Welcome to the huberman Lab podcast, where we discuss science and science based tools for everyday life. I'm Andrew huberman and I'm a professor of neurobiology and Ophthalmology at Stanford school of medicine. Today, my guest is dr. Sara Gottfried dr. Sara Gottfried is an obstetrician gynecologist, who did her undergraduate, training in bioengineering, at the University of Washington in Seattle. She then completed her medical training at Harvard Medical School and she currently is a clinical professor.
Acer of Integrative Medicine in nutritional Sciences at Thomas Jefferson University. She has also been a clinician treating men and women in various aspects of Hormone, Health, and Longevity for more than 20 years. She is an expert in not just traditional medicine as it relates to hormones and fertility. But also nutritional practices supplementation and behavioral practices and combining all of that expertise in order to help women navigate every aspect and dimension of their hormones, longevity and vitality.
Changing from puberty to Young, adulthood adulthood perimenopause and menopause and nowadays, she's also treating men across the lifespan in terms of longevity vitality and Hormone Health during today's discussion dr. Gottfried shares an enormous amount of information and tools that women can apply toward their Hormone Health fertility. Vitality and Longevity. We discussed the gut microbiome which many people have heard about but dr. Godfrey points out, the specific needs that women have in terms of managing their gut microbiome
Oh, and the ways that that influences things like estrogen levels and Metabolism, testosterone thyroid and growth hormone and much more, we also discussed nutrition. And exercise, we touch on how the omega-3 fatty acids, play a particularly important role in managing female hormone Health. Doctor, Gottfried points out why women have particular needs when it comes to essential fatty acids and how best to obtain those essential fatty acids for Hormone Health. We also discuss exercise and she offers some surprising information about the types and
Ratios of resistance training to cardiovascular, training that women ought to use in order to maximize their Hormone Health. We also talked a lot about the digestive system, this was a surprising aspect of the conversation, I did not anticipate, doctor Gottfried shared with us. For instance, that women suffer from digestive issues at more than 10 times. The frequency that do men and fortunately, that there are tools specific to women that they can use in order to overcome those digestive issues. And that, in overcoming, those digestive issues, they can overcome many of the related hormone.
Shoes that so many women face dr. Gottfried also shares with you tremendous knowledge, about the specific types of tests not just blood test but also urine and microbiome tests that women can use in order to really get a clear understanding of their hormone status. Not just of present, but also where the trajectory of their hormones is taking them. So, we have an avid discussion about puberty about young, adulthood, adulthood perimenopause, and how best to manage and navigate perimenopause and menopause.
Including a discussion about hormone replacement therapy, in addition, to her academic and clinical expertise, dr. Gottfried has, authored many important books on nutrition hormones, and supplementation, as it relates to women, and two people generally, the two books that I'd like to highlight in that we provided links to in the show. Notes, captions are women food, and hormones and the hormone cure, I read the hormone cure and found it to be tremendously. Interesting and informative. Not just in terms of teaching me about female hormone health and various treatments for female hormone Health, but also as a man,
Man, trying to understand how the endocrine system interacts with mindset nutrition, and supplementation more generally. So I highly recommend the hormone cure for anybody interested in hormones and Hormone Health, and women, food and hormones in particular for women, although again in both books are going to be strongly informative for women. Wishing to optimize their Hormone Health vitality and Longevity. Before we begin, I'd like to emphasize that this podcast is separate from my teaching and research roles at Stanford. It is however, part of my desire and effort to bring zero cost to consumer.
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A podcast is now partnered with Momentis supplements to find the supplements. We discuss on the huberman Lab podcast. You can go to live momentous spell do us live momentous.com huberman and I should just mention that the library of those supplements is constantly expanding again. That's live momentous.com /, hubermann and now for my discussion with dr. Sara Gottfried dr. Gottfried Sarah. Welcome.
Thank you so happy to be here. Yeah,
I'm delighted and very excited to ask you about an enormous number of topics. You are expert in. So so,
Thing. So the challenge for me is going to be to constrain this walk. As it were, I'm hoping that we can touch on a great number of things today. The first of which is really about hormones and female hormones in particular and I have a question which is is it ever informative for a woman regardless of age to know something about her mother's perhaps even her grandmother's experience vis-à-vis.
Hormones, not just pregnancy challenges with, or he's with pregnancy and child, rearing childbirth, this sort of thing. But you know what? Sorts of conversations should women be having with themselves and with family members to get a window into what their specific needs? Might be.
Well, this question. So my work is really at the interface between genetics and environment. So your question gets to both.
And I think it's essential that you understand what your grandmother went through. I'd even say her. Grandmother depending on longevity in your family, so I grew up with my great-grandmother, I get that, and especially your mother. So I would probably start first with trauma and intergenerational Trauma, because I think that affects the endocrine system. So hugely, especially cortisol signaling. But the broader pie,
find system, Psycho immuno neuroendocrine System and then there's, you know, if I think about
the stages of the life cycle that a woman goes through.
If you think about puberty, I think I don't know how genetically determined the age of puberty. Is certainly there's a lot of environmental influences like toxins can affect it, but pregnancy.
The age at which you start to go through perimenopause menopause. Many of those have a genetic component. So with pregnancy, I mean you can certainly think the shape of the pelvis, your ability to have a vaginal birth, some of that is genetically determined. I mean you do have you know the sperm donor affecting some of that but you know, in my family for instance we have no cesarean sections. So everyone goes through this process of
A relatively easy vaginal birth. I was a forceps baby. But, you know, for the most part you can find out about that. And then there's certain female conditions that have a very strong component, genetically, most of which run in my family. So that includes enemy tree osis fibroids, I just had a hysterectomy, I added 50 plus fibroids and polycystic ovarian syndrome.
And of those three how frequent are those, and maybe I can constrain the question a little bit by saying, today's discussion. I imagine is gonna be heard by men and women of all sorts of Ages. So, I maybe I'll direct the question a little bit toward. You, know, at what age should these discussions start, you know, we always imagine that women in their 30s and 40s and 50s and onward should be getting certain tests and addressing things like ovarian reserve and and other
Other sorts of things but, you know, maybe we could March through and just say, for a woman in her, teens who's already hit puberty, what sorts of biomarkers, whether or not their blood based or poor or phenotyping. You know, the outward appearance of should those young women be paying attention to likewise for women in their 20s 30s. Maybe we could take it a more or less by decade at starting at puberty. Assuming that woman hits puberty sometime. What between what is it? Now, the average in the
Is it somewhere between 12 and 16 years old? Do I have that, right? No, you do not. Oh, great. That wants to be wrong. So
so it used to be 12 to 16, I would say, 50 years ago,
It's been moving younger and we think some of that is related to toxin exposure as I mentioned, but I was 10 when I went through puberty, so why should say menarche and I started growing breasts much before that. So I think
Now I'm going to step away from the science for a moment. I'm going to do that pretty
fluidly and I'll try to call it
out. I think there's also a huge influence from stress. I'm like the development of the adrenal glands. So going back to the science.
