127: How Women Actually Heal: Nervous System, Vitality, Hormones & Pleasure with Dr. Sara Gottfried Szal

Episode Transcript
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Dr. Sara Gottfried Szal (00:00):
We experience more trauma at an

(00:02):
earlier age, more sexual trauma.We're 14 times more likely to be
raped than men. And then thethird is a little more selfish.
Just finding that in my ownexperience, even as a physician,
as I've struggled throughdifferent stages of life.

Kate Northrup (00:17):
I am so excited for today's episode. It was
really, really special because Igot to spend the entire day in
the home of Doctor. Sarah Gottfried Saul, who's the author of
The Autoimmune Cure and alsoWomen, Food, and Hormones, and

(00:39):
many others. She is agroundbreaking women's health
doctor who really understandsthe connection between our
traumas, our emotions, and ourphysical health. The part right
at the beginning of the showmade me emotional because I
asked her why she cares sodeeply about healing women's

(01:02):
bodies, and her answer reallysurprised me and was actually
incredibly personal to me.
So you'll have to listen in tofind out what that was. We
talked so much about hormones,vitality, fertility, both
literally and metaphorically. Wetalked about boundaries, over

(01:24):
functioning, how to let go ofthat, how to have better sex,
more orgasms, how to live ajuicier life on so many levels.
So this episode is a reallyspecial one. It was really
meaningful for me personally,from a legacy perspective around

(01:47):
women's health and I know youare going to love doctor Sarah
Gottfried Saul.
Welcome to Plenty. I'm your hostKate Northrup and together we
are going on a journey to helpyou have an incredible
relationship with money, time,and energy and to have abundance

(02:10):
on every possible level. Everyweek, we're gonna dive in with
experts and insights to help youunlock a life of plenty. Let's
go fill our cups.

[voiceover] (02:23):
Please note that the opinions and perspectives of
the guests on the Plenty podcastare not necessarily reflective
of the opinions and perspectivesof Kate Northrop or anyone who
works within the Kate Northropbrand.

Thank you for being here, Sarah. Well, at your
house. On my podcast. I'm sohappy to be here.

So good.

Thank you. Thank you for your work. I'm so
excited to dive in. So my firstquestion is, what is it about
women's health for you thatmakes you inspired to keep going
deeper and deeper and serving onthe level you serve. Why do you

(03:05):
do this?
Three things. The

first is your mom. I have to say, I
was I was in college in theeighties, and she had a PBS
special where she was talkingabout women and women's health
and the objectification ofwomen, kind of the ultimate
objectification when they're onan operating table and can't
even speak for themselves. And Ifelt like she had a way of

(03:33):
talking about women and women'shealth that deeply inspired me.
Got me to go to medical school.Wow.
So that was number one. Numbertwo is just the the health
hazard that it is to be femalein our culture right now. And
some of those are sexdifferences, things that are
biological, but a lot of themare socially constructed. The

(03:55):
way that we have more emotionallabor, we have more stress, We
experience more trauma at anearlier age, more sexual trauma.
We're 14 times more likely to beraped than men.
And then the third is a littlemore selfish. Just finding that
in my own experience, even as aphysician, as I've struggled

(04:17):
through different stages oflife, that I was dismissed by
our health care system. Evenwith all the effort that we've
put in

Yeah.

Over the past thirty plus years that
I've been practicing, in someways, we're worse off. And so
that that's what gets me to jumpout of bed in the morning. It's
got that, you know, that feelingof, if I'm being dismissed, if
I'm being gaslit, and I'm aphysician, then there are
millions of women that are stillbeing dismissed and gaslit. It's

(04:49):
insane.

I as It is. As a nonphysician, as someone who was
raised by two of them, the veryfew experiences I've had in the
traditional medical system, youknow, both of my births and
since my husband has had avariety of accidents and
injuries, and I go in there, andI am, I mean, I am such a pain

(05:12):
in the ass, and like with thebirths, I was coming in in an
ambulance with my first birth,telling them no to everything,
No, I wouldn't let them put anIV in me. No, I wouldn't,
whatever. You know, all of thatwhile I'm ten centimeters,
pushing into the whole thing.And I'm like, if I am having
this much trouble advocating formyself with the depth of

(05:34):
knowledge and the courage that Ihave and the galvanization that
I have, women are fucked.
Yes. Like, how is this possible?And so when you say in certain
ways it's gotten worse, can youtell me more about that, what
you're seeing?

Well, there's so many ways that it's
worse. I mean, we've known aboutwomen being dismissed and gaslit
for a long time. And I evenremember going to the doctor
with my grandmother. Andsometimes my grandfather would
come along, and I remember thephysician speaking directly to
my grandfather. We think sheshould take this medication.

(06:15):
We think that she should stopdoing this. She's got a heart
condition, and so here's whatwe're gonna do. Right. As if she
wasn't even there.

Talking to her about her in the third person.

That's right. So I witnessed that
growing up. And now I look atthings like women 40 going
through perimenopause andmenopause. What I see is that
the knowledge gap has actuallygotten worse. The research gap,
we hope, is starting to close,but the truth is it is

(06:45):
incredibly slow.
Most of the funding still goesto mens health, or it funds
research that includes men, andthe data are assumed to apply to
women until proven otherwise.

Which we really have no idea. We have no idea.

