Dr. Sarah Daccarett: Unlocking the Secrets of Hormonal Health | Ep. 285

Welcome to the Gladden longevity podcast with Dr. Jeffrey Gladden, where our passion is helping you to become an AJ hacker. On this show, we want to help you optimize your life energy, longevity, health, and human performance with impactful and actionable information by answering four questions. How good can we be? How do we make 100 the new 30? How do we live well beyond 120? And how do we live young for a lifetime? Now, here's today's episode of the Gliden Longevity Podcast.

Welcome, everybody, to this edition of the Gliden Longevity Podcast, where I. As you know, we're asking the big questions here. How do we make 100 to new 30? How good can we be? How do we live well beyond 120? How do we live young for a lifetime? And how do we develop a 300-year-old mind? And I can tell you that one of the centerpieces in longevity itself is optimizing hormones. In my own journey, getting my thyroid right and my hormones right became the centerpiece for all the other things that I've been able to do.

And.

And today we're going to have a really interesting conversation with Dr. Sarah Dacoret, who started off life as a pathologist and then transitioned into hormone balancing. And she has an organization called Inner Balance. And this conversation is really quite wide ranging, but we basically both commiserated with each other about the state of things and also came away with some very clear direction in terms of hormone optimization, predominantly for women, but we also talk about men as well. I think you're really going to enjoy this podcast. I learned a few things from her, and it was super fun to do. So enjoy this. Welcome, everybody, to this edition of the Gladden Longevity Podcast. I'm your host, Dr. Jeffrey Gladden, and I'm here with preeminent scholar and lovely individual Sarah Takoret. Dr. Sarah. So welcome to the podcast.

Hi, Dr. Jeffrey. Thanks for having me. Appreciate it.

Yeah, absolutely. So let me. We're going to talk about hormones, and we're going to talk about them in some really interesting ways that maybe the audience hasn't heard about or thought about. So I'm excited for that conversation. But how did you get into hormones? I'm sure, you know, when you were five years old, you thought, well, when I grow up, I want to be a hormone doc. Right? So how did that actually happen?

You know, it's. It's like I was minding my own business. I was a pathologist, so always interested in the pathophysiology of the body science, like math, engineering, this is what I did before. Like, I was in residency, and then I started going through my own health problems in my 30s. Like, I delivered my son, and then just really, just the wheels fell off the bus. And all of the things that I knew and had been taught that, like, I really had to, like, relearn, like, throw it up in the air and, like, relearn it all, because I had not learned any. None of the tools that I learned in medicine could even help me feel better. I could not get well. I had autoimmunity. I was, like, sick, right? Like, I really was struggling and didn't even know how to heal. Like, autoimmunity. Like, how can you go through an entire pathology residency and not understand the immune system enough in order to reverse autoimmunity? Medicine doesn't know how to do this right? So these were the challenges that I was faced. And I was determined to feel better. I wanted to be young and feel young and feel 36. And I think the problem is that there's nothing for women. And we can talk about this discrepancy, but when I really got into it, when I realized it was hormonal, and then I realized that I probably had problems my whole life and that we look at, like, we don't even understand some women. And I. And then I've learned that I was a fast metabolizer of hormones. And this is where we have not studied a lot of this metabolism, these genes, and these SNPs that make us different. Why was I different than my other friends who maybe weren't going through something at age 36? And when I tried all of the products on the market, literally all of them, I began to realize that. That we have been ignoring this problem for women for decades. We have solutions for menopause. And when we look at women, we'll help them. Like, if you're menstruating and you are having your period, we do not intervene. Your solution is birth control. Period. And then once your period has stopped and you're menopausal for a year, you get hormone replacement therapy. We don't tell men that they. We won't give you testosterone until you're done making sperm. You have to be done making sperm for a year, and then we'll give you testosterone. But we tell women that they can't have hormone replacement therapy until they're done having their period. And then we know a lot about pregnancy. Pregnancy, Right. We can help women get pregnant. OB GYNs are trained to deliver babies. So these two populations, we help a lot if you're trying to get pregnant or if you're done with your period. But this whole age group of women who are doing neither of those and menstruating has no solutions, no products, nothing. If you try out a patch and a pill and the modern day formulations for HRT, they're not going to work for a 36 year old. And this is where my journey began.

