Dr. Sara Szal: Stop Ignoring What Your Body’s Trying to Tell You! (THESE Are the Hormone Signals You Can’t Afford to Miss!

Episode Transcript
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Speaker 1 (00:00):
Some people have a greater risk of developing something like
polycystic over your syndrome where you've got too much androgen
or testosterones, it can lead to infertility. To ACME and other.

Speaker 2 (00:10):
Brands, Hi, everyone, welcome back to on Purpose, the place
you come to become a happier, healthier, and more healed.
Today's guest is here because of so much popular demand
about this theme. You've had so many questions about hormones,
about birth control, about emotional regulation, and fitness and how

(00:30):
it all connects to this big theme. Today's expert knows
everything we need to know about this, so I cannot
wait to dive in. Today's guest is doctor Sarah Suhl,
a Harvard and MIT trained physician, researcher, educator, and author
of four New York Times best selling books on trauma, hormones,

(00:51):
and health. The one that stands out most is called
The Hormone Cure. So if you like this conversation, go
and grab a copy. Doctor Sol serves as Clinical Assistant
Professor at Thomas and Jefferson University and Director of Precision
Medicine at the Marcus Institute of Integrative Health, where her
work focuses on how personalized data and root Cause medicine

(01:14):
revealed the links between mental and physical health. Please welcome
to On Purpose, doctor Sarah sal Sarah, it's great to
have you.

Speaker 1 (01:22):
Here, Jaz so happy to be here.

Speaker 2 (01:23):
Yeah, I'm so excited about this conversation. As I was
saying to our audience has been dying to learn more
about hormones. They are inquisitive, they're curious, and I think
we're almost starting from a baseline of we don't know enough.
And I wanted to ask you the first question, which
sounds really basic, but I think it's the right place
to start, is what are hormones and what is a

(01:47):
hormonal imbalance?

Speaker 1 (01:49):
Hormones are these chemical messages in the body, and I
think of them like text messages. They tell different parts
of the body to do something. There's five ways that
the body community. It's with itself hormones first and foremost, peptides, proteins, nutrients,
and the genome. We want to be working with these

(02:10):
different systems and not against them. So what is hormone
and balance? It's when this exquisite state of homeostasis in
the body gets out of balance, and so that can
happen in women with endometriosis or polycystic ovary syndrome. It
can happen to men with low testosterone. It can happen

(02:30):
with your cortisol if you're someone who's chronically stressed and
you're not attending to it. So there's ways that hormones
get out of balance, but there's also ways to easily
get back into a state of homeostasis.

Speaker 2 (02:41):
What are some of the most common ways that we
end up with the hormonal imbalance that you see in
the modern day.

Speaker 1 (02:47):
Well, I would say stress is number one. So we've
got this stress response system, and I think a lot
of people consider stress sort of this feeling. But the
truth is you can measure stress. You can measures all
you can do it in the blood in the morning.
You can also measure it at four points during the
day and look at your stress response to see if

(03:08):
there's a way that it's getting pulled out of balance.
There's lots of ways to deal with that, but I
would say measurement is really critical. So that's one piece.
Another is genomics. So some people have a greater risk
of developing something like polycystic overy syndrome where you've got
too much androgen or testosterones there's also hormone balances that

(03:28):
are related to other sex hormones like your testosterone, your estrogen,
your progesterone. It can lead to infertility, can lead to
ACN and other problems.

Speaker 2 (03:40):
Do we have the tools to measure stress at home?
Or do we have to go take a test? Now?

Speaker 1 (03:45):
You can do it at home. So I usually start
by doing it a lap because I think working with
a clinician who's knowledgeable about hormones is the best way
to begin. Otherwise you're getting all this information you may
not know what to do with it, but increasingly disintermediating
the medical system, because I would say the medical system
has really failed a lot of people with hormone and balances,

(04:06):
and so testing can be a valuable way to do
to look at it at home in addition to which
you can get at the lab.

Speaker 2 (04:14):
And what are you learning at the lab? Like what
are they testing? What chemicals are they seeing? What are
you hoping to see? Like is it a percented scale?
Is it a writing of one out of ten? Like
where are we trying our stress to land throughout the day?

Speaker 1 (04:29):
It depends on what hormone you're measuring. So when it
comes to stress, Cortisol is the main stress hormone, but
there's others too, like DHA. So what we're looking for
if you measure a blood cortisol in the morning, you
want it to be about ten to fifteen. That's the
optimal range, which is different than the normal range. So
normal is what we tend to use in mainstream medicine.

(04:52):
It's what I was taught to use. But I don't
necessarily want to be like the average American. I want
to be in a more opt stimal state. So that's
the optimal state. If you measured in the afternoon, it's
more like you want your level, it will be about
five to ten. So that's what we want with cortisol, DTA,

(05:12):
and other hormones often very depending on age. So generally
with DHA, I like to see more than one hundred
in women more than one hundred and fifteen men.

Speaker 2 (05:21):
Got it. And if you're seeing yourself outside of that
five to ten in the morning, I'm assuming above.

Speaker 1 (05:28):
We want to see it about ten to fifteen in
the morning.

Speaker 2 (05:30):
And so above that is negative or below that is bad. Both.

Speaker 1 (05:34):
So with all hormones, I can't think of a single exception.
You want it to be in the Schooldilock zone if
not too high and not too low. And when I
first started measuring my mind cortisol, this was in my thirties,
I found that it was about three times what it
should be.

Speaker 2 (05:50):
Wow.

Speaker 1 (05:50):
So I was someone who was a bit of a
stress junkie. I would you know. I was just sort
of used to running on adrenaline and running on cortisol.
And so if it's too high, that can be causing
too much wear and tear in the body. And if
it's too low, that could be a stress response system
that has become exhausted.

Speaker 2 (06:10):
Understood, understood, and so stress was one of the first
ones when we were talking about homonial imbalance.

Speaker 1 (06:16):
What was the second, Well, your sex hormones can get
out of balance. Another system that's critical is your metabolic system.
So this includes hormones like insulin, gluca on. But insulin
is really the start of the show. Here.

Speaker 2 (06:28):
Talk to me about the importance of insulin and the
impact that it has. I think we've all heard about it.
We may understand a little about it, but not enough.

Speaker 1 (06:36):
Yeah, insulin is like the bouncer at a club that
determines whether let glucose into the club or not. So
the club here is your cell. If you're someone who
has insulin that's working well, it's in that Goldilock's position
fasting of about five to seven. Then you're letting glucose
into the cell. You're able to use it as fuel.

(06:57):
You feel good, you're not storing excessive fat. But if
you are someone who has insulin resistance where your cells
become numb to insulin, your insulin can climb and that
leads to more fat storage. It leads to glucose not
getting into the club, and so the streets are full
with glucose. Your blood stream is full of glucose, and

(07:17):
that's where fasting glucose starts to rise, and you can
pick that up in a blood test. You can also
pick it up on a continuous glucose monitor.

Speaker 2 (07:25):
And once the negative effects of having glucose on the streets.

Speaker 1 (07:29):
Well, there's a lot. So having high glucose causes damage
to your blood vessels. That's especially important in women because
lower levels in the pre diabetes range of you know,
somewhere between one hundred, two hundred and twenty five can
set you up for high blood pressure and cardiovascular disease
later on, and that's different than what we see in men,

(07:50):
so they tend to have vascular damage at a higher
fasting glucose. So I think women especially need to pay
attention to this.

Speaker 2 (07:56):
What's the difference between home mines for men women? What
are the key differences that you see, because I think
that's again something we're not that well vested in at
the moment.

Speaker 1 (08:07):
There's a lot of differences. I mean, it's important first
of all to realize that we all have all of
these hormones. Women and men just have different amounts. So
if you think of what's classically thought of as a
male hormone, testosterone, women have about one tenth what men have.
But still we're exquisitely sensitive to it, and so we

(08:28):
want that goldilocks zone. When it comes to women with
other hormones like estrogen, men make it too. If your
estrogen's too low, that can lead to problems with bone
loss for men and then for women. It has about
four hundred jobs, so it's related to brain health, it's
related to memory, it's related to whether you are growing

(08:51):
things insider uterus like fibroids and debitrius is elsewhere in
the body, So you want these hormones to be in
a balance, and generally they very depending on your sex.

Speaker 2 (09:05):
What are the hormone deficiencies you're seeing in women the
most at the moment and in men.

Speaker 1 (09:11):
Well, for both men and women. For people who've got
a stress response issue, this can start to rob you
of some of the sex hormones that you really need
to function well. So what I see, especially for people
in their twenties starting around twenty seven to twenty eight,
if you are a high stress person like I used
to be, that can lead to problems with falling testosterone,

(09:36):
and so increasingly we're seeing low testosterone in men. We
can see that in women as well, so it can
start as early as your twenties. Other hormone deficiencies or
insufficiencies include with your thyroid. So thyroide is one of
those hormones that is kind of like the gas pedal.
Almost every cell in your body has a receptor for

(09:57):
thyroid hormone, and if you're low then that can lead
to fatigue. We gain constipation, feeling like you just don't
have the energy the two ones did. You might lose
the outer third of your eyebrows, have hair, a loss
on your head, so that's a common issue that we
see in terms of forematent balances. Women much more commonly

(10:20):
than men. It's about seven to nine times more common
in women. And the root cause of low thyroid function
most of the time is autoimmune, hashimotive is iyrite ittis
is the typical cause.

