Does Trauma Cause Illness? with Dr. Sara Gottfried

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I'm JJ Virgin, PhD dropout.

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The energy to play full out at 100. This podcast interview might feel like a bit of a departure because it actually felt like more of a conversation with me and a very close girlfriend and that is Dr. Sarah Gottfried. And we are talking today about her new book, the Autoimmune Cure. Really when you unpack it. We're talking about the role of trauma in not just autoimmune disease, but in all diseases and really creating limitations in your life and more importantly, what you can do about it. And I am really excited to be digging into this topic. Let me tell you a little bit about Sarah. Sarah Gottfried is a medical doctor, a physician, researcher, author, educator who graduated from Harvard Medical School and she completed her residency at the University of California, San Francisco. And she is very into personalized nutrition and precision medicine, uses a lot of the different tools deep into her own n of one experiment with her and does the same with all of her patients and focuses a lot on taking care of executives and helping them uncover like she'll work through do ACE scores. You're going to learn what those are to see what the role could be of trauma in what's going on so that she can really help them balance their hormones and get rid of a dysregulated state she is a keynote speaker. She's the author of four New York Times bestselling books and again, her latest book is the Autoimmune Cure. We are going to be putting a lot of information@jjburgeon.com autoimmune cure and some of the bonuses that she has with the book, some of her other interviews so you can dig into all things that Dr. Sarah has done, which she has just had an amazing career and it's like this is really the next level work with her. It's really exciting. 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 Integrated Health and takes care of a lot of executives and professional athletes. So I'm excited to share it with you. So stay with me. I'll be right back with Dr. Sarah Gottfried.

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Dr. Sarah Gottfried, I am so happy you are here.

So happy to be with you, J.J. in a flesh. It's so good.

I know we have to spend more time together. I am so excited about, like, the whole direction your career is going and what you're digging into here with trauma. I'm kind of speechless about all of it, but I'll try to do an interview.

Let me say first that I feel like you have been one of the biggest influences on my career. And so getting to this point of writing book six, I just want to credit you for all the ways that you've mentored me over the years. I just love you so much, and it just means so much to me to be at this point with you and to be having this conversation.

Well, I feel like you're stepping into your biggest work yet, and I've watched you kind of have to peel the onion to get here, and this is really personal work. That's why when we started, I was.

Like, is there any question off limits?

Because you're stepping into something that clearly you had to do your work and go through peeling back the layers to be able to even look at this work on it, et cetera. I mean, we're talking about trauma.

When it comes to topics like trauma, as a writer, you really have to make sure that you're kind of through the process before you start writing about it, because otherwise it becomes more risky and dangerous.

Right.

We want to heal from this. This thing called trauma.

Go in the valley and come out the other side. And Victoria Notorious, not the victim so this latest book on autoimmunity, which I think it's so fascinating, like, I was digging into.

Okay.

The connection between trauma and autoimmunity, But I want to first start with digging into the whole umbrella of trauma and how you started to really look at it and what your journey has been.

Yeah. I appreciate you bringing up the umbrella, because a lot of folks pigeonhole an experience with trauma as having mental health effects, and certainly that's true.

Right.

There's post traumatic stress disorder. There's anxiety. There's depression. There's disordered eating. There's a long list of things that can happen from a mental health perspective. But you and I both know that this division between mental and physical health is actually artificial. You know, there's so much interdependence between mental and physical health. So in the umbrella, you know, I want to invite as many people as possible. I want people to understand that a chronic stress response is underlying dozens and dozens of chronic health conditions. And so, you know, if we look at, for instance, the adverse childhood experiences study that was initially published in 1998, it was a collaboration between the Centers for Disease Control and Kaiser Perfect. So they were looking at mostly middle aged people who, you know, they had a job, they had Kaiser insurance, they were mostly middle class, upper middle class, based in San Diego. And they found that the number of people with adverse childhood experiences. So when you have adverse childhood experiences, that maps to all of these chronic health conditions. And so we need to understand that it's not just a physical solution. You've got to address some of these underlying causes.

