The Root Causes and Solutions for Women’s Hormonal Imbalances - Transcript

Speaker 1: Coming up on this episode of The Doctor's Farmacy. Dr. Sara Gottfried: I don't want women to just sit back and say, "Oh, my doctor checked my labs and said I'm just getting older." Don't settle for that. Don't be dismissed. There's so much misunderstanding about this. Dr. Mark Hyman: Welcome to Doctor's Farmacy. I'm Dr. Mark Hyman. That's Farmacy with an F-A-R-M-A-C-Y, a place for conversations that matter. If you've ever struggled with your hormones, especially if you're a woman, you should listen up, because we are having a conversation today about why our hormones go out of whack and how to get them back in balance, with none other than my good friend and extraordinary physician, Dr. Sara Gottfried, who's been an amazing functional medicine doctor for many decades now. She's a board-certified physician, a graduate from Harvard and MIT, no slacker there. She's practices evidence-based integrated precision and functional medicine. She's a Clinical Assistant Professor in the Department of Integrative Medicine and Nutritional Sciences at Thomas Jefferson University, and the Director of Precision Medicine at the Marcus Institute of Integrative Health, and she's written three New York Times Bestselling Books, including The Hormone Cure, The Hormone Reset Diet, and Younger, and her new book, Women, Food and Hormones is out and ready for you to consume, because it will help you change your life and get your hormones back in balance. So, Sara, welcome to The Doctor's Farmacy. Dr. Sara Gottfried: Thank you so much, Mark. It's so great to be with you. Dr. Mark Hyman: Yeah. So listen, we've been friends for a long time. We've talked about these issues a long time, but I think one of the things that struck me as a physician practicing at Canyon Ranch for almost a decade with women who were between 35 and 60, was the degree to which women suffer unnecessarily from hormonal issues or imbalances. Everything from menstrual irregularities to heavy bleeding, to PMS, to PCOS, to infertility, to perimenopause, to menopause and all the consequences of that. Dr. Mark Hyman: It just doesn't seem like it's their inborn birthright. It just seems it's something wrong and yet, most physicians do not understand how to address this and yet, you've really spent your life looking at this and do how we sort of normalize the problem instead of actually addressing it? Why we normalize if it'd be okay for women to have all this hormonal dysfunction and not actually get to the root cause of it? So, it's really not normal, 75% of women have some time of PMs and 85% women have some type of hormonal issues in their life. Why is this happening? Why has it been so normalized and what are the root causes of all this hormonal dysfunction and what is it? Dr. Sara Gottfried: Well, I would say the days of normalizing this need to be over because women are suffering unnecessarily, as you just described. There's a lot of different hormone issues at play here. One is cortisol related to toxic stress. It can be high, low, a combination of the two. Another hormone that gets out of whack is thyroid. So, Thyropause especially affects women, about sevenfold more than it affects men. Dr. Mark Hyman: Mm-hmm (affirmative). Dr. Sara Gottfried: And that is a common cause of weight gain and hair loss and many of the things that women face. And then as you described, estrogen and progesterone often get out of whack. That can be related to just the cycling years, the reproductive years. It can also be related to being postpartum. And then perimenopause is when a lot of this becomes a perfect storm of many of these hormones out of whack. Insulin's another important one because so many women notice, especially after 35 or 40, that insulin's just not on their side, the way that it once was. They become insulin resistant, which I think of as insulin- Dr. Mark Hyman: It's not on their side, but it goes to their tummy. Dr. Sara Gottfried: That's right. It goes right into the weight. Dr. Mark Hyman: Not to the side, it's in the middle. Dr. Sara Gottfried: Exactly and I think there's a few issues at play. One is the way that our world is changing. It's related to stress. It's related to unrealistic expectations. It's related to over-functioning and trauma, which we know affects women more than men. Men are still affected, but women more so. It's related to the food that we're eating, the way that our food has changed, which you talk to so brilliantly. And it's also related to the fact that physicians are not taught