The issue in teenage years is that the hypothalamic-pituitary-adrenal axis and I like to think of it broader, so stay with me. Hypothalamic-pituitary-adrenal gonadal, over reason, women testes, men, thyroid, gut axis, so that to me is the control system. So, I'm kind of
Expressing my bio engineering side
here. Well, I think it's great to include the other organs and tissue systems of the body. Because as we both know that the narrow definition of just hypothalamic-pituitary-adrenal, it can't be just that
right now. It can't. No, no, it doesn't tell the whole story. So if you look at the main sex hormones, in a young woman who's in her teenage years, the hypothalamic-pituitary-adrenal gonadal part of that.
Is not fully mature. So they're more likely to skip periods, especially under stress. They have a lot of influences that really doesn't get well established until you're done with Allison's. And I'm told that adolescents now is till like, it's 25 to 26. I heard that and I was like, I've got two daughters. I was like, that's a really long
time and not just psychologically defined or
biopsychosocial mostly a psychologically defined. I heard that from a psychologist.
Just so.
Biomarkers. You asked about in your teenage years. What I think is really interesting is to look at cortisol to look at the dance between estrogen and progesterone. In those years is less helpful because I think there's a lot of variability due to the immaturity of the system. If you've got someone as got really regular periods, it's probably better to do some benchmarking at that age. But generally I find that benchmarking
Is best performed in your 20s or
30s are periods. Not that regular in terms of duration of the menstrual cycle when the menstrual cycle four sets in,
it depends. So I was like clockwork, every 28 days until I had my hysterectomy in August. Same thing with my daughters. I've got two daughters 117, the others 23
For a lot of women, they're not regular and then there's the whole piece of oral contraceptives and other forms of contraception where you have no idea what the normal cycle is. And I hope we'll have some time to talk a little bit about oral contraceptives because I think it is this is now opinion again and not science. I think it is the number one endocrine apathy.
That is I had to genetic for women.
We will definitely talk about it. I get a lot of questions about oral contraceptives in the social media space and also questions about iuds quite a lot. Totally didn't particular copper iuds non hormonal iuds so it will definitely touch on
that. I'm an IUD Crusader. So I just want to, you know, give you
that warning. You're a fan that. Do I have that, right? Or your aunt? I am a huge fan. Uh-huh. Which iuds in particular,
Like copper, because it's non-hormonal. It's as effective as getting her tubes
tied, who would have thought, right, man? It's that toxic to the sperm Mobility. Is that how it works? That's my understanding of it is that, that it, that it basically, it's like more or less an electric fence, to the sperm cap, and just that's it.
Electric fence, is a bit of a harsh analogy, but I'll work with that but it's, you know, to have something that can last for 10 years, so that you really have
complete autonomy and sovereignty over your sexual life, that's profound. And it's not get all those Downstream risks. There's associated with birth control pill. The other thing that's important to know about it. I know this is why poor women who use the copper IUD have the highest satisfaction rate of anyone on contraceptives. The highest satisfaction rate and yet it is the least used of all forms of contraception.
Now my favorite is vasectomy, but short of vasectomy. I think ideas really great choice. There are some risks associated with it. I'm not saying it's risk free, but I loved IED and I love it for younger women to because it used to be that when I went through my training, which was 30 years ago, we were told, you know, don't put it in someone who hasn't had a baby and that is patriarchal messaging, but getting back to your original question, which is about biomarkers per decade.
Aid.
In your 20s. That's when you want to do some bass casing with estrogen progesterone and testosterone. So I think it's really helpful to know about this. This Tango your from Argentina or your
father was Argentine lineage. Yes, my grandparents did Tango into their late 80s. I am, I'm in my late 40s and I still haven't started. So I suppose there's
time. It might be a time for you to,
okay?
And it might be a factor.
Their longevity. Did they have good health span not exist
and my grandfather smoke cigarettes daily remain mentally sharp until he died in his late 90s but almost burned down their apartment, several times, falling asleep with a cigarette in his mouth. So I don't recommend anyone spoke by the way, but it was Coffee-Mate red meat and cigarettes and they lived into their 90's. So that side of my family has the genetic Advantage the other side less. So but in any event Tango is a 20
T3 goal. It has been every year the I'm going to hold you accountable to that. Okay will do and there no there will be no YouTube video of me doing
at least not
initially. Tim Ferriss actually phenomenal podcaster as we know is he's a badass, he's a badass Tango Tango dancer. I know this through various
sources. Yes. Yeah, I've seen. Yeah. So this Tango between us shouldn't progesterone is incredibly important. You want to have the right lead you want to have the right follow between the two hormones.
Again, I'm stepping away from my science happen, but what happens, a lot of the time is that estrogen dominates and that Tango. And when that happens, it sets you up for greater risk of fibroids endometriosis, breast pain,
Probably in association with the microbiome. And the, you Strobel
ohm, can you familiarize with the Astro Bloom? Yeah, I'm delighted to know that. I don't recognize the term. Yeah. So the
astrub Alam is the set of microbes in their DNA, their DNA mostly in the gut microbiome that set of microbes in their DNA. So it's in the if you look at the totality
The subset of particular, bacteria, modulate estrogen levels. So a lot of this work was spearheaded by Martin Blaser.
And what we know is that there are some women who have an astro below, that makes them have a greater risk of certain estrogen mediated conditions, like breast cancer and a mutual cancer and in men prostate cancer. So, the struggle them is incredibly important. There's not a lot of attention paid to it, but I always think in terms of my patients, you know, could this be someone who's got a
T a struggle ohm and we need to adjust it with, you know, some of the microbiome modulating nutrients, nutraceuticals that we have, so that they're less likely to have that at Tango, that's not working with estrogen progesterone. So, getting back to the biomarkers,
If you gave me an unlimited budget, which I kind of have with some of my clients that I work with. Now, what I would want to know, is estrogen progesterone testosterone, and I want the timing right for that. I'd want to know about DHEA and sort of the whole interesting bath way. I'd want to know about the metabolites of estrogen because some of them are protective and very helpful. Others are a bit like
Homer Simpson. I mean, they are just like causing all kinds of problems in your body. Increasing the risk of Quinn owns like DNA damage and potentially an increased risk of breast cancer, although, that data, I think it was mixed.
I'd also like to know about their stool. So I want to know about the microbiome. So the best that we have right now is to look, when we do stool testing and I do a lot of stool testing, we can look at things like beta glucuronidase. Are you familiar with BG?
I'm familiar with it as a term. And so for those listening very often, not always, when you hear an ace ASE, you're dealing with an enzyme. So I can take a stab there and it sounds like it's somehow involved in glue.
Echoes metabolism of some sort or
is it clicker on a dacian? So it's involved in when you produce estrogen in the body, this is like the simplified version but when you produce estrogen, you are meant to use it like send it to The receptors where it's meant to go, and then lose it. Like you don't want to keep recirculating estrogen like Bad Karma and that's what happens with people who have high blade at beta glucuronidase. So it's this enzyme that's produced by
Three bacteria in particular in the gut and I see a lot of men and women who have elevated beta glucuronidase and then they have some estrogen dominance related to that is that the total reason we don't really know but it's one of the drivers it's one of the
levers and it can be detected from a microbiome. Take a stool sample. That's right. And in terms of blood testing or various tests for these other biomarkers getting estrogen and testosterone and other ratios. I realize there are people
I have different means financial means but in general, people wanting to do a blood test, it sounds like they're going to need to do it. What women will need to do it at different stages of their menstrual cycle? If they had to pick one, you know, either in the follicular phase and or in the luteal stage of their ovarian menstrual cycle. Excuse me, ovulatory. Menstrual cycle. When would you suggest they do that? If they had to pick one.