Speaker 2 (10:32):
I mean, these are things that I feel like so
many people are struggling and stuffing with today, and I
don't know how quickly we're able to pinpoint that it's
a hormonal imbalance. It seems like we're trying to solve
it in different ways, whether that be weight gain or
hair loss or whatever it may be. We often think
that we're almost not always working to the root cause
of the issue. But I feel like what you're saying

(10:54):
is the hormones are the root cause.

Speaker 1 (10:57):
Yeah, And I would say start there. You know, what
happens for a lot of folks is that they feel tired,
They feel like they just don't have the energy when
they wake up in the morning, they don't feel fully
restored after they sleep, and they assume that it's some
sort of moral failing or that they need to change
their mindset. And I would say, let's start with your biology.

(11:19):
Before we go to the place of moral failing, Let's
start with measuring your hormones and measuring the right hormones.
Looking at your stress response So you can look at cortisol,
but you can also look at heart rate variability, the
time between each of your heartbeats. That tells you a
lot about your stress response system and about your ability
to regulate your nervous system.

Speaker 2 (11:41):
Yeah, it's so interesting. I was saying this to you
before we started. I feel like I I've always been
someone who's tried to solve things at the mind, and
that's been very good for me. I feel like it
strengthened my mind in incredible ways. But it was only
when I started to unlock the potential and capacity of
the body that I was a able to have this

(12:01):
two pronged approach to making a shift in my life.
And I remember in the past, if I remember, even
when I was a monk and I sometimes struggle to
wake up in the morning to meditate, I always felt
it was a moral failing. And I think so many
people today could relate to the fact that you wake
up and you don't want to go to work, and
you think, oh, it's because I hate my job, or
you wake up in the morning and you're feeling rushed

(12:22):
and frazzled and you're thinking, oh gosh, I just have
so much to do and I'm failing at it. And
the reality is that there could be a hormonal imbalance
that's actually making you feel that way. That is then
making it harder to love your job, find meaning, or
support your family. And it's a much stronger place to
start because you'll actually feel the benefits quicker. How quickly

(12:45):
can we create shift in a hormonal imbalance to being
back into their homeostasis.

Speaker 1 (12:52):
Well, I so appreciate this framing because I think the
answer is both. The answer is both banned. So look
at the mindset, look at the way your mind is functioning,
look at your cognition, but also look at your biology.
Put them together. So how quickly can you turn this around?
It depends on the hormone. When it comes to a
hormone like insulin, you can change it with your food

(13:14):
and exercise in three.

Speaker 2 (13:16):
Days, three days, three days.

Speaker 1 (13:19):
So food is such an important driver of what your
body is doing. So going back to you know these
five ways that the body communicates with itself. Hormones are
number one there's peptides, proteins, your genome, and nutrients. So
nutrients here drive so much of your hormonal balance. Now,

(13:41):
other hormones like estrogen, progesterone, those two are kind of
like a tango instead of tango partners. Those take longer
to adjust. They take more like four to six weeks.

Speaker 2 (13:55):
Okay, but that's doing all that long.

Speaker 1 (13:56):
That's not that long.

Speaker 2 (13:57):
That's not terrible at all. I think someone's when you
hear about these things, you go to, oh god, it's
going to take me like three years. It's refreshing to
hear that three days from four to six weeks. I mean,
that's doable, that's realistic.

Speaker 1 (14:08):
It's doable. And there was a study also looking at
folks with high testosterone, women with high testosterone, and they
found that by reducing the car Badgery's say in your
diet within seven days, you can actually change your testosterone levels.
So some of those can happen sooner with the right messages,
with the right orchestra. That's happening in the body.

Speaker 2 (14:30):
One of the main reasons in our twenties and thirties
do we see a decline in estrogen, testosterone, and progesterone.

Speaker 1 (14:38):
They're each a little different. So if we take estrogen first,
the most common reason I see for decline is women
who are not eating enough. They're not getting the nutrients
that they need. Interesting they're not getting the calories that
they need to have the control hormones. Lutinizing the hormen
in particular help them ovulate each month, so their estrogen

(14:59):
might be lower. We also think that exposure to toxins
and endocrine disruptors can affect your estrogen levels. An also
thyroid levels can also affect testosterone. The other reason I
see is women who have premature ovarian insufficiency. So this
is mostly focused on women in their twenties and thirties.

(15:20):
So premature ovarian insufficiency is not an immune process where
the ovaries are attacked by your immune system and you
can start to have symptoms of early perimenopause and menopause,
including low estrogen. So these are women in their twenties
and thirties who have hot flashes, night sweats, mood swings,
and you have to check labs to see if that's

(15:43):
the cause. When it comes to testosterone, the number one
thing that I see that leads to low testosterone in
women is having a heightened stress response, so high stress
being kind of run by cortisol like I was in
my thirties. That can then rob you of the production
of testosterone. Another factor that affects testosterone is insulin, so

(16:05):
if you're someone with high insulin levels, that can affect
the ovariase and lead to dysregulation of testosterone. Usually high
testosterone and something we see with one of the types
of polycystic ovara syndrome. Progesterone is an interesting one. For
people who are not ovulating every single month, their control

(16:26):
system is a little wonky. We see something called late
luteal phase disorder, and that's where you're just not making
as much progesterone, and it can be related to the
health of the eggs that are in your ovaries. It
may be helpful to look at your egg quality to
do a day three FSH follicle stimulating normone and estradiol level,

(16:49):
and then a day twenty one or twenty two progesterone.
So normally on day twenty one or twenty two, if
you ovulated around day fourteen, you want a progesterone to
be about ten to fiveteen or higher, So if it's lower,
that can be because your egg quality is potentially declining,
or there's some kind of nutrient that needs to be

(17:09):
addressed increasingly day. This is super interesting that I've been
reading a lot about the cells in your body that
have the most mitochondria, those powerhouses of the cell that
produce fuel, produce energy. The cells that have the highest
concentration is your eggs in minutes, the sperm. So when

(17:33):
your mitochondria are not working well because your sedentary, you've
got too much stress, you're not getting the right nutrients,
it can show up in your eggs first, and you
might see it with like a low progesterone level. So
tracking your mitochondria, getting things like morning light when you
first wake up in the morning, managing your stress response

(17:56):
so that it's not running the show, getting all the
nutrients that supports your mitochondria. Maybe even some supplements like
co Q ten that can be a way to support
your mitochondria to prevent some of these problems.

Speaker 2 (18:09):
For someone who's struggling with weight loss, what hormonal imbalance
could they be experiencing?

Speaker 1 (18:14):
First, I think about insulin, because insulin is really the
king of metabolism. So I would say, look at your insulin,
look at your glucose. Insulin changes first, it can change
seven to fourteen years before your glucose changes, and probably
the best way to look at insulin is to do
what's called a two hour glucose challenge test where you

(18:36):
look at your insulin glucose fasting an hour later, and
two hours later you give a seventy five gram carp
load to see how your body responds. So fasting insulin
can change, but it changes typically after post prandial insulin,
so measuring is really critical when it comes to weight.

(18:58):
Another factor is in women having excess testosterone. In women,
high testosterone is similar to low testosterone in men, so
it can lead to metabolic dysfunction. It can lead to
cardiovascular risk, It can lead to fatigue and mood changes.

(19:18):
So I like to look at androgens testosterone DHA, and
then another factor, especially in women, is having estrogen and
progesterone out of balance. So if you've got too much
estrogen typical story compared to progesterone, that leads to something
called estrogenism. If you have excess estrogen in the body,

(19:41):
it can lead to more mood swings, It can lead
to more eating habits that you may not want to
be supporting. It can lead to more structural changes in
your body, so it's important to have these Imbalanced thyroid
is another critical one, and then I would say cortisol
really important when it comes to WAKAIN because a lot

(20:02):
of people don't realize that the stress that they have
in their system, in their body could be driving their
deposition of billy fat, it could be driving food cravings,
it could be changing you know. We know people with
depression about half of them have high cortisol levels, and
that can then affect the way that you eat, the

(20:26):
way that you move, the way that you think, and
the risk of wakain.

Speaker 2 (20:30):
As a normal human being who is struggling to deal
with work, responsibilities, commitments to our partners, challenges with intimacy,
someone who's trying to take care of their kids, it
already feels like you have so many factors of your

(20:51):
exterior world that you're struggling with. You're juggling all of
these things, and then at the same time, now you've
opened up to us this interior world of all of
these other things that we're like, oh, yeah, I probably
need to figure out my cortisol. And I'm sure there's
some insulin stuff I need to work on, and it
sounds like I've got too much or too little testosterone,

(21:13):
whatever it may be. Like this, there's almost like this
waking up to the fact that all of this exterior
difficulty is matched with some sort of interior imbalance. Where
would you recommend someone to start if they're starting from
zero and thinking this feels like a lot, it feels overwhelming.