Okay, well, yeah, that, that makes a lot of sense. You know, when you think about it, just listening to what you were saying there, I think that hormone issues for women can almost begin at puberty, quite honestly, not everybody has a smooth cycle, right? I mean, there's a lot of things that go awry early on. Things like endometriosis and pcos and you know, all kinds of things that kind of flare up or get started early in life, quite honestly. And people are left kind of dangling just saying, well, just kind of. I don't know what they tell girls, but something.

So here's your answer. Birth control. This is what traditional doctors are doing. And women, young women are being disproportionately impacted by the environment over men. And like we have plastics, phthalates, which are fragrances. We have, we have a beauty. We're inundated with a beauty routine.

That's right.

We have chemicals, pesticides, These bind to the estrogen receptor. We call them estrogens, which drives me crazy because they're not estrogen. They bind to the estrogen receptor and they prevent your own estrogen from binding. And that's why women are having these really heavy periods when they're 16 and 17. And yeah, so you're right, this is really impacting us early on. Putting them on birth control is making the problem worse. You know, now you have like a woman who's 25 who's been on birth control for 10 years and full blown endometriosis, like.

Yep, no, it's a mess. Yeah, These hormone disruptors are really a huge thing. They're actually a big thing for men and women, quite honestly. I mean, sperm counts are going down, right? Infertility is going down, testosterone levels are falling. So there's a lot of environmentally driven hormone disruptors, let's call them, that are hitting both sides of the fence a little bit differently. But nonetheless, I think humanity is suffering, right?

And it's like a crisis. Like we need to be looking at it and realizing that it is a crisis. I feel like even smart people when we talk about it, the doctors that are hormone replacement therapy specialists and longevity they still refer to these chemicals as estrogens. And so we're still giving this message that estrogen is making men lose their sperm, estrogen is making women endometriosis. And this is really damaging because it's not estrogen that's doing this, it's the chemical that's doing this.

That's right. No, you're right. You're absolutely right. So, yeah, let's, let's talk. You know, it seems like there's so many forks in the road when it comes to women and estrogen. Right. Because you have. Or women in hormones, because you have people that are going down the path of pcos. You have women that are developing endometriosis, things like that. Do you want to give us. Maybe. And it may be impossible to answer this question, but is there kind of a unifying thesis here that kind of holds this all together in your mind?

I have a hypothesis that I'm not like, necessarily going to be right, but I feel like you can, we can tie it together. And if you were to say that one all, the whole root of all of these problems are one thing. Endometriosis, pcos, early perimenopause, menopause, like all of it. Heavy, painful periods. Like, it's a spectrum of disease. So you could even be having endometriosis symptoms but not have endometriosis. You can have PCOS symptoms but not have, you know, it's a spectrum. And they're all caused by low estrogen and progesterone, say, in women. And why does it impact some women more than others? And I think this is a question that we should really be asking. And it could be genetic and it could be these SNPs that we're not studying that we need to study. So, for example, let me paint a picture of a woman for you that has adhd. She's thin, she has a lot of anxiety in her 20s. And then she develops endometriosis later, heavy painful periods. And then she goes on to develop like she doesn't get any help, maybe even has surgery and still develops early perimenopause. And then her ADHD symptoms get worse. She's put on pharmaceuticals, antidepressants, anti anxiety medication, birth control, the stopper period. Everything gets worse. Why did this woman develop endometriosis instead of pcos when probably it was all the same reason. And these could be the reason, could be these underlying genetic factors, like what if this endometriosis patient had comt the fast metabolizer? And this is what gave her this clinical picture, as opposed to a PCOS picture where you're growing hair on your face and losing your hair, gaining weight, becoming insulin resistant, your testosterone is getting high. Right. Like these two women diverged and went into completely different directions, even though the problem was the same problem and maybe even the treatment is the same. But why did, like, could it underlie the way the hormones are being metabolized and we're not paying attention to it. We think that the liver just metabolizes as estrogen and it's done. But we know that actually there's probably methylation pathways that we could look at the estrogens being methylated in different tissues in the brain and then being eliminated really quickly. And so, you know, along with dopamine. So she's becoming worse. Her clinical picture is severe with endometriosis. And then you have other women who, their hormones might drop, but they're not metabolizing it as quickly. So they kind of fly under the radar until menopause. Like, why did I do worse than another woman? I was healthy. You know what I mean? And so I'm a carrier of the COMT gene. Right. So this is snip. So this is like fascinating. Something that we should do research. Women are not being researched enough.