about this, right? I wasn't taught at Harvard medical school about this. I imagine you weren't either. Dr. Mark Hyman: No. Dr. Sara Gottfried: We were taught to hand over prescription for a birth control pill or maybe hormone replacement therapy. Dr. Mark Hyman: Yeah, exactly. Dr. Sara Gottfried: Once a woman was perimenopausal and that is no solution because it addresses symptoms. It does not address the root cause. Dr. Mark Hyman: That's right. And functional medicine and the perspective around functional medicine hormones is so rich and developed and allows us to understand one, root causes, but also all the variables in our life that impact our hormones and how to regulate and change those to create balance, whether it's adrenal and stress hormones, thyroid hormones, sex hormones or insulin and your book, Women, Food and Hormones really helps us to map all that out in a way that gives women a toolkit for how to fix all these problems. Dr. Sara Gottfried: That's right. I mean, this was born of me, struggling myself with almost every hormone imbalance that you can imagine and also struggling with my weight. So unlike you, Mark, when I was sitting down and writing that first book, I gained about 25 pounds. Dr. Mark Hyman: Oh boy. Dr. Sara Gottfried: I've never seen your weight fluctuate very much. I don't know, isn't that true? Dr. Mark Hyman: I have. I go up and down. If I go off the reservation, I was in Italy this summer and I was just eating bread and pasta and drinking lots of wine. I gained about five pounds in a week. So, I can put it on if I go off the tracks and I actually lost weight from being sick, but no, my weight cango up and down, but mostly it's pretty stable. Dr. Sara Gottfried: Well, it sure seems stable. And we know that women have this asymmetric response to stressors, to food. So many of us will gain weight and there's an evolutionary bias for women to gain weight rather than to lose weight because it helps us with fertility. It helps us with creating a pregnancy. Dr. Mark Hyman: Yes. Dr. Sara Gottfried: So, for those of us who are trying to fit into the clothes in our closet, that can present some problems. So, my own struggle with weight, my own struggle with hormones became really the basis of the books that I've written. So, I'm a case study as well as someone who's really curious about how do we get these hormones into balance, especially with targeted lifestyle changes, starting first with food. And then how do we get out of that place of misery around hormone balance? Because the truth is, it's so much easier to get your hormones back into balance than to live with the discomfort, the misery of them being out of whack. Dr. Mark Hyman: Yeah, it's true. And I think the beautiful thing about it is that the solutions are relatively straightforward and yet you're not hearing about them. And I think that the suffering around hormones is quite extreme. I mean, it's irregular period, it's heavy periods, it's PMS, which is a whole range of symptoms from breast soreness and fluid retention to diarrhea, migraines, fatigue, mood changes, sleep issues that could be quite debilitating and they treat it now. They're called PMDD which is Premenstrual dysphoric disorder. They treat it with a version of Prozac. Essentially, they change the name of Prozac to some other name and then they use it for PMS. That's not the solution. And even with postmenopausal symptoms, perimenopausal symptoms, those are often exacerbated by the things that are driving hormonal imbalance. So, I'd love for you to talk about what are the things we know that drive hormonal imbalance and then we'll get to what we do to fix those hormonal imbalances because I think we know a lot about whether it's food or lifestyle or environmental talk. Talk about the things that really drive women's hormones out of whack. Dr. Sara Gottfried: Well, you got it. I mean, I would say food is one of the primary drivers and that includes not just getting sufficient fat, which is the backbone of the sex hormones that you make. It's also getting the right dose of carbohydrates for you, which is so important when it comes to insulin and leptin and some of these other hormones that are involved in fat storage, as well as satiety. Dr. Sara Gottfried: So, getting the carb dose right, also getting the protein dose right. So, dialing in these macronutrients becomes incredibly important. And a big part of what was behind this book was that I was struggling not just with weight gain, but with a loss of metabolic health. And that's something that we know affects about 88% of