So if you force me to pick one, I would say probably day 21 to 22.
You for someone in your 20s. So we're focused right now in that decade. So for most women, they've got a menstrual cycle date, but averages out at 28 days. So this is about a week before they start their period. For women are more irregular. It's harder to do that as women get older. And we'll talk about this in a moment. Usually the cycle gets a little shorter so as they start to decline in their progesterone production, their period gets a little closer together like mine before.
or August was about every 26 days, so,
At that point you want to test sooner like day 1920 and I'm not talking about blood test or a blood test is the cheapest thing. It's usually what's covered by insurance, but my preference would be to do Drive urine. I like to use saliva for cortisol, I like to use dried urine so that I get metabolomic. Syn addition to the levels of these hormones and if I'm forced to I'll use blood testing and that's certainly the gold standard for all of these hormones that we're talking about.
But it's not as comprehensive. And as you know, it's a quick little snapshot while the needles in your vein for you know, 30 seconds.
Yeah, the salivary cortisol makes sense to me because my understanding is that you get free cortisol, which is the act of cortisol. You said with your and you're also getting the metabolites, that's right. And then for blood testing, you're getting it sort of a crude window into the average.
Has a static. Hmm, total level.
So let me go back and say one other thing about biomarkers, a big part of the testing that I do. In phenotyping my patients I practice Precision medicine so I like to
Almost start with nutritional testing.
I don't think I've ever had a teenager. I've got some NBA players that are 19, 20 21, so maybe those count but those are men obviously. But for nutritional testing that would be a potentially, a helpful thing to do in your 20s becomes less important. As you get older and you develop more micronutrient, deficiencies. But micronutrients play a huge role in terms of hormone production magnesium. The Magnesium is hugely involved in the way.
That you get rid of estrogen as an example. So, micronutrient testing. What I usually do is a combination of blood in urine, and so, I'm looking at all of the micronutrients that we can measure that have some clinical scientific basis behind them,
If I could do that for a teenager, I think it might be helpful because I recently gave a lecture on breast cancer. Risk, reduction,
Another quick sidebar and I was sad to find that.
Intake of vegetables, polyphenols is such an important predictor of future risk of breast cancer. Like, when you're at 50, 60 plus and the most important time is when you're a teenager. Now I have one daughter that eats vegetables, she loves them and have another daughter who eats food that's beige and it's very hard to get her to eat the volume of vegetables, you know, five colors a day, which is what I do. And
if you have evidence that you could show a seventeen-year-old that they've got micronutrient gaps,
I think that would be a motivator for them to eat differently at a time when it's so critical. Even though it's you know 25 years in the future that it's going to potentially change this Arc that they're on. What do you
do for a young woman who doesn't like vegetables is or it's not somehow able or willing to to get those five colors a day of vegetable to help support the microbiome? You know, our supplements, a useful tool in that case.
What other sorts of tools Behavioral or otherwise are
useful such a good question. So here, I'm going to invoke Rob night at UCSD. So I think his his, his gut project has really been helpful in terms of understanding, what kind of modulator 's are going to be important. So what I try to get that person to do and I don't see many teens anymore other than NBA players what I try to get them to do is to have a smoothie
Very hard to get them to have a smoothie every day, but if I could get them to have a smoothie, three times a week and a throw, some of these vegetables in that makes a huge difference. I mean we know that makes a difference in
terms of microbiome change to be a blending up broccoli or kale
cauliflower so cauliflowers
parades and they're putting things into the Smoothie.
Yeah, I don't know if you can get a teenager to do that but they often will use like I have them do steamed broccoli that's in the freezer because it's got very little taste so that they could do that in a
At smoothie, they could add some greens. I like greens powders are a super convenient so that with you know, kind of a taste that they like whether that's chocolate which is what most of my clients want or you know, vanilla with berries and that sort of thing. So that can go a long way if you don't like vegetables and short of that, I would say some supplements but I would say that's a distant second to making a smoothie. I've got one patient that I have to mention because
He took this to the extreme so he is a retired physicist professor at UCSD he found out that his microbiome was a hot mess and developed out immune disease. And so he became hell-bent like only a physicist could on changing as microbiome and he dramatically shifted it by having a smoothie every day with 57 vegetables and fruits in it.
57
independent, 57 independent. So, I mean this just warms my heart, the way that he did this, but he would go to the farmers market, he would just get a bunch of this, a bunch of that and he would go home, make the smoothie and then stick it in the freezer. So he'd have a serving every day and he became a completely different person based on this microbiome, change his autoimmune disease.
In remission. He, he dropped a huge amount of weight. He went from being, you know, kind of this phenotype that I know, you know, well of a professor high-performing traveling around the world on so many boards. So much Innovation. So many great ideas supercomputer guy to being someone who gets up in the morning gets knows hot tub. Exercises for like 12 hours a day and then does a little work like he completely shifted the
A that he lives and is microbiome shift, you know? Who knows? What, what's the chicken and what that? What sag there, but he had a huge change in his physiology, glucose went from being quite high. He had any tracks. All of this, of course, it's like
on scientist better. All right. And retired, I suppose might have had,
and he's retired, but he's, he's got the longest time series of anyone. I know and he's tracked, his glucose and Insulin going back, 20 years. So
I can show you. Okay, here's where I start having my smoothie and here's how my glucose and Insulin changed as a result of that.
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And as a way to enhance the microbiome, this is something I hear about a lot. I've heard that excessive doses of capsule probiotics can give a brain fog like condition. I personally don't use capsule probiotics unless I feel like my system is under significant amount of stress in which case I might add that in for brief periods of time. Or if I've just taken antibiotics for a period of time, do you ever recommend that the college student or the high school student that she or he take capsule probiotics? Assuming that they're getting
Three to five servings of vegetables per day either in smoothie form or some other form. What are your thoughts on supplementing, probiotics?
It sounds like such a simple question. It is such a complex answer and I don't think we really have the answer. So I'll tell you the way that I approach it. I look for randomized, trials to support my use of probiotics and frankly I'm underwhelmed. So I've seen some data if I invoke my MBA.
Players for a moment. Almost every player I've tested has increased intestinal permeability. They just have such a high training. Load, probably mediated by cortisol. Very high. Glucose is when they dream that they have increased intestinal permeability. So those tight junctions in their intestine become loose, they develop a lot of inflammation as a result of that. And when you're a professional and be a player, and you're making 20 million a year, like you don't want a lot of inflammation, you want a little bit too late.
Help your muscles recover but you don't want it to be adding two problems when you develop an injury. So this is leaky gut. Leaky gut. I don't love that term but yeah well use it here. So there's a there's a particular probiotic. That is helpful in athletes with leaky gut. So that's the kind of specificity and randomized trial that I'm looking for the rest of it.
