[Bonus Episode] Women, Food, and Hormones with Dr. Sara Gottfried

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Hey, it's JJ and welcome to Ask the Health Expert. But this isn't just any old Ask the Health Expert session. This is your bonus session. Yes, it's the weekend and cause it's the weekend. We are going to take some time with an amazing expert. So be on the lookout for these Saturday Ask the Health Expert bonus sessions where we're going to go deep into an amazing subject with an incredible expert to give you actionable items that you.

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Women, food and hormones. Oh my gosh. Aren't those three things that you want to dig into right now? That is the title of Dr. Sarah Gottfried's next book. I am so excited to be talking with her today, welcoming her back on the show. She's always a crowd favorite and you're gonna love what she has to talk about. Today we're gonna be really digging deep into insulin, growth hormone and testosterone and she's gonna show you how she has cracked the code on getting these things to get into line to be in the Goldilocks zone. So it's easy for you to hold on and build muscle while you burn fat. So let me tell you a little bit about do Sarah. Dr. Sarah Gottfried is a board certified physician. She graduated from both Harvard and mit. She is 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 is practicing evidence based integrative precision and functional medicine. She is also a three times New York Times best selling author. You probably know her from any of those books. I'm thinking hormone Cure is probably the one you know her best from. She is my favorite to talk about hormones and diet and really getting into all the science behind it because she's a like super nerd on all those things that she'll tell you herself. So stay with me. I'll be right back with Dr. Sarah.

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Doctor Sarah Gottfried, welcome back. For what? Like, this is the 20th time?

Oh, JJ. It always feels like the first time. I'm so happy to be with you.

I know. Ha ha ha. And it's never enough. Never have enough time. We just need to have a standing podcast date so I actually get to, like, chat with you because I miss you.

I miss you, too.

All right, so this is very exciting. I'm super in love with the title of your new book. I mean, come on. Women, Food, and hormones?

Yeah, it kind of says it all. I mean, this is. This is the struggle that I see in all of my patients that are over the age of 35. And they always want to know, like, what do I eat? When do I eat? How do I fix my hormones? So that's what this book is about. Cool.

All right. So what do we eat and when do we eat it? How do we fix our hormones?

Well, you and I have talked a lot about hormones and how they relate to weight and the metabolic hormones. But there's a few hormones that I think become especially important once you are in perimenopause and menopause, and those are insulin, testosterone, growth hormone. So to answer that question, I would say you want to eat for your hormones. You want to eat in a way that provides that backbone for making the hormones that are the most important and that keep your metabolism burning the way that we want.

So I love this. It's like the minute I went, oh, eat for your hormone type. But I would say then the challenge is going to be when you think, okay, I should be eating for my hormones. That would then beg the question is a woman needs to know, okay, what the heck is going on with my hormones at this time? So I know how to eat right?

That's right. And you know what I came up with after struggling with my weight? I mean, you've seen me go up and down £20 in the times, the years that we've known each other. What I learned was that a ketogenic diet, at least when I first tried it back in 2015, it just didn't work for me. I think it was at a time where I was too stressed, my cortisol was too high. I think I was probably eating too much fat. And so what I understood from failing at the ketogenic diet for several years was that I wasn't doing it right. And the way that men do it and have so much success, that doesn't always translate to women. Women are not just, you know, smaller versions of men.

Right? What is it men are. Men are not hairy women. We can't sit down and have a ribeye with a. With a cube of butter on it.

That's right. Yeah. I mean, I tried that and it just didn't work. You know, I. I didn't get enough vegetables. I didn't get enough prebiotic fiber. And so I came up with a very clean, well formulated ketogenic diet that combines intermittent fasting and really leverages detoxification, which is what women need the most, I think, before starting on a ketogenic diet so that it works well and you don't end up with, you know, all of these problems with not pooping enough and not getting rid of all those estrogens that can recirculate and cause problems. So that's what this protocol is about.

So let's talk. So, so your protocol then is. Is like a clean, detoxifying keto. So really, keto for women that will help with their hormones. What are the hormones like when you really look at what's going on for 35 plus, you know, can we first unpack those hormones and which hormones could be like, leading us to gain weight and what the problems really are here?