Americans right now. So, 88% of us are metabolically unhealthy. Many of us don't know it. So, it's not just about the bathroom scale, it's not about diet culture. It's about becoming metabolically healthy and the hormones are such an essential part of that. So, as you described food, stressors, especially toxic stress. I think a lot of us going through the pandemic had an experience of toxic stress. Some people had weight gain associated with that. Dr. Mark Hyman: Mm-hmm (affirmative). Dr. Sara Gottfried: There's the changes, there's environmental toxins that we get exposed to that are endocrine disruptors. Dr. Mark Hyman: Yeah. Dr. Sara Gottfried: The root causes are something that many of us encounter. Dr. Mark Hyman: Yeah. Dr. Sara Gottfried: The solutions are not what mainstream medicine is really taught to manage. Dr. Mark Hyman: That's absolutely true. When I think about my patients who have all these hormonal dysregulations, the sex hormone in particular, in insulin, it's even the stress hormones, our diet is super high in sugar and starch. So, carbohydrates are okay, but where are you getting them from? Are they whole grains? Are they beans? Are they vegetables? Are they fruit or is it flour and sugar? That matters. I think caffeine is another huge one that often adversely affects menstrual issues and hormonal problems. Alcohol is a huge one. I remember reading a study years ago that showed that if you were drinking alcohol and you're taking hormones, with Premarin, for example, you would get toxic levels of hormones in your blood that cause cancer and other problems because of the alcohol. Dr. Mark Hyman: In fact, I think another study I read was women drink one glass of wine a day, which is not that much, according to some people. It increased the risk of breast cancer by 40%. That's staggering and has to do with how it affects estrogen and hormones. So, you've got all that and then you've got all the crap in food, all the hormones and dairy, that's a big one. Dairy, I think, is a huge one for people. And I think a lot of women with hormonal dysregulation get off dairy and they feel better. And there's 60 different hormones in milk, including growth hormones and estrogens and progesterones. And as not to mention test, not to mention in antibiotics. Dr. Mark Hyman: So, you've got all these things that are in the diet pretty typically that cause all these issues. And then of course, there's all the hormone disruptors that you mentioned, the pesticides, the herbicides, all the plastics, Phthalates, PCBs, Dioxin. Those are all flame retardants. They're in everything and everywhere and it's hard to get rid of them. So, those are all collectively causing problems. And then the stress, obviously, how stress affects the hormone cascade, because stress is one of those hormones that connects everything together. And so you end up with this big kind of lifestyle, environmental soup, not to mention the fact that only 8% get enough exercise and sleep, sleep deprivation is massive. You add all these things together and it's no wonder women have so many hormonal dysregulation issues. Dr. Sara Gottfried: Well that and I would say women are more vulnerable to them. Dr. Mark Hyman: Yeah. Dr. Sara Gottfried: So, I think in some ways, especially for women who are still cycling, but also true for women in perimenopause and menopause that our hormones get out of whack more easily than what we see with men. And we know that from looking at, if you just look at estrogen, which is the master regulator in the female body, the primary regulator. The kind of changes that women experience during the menstrual cycle and then in perimenopause are really steep and they're quite sudden. Dr. Mark Hyman: Yeah. Right. Dr. Sara Gottfried: They're much more abrupt right than we see with men in testosterone, as an example. Dr. Mark Hyman: Yeah. Dr. Sara Gottfried: And I'm so glad you raised alcohol because I read the same data and I think it's important to realize that the glass of wine that you're having every single night, you're treating something with it. You're treating stress, you're trying to kind of subtle your nervous system., at least that was the case for me and for many of my patients. And we know that three servings a week is associated with an increased risk of breast cancer. Dr. Mark Hyman: Yeah. Dr. Sara Gottfried: So, as you described it, it creates more of what I think of as the Homer Simpson type of estrogen molecules, the ones that we don't want, we want the benevolent type of estrogen molecules. And you're not going to get that from