And, you know, what I what I see now
is that women going throughperimenopause menopause, seventy
three to seventy five percent ofthem don't get the care, don't
get the treatment that theyneed. Yeah. So that has has
worsened. And then I would saymore related to cultural

(07:21):
changes, like what's happenedwith our food supply, what's
happened with Mhmm. Toxicexposures that women get more of
because we we use more skincareand more makeup.
Women now have a rate ofautoimmunity that has
skyrocketed. So I wrote aboutthat in my latest book, but I I
think that's one of those areasthat's worsened. And some of it

(07:45):
is biological. So some of it isrelated to having an X
chromosome. We tend to reactmore to vaccines and to
infections.
We go through things that mendon't go through, like
pregnancy, postpartum,perimenopause, menopause. But
then there's also thesesociocultural differences that

(08:05):
we can do something about.

Yeah.

And that includes, you know, the
greater emotional labor, morecaregiving, more there's a way
that we're expected to be allthings. And we often
overfunction, overwork, overcareat the cost of our own health.

Yeah. So what do you think for women? A lot of
women in our community arearound my age? You know, just
like kind of the way it goes.Right?
And we have you know, 35 to 55is kind of like the the range,
but many of our folks have justsort of, like, come along and
grown up with me. And so and soI'm wondering you know, my

(08:46):
girlfriends and I are talking alot about perimenopause, a lot
about all sorts of things. So Ihave a bunch of questions for
you. And so that, you know,hopefully, at least whoever's
listening to this can help closethat gap of that seventy three
to seventy nine percent orwhatever you said of not getting
the care that they need.

Right.

First question is this. What can we be doing
during our reproductive yearspreventatively to really set us
up for the best experiencepossible in the transition from
perimenopause to menopause?

I love this question because I've got
two younger sisters, and andthey asked me that question as I
was going through my training.And I I really appreciate it
because when you're in yourreproductive years, there's a
way that you or at least I did.I thought about menopause as
being this cliff I was gonnafall off of, like, after 50. So

(09:42):
I didn't even think about it.Right.
Like, it just wasn't even aconsideration. But it's during
your reproductive years that youwanna be tracking stress and not
just a subjective feeling aboutit, but measure that cortisol.
Get a sense of the balancebetween your sympathetic nervous
system, the on button, and yourparasympathetic nervous system,

(10:04):
the, you know, rest and digest,feed, and breed part of your
nervous system. So heart ratevariability is a great way to
measure that. Yeah.
Looks like you've got a ring on

where you're measuring it. And I wanna ask
you about HRV because mine hastanked in the last year, which
is weird because I actually feelso over so not basically, like,
before July of this past summer,I was sick nearly every single
month for a year and a half, andI've done a lot of work on that.
And I am proud to say I have notbeen sick since July.

Oh, good.

Yeah. I feel amazing. I feel like the best
ever, and yet my HRV is stilllower than it was the entire
year previous. I'm like, is ithaving an aftershock? And I was
talking to my girlfriend aboutit last night, and she was like
I was like, what do you do aboutthat?
And I'm like, why is that? Andshe's like, because you're
stressed. And I'm like, Youknow? And and my friends

(10:59):
wouldn't say if they weretalking about me, they wouldn't
be like, oh, Kate is such astress bucket by any means. I'm
so happy.
I love my life and whatever. SoI'm like, what do I do? So what
do I do?

There's a lot to do. So this is where I
get excited, Kate, because whenI work with patients, when I
work with clients, like, theseare the kind of experiments that
we do

Yeah.

Where I I'll take someone, as you
described, with a lowish heartrate variability, or maybe
you've got a baseline frombefore July that was better. And
now you see that there's a trendgoing the wrong direction. Yeah.
There's a lot of things that canaffect heart rate variability.
So that, you know, that thosetwo halves of the autonomic

(11:45):
nervous system.
I think of the sympatheticnervous system as fight, flight,
freeze, fawn, and then stay andplay is the parasympathetic.

Stay and play one.

I like it too.

But I also heard you just say feed and breed, and
I I don't know that I've heardthat before. So I like that

one too. We like all

of it.

And, you know, what we want it's not
that you wanna stay in one orthe other. You but the healing
happens in the parasympathetic.And so you want this fluid
balance between the two. And,ideally, kind of a fifty fifty
split between the two. And withwearables like an aura, you can
actually track that.
Yeah. The number one mostpowerful thing I've seen with

(12:25):
heart rate variability isalcohol. Oh, I don't drink. But
for other people, this is good.So for you, this

just an listen up. She just said the number one
thing she sees is alcohol, and Ithink that's a really important
thing to mention because wedon't need to get into it today.
But, like, obviously, it is soembedded in our culture as just,
like, okay. And for so manyreasons, it's not great for our
health. It's not great for ouremotional lives.

(12:55):
It's not great for really manythings. And now you are telling
me it is not great for ournervous system, which makes
perfect sense. So even thoughthat's not my thing, I'm glad
you said it.

It's especially bad for women. There
are, you know, hormonal factors,other issues that make women
more more vulnerable Yeah.Toward alcohol. Yeah. And then
what we see from the data isthat one or two servings of
alcohol can affect your sleepfor seven to eight nights.

(13:27):
And so the way that it impactsyour heart rate variability

So if you're drinking even every week, you're
never sleeping.

Right? So a lot of people, you know,
they'll just drink on theweekend. So it's it's got this
really important global effect.What I like to do is to notice
when is your heart ratevariability improved.

Mhmm.

So for instance, when I go to Costa
Rica, my heart rate variabilitydoubles to triples.

That sounds so nice. It's really lovely.