I think there's support if you find help from it as you described. If you take a course of antibiotics, I mean first of all, I would question whether you need them but
I try and avoid them there. Have been instances where they've been prescribed and I took the mostly in the past, I was in college. They seem like they kind of gave them out where you had a sinus infections, give you, you know, antibiotics even called like yeah, the worst
treatment ever. Yeah. So if you're coming off the antibiotics, I think that's a good time to do what we call replacement dose probiotics, I think what's far more interesting.
Is prebiotics, I think the data is much better for prebiotics and a selective use of polyphenols,
how would a person in their teens and 20s or any age for that matter? Know what whether or not they have nutritional deficiencies. What is the best way to analyze? If one is getting enough magnesium and for that matter, what is going to be the best way to test the microbiome, you said stool sample,
And I'll come right back with the same question. I asked about blood test what time of day when during the month to establish this. A baseline. So this would be prior to embarking on a, you know, 97 vegetables or how per day 57. Well I love the idea that you're telling us. If I'm hearing correctly is that? Yes there's a case for probiotics but for the typical person regardless of age eating more vegetables or drinking more vegetables as the case may be it's going to be beneficial for the gut microbiome.
Biome, perhaps, without the need to go test. Whether or not one is making a certain number of estrogen related metabolites or not. Just that, that's a great starting. Place eat or consume more vegetables, but if one wants to analyze their gut microbiome, are there. Good tests available to the general public. This has been, I'm not going to name companies, but I've been tracking this over the years and it's never been clear to me, that we know what? Constituents of the gut microbiome are our best. We know that dysbiosis is bad. Yeah. And we know that diversity of the
Home is good. We hear this. Yeah. But no one's ever told me that you want a particular ratio of 1 micro biota to another. In a way that has made any sense to me at least. Totally. I'm not a microbiologist. But whereas with, you know, with testosterone in men, we here. Okay. You want your free testosterone to be about 2% of your total, perhaps with women. You women are going to more testosterone and estrogen on average but still less than men. When you look at testosterone etcetera, Etc, but you can get some, some crude measures but for the
Ryoma just seems like long lists of microbiota for which I just get dizzy. I just if you just wrote out a bunch of eyes and Ells and asses you'd be halfway. You getting a bit. A bit, the same information. I'm not trying to poke it out, feel that's a beautiful field. But they haven't told me what to what I what microbiota ought to look like like what's a healthy microbiome
chart? Well, that's because we don't know.
I mean, the best we have is rough night's work but even that is limited in terms of you know, can I tell you that a woman in her 20s? Should have this particular pattern with her microbiome? No I can't. So let me go to your first question because I think you just asked about six, your first question is about nutritional testing what I like to do with nutritional testing is run a panel that's looking at Antioch.
Grunts it's like vitamin A vitamin C alpha lipoic acid, plant based antioxidants. Because you can measure that in the blood. I like to look at some of the key vitamins especially the b-vitamin range because as you probably know, if you've got a particular genetic polymorphism, see might be less likely to be absorbing the right level of vitamin B9. Folate vitamin B12, Etc,
I'm also looking going back to the antioxidants, it glutathione, because I think that's such an important lever when it comes to detoxification, which we haven't talked about yet. And then I'm looking at some of the Minerals Magnesium is really the most important. And we know that somewhere around 70 to 80% of Americans are deficient in magnesium. That's like the lowest hanging fruit.
I would be curious for instance, like, with magnesium if that number of people are deficient, does that mean that that number of people should be targeting their nutrition towards foods that contain magnesium and or
Meeting with magnesium. And if so, what forms of magnesium, we've talked about mag three and eight. Yeah, sleep. There's an exit right there. So many forms can be a little bit overwhelming to people. So any any detail and sourcing your appreciate
it, great. So, first in terms of testing, what I prefer to do is to mention when more than one lab in more than one brand, and I can just, I'm speaking mostly from experience. So for testing, I do a lot of Genova.
Neutrals during the pandemic they developed an at-home test. Normally with a neutral you have to get your blood drawn and you have to do a urine sample. So a lot of people can't do that. The great thing about this test is your insurance usually pays for most of it and so the copay is about $150. So during the pandemic they developed another test called metabolomic X, which does much of the same testing, but it's a finger prick.
So, most of my patients prefer that in fact, they haven't gone back to the neutral. Second lab is spectra cell. I use Spectra cell occasionally, I find it not quite as easy in terms of fitting into my practice, but I've got friends and mentors like merchiston who does a lot of kind of precision, cardio, metabolic Health, he thinks Spectra, sells the best test out there. So you asked about magnesium.
You have to measure red, blood cell, magnesium like whole blood. And with deficiency, it's interesting with supplementation for my patients who tend toward constipation and that's frankly about 80% of the women that I take care of, really?
Yes. Wow, I'd be curious as to why that that is, is it, I can guess, diet, stress,
patriarchy rage,
Psycho psycho psycho so pined
the pine system,
right? Psycho psychology, Immunology neural and endocrine factors combined. Is that
a? Yes and then I would say there's another factor which is
being female is a health hazard.
So, we have twice the rate of depression insomnia. We've got three to four X increase risk of multiple sclerosis. We've got five to eight times the risk of thyroid dysfunction
So if you just look at that and you look at subtle, preclinical, thyroid dysfunction, a huge number of the women that I take care of. Well, let me back off a large number of the women that I take care of have thyroid dysfunction, that's contributing to constipation. And if we go back to that control system night with lamech pituitary, adrenal thyroid, gonadal got access and they have a lot of perceived stress together with this borderline thyroid function that no mainstream.
Listen, doctor has told her is a problem, and then she's got a problem with the Tango between estrogen and progesterone.
She's going to tend toward constipation women have a lot more constipation. The men, the gut is about 10 feet longer in women compared to men. We should talk about some sex and gender differences and Define those sure. And they are much more likely to have a torturous: and the way you know that is you get a colonoscopy and they tell you, yeah, it's really hard to like get in there and do what we need
to do as a brief tangent. But I think this is the time to ask at what
Age now do Physicians insist their female patients, get colonoscopies for men. I think the age used to be 50 now it's getting ratcheted back to 45 or 40 begin. These are recommendations, not requirements but they're pretty strong recommendations from depending on where you live etcetera for women. How early do you think they should get a colonoscopy to, to explore for possible? Polyps, and or colon cancer?
Yeah, it's a really good question. I don't know. The answer is, so what I've always operated.
This Is 50 the way that I answer that is to go to the US preventive. Task force rating to determine based on their synthesis of the data. What age is the most appropriate has it changed, is you just described for men from 52 younger? I don't know. So we should fact check that
all these additional health hazards for women. You mentioned some of the, you broadly mention psychological impact, right? And of course, these things are all related.