I guess two questions there. The first question would be, who doesn't have adverse childhood experiences? I'm thinking, because at first I thought, well, okay, maybe, maybe my son Bryce didn't have it.

I'm like, oh no.

My son Bryce definitely had adverse childhood experiences. He got to see his son, his brother almost die, and then his parents divorce.

Like, who?

Where's the control group for this?

So the control group is people who have aces that are zero. Are there really people who have aces? Apparently there are. I mean, I haven't met them. I've got a few patients who do not have adverse childhood experiences, but that doesn't mean that they don't have adult traumatic experiences.

No one gets through unscathed. And what would be an adverse experience? So for the listener who hasn't looked at the ACE score, which I'm going to recommend everyone take that.

So in childhood, that would be divorce, sexual abuse, physical abuse, having a parent with addiction, neglect, not getting your needs met with a lot of these, you could then classify them into big T traumas and small T traumas. So, you know, pretty much everyone would agree that sexual abuse is a big T trauma. You know, having as an adult a life threatening car accident, a big T trauma, surviving the Holocaust, surviving 9, 11, those are big T traumas. But there's also these smaller T traumas, you know, sort of the subtle criticizing or made to feel like you had to do something to receive the love and attention you deserved as a kid. So there's also these small T traumas. And I think what's important is to realize that the body in some ways doesn't care whether it's a capital T trauma or a small T trauma. The way that the trauma, the dysregulation, lives on in your body that occurs regardless of what type of trauma you are exposed To. So it's the dysregulation that really matters. It's the way that the trauma kind of lives on in your body that's really key. And this piece of dysregulation, I think, is so important because, you know, we help them with muscle gain and fat loss, and we help them with getting their blood sugar more stabilized. We help them with disordered eating. We help them with hormone imbalances. All of these things are signs of dysregulation. And I just want people to recognize that trauma often is a root cause of it.

Yeah.

And when we look at getting to the root cause, if you're not unpacking that you're just going to be treating the symptoms, how would you know that that is your issue?

Well, I would say measure your dysregulation. I think that's the most important place to start. Look at your relationships. Are you someone who has been happily in partnership for 30, 40 years, or are you someone who has a more difficult relationship, you know, sort of staying in a marriage or staying in a partnership? What's going on with your blood sugar? What's happening with your heart rate variability, which is that measure between your sympathetic nervous system, Fight, flight, freeze, spawn, versus what I now think of as the parasympathetic Stay in play.

Oh, I love that.

That's so good.

Yeah.

So we want to be looking at, you know, what's going on with your cortisol levels. Are they stone cold normal, or are they more like mine? The parts of your body, your system, that are the most sensitive to trauma are called the Pine network. So that's your psycho immuno neuroendocrine network. So the PI network is what you want to keep in mind, and then you want to do what you can to measure, using validated questionnaires, how much trauma you've been exposed to. But a big part of what happens with trauma, like with an elevated ACE score, is whether you had loved ones that you could talk to about it, whether you had someone, you know, kind of a trusted adult who could walk you through it and kind of hear your side of the story and not gaslight you. So there's a lot of other factors. The other thing that I think is important is that these questionnaires aren't perfect. You know, even the ACE questionnaire that was developed back in the 1990s, it doesn't have bullying. It doesn't have some other aspects of trauma that it measures. So we want to make sure that we're taking an inclusive look at someone's experience of trauma. And then we're looking specifically at, is there a signature of trauma that lives on?

And what do you mean by a signature of trauma?

I'm someone who tends to have a low heart rate variability. And I've really taken this on. So I've been tracking it for probably 15 years. And then that allows you to then do and of one experiments to see what might make it better. And so I can tell you, I was just in Japan for a couple of weeks. I had such an incredible time. I was immersed in nature, and even.

Flying back from Japan, it went down.