I can just I can feel it in my body

right now.

May need to try the experiment.

Great. Maybe the Costa Rica experiment?

Yeah. So I've got a retreat there in
July. Okay. There's something Ithink there's something just so
alive about the

Yeah.

The land and, you know, 3% of the
biodiversity in the world isthere. So I I always like to
notice these geographic changes.So when I go to high altitude,
Mexico City, Denver, my HRE ishorrendous. Yeah. Horrendous.
Sense. So we wanna be watchingthose kind of things. I find,

(14:31):
for instance, when I microdoseon mushrooms, that my heart rate
variability is greatly improved.

Oh, really? Yes. That's cool. Okay. Noting that.
Thank you. Putting it on the

list. It's an immunomodulator.

Yeah. I've done a little bit of that, but not in
any sort of organized fashion,and so that's good. That's good
to know. Yeah. So for did youjust say?
It's a

It's an immunomodulator.

It's an immunomodulator.

Okay. So it can modulate your the
matrix of your body, you know,not just creativity, not just

I know that we're gonna come back to your list
because I really want it. Butwhy do you think that is about
mushrooms just from, like, on aspiritual energetic level? Oh my
gosh.

Love that question. There's a a more
science based answer, which Ican get to, but in some ways
that's less compelling to methan the personal experiences
that I see people have withmushrooms. So mushrooms,
psilocybin in particular, it'sone of those, sacred medicines

(15:32):
that I think my experience of itis that it comes into my system
and it cleans. Mhmm. And ithelps open Yeah.
My channel so that I really feelenergy flowing through my
system. And I know that sounds alittle Northern California. But
it's

that's right on point for this show. It connects
you to oneness.

Yeah. It connects you to this
micellial network so that youdon't feel as alone and isolated
and like you're pushing the rockup the hill. It connects you to
higher purpose to a mysticalstate. Yeah. And the idea with
microdosing, different thanmacrodosing, is that you're
taking just a small amount,enough to connect to that web.

(16:22):
Right. And I really feel that.

Yeah. Right. So it's almost homeopathic in a way
of like, okay. There's anenergetic signature. I mean, of
course, I don't know that thisis scientific, but there's an
energetic signature that you're,taking that then is is shifting
the matrix of your body thatthen is making that connection
while you're still able tooperate heavy machinery and, you
know, go

on phone

calls and whatnot. Okay. Great. Thank you.
So microdosing.
So coming back, you were we weyou were listing out about HRV.
Is there anything else that youmight say would be helpful for
folks who are reallyexperiencing those lower rates
than they would like to see withtheir HRV?

Look at your relationships. So I've
tracked my HRV for about fifteenyears. And I can tell you when I
was still married and mymarriage was falling apart Yeah.
My heart rate variability was somuch lower.

That makes so much sense. Yeah. And how wild
that we can track those thingsnow. Right? Like, you know, in
previous decades, of course,people could feel that on some
level, but to just be able tohave the data.

To have the data and even one step
further, there's a apsychotherapist that I really
enjoy, Stan Tatkin. And he talksabout the psychobiology of
relationship. I've had thisexperience with a couple of of
friends who were on the cusp ofdivorce and trying to figure out
if they should stay. And they'vemet with him, and he observes

(17:52):
the psychobiology of theconnection. And he can see
things like the stress response,the lack of repair that happens
when you're talking aboutsomething conflictual.
The, I don't think he's trackingblood sugar, but I am. Yeah. And
so low heart rate variability,more difficulty with sleep, not

(18:16):
feeling fully recovered when Iwould sleep at night. And you
can measure all of these things.And I and my physiology was
different different.
Blood pressure was higher.Resting pulse rate was higher.
My, blood sugar was about 10points higher.

Mhmm.

So I would say assessing your
relationships is important.Sounds like you're very happily
married.

So I don't know that's married for sure. And,
you know, there's somethingabout also mothering young
children. Yes. I mean, my kidsare freaking incredible, and
they're six and nine. So at thispoint, they're much easier than
they were, but it's a lot.
And then also just that I rightnow, I don't I live in a place

(19:00):
that is, like, very intense.

Yeah.

And when you were talking about geographically,
like, there's just a lot ofenergy in my neighborhood. It's,
like, really urban, and I justdon't like it anymore. So that
may be a factor. Thank you forhelping me identify that.

Okay. So when I think it's also an age
issue. So you were asking aboutreproductive years.

Yes.

And there was this really
interesting study that wasperformed by Arthur Stone, and
they call it the u bend. It waspublished in The Economist. What
he did was he did a a survey ofAmericans in The United States,
and he asked questions relatedto psychological well-being. And

(19:44):
what he found is that amongadults, psychological well-being
is really high in your twenties.And then it starts to dip in
your thirties

Uh-huh.

And your forties. And then it starts
to come up again before you turn50. Interesting. Called the u
bend. And when I read about thestudy, I just was like, thank
god someone understands what I'mgoing through.
Like, I'm in the u bend. I'm in

the nadir. Wow. And and and what do you chalk
that up to? What's going on inour thirties and forties that
would account for lower rates ofpsychological well-being? I
mean, I have plenty of ideas,but I wanna know.

Well, maybe we could riff together. I
think, you know, they did lookat parenting to see if parenting
was the cause. I think there areunique challenges that you
experience with parenting, butit it's not just parents. No.
Because some

people aren't parents, I'm sure, who are in
this

study. Right. Right. So I think a lot
of it is, you know, identity andtrying to understand your gifts
and how to share your gifts withthe world. I think there's the
experience of caretaking, so notjust kids, but, you know, maybe
your parents.