Well, I would say not all these hormones are created equal. I think insulin is the most important. It's the one that we want to pay the most attention to because it's that hormone that'll determine whether you're going to store fat or you're going to burn fat. So insulin is first and foremost. Some of the other hormones that I haven't written about before that are in this book are testosterone and growth hormone. There's a few others as well, like leptin, ghrelin, and I've talked before in my books about estrogen, thyroid, and cortisol. But I think really zeroing in on those hormones. Insulin, testosterone, growth hormone, that's what we really cover in this book and talk about how does food serve as a driver for balancing those hormones?

Okay, so it's interesting because I haven't ever heard of anyone talking about that trifecta. Right? They talk about insulin over here, or insulin and cortisol or testosterone and estrogen, progesterone, or growth hormone, like I've never heard them talk about. How do those three relate?

Well, they relate in a few ways. One is they tend to decline with age. And I think let's talk about testosterone first, because a lot of women don't realize that testosterone is actually the most abundant hormone that women have. We always were taught that men have ten times as much testosterone as women. That gives them the testosterone advantage. It's why they lose weight so readily when they go on a diet. But the truth is, testosterone is the most abundant hormone in women. And that means that we're exquisitely sensitive to it. And for a lot of us, it starts to decline in your 30s and 40s. And what you may notice, unless you're checking your testosterone level, as you know, I like to do, what you may notice is that you go to the gym and you just don't see the same response that you used to. You don't get the same, you know, lean body mass response. You may notice that you have less confidence or less agency, less vitality. You may notice that there's just more fat kind of replacing the muscle that she used to have. So testosterone is one of those hormones that I think is so important for women. And we want to be thinking about this exquisite sensitivity that we have to.

It so big ways you would know before you get tested that your testosterone is going down. Biggest one it sounds like is you're just not able to hold onto or build muscle when you're going to the gym. And the vitality. Any other things that we should be looking for?

Well, there's sex, so I was waiting for that. I thought you might be. You teed me up perfectly. So, yeah, you know, a lot of women notice that their sex drive just isn't what it used to be. And that can change, especially when you're in a long term monogamous relationship. But sex drive, I would say, is really what testosterone is known for. So if you're noticing that sex is just the last thing on your to do list, you'd rather do pretty much anything else besides having sex. That's a good time to check your testosterone. I think that's it's just such an essential hormone of, you know, feeling like you're living your best life, your deepest, most fulfilling life.

And when a woman's going to go get her testosterone tested, what should she specifically be getting tested?

Good question. So with testosterone, what we want to know is total testosterone, usually in the blood. And we also want to know free testosterone. That's the amount that's biologically available. So I like to look at both of those. If I get a bonus. I would also like to look at bioavailable testosterone. You can measure it in the blood, you can measure it in saliva, you can also measure it in the urine. All three of those are very accurate.

And someone has low testosterone, is the only way that they can boost it through testosterone supplementation, or are there things that they can do with food and lifestyle?

There's definitely things you can do with food and lifestyle. One of the key issues with testosterone declining is having too much sugar, having too many refined carbohydrates. So there are specific foods that can help you with boosting testosterone. I'm a big fan of a functional shake that I talk about in the book that can help to boost testosterone. There are certain ways that you can exercise. Now, I'm thinking back to many days spent in the gym with you, jj, where we were raising our testosterone with the kind of hiit exercise that we were doing with weights. That's very effective for raising testosterone. So there's a lot of lifestyle things. You know, sleep is essential, 7 to 8.5 hours a night. All of these are really key for raising testosterone.

Do you see women, as they're going through this, able to get their testosterone where they need it to be through diet and lifestyle stuff alone. So they can, they don't like. Some of them may not have to have supplementation like hormones.

I do. In fact, I had a patient today who was saying to me, she's someone who's gone through menopause, she's 52 years young. And she said to me, listen, I think the testosterone is a big part of who I am as a person. And she really wants to make sure that her testosterone is stable and supporting her for the rest of her life. She's someone who's noticed some decline in her testosterone over the past few years since she went through perimenopause menopause. So we are using lifestyle factors to raise her testosterone back to that place that she likes it the best in terms of who she is at work, the kind of personality that she has. She's a risk taker. Testosterone is a big part of that and we're able to do that with diet and lifestyle. Now there's some patients who don't get far enough away in terms of raising their testosterone with lifestyle. So that's one situation where you would want to work with a clinician to support you with that. There are some over the counter supplements that can also help, such as dhea.