Yeah, I, I agree with you. I don't think, I don't think people are deconstructing these problems sufficiently. Right. That's the way that I tend to think about it. And there are a lot of interlacing SNPs here, right. So there are SNPs that really predispose you to anxiety and disposal and predispose us to depression or things like that. There are also genes that predispose us to insulin resistance or being late to the party, as I cause call it, where you really, the incretins don't get released when sugar comes in and you really don't really start releasing insulin until your sugar's already spiked. Right. And then, so there's lots of different genes that, that play with each other here. And I think probably the interplay of the various genes probably determines some of the phenotyp expressions. Right. Which pathway you go down. But I think, I think it's, it's for each individual. It's kind of a knot that you have to unravel. You have to look at the genes related to all those features and then say, oh, okay, here's, here's how we, here's how we take care of all of this. Right? That's kind of how I would think about it.

So I agree. And I think it's also important to remember that genes are, I mean, excuse me, hormones are so powerful that they bind, they directly impact and influence genes 100%. Like if you like development and we can make choline and estrogen turns on that expression of that gene. So when you get pregnant, your estrogen gets to 40,000, you're able to make more choline when you get through menopause and your estrogen goes to zero. Like our choline also production goes to zero. And nobody's eating eggs because apparently we're told that eggs are bad or something. So nobody's eating eggs. And then women's gallbladders become very, very bad and sluggish and they have to get them out and they get gallstones. And people are blaming on estrogen. I'm like, no, this problem is there's no estrogen to protect your gallbladder. There's nothing there to make choline. These, we like gene expression with hormones. Like this is what also gives us like feminine and male features. Like these are powerful. Hormones are very powerful.

You know, when you think about the fact that more women suffer from dementia than men also, right. And we know that again, genes that interplay with each other, right? ApoE4, ApoC1 Tom 40 genes like that to predispose to Alzheimer's, that it's really, really critical for men's brains and women's brains to have adequate estrogen. And so a lot of men get testosterone, they get put on anastrozole, then their estrogen levels go down and cardiovascular impacts, bone density impacts, even abdominal obesity is worse and the brains don't function well. Right. So there's a lot of disservice being done on both sides of the fence here, I think because it's not really adequately deconstructed.

So you're right. Like we're saying that estrogen's bad and it's bad for men too. And so you're right, actually estrogen makes their skin glow, it protects disease. We know that at night when we're sleeping, estrogen helps the cerebral spinal fluid, like cleanse the brain. And that's possible. Maybe it works in men. I know it works that way in women. Does this, you know, it's like this really complex neuroendocrine system in the brain is hormone dependent. And like all this, when you look at the studies like they're, they're address, they're answering this question of can we prevent dementia in like a 55 year old, we should be Thinking about you need to prevent dementia as like a 35 year old.

That's right.

You need to keep that mental clarity and sharpness and prevent the brain fog and keep this system going at a very young age, not like postmenopause.

I actually think when a baby's born we should be doing genetic testing, right. And we should understand, okay, where are the liabilities, where are the assets? How are these snips going to play together? Is there something weird we don't know about so we can at least be aware of it? And then, you know, then you start to play the orchestration of that. Right? Okay, you're hitting, you're hitting puberty. Okay, well let's, let's actually start measuring, measuring hormones and hormone metabolites. Because it's one thing to know you're a fast metabolizer, but I've been impressed that you can measure how the metabolites are coming out. It may not match the genetics. Also apparently there's some other override that can happen. So maybe we start testing more comprehensively hormone profiles in people at younger ages, maybe even 10 year olds or I know I'm thinking 10 year olds pre puberty. Maybe you have to go down to eight years old, I don't know. But to get an idea where you're headed, right. So you can actually help people have a good, good healthy life here.

