December 22, 2022 • 27 mins
In a special two-episode series, the New York Times best-selling author, scientist and physician tells why women’s health needs are different from men’s, and shares her female-focused plan that can help women live a healthier life. On today’s episode: Dr. Sara busts the myths about women’s health, and reveals why keeping hormones in balance and maintaining metabolic health are the key to a brighter mood, more energy and even achieving one’s healthy weight goals.
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Speaker 1 (00:04):
What I would say is hormones are the primary difference
between men and women. And if you want to feel
your best, if you want to serve your mission, hormones
need to be on track. They need to be the
wind ture back. So when you've got your hormones and balance,
what happens. You sleep well, you age more slowly, You're
more interested in sex, your mood is more stable, You're
(00:27):
less likely to have anxiety or psychological distress. That was
Dr Sarah Godfried, scientist, researcher, and best selling author. Dr Sarah,
as she likes to be called, has an innovative, amazingly
effective approach to women's health, an approach that can help
women deal with stress, get more energy, and even achieve
(00:49):
our healthiest weight. I'm Kim Azareli and this is Seneca's
One Women to Hear. Today we'll bring you the first
episode of a special two part conversation with Dr Sarah
Gottfried about women's health. Dr Sarah is a Harvard trained
m D. She's had four books on the New York
Times bestseller list. For most recent is Women, Food and Hormones. Today,
(01:12):
Dr Sarah is going to tell us why women's physiology
is different and what that means for our health, as
she says, we're not just men with breasts. That distinction
has an impact on women's metabolism and a healthy metabolism,
she says, is the key to a healthy life. Dr Sarah,
it's so great to have you with us. Just want
(01:34):
to really thank you for doing this and personally thank
you for writing the book, which has actually had a
huge impact on my life since I've read it over
the past couple of weeks. It's my honor, you know,
this is this is my mission, this is my service
to improve the metabolic health of women in the world.
So you are the author of several books about women
and wellness. You're a gynecologist and a scholar trained at
(01:56):
Harvard and m I T. And you're dedicated to busting
a myth, and that myth being that being a woman
means that you'll always feel overwhelmed, tired, burnt out. But
you say that we need to look at women in
wellness differently. First, why do we need to approach women's
health differently than we do men's health? Kim, That's such
(02:16):
a great question, and I love that we're starting with that,
that myth busting because there's a tradition, particularly in medicine,
of studying men and assuming that what we learn applies
equally to men and women. That's just not true, as
women were just not you know, men with breasts, our
(02:40):
immune system, hormones, metabolism, brain, the way our brain works,
the way that estrogen regulates the brain, even our stress
response is unique. So we require a different approach than
what the standard is for men. So when it comes
to medical care, which is where my area of expertise is,
(03:04):
we see not just sex differences which are biological, such
as hormone differences, but we also see gender differences which
are socially constructed. And a good example here is the
number one killer of both men and women, which is
heart disease. And there's some disparities between men and women.
(03:24):
You know women, for the most part, Men are experiencing
less mortality associated with heart disease women are not. Women
are actually having an increase in prevalence, especially younger women
in the age group of thirty five to fifty four.
And if you look at things like the symptoms that
women experience with cardiovascular disease, if you look at a
(03:47):
woman who's having a heart attack, as an example, they
don't have the classic symptoms that men do. So rather
than the crushing chest pain that feels like an elephant
is sitting on your ches us that radiates down the
left arm, women have more subtle symptoms. They've got smaller
coronary arteries, they have symptoms that are more vague, such
(04:11):
as neck pain, shortness of breath, nausea. And what then
happens is that women often get misdiagnosed and they get
sent home from the emergency room when they present with
these symptoms that end up being a heart attack in progress.
In it's an incredible thing. And then if we take
it one step further, the gender of your doctor matters.
(04:35):
So there was a really fascinating study just published a
couple of years ago showing that if you're a woman
and you present the emergency room with symptoms of a
heart attack, if you see a female physician, your survival
is two to threefold higher then if you see a
male physician. And if you look at male patients who
(04:56):
present with a heart attack at the emergency room, there's
no difference whether they see a male or female physician.
Now that I would say is more socially constructed. That's
a gender difference. But this just gives you a little
flavor of how women are not just you know, smaller
versions of men or men with hips. We've got our
(05:18):
own physiology that we really need to be mindful of. Well,
we are so grateful that you've written this book, Women,
Food and Hormones, and really grateful for your contribution to
metabolic health. So, in a nutshell, if you can say that,
what do you think right now in today's times is
key to improving women's health, Well, it's a It's a
(05:39):
complicated question, isn't it. I'll try to keep it as
simple as possible. I would say what comes to mind
first is awareness, knowledge, and ownership, and I'd love to
dive a little deeper into those. But embedded in this
increased awareness about some of the sex and gender differences
and knowledge about your own body, and then ownership is
(06:03):
that you're thinking about your metabolism. In fact, I want
you to think about it as much as you think
about your retirement account, because your metabolism really is your
retirement account. So i'd say awareness, knowledge, and ownership. What
I see with a lot of women, and I take
care of both men and women and I think this
is particularly true even for very empowered women, is that
(06:26):
often they are empowered in so many areas of their
their life. You know, whether they're a lawyer classically trained
like you are, or they're in the corporate world, and
yet they outsource the ownership of their own health. So
they outsource it maybe to a doctor that they see
once a year, or maybe they see a doctor more frequently.