alcohol. Dr. Mark Hyman: No, it's true. So, when you begin to look at those things, that's the first place people start with their lifestyle and diet. And I think you talk a lot about it in the book and there's also not just what not to eat, but there's what to eat, right? So, can you talk a little bit about what are the hormone balancing foods that we should be eating? Dr. Sara Gottfried: Well, they're the things that help you with your hormones, so that includes making sure that you're getting healthy fat. So, my recommendation for four weeks is to increase your healthy fat so that it's about 60 to 70% of your calories. Dr. Mark Hyman: 60 to 70? Dr. Sara Gottfried: 60 to 70% of your calories per day. Dr. Mark Hyman: Mm-hmm (affirmative). Dr. Sara Gottfried: And this is, for a few reasons, we know that fat is the backbone of hormones, the sex hormones, as we described. It also helps with decreasing gastric emptying so it makes you feel fuller, it helps you with satiety. It's part of this process of nutritional ketosis, where you make ketones, you feel more satisfied, but when you combine that with dialing in your carbohydrates, so what I really like for patients to do, for people who read this book to do, is to get your carbs so that it's less than 25 net carbs per day. Dr. Mark Hyman: It's low. Dr. Sara Gottfried: It's low, but if you're really eating carbs that are from vegetables and you've got that fiber that comes with the vegetables, especially the Cruciferous vegetables, broccoli, cauliflower, radish and you've also got those Methylating vegetables that help you to inactivate the Homer Simpson type of estrogens. That's what really allows you to get into nutritional ketosis and that's the protocol that's in the book. And then the remainder is protein, a moderate routine diet, about 20% of calories from protein. Dr. Mark Hyman: Yeah. That's really quite different than the American diet, which is kind of the opposite, right? It's about 60 to 70% carbohydrates that are mostly starch to refined processed foods. And about 20% protein or maybe 20% fat. So, that's a big shift and I think it creates a lot of changes for people. Not only will they lose weight, but they have mental clarity, more energy they'll build muscle, they'll lose body fat, they'll build bone density, they'll reduce inflammation, everything gets better, right? Dr. Sara Gottfried: Yeah. I mean the sad diet gave me pre-diabetes. It doesn't work in terms of metabolic health. And so, the work I do is precision medicine. I think it's important for us to be thinking in terms of how to personalize diet. So, nutritional ketosis is not for everyone, but for people to try it for four weeks, to see how sated they feel when they're producing ketones, where they've got that mental acuity from this particular set of macronutrients and then to see the metabolic flexibility that it creates so that you can flip back and forth based on the type of fuel available, between burning glucose or carbs and burning fat, depending on what you're eating, what's available. That's what really works for people. Dr. Mark Hyman: Can you talk about this idea of metabolic flexibility because I think it's fascinating and I think it's something we really don't talk much about. Dr. Sara Gottfried: Yeah. Metabolic flexibility, I think of a hybrid car. Dr. Mark Hyman: Mm-hmm (affirmative). Dr. Sara Gottfried: One of my first hybrids was a Prius and you could flip back and forth between burning gas or burning electricity. Dr. Mark Hyman: Yeah. Dr. Sara Gottfried: And the body is very similar. You can either burn carbs, which I think of like gas or you can use electricity pathway, which is burning fat. And so of course the fat is more renewable, we've got more of it and so it's, what's important for folks to realize is that you want to toggle the switch back and forth, depending on the type of fuel that you have. So, for me, this morning, as an example, I haven't had any food yet and I'm burning fat. So, I've got ketones, I feel satisfied, I don't feel hungry. I've got mental acuity, I'm able to focus and that's hardwired into our DNA. Dr. Mark Hyman: Mm-hmm (affirmative). Dr. Sara Gottfried: Now, when I was eating more carbs, what I found was that I was hungry when I first woke up in the morning, I had more sugar cravings, my insulin was out of whack, it was too high. I was stuck in fat storage mode. It just didn't work very well in terms of trying to live the deep life that I want to live. Dr. Mark Hyman: Yeah, sure. So, you get all out of balance and what's interesting is that, sort of, we talked about a