No, I had this heart rate variability that was like, three times higher than I usually am. And so I'm delighted when I see that. And then I want to sort of understand, okay, why is this? Is it the joy that I feel? I wasn't drinking alcohol. That plays a huge role. And then, you know, regular good sleep, being on your game with magnesium, with minerals. So the other thing that the aura does that I really like, which relates to trauma, is that it now has a daytime stress feature. So it tells you during the day, and you're nodding because I think you're tracking this too, whether you're stressed, engaged, relaxed, or restored. And so now I'm so competitive. I'm like, okay, I gotta relax. Where's my restore time? Wait, I'm not restored.

I will tell you, though, I was interviewing Dr. Molly Maloof because I was like, my HRV was so low on my oura ring. I'm like, holy smokes. Like, what do I do here? But Molly told me, you know what? You need to wear the strap. I wore the strap, and my 12 on my Oura ring was a 44. On my. On the Polar, doing it through Elite HRV.

And I went, huh?

It made me kind of a little bit calmed down.

Well, it's probably kind of like a continuous glucose monitor. And then doing a finger stick to calibrate it, I found that the chest strap was pretty close to what I see with the OURA ring. And the composite that they use for the daytime stress is including heart rate variability. So I do find that that particular measure is incredibly helpful. And, you know, the other thing is that it's not so bad that your HRV is low compared to somebody else. What really matters is what we're talking about, which is comparing ourselves with ourselves.

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What are the things that you see that someone with trauma that they have not dealt with? Because we're going to talk about what you need to do to get it out of your tissues, I would guess, you know, if it's in there now, wreaking havoc beyond these symptoms, what are some of the diseases that it could lead to?

Well, the list of diseases is pretty long. So if we go back to that study that was done by the Centers for disease control, there's 45 different chronic health conditions associated with adverse childhood experiences. So that includes cardiovascular disease, which is, you know, like Cardiometabolic disease is nine of the 10 top killers of people in the U.S. so all of those are associated with adverse childhood experiences. Autoimmune disease, diabetes, as I said, metabolic disease, chronic pain associated with trauma. I've been taking care of men and women for about 30 years. I do a lot of hormone balancing and the people who have hormone issues and we work on them and they've got two steps forward, one step back, three steps forward, two steps back. Those are the folks that often have some kind of trauma signature that's leading to some difficulty with managing. So there's the health condition and then there's also how you're recovering from the health condition.

Learning all of this. How has this changed the way that you practice?

It's changed it completely. When I went through medical school and this is now 1989 to 1994, we didn't really talk about trauma. You know, it was sort of relegated to the psychiatrist and it just wasn't considered. Now I would say it's at the heart of it. So every single client that I see, I do an adverse childhood experience experiences score. I'm talking to them about, you know, what happened to them when they were younger and also kind of how their current life is. I'm looking at their relationships, I'm looking at their ability to love, to feel love and receive love. I've got a particular type of patient who's attracted to me mostly because of my own trauma. I imagine the people who are highly self reliant, who are hyper independent, dependent, who learned as children that they had to be a certain way, perform at a certain level in order to receive the love and attention that they most needed, but it leads to a particular pattern which can cause striving, it can cause more difficulty in relationships, it can make it harder to slow down, to be in that place where we try to balance between the sympathetic nervous system and the parasympathetic nervous system. System. All the healing happens in the parasympathetic nervous system. Like that's part of the autonomic nervous system that you and I really need to understand and love and dwell in.

It's great that you're talking about this so people can start to identify it. But then what the heck do you do with this information? With, you know, we always hear the issues are in the tissues, but what do you do about the tissues?

Well, it starts with measurement, so. So I think knowing about your experience with trauma is really critical. Having a sense of how that dysregulation might still be living in your system.

And nothing really seems to work, unless.

It seems like nothing seems to work.

Connected to Dr. Joe Dispenza, the hip, practically.