Maybe your parents. And then those are also
such big earning years. Right?So there's like that.

There's a lot of pressure.

Career, this is the time. Totally. Make hay
while the sun shines. Totally.You know, in your twenties, it's
sort of like, anything'spossible.
And then, you know, it's like 30and 40 are those years to really
go career wise, at least, youknow, in our societal
conglomerate. And then thefifties, yeah, would be more for

(21:25):
some people, of course, not foreveryone, but a little bit more
of a coasting.

For sure.

Right? Or beginning to be more in your
coasting years.

Yeah. I mean, you think about just
dating.

Or your harvest years, I should say. Yeah. I

how old were you when you got married?

31.

Yeah. So I was And I

had my first baby at 30, I don't know, 32, 33.
Yeah. Something like that.

Yeah. So I was the same. So my
twenties were, like, full offun.

Yeah. Lots of fun. Big adventure.

Medical school, but otherwise, lots of
fun.

So it doesn't sound fun.

True. And then your thirties, you're,
like, on task. Like, let's getthis show going. Let's find the
partner, the life partner. Yeah.
Right? Right. And how does thatfit with a career? The stakes
are higher.

The stakes are higher. Yeah. Well, I mean, just
the experience of, oh, wow. NowI'm responsible for the
well-being of this and thesurvival. So first the survival,
then secondarily the well-beingof this tiny human, and I don't
know what the fuck I'm doing.
You know, I thought, justbecause I wanted to have kids, I
thought I would naturally feellike I knew what I was doing.

(22:31):
That was not my experience atall. It just like, ah, which
does transition me to ourconversation that I wanna have a
little bit about hormones eventhough that's a bit of a left
turn. But I wanna hear aboutwhen do you think during our
reproductive years is a goodtime to start tracking our
hormone panels so that we cansee changes, and then at what

(22:56):
point might adding in some HRTbe useful and helpful?

So, of

course, obviously, it's super
individual.

But Well, I think I think you can
say generally that you wanna doa baseline. Yeah. You want a
really good baseline, especiallywhen you're feeling fantastic.
So whether that's in yourtwenties or your thirties, get
an impeccable baseline. Like,look at thyroid, estrogen,
progesterone, testosterone.

(23:24):
Look at cortisol. Yeah. Look athow you're handling stress and
how it's moving through yourbody. Maybe look at anti
mullerian hormone, which is oneof those hormones that tends to
go down as you start to run outof ripe eggs. So get a really
good baseline.
And I would say the sooner, thebetter. You know, one baseline

(23:46):
is good. A couple are evenbetter. It's good to have two
points on the line to get asense of where you were. But
this is critical later as youstart to move toward hormone
therapy or you start to useherbal treatments like cheese
tree as a way of modulating yourprogesterone levels.

(24:07):
So having a baseline, I wouldsay, anytime in those
reproductive years is reallyimportant. Great. And then with
hormone therapy, I was justtalking to my publisher and my
agent, and they were both sayingthat, as women in their mid
forties, that when they listsome of the symptoms that

(24:27):
they're experiencing, which tome are clearly perimenopausal,
there's a 100 plus symptoms, andthey have them, Their doctors
are like, oh, no. You're tooyoung to have perimenopause.
You're too young.
And I'm just like, what? Why isthis still happening? Yeah. So
there's an overlap between yourreproductive years and your
perimenopausal years. Quite abit.

(24:49):
So we wanna be thinking aboutthat Yeah. Through the process.

Yeah. So one of the things that I have heard
that I think has been a shiftover the last decade in the
research is that actuallybeginning some bioidentical
hormones earlier can actuallyenhance our longevity, enhance
our long term, even fertilityperhaps, and certainly just,

(25:13):
like, make us feel better.Whereas before, I felt like word
on the street was a little bitmore wait as long as possible so
that you don't talk your ovariesout of doing their job and don't
make them essentially, like, goto sleep too early. I'm what do
you think about those things?

I think the evolution is correct in our
thinking about this. So I wouldsay I would be a little more
circumspect about the way itused to be Yeah. Which was wait
until you're having hot flashesand night sweats. Yeah. And then
we'll give you probablysynthetic hormones, maybe
bioidentical if you reallycomplain about it.

(25:52):
And that was the main thing thatwas treated.

So Hot flashes and night sweats.

Hot flashes and night sweats. So
that was considered the mostevidence based indication for
starting hormone therapy. Sowhat we realize now as we know
more about the biochemistry ofthis transition that women go
through, we know more about therole of the mitochondria, which

(26:18):
are, you know, we think of themas the power brokers inside of
your cells. They generate ATP.They generate energy.
They convert the food that youeat into the energy that you
feel during the day. We thinkthat in the in the female body,
we know that, your eggs, youroocytes have the highest

(26:41):
concentration of mitochondria.And so the place that you start
to feel it first is in yourmitochondria. So mitochondria in
your eggs, as they start tobecome more impaired, as you get
older, you get exposed totoxins, or you've got too much
cortisol, we think that estrogenis a really critical factor for

(27:02):
keeping your mitochondria young.Okay.
So that's part of the bridge forwhy we wanna intervene sooner.
The other thing that I wannathink about is with these 100
plus symptoms that women have asthey go through perimenopausal
menopause, one of the key onesis sleep and sleep disruption.