Speaker 1 (21:31):
Start with cortisol. There's a few reasons for that. Cortisol
is the great unifier because it's involved in all of
these other systems. So if you're a high cortisol person,
it might be affecting your insulin, it might be dropping
your progesterone levels, it could be affecting your testosterone levels
as early as your twenties. So it would say start

(21:53):
with cortisol. Like the measurement there is critical, And you
made an important link here, Jay, between your external world
and your inner world, and hormones drive so much of
your inner world. The more that you have a sense
of the landscape of your inner terrain, the more that

(22:15):
you're going to be able to work with it, befriend it,
allow these hormones, these messages, these signals to become your
friend and not be you know, some villain that you're
blaming for the way that you're feeling.

Speaker 2 (22:30):
What are the top three things someone could do today
to decrease stress? What should they be focused on?

Speaker 1 (22:35):
Well, I would say number one, measure like know what
you're dealing with. What you measure improves, so know where
you're starting. I think a benchmark is critical. Number two.
You know, I started learning yoga from my great grandmother
when I was five years old. I started practicing meditation
when I was seventeen in college. I think there's nothing
more effective than meditation breath work as a way of

(22:58):
working with your cortisol. And then number three, I would
say there's supplements that can really make a difference. I
don't think you can out supplement a bad diet. I
don't think you can out supplement a stressful life, but
you can really work with supplements like poster title searing
very effective at reducing cortisol that it does to four

(23:20):
hundred milligrams a mega threes. So taking fish oil or
a more plant based source of omega threes those are
really critical. And then fourth, I would say, look at
your relationships. They're often a common source of stress. In
the body, and a lot of people don't put those

(23:41):
things together. So when you've got a relationship with someone
that is co regulating, that allows your nervous system to
calm down and reduce your cortisol to that Goldilocks position
that is so effective. There's just a study that got
pre printed, so it's not published yet in a peri
refuture all, but it's really interesting, Jay, It's about the hassler,

(24:04):
So people who provide some support but also cause a
lot of hassle in your life. And I have a
few of those. Those tend to be associated with shortening
your life and raising your cortisol. So you want to
get a sense of Okay, who are the people that
help me stay in hormonal balance, Because the people you

(24:25):
surround yourself with can affect your hormones.

Speaker 2 (24:44):
Distress you enjoy affect you differently from the stress you
don't absolutely okay, tell me about that.

Speaker 1 (24:53):
So we all need stress, and I don't think of
stress as a negative word in meta in science, we
call it you stress, so U stress eu. Stress is
a healthy form of stress. It's known as hormesis. It's
like a positive intervention on the system of your body.

(25:16):
So your body is designed to deal with stress like
you developed. Our genome developed on the savannah a long
time ago in response to stressors that would occur you know,
once a month, once a quarter or something like that.
But we're not designed to deal with the stressors that
we get, you know, from checking our email inbox every morning.

(25:37):
So we're designed to have a healthy amount of stress.
And you can even imagine there's a U shaped curve
where you want to find just the right amount of
stress that allows you to be the most productive, allows
your system to work really well, allows you to deal
with a stressor and then bounce back. You don't want

(25:58):
so little stress that you're you know, not being of
service and not contributing and not discovering your gift and
sharing it with the world. But she also don't want
so much stress that cortisol is running the show and
leading to disrupted relationships, not being able to really deliver

(26:19):
on your talents and getting this wear and tear process
in the body.

Speaker 2 (26:25):
Can you change the way stress impacts you by how
you see it? So could I change distress to you
stress by viewing it differently? So, for example, my wife
was taking care of her grandma who sadly passed away
last week. For the last four months. As soon as
we heard that she was unwell, she flew back to

(26:48):
London to take care of her and be by her
bedside every day. It was stressful in the sense that
she didn't sleep a lot, she didn't have It wasn't
like she was supported in the support. She was, you know,
doing a lot of things with her and her family.
They were all taking turns. But it was stressful for
her physically, mentally, emotionally. It's her favorite person on the planet,
but she was doing it as a form of showing

(27:10):
love to a person she was trying to repay for
all the gifts that she'd given her her whole life.
Does that change how that stress impacts her or does
it not?

Speaker 1 (27:20):
Oh, it does definitely. At first, I'm really moved by
this story and I'm so sorry for her loss. You know,
there's a way that when we're serving in a place
of love, even if it is leading to sleep disruption,
even if it's leading to more a wear and tear,

(27:42):
the connection, the loving connection, can offset the potential downstream
consequences of having higher cortisol levels. So it's not so
much you know, a week or two or a month
of taking care of someone who's dying that causes a
problem in the body. It's more people who become adapted

(28:05):
to a chronic stress state that goes on for months
to years. That's where we have problems. So yes, you
can definitely turn it around, and you can buffer it,
you can blunt the effects of stress.

Speaker 2 (28:19):
What would you recommend to someone who comes home from
a stressful day of work they had a stressful morning.
We've talked about morning routines for so long, but I
feel people just struggle. They wake up, they've got to
start making lunch, they've got to get their kids ready
for school, they've got to drop them, they've got to
go to work. What can they do after that long
day that will actually help, that will actually make a difference.

Speaker 1 (28:41):
Well, I love to have rituals when the day is closing,
like especially to separate work from family time and personal
time at your home. So just like I love a
morning ritual, I think we need to bookend the day.
So there's a lot of different ways to do that.
And I like to think of an all a carpment

(29:02):
you of what works the best for you. So I
can tell you what doesn't work. Like what I used
to do is I would come home from a busy
day of seeing thirty patients and I would have a
glass of wine. And that does not work. So that
lowers your testosterone, it raises the not so good estrogens
in the female body, and it is toxic to the brain.

(29:27):
It shrinks the brain over time. So I don't think
that's effective. But the very thing that we are trying
to get from a glass of alcohol is what we
want to create in a ritual. So there are advanced beings.
Maybe you're one of them, Jay, who can come home
from a busy day of work and meditate. They can do,
you know, just like touch, have that touch point of

(29:49):
five to ten minutes just to regulate themselves before they
go into, you know, kind of the second half of
the day. So I would say, by whatever means necessary.
So for me, breathwork and meditation is really effective. I
love to go on the deck of my house and
kind of look at the view and trace the horizon,
which relaxes my eye muscles. I like to read something

(30:13):
really beautiful and meaningful. I love to connect with someone
that I dore, someone who co regulates me. So I
would say, develop a menu of a few things that
really work. But I would say the glass wine that
raises your cortisol even further, the very thing that you
are trying to avoid. That's not a solution. What do

(30:36):
you think, like, what helps you?

Speaker 2 (30:37):
No? I love everything you recommended. I think that the
natural response people have. And me admittedly, I mean I'm
in this group sometimes as well, where I'm like, I
have no energy to do anything. And I mean one
of my favorite things is playing pickable. I play a
lot of sport in the evening and it's something I
look forward to and I'm like so excited to get
to And I found that does a lot of things.

(31:00):
Me and my friends have a formula that we try
and stick to of fitness, friendship and fun. And it's like,
how do we do something active together, how do we
hang out and how do we do something that's playful
and makes us feel like kids again? And so I
have a group of great male friends where we just,
you know, three four times a week we're just playing sport,
hanging out in the evenings and having a great time.

(31:21):
That to me is my ideal evening. Now I can't
do that every night when my wife and I are
at home together. Definitely, connecting with her is a high
priority to me, having dinner together. I agree with you
on that connection is so important. But there are those
days where I just want to sit and turn on
a show, and it's usually after I finish it where

(31:43):
I go I don't know if that was worth it,
Like I will sometimes do it and then I feel like, well,
I don't feel more connected to my partner unless the
show is really good and we're really talking about it and
we're really engaging over it. It can almost feel like, oh,
that was a waste of time. And I think at
least what I've noticed is that. But I think the
menu idea that you gave is really good, because there
are some days I just want to switch off and

(32:04):
watch a show because I don't want to think, and
I don't want to use my body or my brain
because I'm exhausted. And then there are certain days where
playing sports does it, and then there's certain days where
connecting does it. And I think the thing I worry is,
and I think what you're saying is when we get
into chronic behaviors where it's like I come on every
night and have a glass of wine. I come on
every night and I just watch TV, and it's like

(32:24):
when you don't have a menu and you don't have
this variety to select from, and it just becomes one
of these patterns that doesn't refuel you and doesn't renew you.
That's when it starts to get really unhealthy. Whereas the
once a week that you twice a week that you
felt like watching a show or whatever is in the
end of the world and it's fine, and it's but

(32:44):
it's hey, do you have other options? I can agree
with you more about looking out into the distance. I
find that to be one of the most powerful things
for my eyes, especially as we're living in such a
short sighted world now where everything's up in our face,
whether it's a zoom screen, our phones and so to
actually be able to look into the distance. And this

(33:05):
is not about sounding poetic or spiritual. I literally think
it's a physical thing that our eyes need of like
looking far at a cloud or looking at a bird
in the sky. And you don't have to find it
mystical or beautiful or special. Just the act of looking
into the distance is an important thing for our mind
and brains and our ability to slow down. I think

(33:26):
when people talk about being with nature, a lot of
people are like, oh, well, what does that even mean
and sounds a bit woo woo, and it's like, well, no,
there's science to prove it. But I think being with
nature is moving at the pace of nature, that's right.
And you know, watching a tree flow is good for
your breath because you can breathe in and out of it.
You would never breathe in and out of watching traffic, right,
and you should, you should breathe healthily when you're watching traffic.