That's right. I mean, there's a lot of people also who've got these kind of vague, mysterious symptoms and they're not quite sure what's going on. They've got non specific things, things like fatigue or joint pain, skin rashes. That's a really critical piece because when we talk about the pine system, we know that some people have a particular vulnerability. Like my vulnerability is immune. And also with cortisol. For other people, it might be more the psychology, they're more on the anxiety, ptsd, depression side of things. But when it's your immune system, it can be much harder to diagnose. So we'll get into the solutions. But one thing I want to mention is that people with autoimmune conditions and autoimmunity predates an autoimmune disease by 7 to 14 years.

And what's the difference?

The difference is there's a spectrum. So at one end of the spectrum, you're normal, your immune system is functioning just the way it should be. At the other end of the extreme is autoimmune disease. Rheumatoid arthritis, multiple sclerosis. Having a clear diagnosis where you have antibodies against your normal tissue, but there's this whole broad space in between where you might be starting to develop antibodies and maybe you don't have symptoms yet, or maybe it hasn't been clustered into a diagnosis yet.

Would you see on a lab test elevated antibodies?

You can see on a lab test elevated antibodies.

And that's where you'll have someone come back from their Doctor saying, well watch that.

There are so many people who have these symptoms that start they will see on average four to six doctors before they get a correct diagnosis. And they can suffer for four to seven years before they get that correct diagnosis. So that's what I want to change. I want people to be connecting the dots.

But the correct diagnosis would be the autoimmune disease, but it wouldn't necessarily be what's causing it though.

Well, we know pretty clearly what causes it. So it's a trio. It's like a Lefisano calls it a three legged stool. So it's genetic predisposition, increased intestinal permeability and then a trigger. So the trigger varies. The trigger could be trauma, it could be toxic stress, it could be an infection, it could be your bout of COVID that you had and now you have long Covid. There's a lot of different things that can be that trigger. But what I saw in my practice was that there were so many people for whom trauma was the trigger. And I started out my book with a case of a woman who had fibromyalgia, endometriosis, adenomyosis, and she went through a really difficult divorce. When she completed the divorce, she found that her symptoms abated, she got so much better. And that's just one example of someone who's got, you know, those aren't classic autoimmune diseases, but they are cases in which the body is attacking itself.

Yeah. So someone takes the ACE score, what would they do to address it? Is an elevated ACE score anything over zero?

Yes. So one or higher. Do you know what your score is? It's four. There's some other questionnaires that have a different denominator. So for instance in the book I reprint the Institute for Functional Medicine ACE questionnaire, and that's out of 24. So when you know that your ACE score is elevated, it's important to combine it with looking at these signs of dysregulation. So simple things like heart rate variability, your resting heart rate, your respiratory rate. There's also some laboratory testing that I think is helpful. Helpful looking at your cortisol, 4 point cortisol or cortisol awakening response. There's some blood testing that can be done kind of looking for pre autoimmunity. So things like antinuclear antibody, thyroid peroxidase antibodies, rheumatoid factor, like if you have joint aches and pains.

Did you put together a panel of all these things?

I did. And then I also have a bonus for people who pre order or order the book that they. And get a copy of this as a PDF. So the book is focused mostly on people who've got immune and endocrine issues related to trauma. And I want to say also that not everyone with trauma develops autoimmune disease, and not everyone with autoimmune disease has a history of trauma. They're just highly correlated.

I was going to say, but how highly correlated?

Very. It's somewhere around 70 to 80%.

And wouldn't you owe it to yourself, especially if you're not seeing the improvement, to look at this?

Well, that's what I believe. I had a falling out with a family member. This happened about five years ago. She and I stopped talking over this conflict that we had. And I was just devastated about this. I don't want to be estranged from anyone I love in this lifetime. If there is something from my past, some way that trauma is impacting my behavior in the present moment, I want to heal that, and I want to heal it as quickly as possible. Let's resolve it. And so that's what got me to really start to look at trauma and to say, okay, there are ways that I need to clean up my side of the street. And so that got me to changing the way that I eat. I did an elimination provocation diet.

You were already eating really well.

I was eating well, but I was, you know, I liked my nightshades, and I liked. I really liked nuts and seeds. And there were some things that were triggering my immune system.