(27:23):
And women may not perceive thatthey have hot flashes and night
sweats, and yet their sleepbecomes disrupted. If we're not
treating that early, it canbecome a pattern that is very
hard

to correct. Right. And then that's almost,
because as your sleep getsdisrupted and you're long term
sleep deprived, then that'sgoing to create all these other
symptoms.

It accelerates the aging process.
It makes you more likely to bedepressed. Yeah. Makes you less
interested in exercise.Terrible.
Makes you crave carbohydrates.Your insulin goes up. You start
to store more fat. Yeah. On andon.
Yeah. So, yes, we wanna addressit as early as possible. So I
might have a woman who's 35.She's got progesterone that's

(28:10):
starting to decline. Mhmm.
I'm gonna use some progesteronein that case. Okay. Or offer it.
Yeah. We'll have a collaborativediscussion about it to see if
that improves sleep.

Yeah. Absolutely. That's great. And then what are
some things? Because regardlessof whether somebody wants to
actually get pregnant or not,there's such a huge connection
between just vitality and lifeforce and energy levels and our
fertility.
So I think, my humble opinion isthat women should be actually

(28:42):
doing all the things that fitinto their lifestyle to support
their fertility more on ametaphorical level. And,
obviously, because from ascientific perspective, it is,
creating that strong foundationfor longevity and vibrancy. And
so given that, what can we bedoing to support our egg quality

(29:05):
whether we are wanting to getpregnant or not in certainly in
our reproductive years, but thenalso as we're making that
transition more intoperimenopause, you know, past
40?

That is exactly the right question.
Like, how do we support our eggquality, our the aging process
of the ovaries? Yeah. And so Ilike that.

How do we support the aging process of the
ovaries? That feels really nice.

Yeah. Yeah. And it's and you're right.

Not anti anything. It's like supporting
the process.

That's right. Yeah. And I I think
what's important to know aboutis the things that are working
against you. Mhmm. So thatincludes being a stress case,
having too much cortisol, havingtoo much sympathetic nervous
system activity relative toparasympathetic.
It includes overeating certainmacronutrients like

(29:57):
carbohydrates. It includesunderconsuming micronutrients
that you need for all of theseprocesses in the body, things
like magnesium, vitamin D,glutathione. Mhmm. It includes
this is gonna get more into yourrealm. It includes understanding
self efficacy

and

and getting a sense of, okay. These
things are not happening to me.They're happening with me and
for me and through me. How can Ipartner with spirit in a way
that I feel like I'm invokingyour mother here? How can I
partner with spirit in a waythat allows me to move forward

(30:40):
with clarity and with theyoungest eggs possible?

I love that. It's so beautiful. Yeah. Because our
eggs are metaphors for ourcreative life force. You know?
They are the living embodimentof that.

That's right.

And so and, you know, like, conception is a
freaking miracle. Right? And soto have all those living
potentialities inside of usthat, you know, have existed
since four months gestationinside our mothers, inside our
grandmothers' bodies is such anhonor. It's such a miracle. So I

(31:20):
love that you're bringing inthat psychospiritual aspect,
that partnering with the divineto say, like, what am I here to
create, you know, living orotherwise?

That's right. And I would even let's
add another layer. Great. I feellike some women, probably
because of our disease caresystem and the way that, we've
set it up the wrong way, a lotof women look at these symptoms
that they experience or start toexperience 35, forty, forty

(31:50):
five, irritability, the moodswings, the, maybe dryness of
the vulva of vagina, not havingthe energy that they once did,
they do look at some of thosethings happening to them. Right.
And I think if we shift the waywe hold these symptoms and see

(32:14):
them more as an initiation and aspiritual process where we're
meant to wake up, I think thatreally changes the way we
approach it. Yeah. Right.

They're an invitation from our bodies being
like, hey. What about this?Yeah. Maybe lean in here. You
know, last year, I verybizarrely lost my hearing in my
right ear, and there were anumber of reasons for it, but I
just it wouldn't come backregardless of what I did.
It eventually did. But and thehilarious part was I went to the

(32:47):
audiologist, and I sat in thatbooth and did the whole thing.
And I came out, and they werelike they were like, clinically
speaking, your hearing isperfect. Yeah. I was like,
that's weird because I can'thear.
Anyway, so but I kept asking. Iwas like, alright. Well, if my
body is not having me here outof one full side of my head,

(33:08):
surely, I'm being asked to, youknow, listen inside. So I just
kept saying to my body, hello.What do you want me to hear?
What do you want me to hear? Andit was it sucked, but it was
also great, you know, because Igot some really strong messages
and invitations.

And What did your body want you to
hear?

So the two things I kept hearing were, like,
inside, were bloom where you'replanted and stop fucking around.
And so for me, what that meantwas I I had this I have this new
book that I'm working on that Iwas really dragging my foot feet
on and getting myself distractedby a million other projects and

(33:50):
shiny objects, which is reallymy kryptonite in this lifetime.
And so it was just that. Andthen the other thing that I was
distracting myself with from thework that I was really supposed
to be doing was, thinkingconstantly about moving and
obsessing over real estatelistings. Amazing.
What a time sink that is. Wow.And and my husband, you know,

(34:10):
god love him. He was like he waslike, babe, you are not allowed
to send me any further homes viatext until you've written your
book proposal. Once you'vewritten your book proposal, I
would love to talk to you aboutour next step and our next move
from our fam for our family.
But until that time, do not sendme another home.

That's so loving. It's a loving
boundary.