(33:48):
But what I mean is you would never breathe at
the pace of traffic, right, It's it would be jarring.
Whereas if you breathed at the pace of watching a
bird in the sky, or watching the ocean, or watching
a tree sway in the wind, that would feel a
lot more natural and a lot more therapeutic and probably
feels like a better thing to try, at least from

(34:09):
my perspect.

Speaker 1 (34:09):
I totally agree with you, and maybe we could riff
to come up with the menu for folks just to
have some ideas, because you mentioned another piece that I
think is critical day, which is to notice when you
try these things, how do you feel in your body? Like,
where do you notice a shift? So if I watch

(34:31):
a show, and I'm watching Homeland right now with my partner,
and it's very triggering. You know, there's just so many
scary things that happen in every episode. I don't feel
that great by the end of it. Like I don't
like to watch it before I go to bed if
that desire, because I feel low in energy and I
want to transition. Like watching a show, If I instead

(34:53):
roll out my yoga mat and do you know, five
minutes pitch and bows or even just a boss for
five minutes, that's a low energy way to integrate and
to regulate. So I feel so much more regulated after that.
But that may not be true for you or for
the next person. I also love cooking, and I really

(35:16):
consider making food to be a sodna, to be this
sacred practice. You know, it's not just chopping to arugula
and throwing it together with some nuts and some goat cheese,
but you know, just very intentional and slowing it down
and breathing regulating as I do it. So tell me

(35:36):
about some of your other rituals. I love this fun
fitness and friends. I think that's a beautiful one.

Speaker 2 (35:41):
That's definitely one of my go tos. I mean, my
wife and I love going on long walks in the evening,
or even a short walk in the evening. Sometimes we'll
just be like, let's have dinner together and then just
have a fifteen to twenty minute walk together. And that
feels like a really low impact. It's not intense, it's
not crazy. And you know, of course, you've got to
have good enough weather wherever you live to be able

(36:02):
to do that, and I appreciate that.

Speaker 1 (36:03):
And it helps your insulin in your glucose even.

Speaker 2 (36:05):
A ten minutes exactly exactly, So we like this. This
solves a lot. It solves our connection. We get to
talk about our day, we get to catch up, but
at the same time it's helping our body digest and
everything else as well. So that for us is a
really really special practice. I've I've definitely found that sitting
for me, sitting with scripture or sitting with some spiritual

(36:28):
text is really powerful. And I found that in the
evening it's not a time when I can do academic
study or a lot of writing or a lot of
memory work, but it is a time where I can
sit with something and just meditate on it for ten minutes,
or let it sink in and let it be there.
And I almost feel like what we're missing is and
I think this has happened by working at home for

(36:49):
a lot of people. I feel like your commute played
a really powerful role in preparation in the morning and
decompressing in the evening. So most p people had an
hour commute on the way to work, and maybe you
still have one, and some people had an hour commute
on the way back. And what that allowed you to
do subconsciously was decompressed from the day you thought about

(37:11):
the day you reflected. Maybe you had a little nap
if you were on the train or if you were driving,
maybe you listened to a podcast, and maybe you're listening
right now and you're reflecting about things. Whereas the challenge
right now is if you literally walk out of your
bedroom or your home office and walk straight into the
dining room, you've had zero minutes to decompress. And I

(37:31):
find that creating a little five to ten minute decompression
ritual of sitting by yourself. That's what you did on
the train or in the car. You sat by yourself
for an hour, and so you may think you don't
know how to meditate, or you may think you don't
have to spend time on your own, but chances are
you've been doing it for a long time and now
creating some intention around it and saying, hey, I'm going
to spend ten minutes and just see how my body feels,

(37:54):
see how my mind feels, and maybe I'll make a
better decision of what to do tonight. I think that's
what it is. Sometimes if I do I don't do
that decompression ritual, I go into my default. But if
I almost spend a moment doing that, I'm like, oh,
I actually want to go on a walk, or I
do want to go and play sport tonight, or actually,
you know, I will go out and go out for
dinner with my friends tonight. Because even though I think

(38:14):
I'm out of energy, sometimes I only need five to
ten minutes to regroup.

Speaker 1 (38:18):
That decompression is so critical. And I would add regulation,
like the decompression often needs to come first and then
the regulation. So I'm going to add a couple of things,
see I may please. So one is a vibe check.
So I've been doing this quite a bit with my
partner recently, where you just spend five minutes just like, Hey,

(38:40):
how's our vibe?

Speaker 3 (38:42):
Like?

Speaker 1 (38:42):
What could I be doing more to support you? Is
there anything going on this week that I could help
you with? You know how I how can I be
the best possible partner. It creates an atmosphere of giving
and service that I think can help with the decompression
and also with the regulation you mentioned going for a walk.
I live in a forest in We're in county in California,

(39:06):
and we know that just five minutes, five to ten
minutes in the forest can regulate your cortisol. So we
talked about our walk after having a meal can make
a difference in terms of insulin and helping you with
your glucose after you eat, these hormones can come into
balance even with these really short rituals.

Speaker 2 (39:26):
I love that. I love that. So it always strikes
me how simple the solutions are to what seems like
very complex problems. I think that's one of the hardest
things for people, because I feel like so often the
people we love, or the people we grew up with
our family can often be the greatest cause of stress
in our life. And I don't mean when they need

(39:49):
help or support. I mean they can say all the
wrong things, they can rub us the wrong way, They
can make us feel disappointed, they can make us they
can make us feel almost the hardest emotions because they
know us the best. Yes, are they homone impacts that
come with divorce? And are they different from men and women?

Speaker 1 (40:08):
Such a good question. So I completed my divorce a
couple of years ago, and so I've been looking at
the data on men and women. Men tend to have
health effects adverse health effects sooner than women. Women often
have health effects that show up later. But sixty nine

(40:31):
to seventy percent of divorces are initiated by women. The
most common age is women who are forty plus. Most
of the women that I work with say that the
level of autonomy and kind of healthier psychobiology is worth
the short term dysregulation that's caused by divorce.

Speaker 2 (40:56):
And who deals better homeonnally with divorce men and women.

Speaker 1 (41:00):
I don't know from a research perspective. Anecdotally from what
I've observed in myself and patients is that women do better.

Speaker 2 (41:07):
Wow, what does it do anecdotally to men's homelands?

Speaker 1 (41:14):
There was this meme that went around like a decade ago.
It was a Stanford psychiatrist who wrote an email that
got spread around the world, which was, if you're a
man and you want to improve your health, be with
a woman. Be married. If you're a woman and you
want to improve your health, be with your girlfriends. Like
it doesn't help women to be married. And so I

(41:35):
think what we see is that men often don't have
a community of people that they're close to, and they
often rely on their wives for that, whereas women are
much more likely to be leveraging oxytocin, the hormone of
connection and love, and they've got more of a support system.

(41:56):
Now there's economic consequences that tend to hit women harder,
and I think that maps to health. But I would
separate that.

Speaker 2 (42:03):
How do we create hormonal emotional distance even if physical
distance is not an option?

Speaker 1 (42:10):
Yeah, I love this question, So I'm going to roof
with you on it because I think you've got some
answers as well. So I think understanding where your vulnerabilities
are is a good place to start. You know, I
think a lot about my daughters. So I've got one
daughter who's twenty another that's twenty five, and I want
them to be aware of their sensitivities and vulnerabilities. They're

(42:33):
both highly sensitive. I'm highly sensitive. About twenty percent in
the population is highly sensitive. Eighty percent is not. So
we live in a world that is not designed for
people who are highly sensitive. When you're highly sensitive and
around some of those people that tend to trigger you
or tend to pull you out of a state of balance,

(42:55):
then that's where you have to have some extra tools
to allow you to not become over stimulated or if
you get triggered by a family member or someone else,
to have this self awareness and these boundaries to be
able to work with it. You know, one of the
things that I think is so helpful is to never
waste a good trigger. So when you're with someone and

(43:16):
you're getting triggered, then that's showing you a place where
you still need to heal. Right, It's showing you a
shadows side, some part of you that's disowned that you
need to work with, some old childhood wound that you
still need to address and heal. What do you think,
how do you deal with us?