And that's. I think that's actually an important one because we can eat healthy, but healthy isn't always healthy for you. And it's something you do need to revisit because you shift. We're not static.

And it got me to look at immunomodulators, vitamin D, dhea, curcumin, some of those things that we know have a benefit, beneficial effect on the immune system. And then it got me to psychedelic medicine. So I'm super excited to talk to you about psychedelic medicine. But I want to mention one thing which is the gold standard, so the gold standard and what I was taught in my medical training is that when you have post traumatic stress disorder, you do talk therapy, maybe trauma informed by talk therapy. And if that doesn't seem to be working, you add on a selective serotonin reuptake inhibitor. That's the gold standard. And GJ, what's the effectiveness? The efficacy is somewhere around 30%.

I tried talk therapy. Talk therapy made it worse. I'm like why are we rehashing this?

It just reinforces the traumatic loop. The part of the brain that understands what happened to you is different than the part of the brain that helps you heal. It may not solve the problem for you. In fact, it doesn't 70% of the time. And then you look at something like MDMA assisted therapy for PTSD, moderate to severe PTSD, and the efficacy is more than double. It's 67% in the first phase three randomized trial of two to three sessions of MDMA assisted therapy, it was 71% resolution of symptoms in the second randomized trial. So when I saw those data, I was just like, okay, let me do everything I can to resolve my trauma.

So beyond mdma, what other things are working, like ketamine or.

So ketamine also effective, mostly used for treatment resistant depression, but that can also have a trauma link. I'm now certified to administer these medicines that we're talking about.

Well, once they're improved or can you do it now?

Once approved? So yeah, we're all kind of in.

A holding position, clock ticking.

The clock is ticking. And then there's psilocybin. Psilocybin has so much potential in terms of depression, end of life care. We're seeing it be effective for alcohol use disorder. So we're just at the learning to crawl stage stage in terms of understanding how effective some of these sacred medicines can be.

Where are these able to be used outside the United States?

The OG is to go to Johns Hopkins. So Johns Hopkins has a ton of research. We're here in New York. NYU has a ton of research. Ucsf, we've got Robin Carhartt Harris that we recruited a few years ago. So he's doing his, his research especially on psilocybin at ucsf. There's an above ground way to do this, which is with licensed clinicians. My preference is to only work with above ground workers. But I also need to acknowledge that there are thousands of years of indigenous healers using these medicines. And so you can go to places like South America, Costa Rica, and you can have an experience with some of these. The safety and the ethical issues can be more problematic and tricky in that circumstance. And they're considered safe and legal, such as Amsterdam.

I've just been concerned that it wouldn't become legal because it's going to change the whole mental health industry.

Certainly it's going to disrupt what psychiatrists and therapists do in the US and broader and know outside of the US But I also, I'm not sure that it should be medicalized and 100% under the control of psychiatrists. We want to make sure that there's some sort of regulating body to keep people safe. I have some caution about, you know, just having the mental health folks kind of be the gatekeepers of this.

And is that because of maybe missing the traditional or the spirit spiritual or that piece of it, the ceremonial part of it?

That's a big piece. I mean, that's something that an individual can bring to the experience. But when you look at, for instance, what's happened in the US with the revolution we're having with psychedelic medicine now in the Bay Area, we've got a ketamine clinic on almost every street corner.

They're just giving ketamine integration everything, man.

Integration is everything, everything. So this spiritual aspect, I think those qualities are so essential. We just want to be careful that this doesn't get corporatized and over medicalized.

I realize I said integration and some of the listeners may not know what.

The heck I'm talking about.

Some of these things can open doors and then you need to really understand what you just went through and figure out how to integrate this back now. How do I bring this into my new reality?

I've got colleagues and friends who with whom I talk about these things. And I have one in particular who's just like, how do I know if I'm doing too much medicine work? And I think the way you know, is that you're not taking the time for integration. I don't recommend medicine journeys more than about once a quarter. I think that's probably as frequent as my system can handle. Some people need to go longer, some people can do it, you know, with shorter intervals, levels. But the key is, are you fully integrated before you go to the next journey. So I think integration is everything.