I love it. Like, and it would take this like idea that we need to start realizing that hormones are protective and beneficial and that we need to keep them optimal at all times. And it's almost like people are not there mentally. They need to keep, make that leap first before we're testing. But I agree it's the best way to personalize it. I had a doctor friend who did test his 12 year old son and his testosterone levels were 1800 at 8, you know, 12 years old. So knowing just like when they peak, making sure that that child under does undergo puberty, that is peaking and it's doing what it's supposed to be doing. And then when it falls off in the 20s so that you can maintain health, it's about maintenance and prevention if you can maintain your health and be optimal. But like we still have this like problem with women and birth control. Like women birth control suppresses hormones and they're not going to ever be. But we have a. Women do not want to get pregnant. I think we have to need to address this for them and like, because.

Yeah, I agree, but they have, you know, you end up with progestins and you End up with no testosterone. And I mean, it's really, it's almost like it feels like the worst thing you can possibly do to a human being.

The worst thing you can do. Like, I don't know, like that one. I mean, one would argue that getting pregnant is the worst thing that could happen to them. And okay, so in that, in this case, the birth control.

I get that.

Yeah. Okay, so that's what.

It's the second worst thing, so to speak. But nonetheless, it's still on the bad side of the ledger.

We're using birth control for everything, like to fix everything. Oh, you have acne, let's give you birth control. Like, oh, you have a mood disorder, we'll give you birth control. And person like when women if understood that it's probably the worst thing you can do for your health because it is taking away your protective hormones. It is not hormone. It is like doing the opposite for you. And even if we could get women to understand there's no informed consent, doctors are not telling women this, like, I'm gonna take away your hormones.

That's right. Yeah. And, and then a lot of doctors.

Know, like, I don't think they get it. They don't understand.

Yeah, they don't. I think it impacts bone density. It certainly impacts or can impact libido in many respects. I don't, you know, and then some people have difficulty with fertility when they try to come off them. Right.

Of course there's post birth control syndrome and then. But we're talking gut health. Like it interrupts like entire gut health. But I think the biggest thing is mental health from women. Like, we see this huge like wanting suicidal ideation. They get anxiety, they get depression, they do not feel well. Like mental health, when you start birth control is humongous. And this is, is probably the biggest problem I see. You know, you can deal with a little bit of gut health probably issues, but when you feel suicidal or not. Well, this is not good.

Yeah. So if you were going to outline kind of, let's just say you have carte blanche to actually redo the system, how would you, how would you actually set it up?

I see like a future, a world where like you would have a healthy population if you were to make maintain these optimal hormone levels like your whole life. This is something that you, we know that you can maintain your metabolic fitness this way. And I think people would probably push back and argue that it's not that, but I do think it's the root cause of like gut problems. Leaky gut sibo. Cortisol. Like we see when your hormones drop, you start aging. Like it is foundational to the longevity period. Like you. When you like your hair and skin and wrinkles, it is like estrogen is. Estrogen is your best anti aging longevity. Longevity drug. And progesterone is there to counterbalance it and make sure that it's like in check because you need them both. But if in a perfect world and if I could redo it, everybody would be healthy because we would and we really. These chemicals that are like in like they absolutely need to be not ignored. We need to address that. They're binding to the hormone receptors and completely disrupting people.

Yeah, yeah, I think. I think that's right. I think cleaning up the environment is. Is kind of the place to start.

Because I also think that in a perfect world we would recognize that reference intervals and laboratory testing are not accurate to dose hormone replacement therapy. That we really should be looking at what the brain is thinking, these feedback loops with FSH and LH and what does the brain think? We tend to think that hormone levels are high, but women feel great on it. So what is the problem? And also we don't even know what high is. We haven't established them. We should be looking at genes. Like we're talking about how do you metabolize it it? Are you fast, are you slow? This we would be able to optimize hormone replacement therapy better. Right now it's a lot of guesswork. It's shooting in the dark. It's telling women that it's safe. Like, it's really scary, like weird. They're scared of it. You know, like, I think we need to get to a place where we really have find like hormone medicine and longevity. It's like its own thing. The doctor we need to really make it an excellent building. Has it potential to be.