Psychology immunology. And one of the I think wonderful things about neuroscience and Science in general and medicine, is that there's now an understanding that all the organs are connected to one another. It's a network, it's a network and that the microbiome sits at had a tacky node within that Network. And I think most people accept that now. Yes, yeah, that seems to be a theme that at least in the last 10 years is really wonderful. Because certainly from Neuroscience it was thought that, you know, unless it's in the cranial vault,
It's not neural, which is ridiculous because there's lots of nervous system outside the skull, but in any
case for up for a second? Yes, please. So, I think you're right that there's an understanding about the network effect, but I think that as much as I love mainstream medicine and I trained in it and I'm so grateful for my education, I still think it is a silo-based way of taking care of patients. So even if there's an understanding of a network effect more at the science level,
Or as you described in Neuroscience. There's still you know, if you are a woman who has constipation fatigue may be an autoimmune condition. Feel stressed out all the time. Feel like your hormones are out of whack. You get sent to the gastroenterologist for the constipation, you get sent to the rheumatologist for your autoimmune issues, you may be get sent to an endocrinologist. If you've got
Problems. And there's very little collaboration between these groups. So even though there's no understanding of the network effect in real life, it's not happening.
Let's, let's go deeper down that path because I, you point out, something really important and that and you've mentioned, constipation a few times. Can we view constipation as a serious enough symptom that it warrants? An immediate intervention that is does it flag or signal?
Problems that are severe enough. That that should be the issue that's dealt with for anybody that's experiencing it and I mean sort of an odd topic for many people because they think oh you know, bowel movements and sort of you know there's that kind of pre-adolescent humor around this but I think it's it's so important when you're what I'm hearing you say is that constipation is far more common in women and it signals a general set many problems occurring. Does that mean that women should address constipation and if so what's the best way to address constipation?
Yeah, I love
This question because you're doing, can we have a quick little meta conversation? So you're doing something that I knew you would do, which is your teaching me something and you're changing like, there's this social genomics thing happening. Where you're changing, my thought about this. So I just wanted to acknowledge that.
Thank you, thank you. Well, I think for me, you know, when I hear that there's a kind of, you know, you're talking about a phenotype constipation is a phenotype, it's one that people generally don't wear a t-shirt explaining it to people, but that I'm guessing anything to do.
Sexual Health, bowel, Health, Urology, people just don't talk about, right for all, sorts of reasons, and those reasons are probably so obvious that they're not even worth discussing, but because I'm also because we won't change them except by talking about them. Yep. So if you say women are far more constipated and that signaling a larger set of problems. Yes, then my immediate thought is well will relieving constipation pun intended retroactively
Will that assist in a great number of issues? And or will it get them down the road of thinking about those other issues more specifically like, do I need more magnesium or should I be putting vegetables in my smoothie? You know, I'm curious about constipation as a Target. Yeah. For intervention that then opens up a bunch of other discussions because there are these certain nodes in the, in the mental health, physical health space, that when someone, you know, like we talked a lot about deliberate cold exposure. Do I think it's magic? No, but I think that if someone's getting themselves,
A cold shower once a day. It opens up a number of questions about themselves and reveals a number of things to themselves. Like how do I buffer stress? Yeah. What sorts of levels of control, do I actually have an on and on? So perhaps not the best example, but
some of us hate cold exposure, right? Which we have like a gene that makes us stress out. Like, you
wouldn't believe which will take special, which I would argue. Makes it very likely that even 10 seconds of cold exposure, gets you the effect that you want as opposed to someone who adores cold exposure like a penguin.
Owen needs a lot more cold exposure for to have the, the Adaptive response. Anyway, that's my way of I've gum being through that. Quite you're quite correct. So, so let's answer this question conservation
issue. Yeah. So this is how you're changing the way I think about this. So you're asking okay, instead of looking at constipation as a constellation of symptoms, what about if you just used it on its own, as sort of a key?
Indicator or signal of dysfunction with by Network, or maybe something broader. And I think that's right. So, it makes me think of a few things, it makes me. You're also changing this book that I'm writing on autoimmunity and Trauma. So thank you for that. So
Women experience more trauma than men. This is well established. If you look at the case studies, that were done by the CDC and Kaiser in 1998, we know that men for the most part. Middle-aged men have about about 50% of them experienced significant trauma as defined by the East questionnaire. Women are at 60% and that's pretty durable since 1998. So women have more, they have different forms of abuse much more likely to have sex.
Sexual abuse, they have a different HP, a response and Men, their perceived stress tends to be higher and I'm generalizing for a population.
Side note, you know, in Precision medicine, we don't do that, we do medicine for the individual individual, not the population, not medicine for the average. And so if you look at the physiology of a female, I think that constipation and that need to like control and restrain and hold things in
Tighten, the anal sphincter. I think that's part of the physiology. So I'm viewing away from the science. But I do think that it is a really important signal to pay a lot of attention to. Now, you also asked about microbiome testing, so we do that or
do yeah. Well, I wouldn't have a couple more questions about constipation. I never thought, I'd ask this many questions are constantly, but now I'm fascinated by the way. Also, this morning, I taught medical students at Stanford about the fact that we are basically a series of tubes. So that you talked about the anal sphincter, we are a set of sphincters from one.
To the other. I mean, we are setting tubes are nervous system, being one of those tubes and about and I think in eastern medicine, they talk about the various locks between those tubes and Chambers and it's not without coincidence. There's some real wisdom there. Of course. Wait, did you
just talk about energetic
Anatomy more less? I didn't say the word chakras but I like I might in. Passing the bond has a bond us. Write our the are, the are the sphincters? Yes, that's right. Thank you for that. The so what defines constipation? I mean.
Other words, let's sing about the healthy rather than thing about the unhealthy. Let's how many bowel movement should a woman or a man have per day? Assuming this is where it gets tricky because some people are doing time restricted, feeding, some people are eating more, some people are eating more fiber, more bulk larger meal, the end of the day, large email, the beginning day, we will never be able to sort out all those variables, but on average, how many bowel movements and his timing during the day for bowel movements at all in.
Formative,
what works for you.
Well, when I'm asleep generally, I don't want a bowel movement, so I'm going to be like most people, right? Well, so is primary free, right? Exactly. I'm I always assumed that morning time yeah. Was a was a healthy time for Mel movements and I think almost everybody babies included recognize the feeling of being lighter and more energetic when they've evacuated totally:. Totally, in fact, so much. So,
I'm obsessed with yogi and Freudian psychology. That the first thing we learn when we come into this world, right? Is that we want something. We we feel some sort of autonomic arousal stress whether or not its food or warmth or the need to have a bowel movement. One of the first things that parents learn is how to recognize that not by the odor coming from the diaper. But by the look on the baby's face or their agitation agitation signals the need for some sort of relief, right temperature relief food relief evacuating, the bowel relief. So
My understanding is that as autonomic arousal increases in the early part of the day. Ideally after a good night's sleep that bowel movements become more likely unless that arousal becomes so great that then people feel. So quote, unquote locked up, right? Because of the balance of the autonomics features. So, early day I'm guessing and again in the second half of the day and here, I'm totally guessing and certainly not having to wake in the middle of the night. Yeah, those are my best guesses.
That's great. So I would
With that when I was at Harvard Medical School and UCSF for residency, I was taught that constipation is having a bowel movement less frequently than whenever once every three days.
Sorry, I don't think I've ever laughed out loud on this podcast is the consequence of of textbook, medical knowledge. Are you kidding me? Is that ridiculous? That sounds like an end here. Pun intended that sounds like the the conclusion of some very concentrated personally and and and in
Other ways constipated individuals and it again, this might seem like an odd conversation, but the the discussion around conservation is, is present in psychological literature. Yes, because of this relationship to the autonomic system.