Speaker 2 (43:34):
Yeah? No, I think that's a really really beautiful point
in a way of looking at it. And I think
that that feels like an evolution from the first step,
which is just I'm exhausted and I need space. I
think a lot of us before we can look at
what we can change, we almost just need to change

(43:54):
our environment. And for me, whether it's crafting alone time
space with people who do lift us up. I've always
said to everyone that for every one person you have
in your life that causes you stress, have three people
that don't. And you can't change that person or that situation,
but you can change the proportion of energy that you're

(44:17):
exposed to. And so if you're exposed to three people
who lift you up and are good energy and make
you feel calm and are good for your nervous system,
even if you have to spend twenty five percent of
your time with the other individual that does the opposite,
it's now in perspective, it's a bigger group of people
that are lifting you up. I think another thing for me,

(44:37):
I mean, I've been a big, big, big proponent of
boundaries for people because I think a lot of the
time it's our guilt that keeps us connected to people
who block our growth. If someone's holding you back, chances
are you're holding on to them. Trying to people please them,
trying to make them know you're a good person, to

(45:00):
make sure that they respect and value you, and sometimes
you have to let go of those things. I think
I've had to be okay with letting people down. I've
had to be okay with letting people think whatever they
want to think of me. I've had to let go
of that perception because it frees me from my own
people pleasing tendencies and allows me to start crafting the

(45:21):
life that I need. And then that gives me the
space to then reapproach them with more respect, with more perspective,
with the ability to say, oh, maybe there's healing that
I need to do and evolution that I need to have.
But that setting of boundaries has been unlimitedly useful for
me because I found that I'm always the one getting

(45:43):
in my own way, and sometimes I need to move
far away from the person that I'm blaming to realize that,
because while I'm close to them, I keep pointing the
finger at them. But actually, when I step away, I
realized it was me compromising my own values, it was
me sacrificing my own boundaries, it was me going against myself.

(46:03):
And then the final thing I'd add is. I think
it comes down to really taking a look at what
really matters and what feels like a waste of time.
And I often find that so much of what we
get wrapped up in in our human feelings are so
based on ego and envy that don't really get us anywhere.

(46:24):
And I think for me, I try and get to
that point as quickly as I can, where I'm like,
does this matter? Do I really care? Is this going
to change my life? And I realized that even if
I solved this situation, it would not change my life,
and so why would I waste any more energy on
it when I could be building something beautiful over here?
And that's usually my personal go to where I realized

(46:46):
that whether it's someone disrespecting me or whether it's some
sort of fallout, even if I solved it, first of all,
I don't think I could solve it even if I tried.
Even if I did solve it wouldn't change the quality
of my life that much. So why give it so
much waiting and why give it so much value?

Speaker 1 (47:03):
It's so profound which you're describing today, and it's reminded
me a bit of your Princeton commencement speech because I
think you had that opportunity with these graduates in twenty
twenty five to share with them some of the things
you've learned. And that piece of people pleasing I want
to highlight for a moment, because a lot of folks

(47:26):
learned people pleasing as a way to adapt to a
chaotic home environment, especially if you were quite young when
you were exposed to some sort of traumatic experience. And
you know, sixty percent of men have that, seventy percent
of women had that as children. The stress response comes
out in different ways. We think of it as fight

(47:47):
or flight, but it's actually much broader. It's fight, flight, freeze,
and fawn. People pleasing is a form of stress response
where you are abandoning yourself to be in relationship with
someone else. So it's an old pattern that we often
have to unlearn. And it's through this process that you're

(48:08):
describing of coming up against that frustration being triggered like
with a family member or friend, that you started to
see that pattern. And then I love how you described
what I think of as radical self responsibility to look
at your side of the street and to look at

(48:29):
what you can clean up. No, I've gone through a
twelve step process with food. I used to have a
very dysregulated relationship with food until I turned forty. And
part of twelve step is really looking at your side
of the street and cleaning it up. And another thing

(48:49):
that we learned that was so surprising to me was
that if you have to choose in a situation with
someone else between guilt or resentment, you should choose guilt.
Now as a mother, that was really hard for me

(49:11):
to do because that's not what I chose for most
of my life. And yet it's a way of witnessing
the way that you tend to make decisions, especially decisions
that lead to resentment, that then are a signal you

(49:32):
might need to set a boundary.

Speaker 2 (49:49):
As a mother of two yourself, I wanted to ask
you about the homeowner shifts that we all go through
from being teenagers to twenty year olds to thirty year
olds to four year olds. What are the decades that
have the biggest hormonal shifts in our lives that we're
not paying enough attention to.

Speaker 1 (50:10):
Yeah, well, the first decade is ten to twenty, and
that's when most of us are going through puberty. If
you're healthy, you're not exposed to excessive endocrine disruptors, and
that's a time of a lot of volatility. So boys
become men, they go through the puberty process, they start
making more testosterone, their voice deepens. Women girls go through

(50:36):
puberty and they start to menstruate. The systems that control this,
which are mostly in the brain, that the almost pituitary
and how they talk to the adrenals and also the gonads,
so over eas and women testes in men, that system
is immature ten to twenty. Now we often intervene in

(50:56):
that time period, which I don't agree with, So I
like to give a lot of room for this control
system to get set up. I'm not a big fan
of giving birth control pills as an example to girls
who have acne or regular periods or painful periods. There's
so many other ways that we can work with lifestyle
first to address that. So right now, millions of girls

(51:20):
between ten and twenty get started on birth control pills.
Hopefully we'll talk more about this and why I think
that is the number one hormone disruptor that we have
in this country. And then if you look twenty to thirty,
that's the period where your control system for hormones becomes
more stabilized, so women often have more regular mensies. Men

(51:42):
reach their peak testosterone and so they often have a
lot of vigor. It's why athletes, you know, I take
care of NBA players, and twenty to thirty is really
when they're at their peak, so performance, it's a time
where you recover better from exercise. It's a great place

(52:03):
to establish critical habits, like with food, with sleep, because
if you don't sleep well, you're going to fall down
a hormonal flight of stairs at some point. So that's
when I think people really need to dial in some
of the boring basics that really sets you up for
the kind of hormonal homeostasis that we're talking about now.

(52:24):
In your late twenties, some hormones can start to decline,
and some of us fertility can start to decline, egg quality,
sperm quality. So thirty to forty is when I like
for people to really focus on noticing any early signals
of change. So that might be in a woman looking

(52:47):
at your day three of the cycle. Estra dial and
follicle stimulating hormone FSAH is one of those control hormones
from the brain, looking at your estrogen to make sure
it's not too high, not too low, looking at testosterone,
So for men, they may want to check their sperm
quality at that time, they may want to look at

(53:07):
a baseline testosterone level free and total. So that's when
things start to get out of whack. And then after
forty that's when women especially start to have symptoms of perimenopause.
And there's more than one hundred plus symptoms associated with that.
Mood swings, irritability, sleeplessness, noticing that your memory might be changing.

(53:33):
You know, you lose your phone, you lose your keys.
So perimenopause is another critical piece to think about. But
there's a myth that your hormones don't change until you
go through perimenopause and menopause or antipause for men. The
truth is it changes decades before that, So we want
to be paying attention throughout what.

Speaker 2 (53:51):
Was the male home ONWNE word change. I've never heard
that ever, anthropause, I've never heard that.

Speaker 1 (53:55):
I'm glad you haven't heard of it, because that probably
means your testosterone is good. So a lot of people
call andropause male menopause, and it's when testosterone starts to decline.
We're seeing this in younger and younger men.

Speaker 2 (54:09):
Why.

Speaker 1 (54:10):
We think it's related to stress, like the amount of
stress that we're managing. We think it's also related to
toxins endocrine disruptors, things like bisphenol a as an example
of something that can lower your testosterone being exposed to
forever chemicals. I know you talked to Dirshunshop about these.
So when it comes to men, the hormonal change of

(54:33):
andropause is gradual and it can sometimes fly below the radar,
Whereas for women, the change in progesterone that kicks off
the start of ery menopause and then the decline in
estrogen is much more sudden. So that's why it tends
to trigger so many more symptoms.

Speaker 2 (54:51):
I wanted to dive into something you mentioned earlier, which
was around birth control, because I think this is a
big topic for our community and our audience. And you
mentioned there that so many teenage women get given birth
control or expression for acne. Why was birth control ever
given for acne or anything else that wasn't connected to

(55:11):
birth control?

Speaker 1 (55:12):
Yeah, the number of reasons that clinicians prescribe birth control
pills has broadened over time. So when it was first developed,
it was for contraception, and it's very effective for contraception,
it's about ninety percent effective. You have to be a
perfect user, like take it at the right time each day.
But what happened was that the pharmaceutical companies that make

(55:34):
birth control pills started to look, especially as their pills
became off patent, look for other reasons to prescribe it.
And I'm an ogun, so I was taught all these
other indications besides contraception to prescribe it. So that includes acne.
Why does it help with acne? Because the birth control

(55:56):
pill raises this intermediate hormone sex hormone binding globulin and
that drops the bodies testosterone level and that reduces acne.
That's related to high testosterone. Now, a lot of teenagers,
women in their twenties and thirties have breakouts, they have acne.
Some of it is driven by testosterone, not all of it,

(56:19):
and so going on the birth control bill can help.
But there's also lifestyle medicine that you could do to
address that. It's given for painful periods. It's another reason
that makes me crazy because we know that the reason
why women have painful periods is something called Prostaclandins are
produced in the uterus, the muscle of the womb, and

(56:43):
you can reduce the prostaglandins by having more and Mega
threes in your diet. So eating smash fish, for instance, salmon, anchovies, mackerel, sardines, herring,
all those things help to reduce prostac landin's and if

(57:03):
you reduce inflammation, it can help you with painful periods.

Speaker 2 (57:07):
Way, so you're saying that women don't always have to
have painful periods.