We just got a hold of a new test from Vibrant America. I don't know if you're familiar with the lab. Vibrant America, they do a lot of really sophisticated testing, gut testing, and now they just came out. A lot of their tests carry the moniker Zoomer. Right. So it'll be like a gut zoomer or an oxidative stress zoomer or whatever. So some reason they've attached zoomer. So they just came out with a hormone zoomer. Right. Which is. Actually, I just looked at the report because we do a lot of hormone testing here, genetic testing, hormone testing, hormone metabolite testing. Right. Urine metabolites, things like that. And I was really impressed with the quality of this test. I mean, it's really kind of breaking things down. And I have no financial ties to this company, but I think it's interesting to see that in the functional medicine longevity space that the labs are starting to realize the need here and coming out with tests where you can go do a single test and if you work with a doctor that knows how to interpret the test. Right. You can actually get some really, really useful information just from a single test because it's so comprehensive. I don't think this particular one is doing genetics. I'd have to go back and look at it. I know with the oxidative stress one, it does include oxidative stress genes as well. Right. And then giving you markers across different, different compartments like lipid oxidation, you know, DNA damage and oxidation, things like that. Right. So super helpful. But I think it would be interesting to do genetics on kids so you actually know what, what cards they're holding and then actually start doing something like this zoomer test, hormone zoomer test, you know, several times during their childhood and then certainly when they hit puberty and then sort of, you know, marrying the things together between the genetics and their symptoms and, and what you're measuring and get a feel for kind of how things are developing for them. Because I think you could avoid a lot of pain, quite honestly, for people. It's impressive to me how many, you know, not being female, of course, but it's impressive to me how many women really struggle at various points in their cycle. Like, I just, I'm off for three days, I'm off for a week. I, I just don't feel like myself for, you know, however long it is. And if there are ways to, to understand that and mitigate that, you know, maybe it's some adjunct progesterone or something. Right. I think it'd be, I don't know, I, I'd be a big fan of, of us doing that. Not waiting until people are, you know, 45. Right.

I have like, I think that this, you. It's not normal to be so out of it for seven days. Say that my period and because period hormones drop to like zero during the period and then a seven day period where you can't function and go to work. This is not like how our ancestors probably functioned. It was probably a very light. I mean, they wouldn't have survived if they were bleeding the way that women are today with like really heavy periods.

Yeah.

And you would. I think that we also need to completely redo this cycling idea that women, we, those studies were based on radioactive Immune assays, which are very outdated. We would actually reject those papers today because the laboratory testing is so outdated we don't even look at these papers anymore. But yet we still tell women that the estrogen peaks this way and progesterone, you know, peaks end of cycle. Doctors base their practice on it. They're trying to get women to just take progesterone last half of the, of the month and that, you know, to try to mimic this cycle. This cycle that's like not based on current science is based on like 1950 year old immunoassay science. We just need to like does this how women really cycle, what's happening? Because what should probably happen is if the hormone levels are optimal all month, she shouldn't notice like a, a five day drop in them because every, the tissues should still be functional and fine. And then when they start picking up again, she should feel good again. If she feels terrible for seven days of the month they were low to begin with. Like, you know, that's like, it makes sense that they were low all month. It's just now they're completely gone and she's feeling terrible.

We, we can do testing where a person can actually test their hormones every day of the cycle. Right. We've done this for a few people to help them get pregnant, let's say, so we can actually map what's happening.

The problem is the variability and analytical variability, Variability, biological variability. Hormones are like being shuffled around. So I mean they can give you kind of a picture sort of like. And if you can do it every day like that, you can kind of maybe, you know, and this is probably a lot more accurate. But I think they also need to be taken into account that it's what, like hormones are not supposed to be in the blood. It's like thyroid. If your, if your thyroid's in the blood, it's supposed to be in the tissue and you can't measure inside the cell what's going on with thyroid.

No, that's true.

So in the thyroid conversion happens in the cell as well. So like the metabolism of the hormone is also when they're in tissues that we're not. Right. Like in the brain and the uterus. Like the, if the uterus is storing all the progesterone and we're measuring the blood, what are we doing? So I even think we need to look at like how we're thinking about the hormones and measuring them for it to make sense. Because if they're in the blood, that's probably means are they being on their way out to being metabolized and getting rid of them. Like, why are they in the blood? Is that a peak? You know, so.