(06:49):
And what I want to change is that that ownership.
I think the more that you understand about your own physiology,
which frankly is totally enchanting, the more you understand about that,
the more you own it and realize that you know,
if you look at a visit to a doctor twice
a year, that's like less than point zero one percent
(07:13):
of your time. Why would you outsource your health to
this person that you spent so little time with. What
I think is increasingly relevant right now as healthcare is changing,
as we have the ability to monitor ourselves more, is
that we've got this democratization of data and we're able
to understand things like what's going on with my metabolism,
(07:35):
why is my weight on the bathroom scale going up?
What's happening with this belly fat that I'm suddenly seeing
why am I so tired? And so the more that
you can own that and develop the awareness and the knowledge,
I think, the better off you're going to be, the
better that you're going to improve your own health as
well as for other women. Well, you know that you've
completely turned me onto this whole way of thinking. I
(07:57):
do feel like having this access to data about yourself,
as you said, awareness and knowledge about what constitutes yourself
and then you know, the ability to act on it
is a very empowering thing. I know it has been
for me. We're at such a crossroads right now when
it comes to understanding their own biology. You know, this
(08:20):
was not the case ten years ago. We've now got
things like, you know, I've got a smart watch on
my wrist. I've got a ring on my finger that
measures my stress levels and my readiness each day in
my sleep. I've got an implanted continuous glucost monitor. Right now,
about fifty of Americans have wearables that they're using. Ten
(08:42):
years from now, we expect that about fifty of Americans
will have implantable wearables. So we're really in this environment
of dramatic change when it comes to each of us
understanding our own physiology and not having to outsource that
to a doctor. I mean that it's a very exciting
concept to be more intimately involved with your own biology.
(09:04):
At least for me, has been pretty game changing because
I have not been the person who was, you know,
very focused, you know on my physical health certainly, and
I was that person who was kind of checking in
once a year or when sick. So I think this
mindset that you're recommending is really really powerful. So what
are the benefits of looking at women's health through the
(09:25):
lens of hormones? In your book, you talk a lot
about hormones. Why is that important? Well, hormones drive what
you're interested in. They are these chemical messengers that I
think of them almost like a text message in the body.
So they they typically are made at a distant organ.
Uh So, for example, in your neck, you've got the
thyroid gland that makes thyroid hormone that then gets spread
(09:48):
through the bloodstream to every cell in your body, and
it's one of the key drivers of metabolism. But taking
a step back, what I would say is hormones are
the primary difference between men and women. And if you
want to feel your best. If you want to serve
your mission, hormones need to be on track. They need
to be the wind ture back. So when you've got
(10:11):
your hormones and balance, what happens. You sleep well, you
age more slowly, you're more interested in sex, your mood
is more stable, You're less likely to have anxiety or
psychological distress, and so I think it's it's really essential
to understand how core the concept of hormones is, particularly
(10:31):
for women. I think it's it's more of an issue
for women were more complex hormonal beings than men aren't,
and it's really important to kind of take on this
piece of your health. So part of your work has
been devising the Godford Protocol, which I think is really
really powerful, and you lay it out in your book,
and part of that is using information about hormones and
(10:54):
many other things to reset your metabolism. Why is this
important right now? When women have been dealing with the
challenges of COVID, of working from home while parenting, of homeschooling.
What about this moment makes this particularly important? Kim? We
were stressed before the pandemic, and I think what's happened
is that all of us are noticing this increased load
(11:17):
of stress. You know, the way I think of it
as a physician is that it's a cortisol load. Cortisol
is the main stress hormone. It can either be on
your side helping you feel energized. Each day. You're supposed
to peak your cortisol within thirty minutes of waking up
and then have this gradual decline over the course of
the day. But what's happened during the pandemic is that
(11:39):
many of us have been traumatized. Depression is about threefold
higher than it was pre pandemic. There's certainly the quarantine fifteen,
you know, the increased weight that some of us have noticed.
But what I think about is the deeper issue of
what's going on with metabolic health. So I care about
the number on the bathrooms Yale, but in many ways
(12:01):
that doesn't reflect this bigger picture, you know, the picture
of complexity of metabolic health and also what's happening with
your hormones. But just taking for a moment these challenges
that we're experiencing. I just was reading a recent paper
showing that depression right now is that anxiety psychological distress.
(12:27):
So these numbers are higher than we've ever seen before.
And before the pandemic, we had a number of surveys
that were published looking at, okay, well, what's going on
with metabolic health in the US, and we found that
only twelve percent of Americans are metabolically healthy. Twelve percent,
I mean, that is so low. And what we've noticed
(12:50):
during the pandemic is that it's those folks who have
a problem with metabolic health that tend to do the
worst with infection with COVID. Now, tell us what you
mean by metabolic health. Such a good question. So metabolic
health the way I think of metabolism, if we start
first with that term, it is the aggregate of all
(13:12):
of the biochemical processes that are happening in the body.