Awesome. Now, what about let's move into growth hormone. I still remember I lived in Palm Springs when it became like super hot to go to these growth hormone clinics. And I remember I had a client that was one I owned the gym who and I actually saw this in numerous clients. So maybe you can explain what was going on here who were doing growth hormone injections and getting fat.

Yeah.

And what I noticed was it appeared that their insulin was going up alongside it. So let's talk about growth, growth hormone and what it does. And you know, should you do those things, how you raise it, all of that?

Well, I always prefer that we do diet and lifestyle first as a way of addressing growth hormone. I think that's always the safest bet. And it's a way that you can address some of these hormonal combinations, as you mentioned, with insulin and growth hormone. So what is growth hormone? It is one of those hormones that helps you grow. So as a kid, it's responsible for your height. There are some kids who don't make enough and they tend to be shorter in stature. Sometimes we give growth hormone to those kids, but as an adult, it's responsible for growth and repair, including that muscle mass. It's a big part of preserving your muscle mass as you get older, which we know is one of the most important factors when it comes to health. Span that period of time that you feel fantastic and relatively free of disease. The main thing I think of with growth hormone is that when it starts to decline, you make more belly fat. I think that's what a lot of women especially notice. Men notice it, too. There's some other weird symptoms that can go with low growth hormone. I've got them in my book on page 47. Signs of premature aging, sagging skin, thin lips, droopy eyelids, wrinkles, feeling less inner peace, having more anxiety. I see that so much in my practice right now associated with lower growth hormone thinning muscles on your hands. Like, noticing that the muscle definition.

I'm not looking at everything. I'm checking everything.

You're looking as we go along. I hope our listeners are doing that, too. Yeah, it's like we're tracking this. There's another one that I like, which is where you pinch the skin on the back of your hand for three seconds. You want your skin to immediately bounce back. And if it doesn't, that could be a sign that your growth hormone is not normal, not where it needs to be.

All right, you're going to tell us what to do now because I did not see an immediate pinch. An immediate. Like how immediate are we talking?

Pretty fast. So I would say within a few seconds. I mean, it can also correlate with dehydration. So you and I are both going to keep hydrating here as we talk with your nails. So longitudinal lines on your nails. I think your nails are done. So it may be a little harder for you to see this, but I noticed this right around the time that I turned 50. I noticed that I had these vertical lines on my nails. Another one is saggy inner thighs. Nobody wants that. And this is an especially weird one. Fatty deposits right at the knee, like the inner knee. I know you don't have this, but some of us do.

I don't think you have the other ones.

Oh, my gosh.

This isn't a little scorecard I want to score high on.

So.

No, no, we want to. We want to normalize this.

All right, so someone has checked the box on a couple of those things. So what do they do? Now, I know that all of this is in this book, and I just gotta tell you, I love the title. Love the title, love the title. I mean, however, food and Hormones, it says it all. But in the book, you are dealing with insulin, growth hormone, testosterone, and what you can do. And I always love your approach. It's like, what can you do with diet and lifestyle so that you can see how far you can go? And then if you need bioidenticals, you can go to your clinician, but you should actually never go to your clinician to get those things until you've done this work first, wouldn't you agree?

That's exactly right. I mean, what I find is that if you end up needing to go on bioidentical hormones, your dose is going to be lower and the duration may even be lower for needing those hormones. So you set yourself up for better success when you do it this way, when you start with diet and lifestyle first.

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So when it comes to growth hormone, we know that, you know, there's specific strategies in the book that help with raising growth hormone, including certain forms of protein, whey protein, as an example. It also is fasting. So I'm a big fan of intermittent fasting. I think you have to be a little bit careful with women who are stressed because you don't want to raise cortisol even further in women who are stressed, that can really cause metabolism to slow down. But we know that intermittent fasting can raise growth hormone by a pretty substantial amount.