little bit, but the cocktail of hormones that go wry in women's forties and early fifties is really not well recognized and that is the sort of the soup of hormones that get out of balance, including stress hormones, cortisol, the sex hormones, estrogen, progesterone and all the other hormones related to sex hormones, thyroid and insulin. And so those are very subtle things to play with in a body and yet they respond really well to lifestyle, to the right supplements, to fixing your microbiome, to just tweaking everything, reducing toxins, detoxifying. I think one of the things you talked about earlier was really important, which is, there are certain foods which we know help with hormonal regulation and balance. Dr. Mark Hyman: One of them is the Brassica family of Cruciferous vegetables. You mentioned that, but I don't want to sort of gloss over, it's really important. I think women should probably have a cup or two a day of broccoli, cauli, kale, cabbage, Brussels sprouts, that whole cocktail of vegetables because of the compounds, the phytochemicals they contain that help regulate estrogen metabolism and sort of de-risk your estrogen from being a carcinogenic type of estrogen to a more healing, beneficial type of estrogen. And I think also, the same thing is true around insulin blood sugar. When you start to sort of get into the trouble with that, you've got to really do what you're saying is shift your diet towards more good fats and less starchy carbs. So, we kind of know that if we kind of work on all these things that the actual women can really get rid of these symptoms. Dr. Sara Gottfried: You can and I think there's a few interesting areas related to this topic. One is that I was taught when I went through my training that the symptoms women start to experience after 40, the difficulties sleeping, the night sweats, the hot flashes, those are these conveniences that could be medicated with hormone therapy in the right candidates. But now what we're actually learning is that many of those symptoms are biomarkers of something much more serious, which is dysfunction of blood vessels, endothelial dysfunction. Dr. Mark Hyman: Yeah. Dr. Sara Gottfried: It's a biomarker associated with bone loss. And so, it becomes much more important, I believe, to get these hormones back in a balance, starting first with diet and lifestyle. Another piece that's really essential is that having large blood sugar excursions, which was my story until I figured this out for the book. Dr. Mark Hyman: Yeah, yeah. Dr. Sara Gottfried: That can trigger hot flashes, night sweats, mood swings, many panic attacks, many of the things that women are starting to experience in their forties. So, the more we can dial in that metabolic health piece, along with balancing these sex hormones, the better off women are. Dr. Mark Hyman: Yeah. So, it's so huge and I think we're really just coming to understand that these are not normal things. They shouldn't be normalized that women are- Dr. Sara Gottfried: That's right. Dr. Mark Hyman: ... aren't just sort of relegated to being quite hysterical, which is the, I hate that word, it's basically come from his hysteria, which is the uterus, right? Hysterectomy and hysteria are not unrelated. Dr. Sara Gottfried: I hate it too, I mean, I love. Dr. Mark Hyman: Oh my God, it's terrible. Dr. Sara Gottfried: You talk about how we don't want to normalize this. And what it reminds me of is that analogy of the frogs and the pot on the stove where you very slowly turn up the heat and the frog doesn't jump out because it's so slow and perceptible. And so I don't want women to just it back and say, "Oh, my doctor checked my labs and said I'm just getting older." Don't settle for that, don't be dismissed. There's so much misunderstanding about this. And so it takes us taking our health in our own hands and saying, "Okay, this is not how I want to live my life after 40. I want to change things." Dr. Mark Hyman: Definitely not and there's things that we also talk about, in terms of how to change things in terms of diets. So, there's questions of people about soy foods and anything about flax seeds. A lot of people "Soy is bad for you. It's going to cause hormonal dysfunction and it's an estrogen." What's your take on that because I think there's a lot of controversy about that. Dr. Sara Gottfried: There is a lot of controversy. I think the problem is with GMO soy. Dr. Mark Hyman: Mm-hmm (affirmative). Dr. Sara Gottfried: So, I think that you can't go overboard with even whole foods. My general feeling is that some of the benefits associated