is always to use food as information, but most people are not quite like us. They’re not super freaks who are eating salmon twice a day.

Jonathan: Yeah. So, the recommendation is we’ve got to make sure we’re getting those omega-3s and if you’re not into the salmons, if you’re not into the sardines, and if you’re not doing a bunch of flax seeds, and even if you are, it’s probably not the optimal type of omega-3s, that’s when you need to go more of a cod liver oil or supplementation route.

Sara: Yes, exactly! You just make me so happy the way that you talk about these things because you are so science based. You’re right. I love flax seeds! You can’t get between me and my flax seeds that I have in my smoothie each day. They’re really good, especially for postmenopausal women who are trying to get their estrogen into balance, but only about 5% of those flax seeds are converted into the type of omega-3 that you really need to rock your mission and to get cortisol in place. So yes, get your omega-3s. The vegetarian sources unfortunately are not as proven as fish oil and my first choice would be to get it from food; if you can’t do that, get it from a supplement; third choice would be vegetarian sources of omega-3s.

Jonathan: I love it, I love it! I derailed you a little bit. We were going in a list and I think we were on cortisol and then we were going to move on to the second of the angelic elements.

Sara: I don’t think you derailed me. I think I derailed myself. When it comes to estrogen – I’m going to give you a couple of tips here. You asked for three tips, but I’m a woman – what can I say? I’m going to give you five. So, when it comes to estrogen, for both men and women, we need to get estrogen into balance. As I mentioned with the three amigos, you’ve got to have the right ratio between testosterone and estrogen. It’s been shown quite rigorously to predict heart disease and, just more from a vanity perspective because often that’s motivational, for guys, if you get estrogen in the right place and it’s not doing a backflip into the kind of estrogen that is bad for you and creates love handles, you are going to prevent andropause. We want this. For women, I find that women especially between 35 and 50 are estrogen-dominant; they have too much estrogen compared to progesterone. You can start to have low estrogen – it’s your overuse or running out of ripe eggs – sometime between about 45 and 55. I’m just giving some general ideas here. So, you can have low estrogen. But if it’s a combination of low estrogen and super-low progesterone, that’s still estrogen dominance. I have a quiz where people can sort of figure out if this is part of their story or not. What do we do about estrogen? Number one, fiber. Fiber, fiber, fiber! I think it’s so important that you get the right dose of fiber. Most of us are woefully under-dosed. We know the average American woman gets about14 grams a day. Oh my goodness! We need about 40-50 grams a day! Do you have anything to say about fiber, Jonathan?

Jonathan: You know I love fiber because obviously the hormonal impact is massive! But if we’re not eating fiber, we’re not getting the satiating impact of fiber and that means we’re eating other stuff. So not only are we not getting the benefits from a hormonal perspective that fiber gives us, but we’re getting the detriments of the stuff we’re eating in place of the fiber!

Sara: So true. Before you know it, you’re eating donuts and you’re down that slippery slope where it’s just another drive-by shooting in your poor body. We’ve got to just stop the drive-by shootings. We need to create a good neighborhood. We’ve got to get people into Boy Scouts. The way you do that is with getting your fiber up to 40-50 grams a day. The other part that I think is really important here when it comes to estrogen – also true for men and women – is that if you are drinking a little too much alcohol – and I’ve been guilty of this in the past – as a woman, if you were drinking more than 3-6 servings of alcohol per week – and for many of us, that’s a weekend or even a Saturday night – 3-6 servings a week increases your risk of breast cancer. It starts to make your good estrogen do that backflip and create bad estrogen that can increase your risk of breast cancer, so we want to be really careful about that. Alcohol has so many other effects, too. It raises your cortisol. It disrupts your sleep; even though you may fall asleep more easily, you’re not going to have the good sleep quality that you need to create the good circadian rhythm that helps you with the neighborhood. So my message here is not that you abstain, unless you’re an alcoholic, but if you have a sticky relationship, you want to look at that and if you’re trying to really do the best with your body with getting estrogen to support you, then you want to drink less, better quality.