So a lot of people think about metabolism as you know,
whether you burn calories slow or fast, and that doesn't
quite capture it. It's much more complex than that. It's
looking at all the ways that you produce energy, all
the ways that you're mitochondria kind of the power factories
and yourselves work. It's the metabolic hormones such as the
(13:38):
ones that we've talked about already cortisol, uh, thyroid, but
the list includes a few dozen hormones like testosterone, growth hormone,
even estrogen, and balanced with progesterone insulin. But when it
comes to metabolic health, the way I think of it
is that it's the way that your body takes the
fuel that you eat. So whatever you had, say for
(14:00):
breakfast today, if you had a breakfast, and then convert
set into fuel for you. So some of us are
really good at that. Some of us are really efficient,
and so they feel kind of steady energy all day long.
They could even skip a meal and that's not a
big deal. But then some of us are not so
metabolically healthy. We're in that category where you have a banana,
(14:22):
for instance, and your glucose spikes way too high, like
maybe up to two hundred, and then it crashes and
you feel exhausted. So metabolic health is the ability to
use food as fuel to do that very efficiently without
a lot of symptoms. And some of the ways that
we measure it include looking at things like fasting glucose, fasting,
(14:46):
insulin levels, some of these hormones that we've talked about
senecas one hundred women to hear we'll be back after
this short break. You mentioned this briefly, but there is
(15:09):
definitely a weight benefit or a benefit of losing weight
when you engage in this type of lifestyle. So let's
talk about the role of hormones and metabolism in maintaining
a healthy weight. Can you briefly outline the components of
what you feel as a healthy diet for women and
what makes it different from the keto diets that we
hear much about. The key concept here is that food
(15:30):
regulates your hormones, and I think that's such an important
message if you learn nothing else today, I really hope
that she will come away with a concept about how
food creates the backbone of the hormones that you make,
and that includes carbonydrates that help you with detoxication. It
includes fat, healthy fat, which is the backbone of the
(15:52):
sex hormones, things like cortisol, estrogen, progesterone, testosterone. And it
also includes protein, which you need for repairing muscle, especially
if you're someone who exercises regularly. So I think the
key to think about when it comes to a healthy
weight and hormones and metabolism is to connect this relatively
(16:15):
new idea that food regulates your hormones. So to get
your metabolic hormones reset to get them back into balance.
There's three components that I came up with when I
was struggling with my own metabolic health, especially in my forties,
and I was struggling with a fasting glucose that was
starting to climb not to the diabetes range, but to
(16:36):
the pre diabetes range. And I found that the three
components that are really important our first detoxification. You've got
to have that in place first before you try a
ketogenic diet, especially in women. Number two, you then layer
in nutritional keytosis, but I've got some particular ideas about
how to do that. And then the third is intermittent fasting,
(16:59):
because intermittent fasting allows you to eat more carbohydrates, and
it's also a backdoor to keytosis. Keytosis is where you're
burning fat and you're creating that metabolic flexibility where you
can go back and forth between burning cards and burning fat.
So in your book you cover extensively the role of
(17:19):
a ketogenic diet and how your protocol works to create
what you call metabolic flexibility. Can you tell us more
about the role of a ketogenic diet in women's health.
I think when it comes to the ketogenic diet. You know,
why is it that I came up with this protocol
and wrote this book. Well, what I found is that
(17:40):
once again, the ketogenic diet was studied almost exclusively in men.
It was developed by a male physician over a hundred
years ago, initially for patients with epilepsy, and more than
eight of the research on the ketogenic diet and what
it does for metabolic health and also for your ways
sign is in men. And so I tried kind of
(18:03):
the male version of a ketogenic diet, and it was
an utter failure for me. So if I was feeling
at it, I imagine a lot of other women have
similarly failed. And I found that, you know, there's some
issues that get in the way, such as the need
for detoxication, the way that women tend to go into
a stress state more easily than men do. I think
(18:23):
that's just a relic of fertility and kind of our
greater sensitivity as women to the environment. A lot of
women on keto will have difficulties sleeping because they're not
getting enough carbydrates to generate seratonin, which is that lovely
brain chemical that's involved in sleep. Appetite and mood. And
(18:44):
so there's some issues that women experience on the ketogenic
diet where I find that some women do fine, like
they don't need any help on classic keto, but I
would say the majority somewhere around of my patients do
not do well on classic keto. It needs to be
adapted for a woman. And what are some of those
(19:05):
key components that you suggest for adaptation. Well, the first
adaptation is to go through these pillars of the program.
So detoxication is the first pillar, and what I mean
by that is that you're having a bout movement every
single day. That's really important because classic keto tends to
(19:26):
reduce the amount of stool that you produce, and it
also if you restrict carbs too much, it's not feeding
those really happy, lovely, benevolent bacteria that you have in
your gut. You know, another concept that's really changed in medicine,
as we used to think of ourselves as these kind
of stable human beings without much change. As we get older,
(19:48):
you can either accelerate or decelerate the aging process, and
increasingly we're thinking of ourselves more as vehicles for the
bacteria that we have in our gut. It's kind of
an existential change in terms about we conceive of ourselves.