Well, that's a metaphor in literature, it's crucial. So you you spoke to a number of different threads that I think are important here. So that's the definition that I learned and I was, I heard that and I was like, hell no, that doesn't work. For me, doesn't work for anyone. I know
And I spent a lot of time, especially in medical school and in my internship, where you rotate on medicine Des impacting, women like, older women, who come in, who haven't had a bowel movement in a month. Whoa, and that let me tell you that. It's not nice for anybody.
Yeah, believe me. I became a scientist in opposition for a number of reasons, both positive and negative. That's one of them. Yeah.
So my definition of constipation as a
Western mostly white girl is that if you're not having a bowel movement every single morning and you have a feeling of complete evacuation anything less than that is constipation. So that's how I Define it if you're in India and you're eating food that's got a fair amount of microbes in it. It's less you know sanitary using that word as carefully as I can.
Generally they have a bowel movement after every meal but they've got a different microbiome. They're exposed to different microbes here. In the US, I would say. Once day, you also spoke to something very important which is the balance between the parasympathetic nervous system rest and digest and poop versus the sympathetic nervous system. Kind of the on button, you know fight flight freeze on
so, I think for those of us who've got
Issues with autonomic balance.
It can lead to constipation and I like that constipation could be pulled out and kind of RIT larger as an important signal.
What sorts of tools do you recommend people use to relieve constipation in eating more fiber sounds like reducing stress is going to be a huge one. Yes what are your favorite stress reduction tools. I like to divide these into real-time tools. So, big proponent of like,
Like physiological sighing real-time, you know, these sorts of things, but things that can really lower the Baseline on stress, overall to facilitate constipation and other other broad indicators of
Health.
So I'm not a fan of lowering stress, I'm a fan of luring, perceived stress, and I think the distinction is really important.
I learned when I was in my 30s that
I was a massive stress case and I didn't know it. It was just sort of I think I threw residency through working on heard 20 hours a week. I just was so accustomed and sort of
that was 120. Not under 20 folks. Yeah, that's not unusual in medicine.
Well they've changed training so that you work no more than 80 hours a week now, but that was before my time. So,
I became accustomed to a massive amount of cortisol. Massive. And I would say, I've spent the past 20 years really, working on perceived stress to find. I think all of us need all a carte menu of what is most effective. So, what works for me, now, at my age is different than, you know, the the TMI did as a college student Transcendental Meditation, it's different than the
I became a certified yoga teacher. When I was in my 30s that is very effective for a lot of people. It wasn't enough for my Matrix. I do holotropic breathwork, I didn't read it but I saw that she just had a paper in Seoul on your sign and it kind of made me think like
Teach me how to cite each. Teach me how to Psy. Like, can you say a little bit about that? Was sure. You do
it. Yeah, but very briefly that study was, we wanted to find a minimal effective, dose intervention. Yeah. Fine. I just wanted. Yeah. So five minutes a day. We need to figure out what people do everyday. Yeah. And we were monitoring subjective mood at cetera, but also Biometrics remotely, so it's kind of
nice. Which Biometrics
it Derby HRV. Nighttime sleep. Where does all I wish. So this was done during the pandemic more.
100 subjects, the advantage was that we got data 24 hours a day because they're peeing us in their data
wearing HRV 24. Yeah. Now, yes.
So that was nice resting. Heart rate, subjective mood. We would get in touch with them daily. So when people were swapped between groups like any good study, but five minutes a day of sort of standard if you will forgive me meditations or just sitting, no instructions about how to breathe, just focusing on closing their eyes and focusing on focusing. Yep. Another
Did box breathing? Yep. Inhale hold exhale. Hold for equal durations. The duration of each of those inhales and holds was set by their carbon dioxide tolerance. So somewhere between three and eight seconds depending on how well, they regulate carbon dioxide, another group did cyclic sighing. So this would be double, inhale, through the nose. So big, inhale through the nose.
Followed by it to lungs. Empty, exhale, that s inhale after the first big long inhale through the nose is really important because it makes sure that all the collapsed alveoli lungs totally snap open and then the Excel you offload. A lot of carbon dioxide.
That's very similar to holotropic
breathwork not. Yes not not not unlike holotropic breathwork little bit pranayama ish but the exhale is rather passive as opposed to active and then the fourth category was sick. Like,
Elation, which is a lot like to mow AK, Wim Hof ish breathing different than women off breathing. So this would be so very active inhales and exhales. Every 25 cycles of inhale, exhale, that would be one cycle long exhale, hold lungs, empty 15 to 30 seconds, then repeat for about five minutes. Now, the if everyone did that for five minutes and what we found was that the cyclic sighing led to the greatest improvements in mood Around the Clock, not just around the practice or during the practice.
As well as lowered resting heart rate improvements in sleep Etc.
And you got to publish and sell, we were there for Jay-Z very
fortunate. I think they're the thankfully, the reviewers and editors understood that these minimal intervention things. Hopefully, we're going to be of use to people.
So, so useful to people. I mean, how often do you read a paper like that? That could offer a behavior change.
That is so easy to implement. I mean I love that question. Thank you. So what about did you tell them not to drink? Because alcohol is such a huge effect on
HIV. So in this case, we didn't tell them to alter anything else about their
behaviors. Hoping it was background. Kind of across this Aaron.
Yes, and some were Stanford students. Others were from the general
population. Any Frat Boys. Were drinking heavily,
probably, not. Well, during the pandemic, I think alcohol intake went Wade way up across the board.
And I mean, isn't if I had a magic wand I would I would ask that people either not drink or drink two drinks per week maximum. At least that's my understanding of the literature.
Are you familiar with the whoop data with alcohol?
No, but we have a collaboration with route through that paper. Yeah. And it certainly disrupts patterns of nighttime sleep in particular. My understanding that first phase of sleep that's related to the massive growth hormone release you, we all really need and want
in the first measure growth
woman. We did not know the second iteration of this.
He will certainly include free cortisol by saliva hormone panels. Well, I'm beginning to think that we should also be asking people how often they're going to the bathroom. And what time of day? Yes. I mean, this thing around constipation is is super interesting and I think that plus blood blood markers and then I'm, I'm very excited to learn that that urine contains additional markers, that could be informative. So yeah, it was, it was a fun study, not easy study to do with that. Number of subjects,
takes a lot of training
For your research
assistants? Yeah, it was a big group was nine people in our group, and three clinicians, and a lot of lot of phone calls and a lot of back and forth. But, you know, and thank you to the subjects who served as the real-life guinea pigs. So yeah, I think that stress, you know, people's I think people are starting to appreciate that. There are ways that they can relieve their stress that don't all only fall under the categories of vacation, right? And meditation. But I want to say that meditation is obviously a wonderful tool. It's just, it's a it's a tool.