Jonathan: So we’re focusing more on having that nice red wine rather than knocking back the 40-ouncer on the street corner in a paper bag. We’re talking about drive-by shootings, so I just thought….

Sara: We’re just going to stay with the neighborhood analogy, so yes. It’s not just red wine because not all these red wines are created equal. I just heard this joke. Somebody told me that Malbec is ‘cougar juice’. I was a little bit horrified because I really love Malbec. It turns out that Malbec, Zinfandel – those super fruity wines – are the one that are the worst players when it comes to your cortisol levels, so you want to go more for the low residual sugar wines and this is the Cabernet, the drier wines – they are not the big huge oaky California Merlots.

Jonathan: I love it, I love it! Well, what about #3? What about the trifecta? Let’s round it out.

Sara: When it comes to your thyroid, I have so much to say here. In my book, this is chapter 9. You heard me already dish about copper. You really want to get copper, zinc, and selenium in that Goldilocks’ position so that you’re able to make sufficient thyroid hormone, but what I’d love to really emphasize here is the central role of vitamin D and how important it is for your metabolism, especially your thyroid. So here’s a little… I feel like I should maybe sing a Top 40 tune, maybe a Taylor Swift song related to vitamin D. “You’re never, ever, ever getting back together…” We’ve got to get vitamin D into that range that is going to support you and this is one of those places where… Vitamin D has about a thousand jobs in your body and even in the Bay area where many people are smart about health, 50% of us are not getting sufficient vitamin D. I happen to have the world’s worst vitamin D receptor, so I have a DNA tendency – probably from my great-grandmother because she just never went in the sun – to take vitamin D and it just barely shows up on my blood testing, so I have to take a pretty whopping dose of vitamin D to get into what I consider to be that Goldilocks’ position vitamin D level of about 52-100. This is so important for your thyroid.

Jonathan: While we’re talking about Taylor Swift, I was going to make a Taylor Swift reference, which was talking about knowing that that low-fat, high-starch diet was ‘trouble when it walked in….. So, shame on us right now’. Because that’s not going to help you with vitamin D, either.

Sara: Jonathan, you went there with me! I’m just getting chills! Love it!

Jonathan: To make sense of my absurd babblings, not only is it the taking of vitamin D and getting the sunlight, but ensuring that, for example, if we eat a low-fat, high-starch, high-sugar diet, in many ways, we can take in as much vitamin D as we want, but our body is not going to be able to make as good use of it. So it’s not just about taking more vitamin D, it’s also making sure we’re taking in the whole nutrition and the healthy fats that enable our body to do its thing with vitamin D.

Sara: Oh, yeah, you totally got it! It gets to this much bigger picture of how these different issues cross-talk. It’s not like we’re talking about cortisol in isolation in a vacuum, we’re talking about how these hormones – and vitamin D is a hormone – how they all interrelate and they cross-talk; another term for it is interdependence. So just like you want all these three ‘Charlie’s Angels’ working for you, not against you, you want to optimize that cross-talk between them. This is part of amplifying the innate intelligence of the body. When you get your vitamin D together with having lowish carb, high vegetable, plenty of healthy fats, optimizing especially for you and your genotype – that’s what we want. We want the bigger picture. We’re not talking about any of these individual pieces in isolation.

Jonathan: Sara, that’s what I think is so empowering about when we talk about getting back to the real food – that there are so many… I’m sure you would agree with this very much, being immersed in the research, is we’re just learning how much we don’t know. It’s like the more we learn, the more we realize, “Oh, dear God! There’s not just one type of vitamin D, there’s all these different types of vitamin D!” and it’s like “Okay, I’m taking that one form as a supplement. What about the other ones?” It’s just so complicated that if… Obviously, we don’t want to get too woo-woo here, but there is a lot of wisdom in the sense that our bodies have evolved over millions of years and they were evolving in an environment and the idea that they would thrive based on things that are naturally available in that environment – there’s a level of wisdom there that is very difficult to completely uncover in 20 years’ of research.