But when it comes to detoxification, this was really the
missing piece for me when I failed keeto the first
couple of times. So really focusing on a daily bowel movement,
(20:12):
getting sufficient vegetable based carbohydrates so that you're able to
detoxify and support your liver, and that includes some additional
nutrients that you can get from food, such as B vitamins,
methylating vitamins that help you to inactivate estrogen. The whole
idea with estrogen news you want to use it and
(20:32):
then you want to get rid of it. You want
to poop it out and pee it out. So detoxification
is one of those components. The nutritional ketosis. It's a
little bit more detailed, but it's basically a high fat,
moderate protein, low carbohydrate diet, but you have to be
careful with women that the fat is not too high
(20:53):
and that it's mostly plant based fat. You want to
make sure the protein is sufficient so that it's enough
to maintain in your lean body mass, especially those of
us over the age of forty, and then you want
to make sure that the carbs are high enough that's
you're you're able to get some of those benefits that
we talked about, like making the serotonin and feeding the
(21:15):
gut bugs, but also keeping your thyroid in check, because
if you restrict carbs too much, that can actually raise
this intermediate hormone called reverse T three and it can
block thyroid function at the level of the receptor. So
those are some of those components. I'm so glad that
your book includes a very detailed eating plan as well
(21:37):
as really great recipes, so I highly recommend that in
addition to the eating plan. Are there other basic components
to maintaining metabolic health? Oh, there certainly are, So you know,
I like to start first with food because I think
that's the biggest needle mover. You know, when you think
about your metabolic health, I would say somewhere around seventy
(22:00):
to of it relates to your food. Food is such
an important source of information for your DNA as well
as for the microbes in your gut, as well as
for your hormones. So I would say food first. But
once we get the food dialed in, there's exercise, mindset, sleep, stress.
(22:20):
I'm sure there's some other's love purpose meaning, but I
think it's really important to realize if we start first
with exercise, that a lot of us don't exercise in
a way that is consistent with the latest scientific information.
And I would raise my own hand here because up
until about five years ago, I was kind of a
(22:43):
cardio addict. I would just get on the elliptical, get
my New Yorker, and just go to town, you know,
for thirty to sixty minutes. And what we now know
in terms of cardio metabolic health and really keeping your
your system supporting you, is that you want about two
thirds weight training and one third cardio. That's really the
(23:06):
combination that works the best, and people can build up
over time. And with mindset, I would say this is
where healing comes in. You know, there's a lot that
we can do in terms of managing tactically your hormones
and getting your hormones into balance, dialing in your food,
maybe using the continuous glucose monitor, but there has to
(23:27):
be a healing growth mindset, one that is continuing to
generate what we think of as neuroplasticity in the brain
as you get older. That's especially important after the age
of forty for women, because we know that neuroplasticity starts
to decline, especially as the primary regulator of the female body, estrogen,
(23:50):
begins to decline. So it tends to to go down
sometime around age forty three to forty five, and that's
where women about women start to notice this slowdown in
terms of brain function. And so I really want to
encourage our listeners to be thinking about this healing growth mindset,
to be thinking about exercise as well as how you
(24:14):
dance with stress, especially as we're thrown extranally so many
things during the pandemic. And then sleep. I would say
sleeps is a close to a panacea as we have,
so I would say sleep is a really important place
to focus. Well, this is obviously a lot to take in,
but once you do take it in, you start asking
(24:34):
more and more questions. And that's why we're so excited
to have you on the show. But Sarah, I really
want to just thank you for your work and what
you're doing. It's really changed my life already, and I
hope it will change the lives of many many listeners. Well,
thank you so much, Kim. It's been such a delight
to hang out with you and get to know you
and to witness this unfolding that you've experienced with your
(24:57):
own health. Thank you, thanks so much for joining us. Thanks.
We are so lucky to be able to share this
helpful advice from Dr Sarah Godfried. Here are some of
the key concepts from today's conversation. First, it's important to
look at women's health through a uniquely female lens and
to acknowledge that how we diagnose and treat women needs
(25:21):
to be different from the way we diagnose and treat men.
Women's hormones are different, our metabolism is different, and how
we react to medication and even food is different as well. Second,
as we've heard, a healthy metabolism is the key to
good health, and maintaining that healthy metabolism requires thinking about food, exercise,
(25:42):
and sleep in a new way. It's not just about
what you're eating, but it's about when you're eating it.
Of course, exercising regularly, but how you exercise and when
you exercise matters, and getting enough sleep is also key.
Will drill down into the specifics with Dr Sarah in
the next episode. Finally, it's important to be aware of
(26:03):
how food affects our health. Food regulates hormones. According to
Dr Sarah and the eating plan that works well for
a man will often fail for a woman. But when
women get the right balance of healthy fats, proteins, and carbohydrates,
we can reset our metabolic hormones and maintain a healthy
and happy lifestyle. In our next episode, we'll go even
(26:25):
deeper into what metabolic wellness means for women and how
to make the most of this new approach to women's health.
Thank you for listening, and please share today's podcast episode
with others in your life. This is Kim Azarelli, co
author of Fast Forward and co founder of Seneca Women.