Speaker 1 (57:10):
No, And this idea that pain is a normal part
of being female and cycling is a myth that we
totally have to bust because it's not normal for your
periods to hurt.

Speaker 2 (57:21):
Wow, I mean that feels like pretty shocking information. Like,
I mean, I feel like that's a myth that well,
that's at least a belief that has been around for
a long time, and.

Speaker 1 (57:32):
It's been for a long time. And I feel like
if if boys and men suffered the way that women
do with painful periods, we would assault it a long
time ago. So the way that you eat, the supplements
that you take can really make a difference in terms
of painful periods. So even taking a Mega threes at

(57:53):
a dose of one thousand to two thousand milligrams can help.
Having a diet that reduces inflammation not just when you
have period, but really for the week or two before
really makes the difference in terms of painful periods.

Speaker 2 (58:05):
What are the lifestyle choices that people could change for
acne and irregular periods instead of going on the pill.

Speaker 1 (58:12):
When it comes to acne, I mean, first of all,
know the root cause, so run a hormone panel, n
see is it pcos, is something else that's driving it.
But when it comes to acne, you know, a common
cause of acne is having too much inflammation in the body.
I think of it Jay kind of like a frat party,
you know, sort of this party that's happening in the
body that's going on too long. The party was fun initially,

(58:35):
and then it causes a problem when it goes on
for more than three days. So having an anti inflammatory diet,
cutting out gluten, cutting out dairy, reducing sugar can make
a big difference when it comes to acne. With painful periods,
we think about the prostac landings as a driver of
painful periods, but there's also ten percent of women who

(58:57):
have endometriosis as a cause of painful periods or addnomiosis,
which is where you have endometrial cells growing in the
muscle of theaterists and it causes pain. In those situations,
you want to get a diagnosis and you want to
get it treated, and there's lots of ways that you
can deal with it using lifestyle medicine. You may end

(59:18):
up on the birth control bill that might be the
best solution, but there's also surgical options, even laparoscopic methods
that can treat the underlying cause. So there's lots of
ways of dealing with it. You don't have to jump
to the birth control bill. And I think the part
that bugs me the most, that troubles me the most deeply,

(59:39):
is that we prescribe birth control pills to girls and
women without giving them full informed consent about the consequences.

Speaker 2 (59:50):
What should women know about the long term consequences of
birth control pills.

Speaker 1 (59:55):
They need to know first that it reduces sex hormone
binding globulince, so that SHBG, something you can measure in
your blood, is kind of like a sponge in the blood,
so it soaks up your free testosterone. When you go
on the birth control bill, some women don't notice any
problem with their testosterone dropping as a result of sex
hormon binding globulin going up, but other women do so

(01:00:18):
about twenty five percent have decreased libido or vaginal dryness
because their testosterone is lower. Now, in women with acne
that's caused by testosterone, that's potentially a good thing to
drop their testosterone. But here's the part that most women
don't know. When you raise sex hormone binding globulin by
going on the birth control pill, and then you come

(01:00:40):
off of the pill a year later, the sex hormon
binding globulin is still elevated, not quite as high as
it was on the birth control bill, but it's still high.
So we're changing the hormone balance in women in a
way that may not be completely reversible. So that's one piece.
Another piece is that the birth control pill can raise inflammation.

(01:01:04):
So if you use a marker of inflammation like high
sensitivity zeractive protein, I know you run function tests, so
I know you measure your hsc ORP. So we know
the birth control pill can double to triple the level
of inflammation in the body. And a lot of women
don't realize that a third factor is micronutrient depletion. So

(01:01:27):
that means the birth control pill, just by blocking some
of these normal hormonal pathways in the body can deplete
you in certain nutrients that are really important magnesium, co
Q ten, vitamin bs like B two, B six, B nine,
B twelve. It can cause problems with mitochondrial function. And

(01:01:50):
so this is never part of the informed consent, and
I think it should be like we should have eyes
wide open going in and seeing what can result. Now,
the microbiome can also be affected by the birth control bill.
In fact, one autoimmune disease Crohn's disease, the risk of
it is increased by going on the birth control bill.

(01:02:11):
But women who get diagnosed with Crowns disease often don't
get asked, hey, did you get started on the birth
control pill when you're sixteen? So I think women deserve
to have choice. I'm not removing the choice of birth
control bills. There's time and a place for it. But
I think women need to know what the risks are.

Speaker 2 (01:02:32):
I mean, hearing that feels scary, I mean the amount
of you know, there's not just one or two or
three side effects. I mean there's so many consequences that
you just ruled off. If a woman has been on
the birth control pill since she was a teenager and
she wants to reverse some of this that's happened to her.

(01:02:54):
What should she be doing.

Speaker 1 (01:02:55):
Well, there's a lot of things you can do. So
first with the micronutrient depletions, that's probably the easiest place.
Start a multivitamin. Now, you could measure and see if
you're depleted in any of these micro nutrients and then
adjust supplements to address that or your food. But I
would say the simplest hack is to take a multi vitamin.

(01:03:17):
The other thing that women can do is they can
measure inflammation in their body, and if their inflammation is increased,
they can address it. You can address it with an
anti inflammatory diet. As an example, if you're someone who
is having low testosterone symptoms, you can measure your free

(01:03:37):
and total testosterone. You can measure your sex hormone bining globulin.
See if you're one of those women who's affected. Now,
there are some women who can stay on the birth
control pill and they can address some of these side effects,
but then there are other women who say I'm done
with this. Like the one that really gets women is
that the birth control pill can shrink the glitteris by

(01:03:59):
twenty percent twenty percent. Now, most women do not want that.
So if I have a woman who's on the fence,
she's not sure if she wants to continue the pill,
that often seals the deal. So what I usually advise
women who are interested in coming off of the birth
control pill but they still need contraception, is to choose

(01:04:20):
something that's non hormonal, like the copper eud.

Speaker 2 (01:04:23):
It seems like a homemones is something that shouldn't be
artificially messed with because there's so much going on anyway,
and there's so many shifts that are going on decade
by decade by decade that when you start playing around
with it, there are so many long term effects. And
I wanted to ask you, does the birth control pill
affect fertility?

Speaker 1 (01:04:40):
So the effect on fertility is mixed. There are some women,
you know, I've been taking care of women for thirty years.
There are some women who come off the birth control
pill and it takes some a year longer to get
back into a normal ovulatory pattern where they're producing an
egg each month. There are other wa men who come
off the pill and they get pregnant right away. I mean,

(01:05:02):
there are women who get pregnant on the pill. So
there are some women in whom fertility is affected in
some women for whom it is not.

Speaker 2 (01:05:10):
And what do you think that is? What do we
know that that is what's making a difference day? Is
it health in different areas? Is it?

Speaker 1 (01:05:19):
I don't know that we understand it completely, ja. I
mean this is part of the work I do in
precision medicine is trying to understand, you know, when you
start a pill for somebody, whether it's the birth control
bill or a statin, who are the people who are
going to benefit the most with the few as side effects. Now,
I was taught in mainstream medicine that you make a diagnosis,

(01:05:41):
you know, someone who wants contraception or has endometriosis, and
then you prescribe a pill. But that is really a
way of practicing imprecision medicine. In precision medicine, we personalize,
We understand the measurements for the individual, unerstand your values,
and understand what might work the best for you before

(01:06:04):
we have that knee jerk response to write a prescription
for a bill.

Speaker 2 (01:06:08):
I think, I mean you mentioned function that that was
one of the reasons why I invested in functional health
was because I wanted people to have more precision in
how they took their health into their own hands. And
I just found it was so hard for people to
get those kind of tests done and find access to it,
and give people the ability to have their results and

(01:06:31):
be able to talk to their doctor and say, hey,
here's what I'm seeing. Here are my two hundred lab results,
what looks odd and what doesn't. And it's hard. It's
hard for people to have to own that process because
if you're not educated and trained as a doctor or
as a professional, it's even as for me, I find
it so complex to look at all of these data

(01:06:53):
points and make sense of it. And I feel fortunate
enough to have good doctors and good professionals around me,
but I felt at least as a starting point, functional
health allowed people to have that and have the right conversation.

Speaker 1 (01:07:06):
It's a critical starting point, and it's you know, I
think that putting the power of testing in the hands
of the individual is critical because there are so many
people who are failed by mainstream medicine. And I'm not
throwing mainstream medicine under the bus. I trained in it.
Some of my best friends are still working in the
mainstream system. But there are a lot of people who

(01:07:29):
are failed, who don't get in early diagnosis of autoimmune disease,
who don't know that their thyroide is not working, who
don't know that their cortisol is two to three times
what it should be. So to put that testing in
the hands of the individual, I think is so important.
And you mentioned something else that I think is critical here,

(01:07:49):
and that is, Yes, there's complexity to the hormone system,
but there's also an exquisite simplicity And at one of
the things that you know come back to the foundational
aspects of a life well lived, of lifestyle that's managed

(01:08:10):
for the individual help you with your hormones. So yes,
there's complexity, but there's also a simplicity here. You know,
getting the right amount of sleep seven to eight point
five hours every night, tracking your deep sleep, tracking your
rem sleep, Knowing how long it takes you to fall asleep.
Normal is ten to twenty minutes. If you're falling asleep

(01:08:30):
before ten minutes, you probably have sleep debt. Knowing what's
going on with your heart rate variability, Knowing about relationships
and how critical they are to your hormonal balance. Knowing
about your metabolic health because more than ninety three percent
of Americans are metabolically unhealthy. So not outsourcing that to
your doctor because you're really your best your best doctor, right,

(01:08:53):
I mean, you spend less than one percent of your
time in a doctor's office, So living your life and
kind of tracking how these measurements can reflect the way
that you're living your life and then allowing you to
course correct and code switch. That's very empowering.