Not unlike any other tool. That is great for some people unless great for
others. Well certainly, it's a great tool and it's got such a scientific basis behind it. But there's so many things on this Alucard menu sacks, orgasm connection, feeling heard and seen and
loved it. Let's talk about that. You know you mentioned earlier that all these stress factors you you said patriarchy right. But I think what if I met at risk of
Of just strengthening that statement. I mean that to me it's signaling a bunch of other factors around as you said like keeping keeping things in what do you think explains? Let's talk about that because I think that's likely to have raised a certain flag in people's minds like what exactly is she talking about? Are you talking about less opportunity? Are you talking about less opportunity to to vocalize? Are you talking about less opportunity to vocalize and be heard? I mean I
There an infinite number of variables but given that it sounds like a really strong input to the system. What I mean by that is that psychology is influencing biology and you're saying that that these that these Powers power dynamics structures and Dynamics are impacting. I'd love to let's hear your thoughts on that because I hate to let a flag like that go by without flushing it out and never waste a good flag. Well and let's preface it by by just saying that like people will have
of different opinions on this and that's and I think that's healthy and like what the discussion about constellation. Let's talk about what people aren't willing to talk about when it comes to health.
Love it. So we might need to talk about patriarchy on part two, but I'll give you some material that I've been working. With, I started I did not even understand the existence of patriarchy until I was a bioengineering
undergraduate at MIT. I should mention which has always had a bit of a of a male eschewed.
So in terms of Faculty numbers, well, my is true that most universities true. Well, my postdoc advisor was the late been beerus who was a female to male transition, transgender enter first transgender member of the, National Academy of Sciences were my closest friends. Unfortunately, he died of pancreatic cancer. We're very very close. They're actually making a documentary about Ben but Ben this is interesting. Been went to MIT because he wanted to be around a lot of men. Yeah, that's a lesser-known fact. But then he was a very strong advocate for
Women. He went as Barbara when he was Barbara, and by the way, he's giving me permission to share all this prior to his death. I recorded a lot of conversations with that. I only ever knew him as been by the way, but when he was at MIT, he was identified female and he later talked about the intense suppression. Oppression litter is how he described it especially given that he was performing so well.
Yes.
Yes, so you just defined patriarchy. You did it yourself.
A couple things when I was in. Bioengineering, I took a woman's studies class and it was all about teaching undergraduates about the existence of patriarchy which I would Define maybe at its simplest such as power over.
I'm not saying men are patriarchy, I'm saying something very different which is power over.
Let me correct. One thing that you said, I didn't go to MIT as an undergraduate. So I am from I was in Alaska and I went to the University of Washington for bioengineering in Seattle in Seattle. Okay, I dropped out of a graduate program in bioengineering to go to the Harvard MIT program for Health Sciences and technology in Boston.
Thanks for that clarification University of Washington also, wonderful place. I have many, many has many, many
Many, wonderful close colleagues there. It's an incredible place, especially for vision science,
it's especially good for engineering, bioengineering, but yeah. So my, my MD is jointly between MIT and Harvard and it's the oldest. Maybe largest, although Harvard's dozens a lot program for biomedical engineers and MD phds Physicians scientists training program.
Great. Thanks for that clarification. I'm going to blame the internet for this one. I am I think we need to send our Wikipedia editors out there. I think LinkedIn
is correct. Okay, great. Well,
we could pedia editor's note get out there and make that make the correction now, you heard it. So stress that it what you're really talking about is systemic stress in the body as a Concepts as a consequence, scuse me of systemic stress of
environment. That's right. But there's you know, there's particular form.
As of it, I would say this also relates to White Privilege it relates to racism. And when you look at, you know, kind of the way that systems, including my beloved, a mighty, the way that they're set up, is that might make Chris makes, right and generally, the people that are the strongest, you know, big men, strong men. They're the ones who tend to be the most successful. So for people who
By POC for people who don't have white privilege for women. It's a different experience. And so I'm using patriarchy, as kind of a umbrella here, but it connects to many other things
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Clear on the fact that a woman in her late teens, early twenties ought to know something about her testosterone, estrogen thyroid, cortisol levels should start at least thinking about her microbiome. Should be thinking about.
How how many bowel movements in the timing of those bowel movements per day, really? And I'm assuming that, what I just described is also true for women in their 20s. 30s 40s 50s on up to hundreds, is that correct?
That's correct. But I would say that there are
Differential opportunities by decade. So I'm glad she circled it back to teenagers and testosterone because I think if, you know, for instance, in your teenage years that you have high androgens and that you've got this potential phenotype way into the future that you may not even notice, I mean, maybe you knows, you got a few extra hairs on your chin or something. If you know that your testosterone is all evaded or some other e antigen,
It might change the Arc of how you take care of yourself. So I think that could be very helpful in your teenage years in your 20s. For people who are a stress case like me, so age 27 on the words at UCSF. If I had known that, I was such a high cortisol person, I think I would have done things differently, I would have changed my behavior and I don't know because I didn't base case these but
Your testosterone can decline, starting your 20s kind of, depending on how much stress your Matrix is under. So, for women that can start as early as 28, usually your testosterone declines by about 1% per year.
What level of testosterone do you like to see in a woman once she's sort of post, let's say after age 25 what kind of range is healthy, I know what the reference range is only because I know one could look it up. I don't know if the top of my head immediately but what
What's a kind of a nice reference point
there? So the way I tend to describe this on podcasts is the top half of the normal range. Great. So that I think is a good Benchmark, you know for PCOS. Generally it's much higher than that. You know I've seen patients with PCOS where their total testosterone it's 100 to
200. I always have peripheral manifestations of that little bit of hair, the skin plaques I've heard about you know so darkened skin by regular periods
It's regular periods. Is that? You know, I get a lot of questions about PCOS. Yeah. And you're the first person we've had on this podcast, it's really qualified to talk about PCOS and in a real way. So here we're talking about too many androgens. Cysts on the ovaries irregular ovarian meant slot, excuse me. I keep saying that ovulatory / menstrual cycle, what are some other indicators and do you recommend that women? Start taking Androgen blocker.
What is it? Where I mean, how does seem to be a lot of PCOS out there? I'm hearing about it a lot.
So glad you asked about this. So PCOS is one of those really poorly understood conditions that gets it kind of flows flies below the radar until a woman wants to get pregnant, or she's got some other issue that drives her to a physician
The problem is that it is a syndrome, right? So polycystic, ovary syndrome, sometimes polycystic ovarian syndrome and syndromes don't necessarily fit together into a really clear diagnostic criteria. So in this instance, there are three different criteria that we look for. So this is some ovaries having clinical manifestations of hyperandrogenism so that could be hirsutism acne other than
Things. And then usually a regular periods. And the way that that's defined at least by the latest criteria is having a period every 35 days or less. So, typical cycle length, 28 is 35 days. You know, you're skipping a period here and there. So those are the, those are the criteria that we use to diagnose PCOS. There are about four different systems out there in the literature for diagnosing PCOS, which is where it starts to get confusing. So, there's
Women who have gnosis on their ovaries, but they've got hirsutism and they've got a regular
periods. Could you Define heresit ism?
Hirsutism is increased hair growth, usually in places that you don't want it. So, for women, it can be, you know, kind of male pattern. They might notice it on their breasts, on their chest and then there's, of course, familial quality to that, like, I was just looking at a paper last night, looking at Israelis and how much here citizen they have and whether the
This is related to CAG repeats, on the Androgen receptor.