So for intermittent fasting to raise growth hormone, what is the window that's optimal? Is there one?

Yeah, great question. So what I found in my research, so I've done n of 1 experiments with this particular protocol with patients in my practice, and what we found is that somewhere between 14 to 16 hours of fasting is really ideal for women over the age of 35. Once you get beyond 16 hours, it becomes more stressful. And if we take a step back, you know, the whole purpose of a ketogenic diet is really to trick your body into thinking that you're fasting because there's so many beneficial things that happen with fasting. So when we do intermittent fasting, it is a back door to ketosis. And for a lot of us, 14 to 16 hours of a fasting window is enough to trigger the production of ketones. And then if you can support that with a well formulated ketogenic diet, you're golden. That really provides the kind of hormone balancing that we're seeking.

You know what's awesome about that too is that's so doable.

It's so doable.

Like the one meal a day, that's a little rough.

It is a little rough. It's stressful, I think.

Yeah, it's super stressful. I have, I've not ever completed a one meal a day, but, but doing two and getting like for me I just, I eat somewhere between 10 and 11 in the morning. I have dinner somewhere between 5 and 7. That's it simple. Like this is not hard. And sometimes on the weekends it's a little bit, you just go a little later, just do it a little earlier, but it's not a big deal.

Yeah, I think that's, that's the best strategy. And you know, if you find that eating at 10 to 11 and then again, you know, around 5 to 7pm if you find that that's too stre, like you get too hungry in between, that's another sign that your hormones are not supporting you the way that they could be. So back in the days when I had insulin block where my cells were really resistant to the signal from insulin, they were numb to it, and I had really high insulin levels in my blood. I couldn't go more than three hours without eating. So I had to heal that. I had to heal the insulin, heal the testosterone, heal the growth hormone so that I could do what you're describing with intermittent fasting.

So you said 14 to 16 hours was what they found was the best. What were they like, what were they looking at? Or was this you were looking at in your, like, where did these numbers come from and what did they see was made it ideal?

So there's two sets of research here. There's the research that I've gathered in my patients where I saw a pretty significant increase in growth hormone as measured by IGF1 with doing a 14 to 16 hour window together with a well formulated ketogenic diet. So I saw increases in growth hormone somewhere around 20 to 60%. Now that's crazy. It's pretty good. I mean that's huge.

Yeah.

We'll have to come back to all those folks that you were talking about who were taking the growth hormone injections. Now we have peptides. So that's like a whole other conversation. But the other research, which was not done by me, looked at 24 hour fasts and they Found really pretty dramatic increases in growth hormone. I would say probably a little higher than we want. Because you want all of these hormones, growth hormone, insulin, testosterone, you want all of them to be in the Scolilox position where it's not too high and it's not too low. Now those folks who take injections, I remember when I first started going to the A4M conferences.

A4M? Yep.

A4M. American Academy of Anti Aging Medicine. And you know, people just look a little different at those conferences.

Right? A little acromegly. Yeah.

Because they've got the growth hormone on board. And when I first heard about growth hormone and you know, some of the risk of cancer associated with taking the injections, I just realized as a physician, I'm not comfortable with this. We always know that diet and lifestyle is the place to begin when it comes to balancing your hormones because we know it's safe. We know that, you know, it's. It's going to modulate the levels without being extreme.

Yeah, that's. It is funny that you mentioned it that everyone started to look a little. A little strange.

A little strange. I did not aspire to look like that.

Yeah, gosh, no. Nope. If I wanted to look like the monsters, you know, like. So let's unpack. First of all, that's. That's incredible. Oh, one other thing around growth hormone. So beyond intermittent fasting and using your cleaner keto diet, what, any other things that help that you've seen?

Well, exercise too. So my first foray with Licknet growth hormone was probably about seven years ago when I met up with a friend of mine who told me about this thing called Sprinate. You probably have heard of this where you do high intensity interval training for a minimum of eight rounds with a rest of 60 to 75 seconds in between the bursts of energy. Burst training in the language of JJ Virgin. So this is another way of raising growth hormone. And I actually measured, of course, I did an experiment. You know me how I like to science myself.

Yeah.