with soy, with phytoestrogens like flax, outweigh potential risks of them. I mean, you have to be cautious about getting the dose, right. But for the most part, I think having whole soy in your diet once or twice a week, having whole flax in your diet a couple times a week is very healthy for you. It's not really the whole foods that we're having a problem with in the US, it's those processed foods, the ultra processed foods, the foods that are genetically modified. Those are the ones that are causing problems with hormones, not really the whole foods. Same thing with Goitrogens. I always get asked about, well, what about the Brassica family? Is that going to slow down my thyroid? So, you lightly cook them that reduces the goitrogenic effect. I've looked at the data, I've been underwhelmed by the data really showing a significant impact on thyroid function. You get so many benefits from eating these foods that I think once again, the benefits outweigh the risk. Dr. Mark Hyman: It's so true. I think people and it cracks me up that a lot of doctors who treat cancer patients, breast cancer patients will say essentially that they shouldn't eat soy food because they're worried about cancer. And yet they say that it's okay to drink alcohol and to eat sugar. Dr. Sara Gottfried: And to have Ensure. If you're losing weight, have Ensure. Dr. Mark Hyman: Yeah. Oh my God. Yeah. It's crazy. It's really crazy. So, I think what you're saying is important. I want to come back to the glucose thing, because you mentioned the changes in blood sugar and glucose, they also affect hormones. And we know, for example, in men who eat a lot of sugar and starch, they tend to get more estrogens. They tend to get breast enlargement or man boobs, they lose the hair on their body, they get big bellies, they get soft skin and it's because the fat produces estrogen and the fat is laid down because of high insulin. Dr. Mark Hyman: And so you discovered a lot by using the continuous glucose monitor, which is really a, kind of a new advance in actually personalizing medicine, what you call precision medicine and you are an advisor to level, so am I, in terms of this company that is really driving the space around, looking at our own blood sugars in real time and how different foods affect it, how we can modify our diet to actually keep our sugars in balance. So, what did you learn from doing it yourself and why is it so important for estrogen and hormone balance in general? Dr. Sara Gottfried: I'm a huge fan of continuous glucose monitoring. The great thing is that you don't have to have a continuous glucose monitor to benefit from monitoring your glucose. You could also use just a $25 glucose meter to get some of the same data. It's not quite as dense or comprehensive, but I had a lot of surprises. I started wearing a continuous glucose monitor about four years ago. And at the time I had pre-diabetes, my fasting glucose was about a 105 to 110. Dr. Mark Hyman: Wow. Dr. Sara Gottfried: And what I discovered was that many of the foods that I thought were healthy were giving me these massive excursions with glucose things like beans, chickpeas, legumes, sweet potatoes, apples. Dr. Mark Hyman: Wow. Apples. Dr. Sara Gottfried: A lot of foods were just making me spike so high, grapes, peaches. Dr. Mark Hyman: Yeah. Dr. Sara Gottfried: So, what I had to do to reclaim metabolic health was to really dial in my food plan and to avoid some of those foods that were spiking me to the diabetic range. And I found that that really helped. So, a big part of what I learned as I dove into the literature for this book was that you've got a few choices for metabolic health. One is to go 100% plant-based and there's a lot of evidence behind that. And what I discovered myself was that being 100% plant-based was not the best fit for me. I started to lose muscle mass, I'm Jewish, I'm hungry all the time and so 100% plant-based just didn't work very well for me. Dr. Mark Hyman: Wait a minute. When you're eating the way you're now, you're still Jewish and you're not hungry all the time. So, I'm not sure that logic flows, Dr. Gottfried. Dr. Sara Gottfried: Well, I have to say keto-safe. So, going on a ketogenic diet made my blood sugar go from severely spiky, which you don't want, to a lovely flat line where my mood is more stable. I don't have anxiety anymore. I've got this feeling of the angels are singing because I can focus. I don't have this jacked up glucose every day. So, 100% plant-based or a ketogenic diet. That's what I found in the literature to be the most evidence-based way to