To learn more about Seneca Women, go to Seneca Women
(26:45):
dot com or download the Seneca Women app free in
the app store. Seneca's one hundred Women to Hear is
a production of the Seneca Women podcast network and I
Heart Radio. Have a Great Day. For more podcast us
from I Heart Radio, check out the I Heart Radio app,
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(27:07):
H M HM
What I would say is hormones are the primary difference
between men and women. And if you want to feel
your best, if you want to serve your mission, hormones
need to be on track. They need to be the
wind ture back. So when you've got your hormones and balance,
what happens. You sleep well, you age more slowly, You're
more interested in sex, your mood is more stable, You're
(00:27):
less likely to have anxiety or psychological distress. That was
Dr Sarah Godfried, scientist, researcher, and best selling author. Dr Sarah,
as she likes to be called, has an innovative, amazingly
effective approach to women's health, an approach that can help
women deal with stress, get more energy, and even achieve
(00:49):
our healthiest weight. I'm Kim Azareli and this is Seneca's
One Women to Hear. Today we'll bring you the first
episode of a special two part conversation with Dr Sarah
Gottfried about women's health. Dr Sarah is a Harvard trained
m D. She's had four books on the New York
Times bestseller list. For most recent is Women, Food and Hormones. Today,
(01:12):
Dr Sarah is going to tell us why women's physiology
is different and what that means for our health, as
she says, we're not just men with breasts. That distinction
has an impact on women's metabolism and a healthy metabolism,
she says, is the key to a healthy life. Dr Sarah,
it's so great to have you with us. Just want
(01:34):
to really thank you for doing this and personally thank
you for writing the book, which has actually had a
huge impact on my life since I've read it over
the past couple of weeks. It's my honor, you know,
this is this is my mission, this is my service
to improve the metabolic health of women in the world.
So you are the author of several books about women
and wellness. You're a gynecologist and a scholar trained at
(01:56):
Harvard and m I T. And you're dedicated to busting
a myth, and that myth being that being a woman
means that you'll always feel overwhelmed, tired, burnt out. But
you say that we need to look at women in
wellness differently. First, why do we need to approach women's
health differently than we do men's health? Kim, That's such
(02:16):
a great question, and I love that we're starting with that,
that myth busting because there's a tradition, particularly in medicine,
of studying men and assuming that what we learn applies
equally to men and women. That's just not true, as
women were just not you know, men with breasts, our
(02:40):
immune system, hormones, metabolism, brain, the way our brain works,
the way that estrogen regulates the brain, even our stress
response is unique. So we require a different approach than
what the standard is for men. So when it comes
to medical care, which is where my area of expertise is,
(03:04):
we see not just sex differences which are biological, such
as hormone differences, but we also see gender differences which
are socially constructed. And a good example here is the
number one killer of both men and women, which is
heart disease. And there's some disparities between men and women.
(03:24):
You know women, for the most part, Men are experiencing
less mortality associated with heart disease women are not. Women
are actually having an increase in prevalence, especially younger women
in the age group of thirty five to fifty four.
And if you look at things like the symptoms that
women experience with cardiovascular disease, if you look at a
(03:47):
woman who's having a heart attack, as an example, they
don't have the classic symptoms that men do. So rather
than the crushing chest pain that feels like an elephant
is sitting on your ches us that radiates down the
left arm, women have more subtle symptoms. They've got smaller
coronary arteries, they have symptoms that are more vague, such
(04:11):
as neck pain, shortness of breath, nausea. And what then
happens is that women often get misdiagnosed and they get
sent home from the emergency room when they present with
these symptoms that end up being a heart attack in progress.
In it's an incredible thing. And then if we take
it one step further, the gender of your doctor matters.
(04:35):
So there was a really fascinating study just published a
couple of years ago showing that if you're a woman
and you present the emergency room with symptoms of a
heart attack, if you see a female physician, your survival
is two to threefold higher then if you see a
male physician. And if you look at male patients who
(04:56):
present with a heart attack at the emergency room, there's
no difference whether they see a male or female physician.
Now that I would say is more socially constructed. That's
a gender difference. But this just gives you a little
flavor of how women are not just you know, smaller
versions of men or men with hips. We've got our
(05:18):
own physiology that we really need to be mindful of. Well,
we are so grateful that you've written this book, Women,
Food and Hormones, and really grateful for your contribution to
metabolic health. So, in a nutshell, if you can say that,
what do you think right now in today's times is
key to improving women's health, Well, it's a It's a
(05:39):
complicated question, isn't it. I'll try to keep it as
simple as possible. I would say what comes to mind
first is awareness, knowledge, and ownership, and I'd love to
dive a little deeper into those. But embedded in this
increased awareness about some of the sex and gender differences
and knowledge about your own body, and then ownership is
(06:03):
that you're thinking about your metabolism. In fact, I want
you to think about it as much as you think
about your retirement account, because your metabolism really is your
retirement account. So i'd say awareness, knowledge, and ownership. What
I see with a lot of women, and I take
care of both men and women and I think this
is particularly true even for very empowered women, is that
(06:26):
often they are empowered in so many areas of their
their life. You know, whether they're a lawyer classically trained
like you are, or they're in the corporate world, and
yet they outsource the ownership of their own health. So
they outsource it maybe to a doctor that they see
once a year, or maybe they see a doctor more frequently.