No. It is. Thank you for that. Thank you for
that. Okay.
So egg quality, vitality,hormones. I also wanna know what
are so so at this stage of thegame, like, as you are this
world's leading expert on experton women's health, what are you

(34:52):
excited about in terms of newfrontiers for women's vitality
and thriving?

Oh my gosh.

What should we look forward to?

Oh, so much. You know, I feel like
here's what I notice. There's4,000,000 podcasts now.

Really?

Dr. Sara Gottfried Szal: 4,000,000. Wow. And some of the (35:10):
undefined
guys that I enjoy listening tothe most are Andrew Huberman and
Peter Attia and even Joe Roganoccasionally. Mhmm. And there's
there's a way that they'regiving bro advice.
Mhmm. It's what they know. Yeah.They're bros. They're bros.

(35:33):
They're talking about datathat's mostly in men. They are
not calling out when it'sdifferent in women. They're not
saying, okay. All of this datathat we have on deliberate cold
exposure is in men, and we havevery little data in women. So I
feel like what I'm excited aboutpersonally is really

(35:56):
understanding health span andlongevity Yeah.
From a female perspective. Sothat I'm super excited about.
I'm excited also I mean, thissounds a little bit warped. When
we think about the nadir, whenwe think about this u bend, I
want solutions. I want realsolutions, and I wanna work
together with other women tocome up with how do we say to

(36:21):
the woman who's overfunctioning,who's overworking, who's
overextended and burnt out andsay, darling, here's what
actually works.
Here's what works in women.Here's what's been studied. You
don't have to be part of some,you know, uncontrolled medical
experiment like we keep doing towomen over and over again.

(36:42):
Here's data that actuallysupports and points us in a
direction

Mhmm.

To help you. Yeah. So that's what I'm
excited about. I'm also excitedabout launching a podcast, doing
that again. Congratulations.
I'm super excited. Excited tohave you on it. And I I feel
like there's a way that you caneither pontificate on a podcast
and sort of have peopleeavesdropping in, which is kind

(37:09):
of a masculine way to do it.Mhmm. Or you can take your
audience with you Yeah.
Which is what you do in yourpodcast. And that's a very
different form of service.

It is a different form of service, and I'm so
excited for you to be doingthat. And I have a couple of
questions. One is, are you goingto be writing that book on
health span and longevity from afor women?

Yes.

Okay. Great. Can't wait to read it. I will be
waiting with bated breath.

It's due in two months.

Oh, my oh gosh. Okay. So you're writing it right
now? Yes. Okay.
Okay. And then when we'll justhave you back on the podcast.
Perfect. If you'll let me comesit on your couch again, and
we'll talk about that. And thenmy second question is for you.
What was it that worked for youin your own life to stop
overfunctioning in that nadirthat you could say to a woman

(38:00):
like, this is what actuallyworks. This is what I did. This
is how I made that shift.

It's such a good question. Number
one, the whole body. Yes. So Ilearned this from a coach, Diana
Chapman, and she learned it fromGay Hendrix and his wife, I
think, Susan Hendrix. Katie.
Katie Hendrix.

I freaking love them. Yeah. Katie Andrix. On the
Internet. Right.
Haven't met him in person yet,but I'm looking forward to it.

Well, she was mentored by them. Mhmm.
And this idea of a whole bodyyes, I think this is foreign for
a lot of women. Yeah. The ideais that you don't just give a
cognitive yes.
Like, oh, yes. That sounds likea good idea. It sounds like it's
good for my family.

Goals. And how it would look and pleasing

the people. Right. Mhmm. You
check-in with your entire body.And so I was taught to check-in
with my heart, to check-in withmy gut.
Mhmm. But I would add, we alsohave to check-in with the vulva.

A 100%. A 100%. Or as mama Gina would say, the
pussy.

Yes.

Yeah. A 100% because, like, if that's where
life comes from, how could thatnot be the best place to make
decisions from?

For sure. And it's amazing what
truths come from the vulva.Yeah. So that was a huge for me.
That's great.
And what I realized is that I'vespent a lifetime up until a
couple of years ago saying apartial yes, saying a a lot of
cognitive yeses, and the andthen dragged the rest of my body

(39:36):
along for the ride. And that hasto stop. So the whole body yes
you know, you and I are atdifferent life stages. My kids
have just they're both out ofthe house. They're launched.
And that opens up a whole newportal. I mean, you think about
I think about, BKS Iyengar, howhe talks about, you know, kind

(39:58):
of being as an adult, you're astudent, and then you're a
householder, and then you're aforest dweller, and then you're
a sadhu, kind of a spiritualrenunciate. And so I'm in the
forest dweller phase. You're inthe householder phase. And so

(40:19):
really acknowledging that, myrole sort of day to day as a
mother has shifted.
Yeah. You know, I'm much more ofa guide Right. And, not quite a
peer, but our relationship haschanged. Not always the case.
You know, I still get emergencyphone calls.

For sure.

But that foresweller part, you know,
just really making sure that youdon't kind of continue the
householder way of working, andyou get very deliberate about
how you want your forest dwelleryears to be. Yeah. And for me,
you know, part of that was goingthrough a divorce, which was

(40:59):
really painful and messy anddifficult, but I stepped into
authenticity in a way that Ihadn't before. And I was taught
as a kid that you stayconnected. You don't get
divorced.
You hang in there, especially ifyou have children. You've got a

(41:20):
responsibility to your children.And I sacrificed authenticity
for connection Mhmm. And what Iperceived to be attachment, and
that doesn't work. That doesn'twork.
Really, you need both. You needsecure attachment and
authenticity. So that was a hugeshift. And then I think all of

(41:42):
this relates to boundaries. Sothose are the things that really
made a difference for me.