reclaim metabolic health. Dr. Mark Hyman: But often vegan patients start to change their hormonal patterns. They stop menstruating. Dr. Sara Gottfried: They do. Dr. Mark Hyman: They have all sorts of issues. So, how do you sort of explain that? Dr. Sara Gottfried: Well, what I see with a lot of folks who are vegan or 100% plant-based is that they don't often get sufficient fat. So, fat is so important. We talked about how it's making the backbone of your sex hormones. Your body goes from Pregnenolone, cholesterol to Pregnenolone, the mother hormone of all your sex hormone. That thing goes on to make a few other hormones that are so important for your health. And so what I see with a lot of vegans is that they're not getting sufficient fat, they're not getting the extra Virgin olive oil, the avocado oil, the nuts, the seeds that they really need. Sometimes they're eating too much processed food, because we know there's a lot of vegan processed food that you think might be healthy, but it's not necessarily. Dr. Mark Hyman: Yeah. Dr. Sara Gottfried: So, I think that's a really important piece to understand. And the great thing here is that you can personalize. You can use devices, wearables like continuous glucose monitoring or using a glucose meter to see what sort of food is the best fit for you. What I discovered was that nutritional ketosis or ketogenic diet adapted for women. So, with sufficient carbohydrates to keep my thyroid working, to make enough serotonin, to avoid raising my reverse T3, to help me with not raising cortisol too excessively, that's what worked really well for me. Dr. Mark Hyman: Mm-hmm (affirmative). I see. Dr. Sara Gottfried: And for hundreds of patients who followed after my protocol. Dr. Mark Hyman: Now, you mentioned, muscle mass as being key. Can you talk a little bit more about that in relates to hormones and particularly sex hormones for men and women and also cortisol and growth hormone and insulin, which are all affected by your muscle. Dr. Sara Gottfried: Yes. Dr. Mark Hyman: Which people don't think of as important. I mean, people like "I'm going to get my heart healthy, my brain healthy and get my joints healthy," but no one's like "muscle," but muscle is actually the currency of health. Dr. Sara Gottfried: Muscle is the currency of health. I think I was taught a model that was very disease-centered, not health-centered. And the work that you and I do, I think, is turning the ship so that we can be more health-centered and a big part of being health-centered is to make sure that you preserve your muscle mass as you get older. So, we know that maintaining your muscle mass, maybe even growing it as you get older, is one of the most essential markers of health span, that period of time that you feel fantastic and relatively free of disease. So, one of the things that I found when I was on 100% plant-based diet was that I was losing muscle. Dr. Mark Hyman: Mm-hmm (affirmative). Dr. Sara Gottfried: Yes, I had a high stress life. I think cortisol was part of this story. So, high cortisol can be associated with breakdown of muscle but the other thing to think of with insulin and with blood glucose is that the math comes out to what are your inputs? So, what are you eating? But also how are you disposing of that glucose? And that's where the muscles become so important. Dr. Mark Hyman: Yeah. Right. I mean, it's interesting because the muscle is really where your metabolism is, so your mitochondria and as muscle goes down, your insulin goes up, your blood sugar goes up, your blood pressure goes up, your cholesterol goes up, your sex hormones go down, in terms of testosterone for men, growth hormone goes down, cortisol goes up. So, you get this whole soup of hormonal change that is characteristic of rapid aging. Dr. Sara Gottfried: Yes, Sarcopenia. Dr. Mark Hyman: Yeah. So, I think, I've come to really appreciate it more and I always talked about exercise and strength training, but I was kind of lazy and I never did. Well, I like the outside. Dr. Sara Gottfried: It was hard in medical school to put in the time, I have to say. Dr. Mark Hyman: Well, even after, I mean, even after. I like yoga, I like tennis, I like biking. I do other stuff and it was pretty good cardio, I'm right and yoga's good, but I actually, it wasn't. And I actually started doing strength training about a year and a bit ago and my body has completely changed. I'm going to be 62 shortly. And I just, it's amazing to see what happens when you start to actually use your muscles as they were intended to be used. Dr. Mark Hyman: And unfortunately, we