(06:49):
And what I want to change is that that ownership.
I think the more that you understand about your own physiology,
which frankly is totally enchanting, the more you understand about that,
the more you own it and realize that you know,
if you look at a visit to a doctor twice
a year, that's like less than point zero one percent
(07:13):
of your time. Why would you outsource your health to
this person that you spent so little time with. What
I think is increasingly relevant right now as healthcare is changing,
as we have the ability to monitor ourselves more, is
that we've got this democratization of data and we're able
to understand things like what's going on with my metabolism,
(07:35):
why is my weight on the bathroom scale going up?
What's happening with this belly fat that I'm suddenly seeing
why am I so tired? And so the more that
you can own that and develop the awareness and the knowledge,
I think, the better off you're going to be, the
better that you're going to improve your own health as
well as for other women. Well, you know that you've
completely turned me onto this whole way of thinking. I
(07:57):
do feel like having this access to data about yourself,
as you said, awareness and knowledge about what constitutes yourself
and then you know, the ability to act on it
is a very empowering thing. I know it has been
for me. We're at such a crossroads right now when
it comes to understanding their own biology. You know, this
(08:20):
was not the case ten years ago. We've now got
things like, you know, I've got a smart watch on
my wrist. I've got a ring on my finger that
measures my stress levels and my readiness each day in
my sleep. I've got an implanted continuous glucost monitor. Right now,
about fifty of Americans have wearables that they're using. Ten
(08:42):
years from now, we expect that about fifty of Americans
will have implantable wearables. So we're really in this environment
of dramatic change when it comes to each of us
understanding our own physiology and not having to outsource that
to a doctor. I mean that it's a very exciting
concept to be more intimately involved with your own biology.
(09:04):
At least for me, has been pretty game changing because
I have not been the person who was, you know,
very focused, you know on my physical health certainly, and
I was that person who was kind of checking in
once a year or when sick. So I think this
mindset that you're recommending is really really powerful. So what
are the benefits of looking at women's health through the
(09:25):
lens of hormones? In your book, you talk a lot
about hormones. Why is that important? Well, hormones drive what
you're interested in. They are these chemical messengers that I
think of them almost like a text message in the body.
So they they typically are made at a distant organ.
Uh So, for example, in your neck, you've got the
thyroid gland that makes thyroid hormone that then gets spread
(09:48):
through the bloodstream to every cell in your body, and
it's one of the key drivers of metabolism. But taking
a step back, what I would say is hormones are
the primary difference between men and women. And if you
want to feel your best. If you want to serve
your mission, hormones need to be on track. They need
to be the wind ture back. So when you've got
(10:11):
your hormones and balance, what happens. You sleep well, you
age more slowly, you're more interested in sex, your mood
is more stable, You're less likely to have anxiety or
psychological distress, and so I think it's it's really essential
to understand how core the concept of hormones is, particularly
(10:31):
for women. I think it's it's more of an issue
for women were more complex hormonal beings than men aren't,
and it's really important to kind of take on this
piece of your health. So part of your work has
been devising the Godford Protocol, which I think is really
really powerful, and you lay it out in your book,
and part of that is using information about hormones and
(10:54):
many other things to reset your metabolism. Why is this
important right now? When women have been dealing with the
challenges of COVID, of working from home while parenting, of homeschooling.
What about this moment makes this particularly important? Kim? We
were stressed before the pandemic, and I think what's happened
is that all of us are noticing this increased load
(11:17):
of stress. You know, the way I think of it
as a physician is that it's a cortisol load. Cortisol
is the main stress hormone. It can either be on
your side helping you feel energized. Each day. You're supposed
to peak your cortisol within thirty minutes of waking up
and then have this gradual decline over the course of
the day. But what's happened during the pandemic is that
(11:39):
many of us have been traumatized. Depression is about threefold
higher than it was pre pandemic. There's certainly the quarantine fifteen,
you know, the increased weight that some of us have noticed.
But what I think about is the deeper issue of
what's going on with metabolic health. So I care about
the number on the bathrooms Yale, but in many ways
(12:01):
that doesn't reflect this bigger picture, you know, the picture
of complexity of metabolic health and also what's happening with
your hormones. But just taking for a moment these challenges
that we're experiencing. I just was reading a recent paper
showing that depression right now is that anxiety psychological distress.
(12:27):
So these numbers are higher than we've ever seen before.
And before the pandemic, we had a number of surveys
that were published looking at, okay, well, what's going on
with metabolic health in the US, and we found that
only twelve percent of Americans are metabolically healthy. Twelve percent,
I mean, that is so low. And what we've noticed
(12:50):
during the pandemic is that it's those folks who have
a problem with metabolic health that tend to do the
worst with infection with COVID. Now, tell us what you
mean by metabolic health. Such a good question. So metabolic
health the way I think of metabolism, if we start
first with that term, it is the aggregate of all
(13:12):
of the biochemical processes that are happening in the body.