Well, yeah, I mean, there's going to be some in the blood, just like there's going to be some thyroid in the blood. But to your point, you know, what we have found with thyroid is that the blood work is not terribly reliable when it comes to actually managing somebody's thyroid. It's really resting metabolic rates. Right. That we look at so that we can see what's happening at a tissue level. And then we look at genetics. Like the DIO2 in the brain. Right. Can you take the iodine off and make T3 in the brain? Because that's different than making it systemically. Right? So when you put all those pieces together, all of a sudden it's like, oh, we can get somebody feeling great again. I wish we had the equivalent of a resting metabolic rate for hormones. Right?

Yes, because you're right. Like, we are not like, you've. You've. Perfect. You're like, I've never heard that before for thyroid. And it sounds so much better than the way that other doctors are, like, chasing these lab tests. And it sounds exhausting when I don't do thyroid. That's not my specialties. But I do know that it is a complicated. And I see that you have to chase. And it's like hair shedding, huh?

We never chase the blood numbers. We never chase them. We. What we do is we do resting metabolic rates and we look at their genetics, and then we do look at that to see if there's reverse T3 or, you know, something like that, or if there's antibodies against the thyroid. Like they have Hashimoto. So we look at it for that. And we like to see that the TSH isn't zero. Right. So we're. But we like to. But we really, really base it on the resting metabolic rate. That's the set point. That's. That's where the thermometer is set or thermometer.

We. We need, like, a comprehensive view of hormones that make sense, especially for this perimenopausal phase. Like, we're telling women that they're estrogen dominant. Oh, your estrogen's high. But it's like, like, why did we get that high measurement to begin with when you're 45? You know what I mean? It doesn't even make any sense. And like, we're not thinking about it. We're just telling her that she doesn't need estrogen. Let's block it. Let's give her dim. It's wild. Like, what? We've not really have developed a very. For women especially, I feel like for men, it's not perfect, but at least we've established those reference intervals based on, like, fsh. And we know that if I give you this much and kind of, like, you know, we're shutting off this pathway. We've not done that for women. Like, I want women to know, hey, like, this has not been done for you. So if a doctor says that your estrogen's high, like, what are they basing that off of? Like. Yeah, their own fear. It's like, it's. It's actually, I'll tell you, it's their own fear of estrogen. I don't know how to do it. I don't know how to do hrt, so I'm gonna fear it. It's not based on any. We have no science like I. That I've seen that's great for lab testing and establishing, like, perimenopausal. We even tell women perimenopause is a clinical diagnosis because the labs are so bad that, like, this is embarrassing.

Yeah.

Like, we need to have, like, a better way to, like, be able to tell a woman that she's perimenopausal.

Yeah, I agree. You know, we. One of the things we. We are concerned about for men, of course, is developing prostate cancer. Right. So we're, you know, we're pretty meticulous about looking at urine hormone metabolites, dihydrotestosterone, 4 hydroxy estrone, 16 hydroxy estrone, you know, making sure people can methylate, getting the COMT gene to work properly, you know, things like that. And certainly many women are concerned about the risk of breast cancer because there are estrogen receptor positive breast cancers. Right. And so. And there are genetics for men that can make, you know, prostate cancer flourish in the face of androgens. Right. So there's. There's a lot of sort of balancing in people's minds here that goes on too. I know my mom. Mom who's now passed away, would never take hormone replacement because she was so worried about breast cancer. She died from, you know, osteoporosis, essentially with repeated falls. So, you know, it's. It's almost like pick your poison a little bit.

But I think it's like we. That whole breast cancer thing too. Like, if it's an, er, positive, if you have a receptor for estrogen, progesterone, on your cancer cell, this is a good thing. You know, it's like, it means that the body has not lost its receptor and it's still responding to normal cellular body signals. If you lose those receptors, that cell is completely malignant and dangerous.

Yeah.

And so, like. But we look at in vitro studies where they grow in the presence of estrogen, but this is not what's potentially happening in the body where you have progesterone that suppresses growth, potentially. So when you look at in vivo and, like, all the different mechanisms that are involved in cancer growth, and then we're simplifying.