Speaker 2 (01:09:08):
You're so right that what you just said really hit me.
The idea that you only spend one percent of your
time in your doctor's office and to expect that one
percent to positively impact the nineteen nine percent of life.

Speaker 1 (01:09:18):
Well that and I mean the cool thing here is
that I feel like younger people are changing this, which
I totally love. You know, like, I'm I'm gen X,
and my generation was okay with being dismissed by physicians.
I mean not totally, but baby boomers especially, But it's

(01:09:40):
the younger generation that is really wanting to own their
health and participate it in a way that we've never
seen before. Millennials, gen Z. They're saying, you know, this
idea that I go to see a doctor once a year,
and that's when I get a few hormone tests. Hormone
tests or they get told by the doctor, oh no,

(01:10:01):
we don't check hormones. They vary too much. No, They're like,
that's not how I want to live my life. I
want a different bath.

Speaker 2 (01:10:09):
Absolutely, there's a growing movement for natural birth control, especially

(01:10:29):
amongst younger people, or ditching the pills. So what are
the most effective forms of natural birth control and are
they as effective?

Speaker 1 (01:10:37):
The key way of doing natural contraception and natural family
planning is what it's called is to be able to
track your cycle. So this is assuming that women have
a healthy, regular menstrual cycle. And if that's the case,
then you can track your temperature. You can use wearables
to understand when your fertility window is, and then you

(01:10:58):
can have during that time of your fertility window. This
is the Family Show, So I'm going to be careful
about my language. So that's one way. But I would
also say, you know something like a copper IUD, and
we're seeing younger and younger women use a copper ID.
That is a form of natural contraception. And here's the

(01:11:19):
part that I think is so important. I want to
shout this from the rooftops. Women who have an ID
are more satisfied with it than any other type.

Speaker 2 (01:11:30):
Of birth control bill in what way and why?

Speaker 1 (01:11:32):
They're just they don't have to think about it. They
don't have to take a pill every day. It's not
messing with their hormones. It's not you know, they don't
have to worry about unprotected sex. They there's a level
of security, there's a level of being symptom free. So
it is the highest level of satisfaction, and yet it

(01:11:53):
has the lowest usage. So there's a total disconnect that
we have to change.

Speaker 2 (01:11:58):
Wow, I mean, and is it growing fast or is
it not?

Speaker 1 (01:12:01):
I'm not as fast as I would like. I feel
like an ID crusader. So yeah, let's get more people
to get their IDs.

Speaker 2 (01:12:08):
Yeah, well, you're telling everyone here. I think I'm going
to see a lot of search is on CHATGBT and
Google with it. There are so many women that are
scared of getting an IUD because of how painful the
process can be. What are your suggestions for that.

Speaker 1 (01:12:23):
You've got to find a doctor who's willing to give
you some nummy medicine. So I've put in probably five
thousand IDs over the course of my career. I always
do a cervical block. Why because the uterus, the cervix,
and a woman is our deepest, most sacred part. So
to go stick an ied through the cervix up inside

(01:12:47):
the uterus with no pain medicine, that's criminal, Like I
don't agree with that at all. So find a doctor
who will give you some nummy medicine. And then another strategy.
I'm a big fan and of using other ways besides
medications to help you relax and be able to adjust

(01:13:07):
to having an ID inside your uterus. So meditation, hypnosis,
breath work, having a clinician who's talking through what they're
doing so something doesn't happen all of a sudden and
set off a few response fight, flight, freeze. Use some
of these other strategies. Use breath work, use hypnosis. It's

(01:13:29):
been studied to help with pain and to reduce the
pain response. You can also use some of the lifestyle
strategies that reduce the inflammation so that you don't get
as much inflammation to having the ID inserted.

Speaker 2 (01:13:43):
And the other thing I want to ask to you
was about is there a difference between the HOMEO one
OLIUD and the home one O birth control pill. Would
you still recommend the ID in that consideration?

Speaker 1 (01:13:55):
I would. I mean my preference first and foremost, probably
my first three choice would be copper ID, copper IUD,
copper ID. But there are some women who have really
heavy periods or they've got some other reason that a
hormonal ID is a better choice. So it doesn't mess

(01:14:16):
with your hormones quite as much as an oral contraceptive does.
It still has in about five to ten percent of women,
up to twenty percent, it can have systemic effects. What
the makers of the hormonal ID say is that the
hormones are local, so they're just released insibeaterus and they

(01:14:38):
don't affect the hormones and the rest of the body.
That's true for some women, but not all. So I
still think that the hormonal ID is a second choice
to the copper IED and definitely better than the oral contraceptive.

Speaker 2 (01:14:53):
If there are women that are struggling to transition from
the birth control pill to being able to conceive, what
lifestyle changes would you encourage to help with fertility? What
can people do if they're struggling right now?

Speaker 1 (01:15:09):
Well, this is where what I like to think of
as the boring basics are so important, so really dialing
in your sleep, tracking your sleep, understanding your stress response,
because when you want to have a baby, when you're
heading toward that phase of futility, you want to make
sure that cortisol is not impacting the way that your

(01:15:30):
hormones are produced. And these hormones are not a democracy.
It's not like cortisol is equal power as progesterone and estrogen.
Cortisol is really at the top of the hierarchy, and
so you will make cortisol no matter what. Your body
doesn't actually need to make estrogen and progesterone to survive,
but you have to make cortisol. So when you're getting

(01:15:51):
ready to conceive and you're transitioning to it, nutrition is
so important. So one of the things I like to do,
especially to avoid micronutrient efficiencies, which become more of a
problem if you've bet on the birth control bill, is
to make sure you get five to seven colors at
the rainbow with your vegetables and fruit sieach day. That's
one of the ways that you can avoid micronutrient deficiencies.

(01:16:14):
Nutrition is so important. It can sometimes be helpful to
look at some of your genes, your genomics because some
of us, myself included, need more certain B vitamins. You
may want to start a prenatal vitamin for three to
six months before you start trying to conceive, and that

(01:16:35):
helps to replace those micronutrient deficiencies that could potentially cause
a problem in a pregnancy, so you want to avoid that.
Another piece that I think is really important is to
measure your hormones as soon as possible, Like, don't wait
until you've been trying in earnest for six to twelve
months before you get your hormones tested. And this is
one of those situations where women who are trying to conceive,

(01:16:57):
who've been trying for a year, or are they've been
trying for six months and they're over the age of
thirty five, we check every hormone. Now, women who are
not trying to conceive, that's a situation where they often
are told, oh, no, they very too much, we don't
check them. That's double standard. So I think all women
deserve a hormone panel, regardless of whether they're trying to

(01:17:18):
conceive or not.

Speaker 2 (01:17:19):
The other question I want to ask you is I'm
seeing a lot about balancing hormones and cycle sinking for
women on social media, these trends scientifically grounded? Is there
value in that?

Speaker 1 (01:17:30):
So the data is pretty limited? You know, I'm a researcher.
I really think about the hierarchy of evidence day. You know,
the highest quality of evidence that I was taught at
Harvard Medical School is the randomized trial. The problem is
randomized trials are really designed for looking at drugs like
a statins. What I was also taught at Harvard is

(01:17:52):
that even better than the randomized trial is the end
of one experiment where you serve as your own control
and you have an intervention like cycle sinking. So there's
not a lot of data in cycle sinking. I think
it's something that you could try for four to eight
weeks and see if it makes a difference.

Speaker 2 (01:18:09):
Got it.

Speaker 1 (01:18:10):
Now, when we think about some of the hormones and
sort of the natural cycle of your estrogen production and
your progesterone production if you're female, your testosterone production which
tends to peek around day nine ten eleven, what we
know is that it makes sense to change your fitness
goals as an example, depending on where you are in

(01:18:32):
the cycle. It may also make sense to change how
many carbhydrates you're consuming depending on where you are in
the cycle. So I think there's better evidence for that,
But in terms of you know, seed cycling or some
of the other strategies that are used, I would say
not as much evidence. But lack of proof is not
proof against so do the end of one experiment.