So a lot of people think about metabolism as you know,
whether you burn calories slow or fast, and that doesn't
quite capture it. It's much more complex than that. It's
looking at all the ways that you produce energy, all
the ways that you're mitochondria kind of the power factories
and yourselves work. It's the metabolic hormones such as the
(13:38):
ones that we've talked about already cortisol, uh, thyroid, but
the list includes a few dozen hormones like testosterone, growth hormone,
even estrogen, and balanced with progesterone insulin. But when it
comes to metabolic health, the way I think of it
is that it's the way that your body takes the
fuel that you eat. So whatever you had, say for
(14:00):
breakfast today, if you had a breakfast, and then convert
set into fuel for you. So some of us are
really good at that. Some of us are really efficient,
and so they feel kind of steady energy all day long.
They could even skip a meal and that's not a
big deal. But then some of us are not so
metabolically healthy. We're in that category where you have a banana,
(14:22):
for instance, and your glucose spikes way too high, like
maybe up to two hundred, and then it crashes and
you feel exhausted. So metabolic health is the ability to
use food as fuel to do that very efficiently without
a lot of symptoms. And some of the ways that
we measure it include looking at things like fasting glucose, fasting,
(14:46):
insulin levels, some of these hormones that we've talked about
senecas one hundred women to hear we'll be back after
this short break. You mentioned this briefly, but there is
(15:09):
definitely a weight benefit or a benefit of losing weight
when you engage in this type of lifestyle. So let's
talk about the role of hormones and metabolism in maintaining
a healthy weight. Can you briefly outline the components of
what you feel as a healthy diet for women and
what makes it different from the keto diets that we
hear much about. The key concept here is that food
(15:30):
regulates your hormones, and I think that's such an important
message if you learn nothing else today, I really hope
that she will come away with a concept about how
food creates the backbone of the hormones that you make,
and that includes carbonydrates that help you with detoxication. It
includes fat, healthy fat, which is the backbone of the
(15:52):
sex hormones, things like cortisol, estrogen, progesterone, testosterone. And it
also includes protein, which you need for repairing muscle, especially
if you're someone who exercises regularly. So I think the
key to think about when it comes to a healthy
weight and hormones and metabolism is to connect this relatively
(16:15):
new idea that food regulates your hormones. So to get
your metabolic hormones reset to get them back into balance.
There's three components that I came up with when I
was struggling with my own metabolic health, especially in my forties,
and I was struggling with a fasting glucose that was
starting to climb not to the diabetes range, but to
(16:36):
the pre diabetes range. And I found that the three
components that are really important our first detoxification. You've got
to have that in place first before you try a
ketogenic diet, especially in women. Number two, you then layer
in nutritional keytosis, but I've got some particular ideas about
how to do that. And then the third is intermittent fasting,
(16:59):
because intermittent fasting allows you to eat more carbohydrates, and
it's also a backdoor to keytosis. Keytosis is where you're
burning fat and you're creating that metabolic flexibility where you
can go back and forth between burning cards and burning fat.
So in your book you cover extensively the role of
(17:19):
a ketogenic diet and how your protocol works to create
what you call metabolic flexibility. Can you tell us more
about the role of a ketogenic diet in women's health.
I think when it comes to the ketogenic diet. You know,
why is it that I came up with this protocol
and wrote this book. Well, what I found is that
(17:40):
once again, the ketogenic diet was studied almost exclusively in men.
It was developed by a male physician over a hundred
years ago, initially for patients with epilepsy, and more than
eight of the research on the ketogenic diet and what
it does for metabolic health and also for your ways
sign is in men. And so I tried kind of
(18:03):
the male version of a ketogenic diet, and it was
an utter failure for me. So if I was feeling
at it, I imagine a lot of other women have
similarly failed. And I found that, you know, there's some
issues that get in the way, such as the need
for detoxication, the way that women tend to go into
a stress state more easily than men do. I think
(18:23):
that's just a relic of fertility and kind of our
greater sensitivity as women to the environment. A lot of
women on keto will have difficulties sleeping because they're not
getting enough carbydrates to generate seratonin, which is that lovely
brain chemical that's involved in sleep. Appetite and mood. And
(18:44):
so there's some issues that women experience on the ketogenic
diet where I find that some women do fine, like
they don't need any help on classic keto, but I
would say the majority somewhere around of my patients do
not do well on classic keto. It needs to be
adapted for a woman. And what are some of those
(19:05):
key components that you suggest for adaptation. Well, the first
adaptation is to go through these pillars of the program.
So detoxication is the first pillar, and what I mean
by that is that you're having a bout movement every
single day. That's really important because classic keto tends to
(19:26):
reduce the amount of stool that you produce, and it
also if you restrict carbs too much, it's not feeding
those really happy, lovely, benevolent bacteria that you have in
your gut. You know, another concept that's really changed in medicine,
as we used to think of ourselves as these kind
of stable human beings without much change. As we get older,
(19:48):
you can either accelerate or decelerate the aging process, and
increasingly we're thinking of ourselves more as vehicles for the
bacteria that we have in our gut. It's kind of
an existential change in terms about we conceive of ourselves.