So good. I'm curious. I was at a conference
recently, and a bunch of peopletalked about the nervous system,
which I was really excitedabout. Except nearly pretty much
a 100% of those conversationswere still essentially, they
were talking about mindset work.Mhmm.
And I was like, Interesting howwe're talking about the nervous

(42:09):
system and yet keeping things onthe level of the cognitive

Right.

And the mind. And I was like, what about the body?
And so I'm so glad you talkedabout the full body yes as being
the compass because that is nota head down approach. That is
not like, let me check-in withmy mind. Let me be you know,
it's like there's so muchinformation available to us if

(42:36):
we go beyond the verbal, if wego beyond what we can even
articulate as a thought, youknow, that just deeper knowing.
And so I'm curious. When peoplerefer to the body as a meat
suit, How do you feel as awomen's health doctor, and what
do you think about when you hearthat?

Oh my gosh. Well, it makes me think of
Lady Gaga. Right? Oh, yes. Sherocked

the meets it. Forgot about

that. I

must say.

Yeah. Rebranded the meets

so weird and fabulous. It's so weird. Yeah.

Yeah. I really appreciate this question,
Kate. And I know you've beendoing some certifications
related to nervous systemregulation and trauma, and I so
appreciate hearing about that onyour podcast. And I feel like
that's that's part of what we'retalking about here in terms of
reclaiming authenticity andreclaiming a path that is less

(43:35):
about what your mind thinksneeds to happen versus getting
your whole body on board. Yeah.
And nervous system regulation issomething that I knew about
going through my medicaltraining. And when I was in
medical school, I used to go toKripalu as often as possible
just to practice yoga. I becamea yoga teacher. I teach

(43:56):
meditation. Love your meditationthat you have on your podcast.
Thank you. Beautiful. And I Ifeel like nervous system
regulation is so critical. Mhmm.And a lot of women, men too,
understand cognitively what thatis, but they don't feel it.
Right. They don't feelregulated, and they don't know.

(44:17):
And I I feel like a lot of it isI had this experience when I
started doing psychedelicassisted therapy of realizing
how dissociated I was. Mhmm. Sothat I was I spent most of my
time upstairs Mhmm.
And with the cognitive approachand kind of dealing with my meat
suit. And it wasn't until Istarted to heal that and started

(44:38):
to learn how to do nervoussystem regulation that it
allowed me to just open up allthese drains of body wisdom, of,
spiritual wisdom. So I feel likethat is a really critical part.
Yeah. And this functionaldissociation that so many of us

(44:59):
have, you wanna ask yourself ifyou have that.
I mean, I know you don't. But

I mean, all listeners. Right?

Well, it's an old pattern.

It's an old pattern. And and when you come
through the world in familiesthat really are focused on
academic achievement, and then,you know, you're in New England
in school, and it's like allabout being celebrated for being
smart. Right. You know, andfiguring it out everything with
your mind. It you know, when Igot pregnant with Penelope my

(45:32):
first and then gave birth to herin that first year of her life,
none of my old tricks worked.
I couldn't get through thatchallenge by being smarter,
being stronger, trying harder,doing more. Like, none of those
things worked. And so it reallywas that invitation to say,
well, I need a different skillset here. Like, one that I've

(45:55):
has not been shown to me and hasnot been modeled, has is is
really not many places in ourculture, at least, you know,
where I was living and in the inthe part of the world that I was
I was in. So I appreciatecalling attention to that
dissociation and really feelingthe degree to which we over

(46:17):
celebrate the mind.

We do. And you're right. I mean, that
sort of mindset training andusing that as a path forward
never worked for me.Interesting. And I couldn't
think of my way out of theproblems that I had, especially
with overfunctioning.

Yeah.

It had to be this bottom up. Mhmm.
Like, I had to feel it inside,not up here, but downstairs,
like, in my body Yeah. To reallybe able to make change.

And so you mentioned, you know, you
mentioned yoga. You mentionedpsychedelic assisted therapy.
What are some of the other,like, downstairs practices that
have been really useful for youin I don't know. Maybe you
wouldn't say it this way, but,like, the reclamation of your
embodied wisdom.

Oh, I would say it that way. I mean,
definitely sex. Yeah. Orgasm.Yeah.
Female pleasure. Our bodies aremade for pleasure. Mhmm. And if
you're spending most of yourtime, including sexually
upstairs, it just doesn't work.So I think that's a huge part.
I've always been someone wholoves the outdoors. I spent a

(47:34):
lot of years in Alaska. I wentto high school up there, and my
parents lived there for twentyyears. So wilderness, like, it's
a place that I connect to spiritand to divinity very easily. So
spending time outside is reallyimportant.
Spiritual practice,relationship. It's so critical.