Speaker 2 (01:18:54):
I'm hearing that more and more now and it's so
refreshing to hear you say as well, with all your
incredible expertise research the amount of work you do with individuals,
of just how focused this has to be on you
and the individual and what your experiences and trying things out.
And I think we all get mad at diets or
fads or trends or whatever it may be. And the

(01:19:15):
truth is that might work really really well for one
person and they're sharing it and saying that it helped them,
and hey, there may be thousands of people that it helps,
but that doesn't mean it's going to help you. And
that doesn't mean that trend or diet or whatever it
didn't work. It's just that it didn't work for you.
And when we take our health into our own hands,

(01:19:35):
I think we get into that feeling. I mean, I
had that experience with protein recently, I was taking as
much protein as everyone's being recommended to take, and it
was just too much for me. I didn't enjoy it physically.
I didn't enjoy it from a gut perspective. I felt
bloated and heavy all day. And I'm so much more
happier having one hundred grams of protein to day than

(01:19:55):
I was having like one hundred and twenty, one hundred
and thirty or whatever it was. And it was just
too much. And it was only something that I had
to do by testing. I could have known that. And
I don't think the number that's out there is wrong
or bad. It's just that it didn't work for me.
I wanted to ask you, if there are women right
now who want to transition away from the birth control pill,

(01:20:17):
how do they do that safely?

Speaker 1 (01:20:19):
I would say, first run some measurements, So look at
micronutrient deficiencies, what's going on with your testosterone, look at
the sex wom and binding globulin level, take a look
at your thyroid function because the birth control book can
affect that as well, and then I would come up
with a bridge, like what's the transition plan if you're

(01:20:41):
going to come off the birth control pill. You might
want to get an ID inserted before you come off
the pill, like make sure the ID is a good
fit for you before you come off of it. So
I think coming up with a bridge, talking to a
collaborative clinician who's not just going to do power over
and saying, oh, no, you have to stay on the pill,
but someone who says, yeah, I get it. I understand

(01:21:03):
you don't want the inflammation. Yes, the micronutrient deficiencies are real.
Let's track your hormones and see what might be a
better fit for you. So I would say build that bridge,
and it can take some adjustment. It's kind of like
shoe shopping jay, where you know, sometimes you buy the
shoe and it's the perfect fit, and you buy three
more pairs because they're fantastic, But sometimes you have to

(01:21:26):
futs a little bit and find the right fit for you.

Speaker 2 (01:21:29):
I feel like Sarah talking to you. You have such
a medical research based background, but you also have such
a spiritual awaken self, and I wanted to ask you
how have those both together worked in your favor and
how have they supported and complemented each other.

Speaker 1 (01:21:44):
Well. I feel like spirit is such a critical part
of how I take care of patients. It always has been.
There was a way that it would be more suppressed
when I was in a conventional medical system. You know,
a big part of the way that I take care
of people is from the heart. You know, so many

(01:22:04):
of the patients who come to me are in a
state of fear or a state of dysregulation, and they
don't want you know, the top ten cognitive strategies for
how to get their insulin back into balance. There's a
way that they need to be met and seen and
heard first. So it's not everything, because people come to

(01:22:31):
me because they want some answers, or they at least
want to talk through the problem and kind of solve
it for them. But it's a through line of everything
I do. And then secondly another piece, and I would
love to hear your comments about this. I'm someone probably
because of childhood patterns. I had a lot of early

(01:22:54):
childhood trauma before age three, which tends to lead to
more dysregulation than other people who are exposed to trauma.
I'm someone who would burnout constantly. So this was mostly
in my thirties, like especially once I started having kids.
I had my first kid at thirty two, and I

(01:23:15):
would work hard, hard, hard, come home exhausted, have that
glass of wine didn't work, and I would be facing burnout.
And in my thirties I would plan these increasingly more
elaborate vacations as a way of trying to bypass the burnout.
But what I needed to bring in was spirit and

(01:23:35):
meaning and purpose and this heart connection and really seeing
the person in front of me, not you know, doctor patient,
but here's this beautiful person, and my job is to
serve them and to understand what their gifts are and
to understand their values, and not to impose my values,
but to really bring a sense of wholeness and to

(01:24:00):
help to activate their own healing capacity. So that's different
than the model that I was taught in medical school
and at UCSF and residency, but it's what works for me,
and it helps me avoid the burnout that I had
in my thirties.

Speaker 2 (01:24:18):
It's incredible, it's so wonderful to hear and so much
of what's needed. I feel the two worlds that are
seemingly opposite to each other and or often pit against
each other, and there's a debate about which has more
value to offer, But I really do believe it's the
synergistic approach and the synchronistic approach that actually helps people
the most because there's value in both of them. And yeah,

(01:24:41):
you're asking for me. I relate to everything you're saying.
I feel like spirituality, spirit philosophy gives me the map
of why I'm going, where I'm going, and where I'm
going and why I'm here. But then the more physical
aspects tell me what to do each day and how

(01:25:01):
to function in the real world and what it takes
to work in the real world but not be of
this world. And I think that is the paradox and
the juxtaposition of everyone's life, where we know we are
more than what we see and what's here, but we're
living here and knowing the skills to operate where we

(01:25:25):
are and the perspective to recognize this is not all
there is. You need both of those to function. I
think if you only have the skills to function here,
it can feel meaningless. You can be overworked, overwhelmed, you
can feel purposeless. I think if you only have purpose
and you don't know how to function here, you kind
of feel disconnected, unrelated and can kind of create a

(01:25:47):
lot more problems as well in the immediate world, and
so I think both have to go together, and trying
to walk those two paths in parallel looks like a paradox,
but it actually creates great harmony.

Speaker 1 (01:26:00):
It does. There's a synergy that I think you're speaking
to that's so critical. And I love how your voice
got a little deeper and slower and quieter as you
talked about this, because that cartography that you talked about,
you know, kind of the map of purpose and how
that evolves over time. Spirit is such a critical part

(01:26:20):
of that, and it's you know, it's not I don't
wake up in the morning saying Okay, here's what my
spirit is going to do. Like it's getting quiet enough
and regulated enough to let it flow through me. I
appreciate that.

Speaker 2 (01:26:35):
Yeah, I love that me too, Sarah. We end every
episode of On Purpose with a final five. These have
to be answered in one word to one sentence maximum.
So Sarah, sal these are your final five. The first
question is what is the best advice you've ever heard
or received?

Speaker 1 (01:26:51):
Get curious, not furious.

Speaker 2 (01:26:55):
I like that that applies to so many things. That's great.
Question number two is the worst advice you've ever heard
or received?

Speaker 1 (01:27:03):
Hormones can't be measured. They changed too much, they fluctuate
too much. It's a waste of time and money.

Speaker 2 (01:27:09):
Question number three. If you could encourage everyone who's listening
and watching right now to change one habit over the
next thirty days, what would you ask them to do
or practice one habit over the next thirty days. What
would it be?

Speaker 1 (01:27:25):
Look at your stress response track it maybe start with
heart rate variability. I think it's important to know what's
true for you and then to set up these little
experiments and of one experiments like I find, for instance,
certain zoom meetings raise my HRV. I want more of

(01:27:45):
those people. As you said, three to one.

Speaker 2 (01:27:48):
Yeah, yeah, no, that's such a great answer. I couldn't
agree with you more. I'm constantly trying to figure out
where my stress is coming from and how you can
do less of that and move away or get curious
about why it's stressing you out what it's triggering. Question before,
what's something you used to believe to be true about
health but you don't agree with anymore.

Speaker 1 (01:28:09):
I used to believe that you should suck it up
and stay no matter what, especially when you have kids
and there's a health cost for some of us that.

Speaker 2 (01:28:24):
We need to acknowledge to suck it up and stay. Yes,
it's okay to leave, So.

Speaker 1 (01:28:29):
Can I leave? When you suck it up and stay,
often there's a self abandonment that occurs that is not
good for your spirit, is not good for your hormones.
There's a lot of downstream consequences. Don't sacrifice authenticity for connection.

Speaker 2 (01:28:48):
Yeah. Fifth and final question, we asked this every guest
who's ever been on the show. If you could create
one law that everyone in the world had to follow,
what would it be.

Speaker 1 (01:28:59):
Regulate your off and then decide. Don't make decisions from
a disregulated state, like start to really learn what your
body feels like, which you notice when you're dysregulated, when
you're in fear. So regulate first, then decide.

Speaker 2 (01:29:18):
It's a great answer. I love that, Doctor Sarah shal
thank you so much for joining me today. The book
that Sarah recommended if you love this conversation is called
The Hormone Cure. Go and grab a copy. If you
want to learn more about how to take your hormones
into your own hands to actually be able to have
an impact and control on your health and well being,

(01:29:38):
Please go go get tested. It's never too early to
get tested. I think it's so important to be working
from a place of data and insight rather than guessing
and wasting so much time and money and energy trying
to figure it out. And again, Sarah, I hope you'll
come back to share more great insights with us. I
learned so much from you today and I'm so grateful
for your work, your heart, and this is your spirit

(01:30:00):
and the way you show up. So thank you so much, truly.

Speaker 1 (01:30:02):
Thank you, Jane, such a pleasure.

Speaker 2 (01:30:04):
Thank you. If you love this episode, you'll enjoy my
interview with doctor Daniel Ahman on how to change your
life by changing your brain.

Speaker 3 (01:30:13):
If we want a healthy mind, it actually starts with
a healthy brain.

Speaker 2 (01:30:19):
You know.

Speaker 3 (01:30:19):
I've had the blessing or the curse to scan over
a thousand convicted felons and over one hundred murderers, and
their brains are very damaged.

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Host

Jay Shetty

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