But when it comes to detoxification, this was really the
missing piece for me when I failed keeto the first
couple of times. So really focusing on a daily bowel movement,
(20:12):
getting sufficient vegetable based carbohydrates so that you're able to
detoxify and support your liver, and that includes some additional
nutrients that you can get from food, such as B vitamins,
methylating vitamins that help you to inactivate estrogen. The whole
idea with estrogen news you want to use it and
(20:32):
then you want to get rid of it. You want
to poop it out and pee it out. So detoxification
is one of those components. The nutritional ketosis. It's a
little bit more detailed, but it's basically a high fat,
moderate protein, low carbohydrate diet, but you have to be
careful with women that the fat is not too high
(20:53):
and that it's mostly plant based fat. You want to
make sure the protein is sufficient so that it's enough
to maintain in your lean body mass, especially those of
us over the age of forty, and then you want
to make sure that the carbs are high enough that's
you're you're able to get some of those benefits that
we talked about, like making the serotonin and feeding the
(21:15):
gut bugs, but also keeping your thyroid in check, because
if you restrict carbs too much, that can actually raise
this intermediate hormone called reverse T three and it can
block thyroid function at the level of the receptor. So
those are some of those components. I'm so glad that
your book includes a very detailed eating plan as well
(21:37):
as really great recipes, so I highly recommend that in
addition to the eating plan. Are there other basic components
to maintaining metabolic health? Oh, there certainly are, So you know,
I like to start first with food because I think
that's the biggest needle mover. You know, when you think
about your metabolic health, I would say somewhere around seventy
(22:00):
to of it relates to your food. Food is such
an important source of information for your DNA as well
as for the microbes in your gut, as well as
for your hormones. So I would say food first. But
once we get the food dialed in, there's exercise, mindset, sleep, stress.
(22:20):
I'm sure there's some other's love purpose meaning, but I
think it's really important to realize if we start first
with exercise, that a lot of us don't exercise in
a way that is consistent with the latest scientific information.
And I would raise my own hand here because up
until about five years ago, I was kind of a
(22:43):
cardio addict. I would just get on the elliptical, get
my New Yorker, and just go to town, you know,
for thirty to sixty minutes. And what we now know
in terms of cardio metabolic health and really keeping your
your system supporting you, is that you want about two
thirds weight training and one third cardio. That's really the
(23:06):
combination that works the best, and people can build up
over time. And with mindset, I would say this is
where healing comes in. You know, there's a lot that
we can do in terms of managing tactically your hormones
and getting your hormones into balance, dialing in your food,
maybe using the continuous glucose monitor, but there has to
(23:27):
be a healing growth mindset, one that is continuing to
generate what we think of as neuroplasticity in the brain
as you get older. That's especially important after the age
of forty for women, because we know that neuroplasticity starts
to decline, especially as the primary regulator of the female body, estrogen,
(23:50):
begins to decline. So it tends to to go down
sometime around age forty three to forty five, and that's
where women about women start to notice this slowdown in
terms of brain function. And so I really want to
encourage our listeners to be thinking about this healing growth mindset,
to be thinking about exercise as well as how you
(24:14):
dance with stress, especially as we're thrown extranally so many
things during the pandemic. And then sleep. I would say
sleeps is a close to a panacea as we have,
so I would say sleep is a really important place
to focus. Well, this is obviously a lot to take in,
but once you do take it in, you start asking
(24:34):
more and more questions. And that's why we're so excited
to have you on the show. But Sarah, I really
want to just thank you for your work and what
you're doing. It's really changed my life already, and I
hope it will change the lives of many many listeners. Well,
thank you so much, Kim. It's been such a delight
to hang out with you and get to know you
and to witness this unfolding that you've experienced with your
(24:57):
own health. Thank you, thanks so much for joining us. Thanks.
We are so lucky to be able to share this
helpful advice from Dr Sarah Godfried. Here are some of
the key concepts from today's conversation. First, it's important to
look at women's health through a uniquely female lens and
to acknowledge that how we diagnose and treat women needs
(25:21):
to be different from the way we diagnose and treat men.
Women's hormones are different, our metabolism is different, and how
we react to medication and even food is different as well. Second,
as we've heard, a healthy metabolism is the key to
good health, and maintaining that healthy metabolism requires thinking about food, exercise,
(25:42):
and sleep in a new way. It's not just about
what you're eating, but it's about when you're eating it.
Of course, exercising regularly, but how you exercise and when
you exercise matters, and getting enough sleep is also key.
Will drill down into the specifics with Dr Sarah in
the next episode. Finally, it's important to be aware of
(26:03):
how food affects our health. Food regulates hormones. According to
Dr Sarah and the eating plan that works well for
a man will often fail for a woman. But when
women get the right balance of healthy fats, proteins, and carbohydrates,
we can reset our metabolic hormones and maintain a healthy
and happy lifestyle. In our next episode, we'll go even
(26:25):
deeper into what metabolic wellness means for women and how
to make the most of this new approach to women's health.
Thank you for listening, and please share today's podcast episode
with others in your life. This is Kim Azarelli, co
author of Fast Forward and co founder of Seneca Women.
To learn more about Seneca Women, go to Seneca Women
(26:45):
dot com or download the Seneca Women app free in
the app store. Seneca's one hundred Women to Hear is
a production of the Seneca Women podcast network and I
Heart Radio. Have a Great Day. For more podcast us
from I Heart Radio, check out the I Heart Radio app,
Apple podcast, or wherever you listen to your favorite shows.
(27:07):
H M HM
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