(47:54):
And I I love how you talkedabout mothering Penelope and how
your intellect didn't help you.And I I feel like that's that's
really true. That was one of thefirst places that I hit the
wall.
I felt like, yeah, there's athere's, like, a raw mammal

(48:14):
quality to mothering that's soimportant, and that never goes
away. Like, you don't you don'tmove past that. Like, there's
still it's such a, touch point,and it's so critical for them.
And then it also you know, thisthis is there's an unselfish

(48:36):
quality to this. I'll just sayit.
There's a way that my childrenhold me to a standard that is so
much higher Yeah. Than thestandard I hold myself to. So
what I expect what I want forthem, like, in terms of their
relationships and thesatisfaction that I want them to

(48:59):
have in their careers, what theyexpect from their friendships,
how they expect to be treated,how they develop secure
attachment. I have to bemodeling those things. Right.
Even now, even though they'reout of the house. Oh, yeah. So
it's I really appreciate, whatyou're saying about mothering.

Yeah. That is so true about and it's not even
like for in my experience, it'snot even like they're holding me
to a higher standard in terms ofany kind of, like, hierarchical
structure that we would haveexternally. It's that higher
standard of wholeness and fullliving. Yes. You know?

Dr. Sara Gottfried Szal: Authenticity. Yeah. (49:38):
undefined
Authenticity. Wholeness isexactly right.

Wholeness. Okay. So as we wrap up here, this show
is really about abundance, andand and in and I talk a lot
about people's relationshipswith money. You discussed HRV
and our overfunctioning and, youknow, the nadir, that dip of
over you know, the u, whatever uwas the study.

U The u Bend. Thank you.

Overworking, and so much of that is tied up for
women in our relationship withmoney. And so it's kind of a big
question, but answer howeveryou'd like. What do you see are
the impacts that ourrelationship with money has on
women's bodies and our healthand vibrancy?

Oh, it's such a good question, Kate.
So let me let me feel into itGreat. With a little bit at a
time. I feel like I used to havethe wrong idea about money. You
know, I felt like especiallygoing into medicine, I felt like
I need to have a stable careerand stable income, and I need to
sock the money away and the fourzero one k, and I need to have a

(50:44):
house and pay off my mortgageand have equity.
I thought all of those thingswould provide security and
safety, and it turns out theydon't. It turns out that safety
and security is an inside job.And I know that's easy to say,
but we are now finally at astage scientifically where we

(51:08):
can say, here's how you createsafety in the body, and here's
how you measure it. And we'vetalked about some of the
measures, like heart ratevariability and cortisol and
even, you know, estrogen,progesterone, testosterone. We
can actually we can definesafety in the body.
And I think the experience overmy lifetime of realizing how

(51:33):
unsafe I felt as a kid and howforeign the idea of safety was
until I really started to learnabout nervous system regulation,
that has been a gigantic gamechanger. And then it maps to
money because I used to think,you know, I just need to charge
as much as possible and, youknow, sock away this money and

(51:56):
be able to pay for my kids to goto college and maybe help them
buy a house. And now I realize,no, the security and the safety,
I could have that driving aroundin a van. Yeah. And it has the
same physiological effect.
So I've really changed the waythat I think about money as an

(52:19):
exchange of energy. But you'reasking a bigger question, which
is, you know, what do I see inwomen? I see a lot of women who
compromise their authenticity toprovide what they perceive to be
safety and security, and I thinkthat's that's a huge question.
They sacrifice their wholeness.They sacrifice their gifts

(52:41):
because they think they need tostay in a marriage that maybe is
dead, isn't working.
They feel like they need to stayfor the kids. Mhmm. So I I see a
lot of that. And then I also seevarious patterns of women who
maybe because they grew up witha feeling of lack, chase money

(53:06):
in a way that leads to, youknow, kind of a basic level of
overwhelm and overwork andoverfunctioning. But, also,
there's another pattern of womenwho are not appreciated and
still hang in there in arelationship that's not working.
And it's more of a neglectsituation. And then there's a

(53:29):
more advanced version, which Iprobably had, which was this
chronic state of overworkingYeah. And, and waiting until
your body objects with the lowheart rate variability, the
repeated infections, the thecortisol that never seems to get

(53:49):
better. So those are some of thepatterns that I see in the women
that I work with.

Thank you so much for saying that. I mean, I you
know, for you listening, I did Idid not ask Sarah to say those
things about money and safetyand the nervous system, but
that, I mean, that is the coreof what I what I'm here to share
at this particular time that Weneed to educate. Yeah. Without

(54:15):
the embedded embodied feeling,no amount of money is ever gonna
make you feel safe if you can'tfeel safe already. And then once
you do, great.
Add more money. Wonderful. Ornot. And the cool

thing is once you feel safe, there's
no going back. Like, there's noway you can tolerate Yes. That
lack of safety again.

That's very cool. Yeah. That compounding impact of
nervous system regulation.

Yes.

This has been just an absolute pleasure. I
think you're the best. Thankyou. Thank you for this
conversation. I know you haveyou have so many beautiful
books.
You have a new podcast out. Socan you tell folks where to find
you, where to connect if theywanna dive in deeper?

Well, I'm going through a name change,
so I'll mention that first. Iused to be known as Sarah
Goughried, and, I'm going backto my maiden name, which is
Sarah Zal, s as in Sam, z as inzebra, a l. So my website,
sarahzalmd Right. We justrebranded, and the podcast is
there. It's called treated withdoctor Sarah.

(55:22):
Those are the main ways.Beautiful. I hang out on
Instagram. That's a good placeto interact.

Great. Okay. Amazing. So find doctor Sarah
Zal, all the places. Thank youfor being here.
I really appreciate you. Thankyou, Kate. This episode is
brought to you by Glossy, whichis skin care you can drink. I
have been using and lovingGlossy for the past couple of
months, and it combines abeautiful blend of clinically

(55:50):
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