So I measured my growth hormone, IGF1 before and after doing this sprint 8 process in the gym and my level went up about 56% and that was over about a six to eight week window. I'd have to go back and look at my notes to see why do.

People need to take injections like this has never made any sense. Sense to me, you know.

Well, it's a really good point. I mean, why? Because yeah, it's hard to do behavior change, but really this is the key to creating that Kind of health that all of us want. So we need to get on board. We need to get on board and figure out, okay, what is it you really want? I want to be as lean and as healthy as I possibly can as I get older. I don't want to be, you know, like, in an assisted living center, not able to recognize my great grandchildren. So. So that really motivates me. That motivates me today to do my burst training and to eat my whey protein shake and to follow the precepts in this book.

So let's go to the final piece of it, because you mentioned being insulin resistant. And so insulin, you talked about insulin being the big key here. And I know that you're going to be giving away a blood sugar guide, so stay tuned and I'll tell everyone how to get that. But let's talk about insulin. Because you were insulin resistant, you had to heal that. So how did you do that?

Yeah, insulin resistance, I think is, in some ways, it was a really humbling experience for me because I remember hanging out with you in places like Las Vegas and feeling like, oh my gosh, jj, you have the most amazing muscle definition. You have no belly fat. How could I ever be similar to you? And the thing that was challenging for me was insulin block, insulin resistance. So I've tried a lot of things over the years. I tried changing my food, low carb diet. Didn't find that that was as successful as I had hoped it would be. I found that stress played a major role. And so I really had to dial in how to navigate stress in a whole new way. You and I were just talking about that before we pushed the record button. And also here was a big game changer for me. And I know not everyone can do this, but I started to measure my fasting glucose and my postprandial glucose. Now you can do that with a 25 little glucometer that you can get on Amazon or, you know, online or cgm or you can get a continuous glucose monitor. And it was the continuous glucose monitor that helped me heal the insulin resistance. So it's what I used for myself as well as for my patients who went through my protocol to really make sure that we were using this well formulated ketogenic diet combined with detoxification and intermittent fasting to get that glucose back into that so called Goldilocks position. So that's what really made the difference for me. That's how I lost £25 and have kept it off for a couple of years. I'm so Pleased.

I think it's really important to underline because here you are, like, you meditated, you worked out, you ate healthy, and you're insulin resistant. Like, you said that at the start of this. I'm like, how in the heck were you, insulin resistant, doing all of those things? And so it just shows how important it is to measure and to be able to identify. Because I would never have thought that, like, it just. You wouldn't, you wouldn't think outright with everything that you were doing that that was a thing. And then by using blood sugar monitoring to be able to fix that and then to be able to do that with all of your patients, to really be able to dial in a diet, because this is a. This is a classic problem for so many people. And probably for you, since so many of your lifestyle things were dialed in, was probably a big, big stress situation, wouldn't you think?

It definitely was stress. That was a huge part of it. But, you know, the other thing that was happening was that I was eating foods that were jacking up my glucose, and I didn't know it.

Which foods were you doing that were having that effect that you were? And you were able to see this. I would take it by when you started. I know measuring your blood sugar is like one of the most. It's one of the cheapest things you can do that gives you the biggest information.

It totally is. I mean, I. I can't believe what a difference it made for me. I'm sad that it took me so long, but. But I can save that time for our listeners. I hope that this is a challenge that you'll accept, that you'll look at your glucose as well. But here's some of those foods that I was so surprised to find out were causing problems for me. Sweet potatoes. I would get a glucose. I'd go from a level of about 80 up to 180 when I ate sweet potatoes. Legumes, especially chickpeas. I love hummus, and I had hummus a few times a week, and it was making me so spiky.

Wow.

Pretty amazing. Definitely fruits, so apples, grapes are probably the worst offender. But there's a lot of personalization here that's not true across the board for all people. That was what was true for me.

I know, for apples, for me, because I know what happens to my blood sugar after I eat them. I've never been able to eat apples.

Well, this, I mean, this is all part of a bigger point, which is what you measure improves. And so I think measuring is such a key part of this process.