And what has happened to you because of this? How has it shifted your health, your life, everything?

This is where I get a little quieter because it has shifted everything. So I'll start first with my motivation for doing MDMA assisted therapy. And that was the falling out estrangement I had with a family member. And we reconnected. So we were estranged for about a year. I cleaned up my side of the street. That relationship is now healed. My marriage of 20 years wasn't the right fit for either of us. That wasn't MDMA so much. That was more an experience with ayahuasca. The spirit of ayahuasca really points out the parts of your life that are maybe inauthentic. My experience with MDMA assisted therapy. I've probably done it maybe 12 times over the past five years, never more than once a quarter. I feel like the way that trauma lives on in my body is maybe like 90% reduced compared to when I first started. I don't have science to support that, but I can tell you, when I look at my heart rate variability, after I do one of these experiences, once the autonomic effects wear off, my HRV is typically double or triple what it was before. And that's true with ketamine, it's true with mdma, it's true with psilocybin.

And how long does that last?

A lot of it is on me. I would say it's mostly durable. It's, you know, I've made some big changes in my life and I feel just so much more like fully who I am. A sense of wholeness. I'm so grateful for that because. JJ Virgin Vol. 22 Sarah Got Freed, Volume 2. This is the best time of our life.

It really is. That's really my big message.

That is my clear message.

Coming forward is like, this is it. And I love that you've done all of this work and it's also a very vulnerable place to come out. You're really an innovator, early adopter with this stuff. It's a little risky to come out with. And I love that you are doing it, taking a stand and getting this work out there, like. APPLAUSE thank you.

Yes, thank you.

Yes.

Yes.

It is this opportunity to start to change the roles in your life, to start to change the love relationships, the way that you give and receive love. The more that you can kind of lift yourself above and sort of look at this process that's happening and think of it as an initiation. I think that's really cool.

And take off your darn superwoman cape.

That's right.

Throw it away.

Burn it.

So your book's out, the autoimmune cure, right?

Yes.

And so we'll have all of that in the show notes, along with our other interviews, all your other books, since this is book number six and you'll still have the bonuses. Tell everyone about the bonuses they'll get when they grab the book.

Yeah. So we've got a number of bonuses. The PDF of optimal lab ranges, we've also got.

And those are different labs than what people are used to.

Yeah. So these are labs that I order as a precision medicine doctor and as someone who does functional medicine. It's not necessarily the normal ranges, it's the optimal ranges, which is different. And then I've also got a meditation, a guided visualization that. Did you do it? Yes. Wow. So, you know, there's a chapter in the book on embodiment and you know, just really kind of coming downstairs from this hypercomative place which is where so many of my clients reside. And so it's a 10 minute vision visualization. To help you do that, we're putting.

It jjvirgin.com forward/autimmune cure.

Great.

Fabulous.

And I just am so excited about all this work that you're doing.

Thank you for mentoring me and thank you for helping me get to this place. I love you so much.

Be sure to join me next time for more tools, tips and techniques you can incorporate into everyday life to ensure you look and feel great and more.

Important importantly, that you're built to last. And check me out on Instagram, Facebook.

YouTube and my website, jjvirgin.com and make sure to follow my podcast so you don't miss a single episode@subscribetojay.com See you next time. Hey JJ here. And just a reminder that the well Beyond 40 podcast offers health, wellness, fitness and nutritional information that's designed for educational and entertainment purposes only. You should not rely on this information as a substitute for, nor does it replace professional medical advice, diagnosis or treatment. If you have any concerns or questions about your health, you should always consult with a physician or other healthcare professional. Make sure that you do not disregard, avoid or delay obtaining medical or health related advice from your healthcare professional because of something you may have heard on the show or read in our show notes. The use of any information provided on this show is solely at your own risk.

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 tag 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 what Should I read next podcast.com to find out more.