have to do a strength training now because we're not living lives where we're actually active and carrying shit and moving stuff around and actually using our bodies, so we have to do it, but it's just amazing. It's made me feel better, more energies, help my metabolism. It's helped my whole way of moving through space and life and the ability to do stuff and have fun. So, I don't find myself to declining at all. I find the opposite is happening and I'm planning on going helicopter skiing, which is obviously a big luxury, but I've been dreaming about it my whole life and I'm always terrified. What, can I do it? Am I strong enough? And now, my God, I can do anything, which is pretty amazing. Dr. Sara Gottfried: Well, that's such an inspiring message because the truth is, it's never too late to change the way that you move and what you've done with strength training, what I imagine is that you probably have increased your muscle mass, your lean body mass. Dr. Mark Hyman: Mm-hmm (affirmative). Dr. Sara Gottfried: And that's associated with slowing down the biological clock. So, it's so good for you. I think of it in the service of that means you can dance with your great children at their wedding. That's one of the things I hope for myself. Dr. Mark Hyman: There you go. Dr. Sara Gottfried: And to do those things that you've always sort of thought about doing like the helicopter skiing, I mean, how fantastic to live your life in that way, not sort of signing up for this slow decline that we see in so many folks. We know after age 40 that most of us are gaining five pounds of fat and losing five pounds of muscle, unless you're doing something active, like strength training. So, what I talk about in the book is to do about two thirds of strength training about one third cardio. I think that combination is probably the most proven when it comes to cardio metabolic health. Dr. Mark Hyman: So true. So, Sara, your book is so important this time because I think more than ever, we're seeing this epidemic of hormonal dysfunction, including insulin, blood sugar, as well as the sex hormones, cortisol, thyroid hormones and you talk about it so well in your book. You cover so many things, we wish we had more time to talk about, including the tests you need to do to look at hormonal imbalances which are quite different than what you get from your regular doctor, the supplements you should take and why we need to think about things like intermittent fasting and our microbiome and many, many other things. So, the book is really a treasure trove of wisdom and knowledge that you've gained not only on your own body, but working with thousands of patients and reading the science and putting it all together in a really digestible form. Dr. Mark Hyman: So, the book everybody is called Women, Food and Hormones, A 4-Week Plan to Achieve Hormonal Balance, Lose Weight and Feel Like Yourself Again. You can get it anywhere you get books, it's out now. If you're interested in more in Dr. Gottfried's practice, Dr. Gottfried's precision medicine practice, go to Marcus Institute, that's M-U-R-C-U-S You can use the hashtag if you post from this called #womenfoodhormones, that'd be great for her. And I really would love for you to share your stories about how you've regulated your hormones through lifestyle and food. Where have you struggled with hormonal imbalance? Tell us what you've learned about yourself. We'd love to learn, leave a comment about that. Subscribe where you get your podcast share with your friends and family because I bet you there's a lot of people who are listening, who have friends and family who are also suffering needlessly. And I think we all need to actually think about how we can collectively help each other and you should subscribe at your podcast and we'll see you next week on The Doctor's Farmacy. Speaker 1: Hi, everyone. I hope you enjoyed this week's episode. Just a reminder that this podcast is for educational purposes only. This podcast is not a substitute for professional care by a doctor or other qualified medical professional. This podcast is provided on the understanding that it does not constitute medical or other professional advice or services. If you're looking for help in your journey, seek out a qualified medical practitioner. If you're looking for a functional medicine practitioner, you can visit and search their find a practitioner database. It's important that you have someone in your corner who's trained, who's a licensed healthcare practitioner and can help you make changes, especially when it comes to your health.