So perfect timing because you're going to be giving everyone the blood sugar guide that you've created. I'm going to put it@jjvirgin.com Drceraguide because I think we have so many things that we've put together over the years with us that I have no idea. So I know that we haven't done Dr. Sarah guide yet. And we'll have information too, on the book because you definitely want to want to grab women, food and hormones. Yet another of these amazing books, the Dr. Sarah books you want in your library. And just walk us through what they're going to find in that guide.

Yeah, so the guide is really designed for people who are looking at their blood sugar for the first time. And so I walk through how you can use a glucometer if you know that's what's in your budget. I also walk through what my recommendations are in terms of numbers. That's what everybody tends to want to know. And we were talking about this earlier. It wasn't just that I had insulin resistance. I was pre diabetic and a lot of that was related to my hormones. So not just insulin, but cortisol, that stress hormone that tends to cause problems with insulin. And it was when I was measuring it regularly that I could really see the effect through these NF1 experiments of what I was doing. So that's what helped me dial it in better than anything. So I talk about some of the ranges, the ranges that you hear from your mainstream doctor. Fasting glucose of 70 to 99. I don't agree with that. Right. Like, optimal is 70 to 80 in terms of cardiovascular benefit, 70 to 85 in terms of having a normal glucose and insulin response. So, you know, the thing with pre diabetes is that somewhere around 88 to 90% of people don't know they have it. So that's where testing can be so helpful.

Yeah. Wow, that's incredible. This is great information. You're right. It's the big challenge when you get these monitors is that you don't know what you really should be looking looking for. So. And the other key point I want to underline is that you said earlier is you're really finding out what works best for you. You may find that you're fine with sweet potatoes and you know, or you're not. So it all is about customizing it. And that's what's so great about having these little things that we have now, the Apple watches and oura rings and CGMs and all of these things because we can really see what's going on. Yes, we're all tracking all the things.

Well, this is such an important point because. Because it is all about personalization. The work I do at Thomas Jefferson University as the director of precision medicine, it is about how do we personalize a plan for you? This idea that there's a one size fits all, that's not the future of medicine. The future of medicine is that we personalize and we figure out, okay, here's the food plan that really works for you. And it's with these devices, these wearables like continuous glucose monitors and the trackers that we can really do that dial.

So cool. All right. Jjvirgin.com forward/drsaraguide grab women, food and hormones. And thank you so much for being on. And I will make sure that you're on sooner. You were so hard to pin down this last time. I think this has been like a, Like, I had to go search for where this was in Zencaster because it was like a year out. I've been waiting.

Oh, I so appreciate it.

I'm gonna hunt you down sooner, my friend.

Thank you, jj.

Thank you. All right, I just want to remind you to grab that blood sugar guide. It's free. And you can get that@jjbirgin.com drceraguide and remember to get women food and hormones because what we gave you today was a great overview looking at insulin, testosterone, and growth hormone and starting to talk about some of the things that you can do through diet and lifestyle to make a major impact on them. And remember, if you are starting to notice things shifting diet and lifestyle come first. And then if you're still not where you want to be, that's where you can work with a clinician to get bioidentical hormones if they are right for you. Diet and lifestyle first. And this is a great roadmap to help get you there. If you've not subscribed yet, make sure you do. Subscribetojay.com and I'll see you next time. Bye. Foreign.

Hello listeners. This is Anne Bogle, author, blogger, and creator of the podcast what Should I Read next? Since 2016, I've been helping readers bring more joy and delight into their reading lives. Every week, I take all things books and reading with a guest and guide them in discovering their next read. They share three books they love, one book they don't, and what they've been reading lately. And I recommend three titles they may enjoy reading next. Guests have said our conversations are like therapy troubleshooting issues that have plagued their reading lives for years, and possibly the rest of their lives as well. And, of course, recommending books that meet the moment, whether they are looking for deep introspection to spur or encourage a life change or a frothy page turner to help them escape the stresses of work, school, everything. You'll learn something about yourself as a reader, and you'll definitely walk away confident to choose your next read, with a whole list of new books and authors to try. So join us each Tuesday for what Should I Read Next? Subscribe now wherever you're listening to this podcast, and Visit our website whatshouldireadnextpodcast.com to find out more.