Sara: Yes, I think you articulated that really beautifully. I would even say that what’s happened with evolutionary pressure – sort of the sad news – is that most of us have evolved to that point that you were describing, with the postmenopausal woman who is doing her absolute best with weight loss and for her husband the pounds are dripping off. We had about 100 times more thrifty genes than we do skinny genes – and no one knows this like I do because I am one-half Irish Catholic and one-half Polish Jew.

Jonathan: Are you Jewish? I’m Polish as well. My last name is actually Bielkovsky, but my great-grandfather changed it because he couldn’t get a job because he lived in a German neighborhood. Sorry, just separated at birth again. Keep going.

Sara: It’s all coming together because I think we grew up like right next to each other. So, I have so many of these thrifty genes. It’s like the Amish. The Amish have this really high rate of obesity genes – just like the Irish Catholics and the Polish Jews – it makes them survive a famine very well, but when you’re trying to rock your skinny jeans, it makes it very hard, like that poor postmenopausal woman who is just trying to do everything right, and when it comes to the Amish, the reason why they’re thin is because they have three hours of hard labor each day. I don’t know about you, but I don’t want to have three hours of hard labor a day. I want to figure out how to rock these thrifty genes that I have and be really smart about it.

Jonathan: Absolutely! Sara, I just realized I’ve been ignoring my little timekeeper over here and it’s just because I feel like we can talk for hours and hours and hours and I was about to ask you, “Well, let’s start talking more about that and how we do that.” But I know you are exceedingly busy. Right now, you’re in the thick of it. Folks, Sara’s book just came out and it just hit The New York Times Best Sellers’ List. Well, by the time this show airs, you’ll have already been there, but you’ve got some pretty exciting media engagements coming up as well, don’t you, Sara?

Sara: I do. We have some love happening on national TV – I can’t wait for that! That’s coming up next week. Yeah, I could talk to you for hours – no question. I know it’s the Taylor Swift and my beautiful voice that really won you over!

Jonathan: It absolutely is! We’re going to have to have like an American Idol type of hormonal hybrid show – it’s going to be awesome! Maybe you should start pitching that when you’re over at the networks next week.

Sara: I’m seeing Thrift Shop together with insulin – I think there’s some combination there that we need to work with.

Jonathan: Absolutely! I love that. I’m here in Seattle, so I walk down the street and I see Macklemore every day.

Sara: You and he are like this.

Jonathan: Exactly. Well, Sara, we’ve got to have you back on the show. This is an absolute pleasure. Absolutely, folks, if Sara’s willing, this won’t be the last time you hear from her, but if you can’t wait until the next show, she’s got a bunch of great stuff! First is – and this is a little bit long of a URL, so get your pen and paper out – it’s the quiz Sara mentioned earlier. It’s TheHormoneCureBook.com/quiz. Don’t worry, write that down because it will also remind you of the name of her book, which is The Hormone Cure – great stuff in there! Finally, you can learn more about Sara, the woman and the legend, at SaraGottfriedMD.com. Sara, am I missing anything?

Sara: Oh, Jonathan, I feel like I should say that I’m happily married, but it’s been so much fun with you! It’s been so much fun! Thank you! I hope we’ve provided some service to our listeners in addition to having fun. You’ve got to laugh. I just want to maybe end on that note. It’s easier to balance your hormones than to live with the misery of hormone imbalance and bonus prize – laughter, music – they help get that cortisol into the normal position again.

Jonathan: Well, Sara, it gets back to the earlier thread which is, if your pursuit of health is making you sad and miserable, that is a giant red flag that you may not be approaching that the correct way because if it’s in line with science, if it’s in line with evolutionary biology, you’re going to be full, you’re going to be satisfied, you’re going to be smiling, you’re going to be feeling good!

Sara: Maybe even singing Taylor Swift songs.

Jonathan: Exactly! Well, folks, thank you so much for joining us. Sara, thank you so much for sharing your time with us. I really appreciate it.

Sara: Thank you, Jonathan. Thanks, everybody.

Jonathan: Listeners, remember – this week and every week after, smile, laugh, eat more and exercise less, but do that smarter. Talk with you soon.