Do they get? Not Israelis, but do women, who who might have PCOS experience androgenic alopecia, so hair loss that sort of of the quote-unquote male pattern baldness. Of course. It's Androgen pattern baldness, as opposed to mail, we're taking testosterone DHT
related. Sometimes, you know, this is where I'm going to invoke, clinical experience rather than what I've seen in the literature. Women definitely can have some antigen
Enoch, alopecia.
I tend to see it later in life but this is an important point because we think of PCOS as you know I was just talking about it in teenage years like wouldn't it be nice to know that you have this phenotype and you're at risk for all the things that people are at risk for? And we haven't talked about glucose and Insulin yet, we should what we know is that PCOS is not just a problem in terms of irregular periods and then difficulty getting pregnant. So those are mostly problems in your
20s 30s, early 40s, but it is a massive risk factor for cardiovascular disease as you get older. So many people tend to pigeonhole PCOS is a problem of reproductive age. We have to be thinking of it over the entire female life cycle and I would say it's even more important to consider it over the age of 50, you know, average age of menopause is 51 and 52. Because we know that that elevated testosterone the height and
Engines are probably the greatest cardiometabolic driver of disease for women with PCOS. Wow. Now, one of the thing I want to mention and I still have my notes that were going to talk about microbiome testing because that's such a fun subject.
What I was taught to do against a Miss with so much love, for the people who have taught me how to do medicine, what I was taught to do is that if you have a woman with PCOS, you make the diagnosis you measure testosterone, you see if she has acne blah blah blah.
You ask that woman one question?
Do you want to get pregnant or not?
So then you have these women with PCOS who get started on a birth control pill. If they don't want to get pregnant, if they want to get pregnant, then you help them get pregnant by addressing some of these PCOS issues. Like, maybe you give them Clomid or you do something, to make them ovulate more frequently. That is the way that most conventional medicine approaches us, and it does women at gigantic disservice. So one of the things I'm speaking into is the gender gap that exists. So I my
feeling is that the research money that goes into women's health is abysmal compared to what goes into mental, really. And I think that's changing but there's also a huge lack of awareness of sex and gender differences when it comes to the way that we construct clinical trials and other experiment. Well, that's absolutely true. I mean, I sit on I've sat on an NIH review panels for more than a decade. Now I'm a regular standing member which is only to say that. I see the research as it's being proposed. Yes. And now
It's required. No Grant will get funded without sex as a biological variable. And here, I'm by the way folks, this is sex, biological sex than noun, not sex. The verb both are super interesting, obviously. But when we say sex is a biological variable, meaning even, even if it's a study on mice, we're at about start though. I didn't start that long ago. Must have been. I think we can. Thank, I Don't Wanna Miss attribute here. I think we can thank Francis Collins for insisting
on this. A man Francis. It's a lie Bernadine Healy has.
Done so much to help us but you know she made the Women's Health Initiative which I hope will get you which is a hot mess like so confusing, the data that came out of that.
So in these trials are long and so the data are only now starting to emerge. So just to be clear. I mean I have a question that I don't think it's going to take us off track, but this is, I'm going to pose this question as a hypothesis because I think it's likely to be a little bit of a, not a barbed wire question, but maybe like a prickly question when people first hear it, but
It's poses a hypothesis. You mentioned some of the psychosocial stress issues based on at the organizational level institutional level. Societal level may be right down to the family and and just life that are biasing Health outcomes for the worse in female populations. Okay. You referred to as the patriarchy. I'm just trying to put, make sure that we're both talking about the same thing and that's non-exhaustive I realize that's just a subset of the issues.
I'm also hearing there's a lot more PCOS which is hyper Androgen ization of the ovary. In there were talking about you mention it, you know, excess testosterone which females naturally have more testosterone than they do estrogen anyway, but we're talking about elevated levels.
Here's a hypothesis, one. Hypothesis would be that the increased androgens and the psoas PCOS are a consequence of the psychosocial conditions that are, I don't say forcing, but our biasing the need for females to think behave react act in certain ways, to survive. Let alone Thrive, is that a I don't say this for any kind of political correctness hypothesis.
This is a in my this would be a fun interesting. And I think important study to run, right? Depending on stress and the conditions, the specific type of stress, do females under produce or overproduce androgens, or is it a neutral effect that make quite make sense. I love this question. So let me just paraphrase. The last part of it to make sure I got it. It sounds like what you're asking is
Could PCOS or at least some phenotypes of PCOS, be a response to what I'm calling patriarchy. And then you had a second part to it which is do healthy women like, what is their production of testosterone? Like is that right?
Yes. And and with the acknowledgement of a you're the expert here, you're the physician clinician and expert in hormones and I'm not but with the understanding that absolute levels of hormones are interesting but perhaps not as
Seeing as the ratios of testosterone to estrogen. So when we're talking about excess testosterone, we're really not talking about women, making a lot of testosterone. Because, frankly, they already make a lot. Like then most people that weren't aware of that, I wasn't aware that women make more testosterone when he's a surgeon, right? And so it's not saying that testosterone in women is bad or is always a reaction to the environment. Yes. But when it becomes super physiological or hyper elevated is, I could imagine all sorts of social conditions that would create that.
So in males and females but here we're talking about PCOS and females in particular. So I'd love for you to speculate. Should we run the
study? We should totally run this study because
I don't know the answer.
I suspect that you're onto something.
It may not explain all of the women with PCOS because as I mentioned there's a lot of different phenotypes but I think it could explain.
A significant portion and you know, you're almost you're saying if we look at the gene environment interface this environmental influence of having being someone who's got power over you if if PCOS was response to that.
The way that we treat it would be completely different. So, on the one hand, I want to be careful, not to dismiss the suffering and experience of women with PCOS. I've got a lot of women with PCOS, my family and it is
there's so much pain and suffering, you know, especially if you want to have a baby and you try for years and you just can't ovulate
on the other hand.
I read a paper recently it maybe we could say this that compares the phenotype of a woman with PCOS to a man who has hypo intergenic. And I think that's a really interesting way to look at this because
The thread we haven't talked about with PCOS is the role of insulin and glucose. So for some of the phenotypes of PCOS, the problem is hyperinsulinemia high insulin in the blood is driving those theca cells in the ovaries to over produce testosterone. These
women are insulin insensitive. So more insulin to being cranked out and the cells in the ovary are there for making more
Androgen. You don't like to say insulin
resistant. Oh I can
I don't have a problem saying. Okay. I just I like I'm just I'm just a little bit outside the lane lines of my expertise. I was trying to use it. What is the correct nomenclature? So that we can make sure
what what I like about insulin insensitive. The way that she just said it is that I think that offers people a way and and I love to do that in terms of messaging insulin resistance starts to lose people because they don't really get what that means. That a receptor level,
I think I say insulin insensitive because when people hear insulin sensitive, it almost sounds like a bad thing but that's actually what you
You want so I think I think that's how I defaulted to insulin in. What's your insulin? I don't know what to do for a blood test. Yes you are. I'm due for a blood test. I had blood work done about eight months sure that'd be great. I die I'm always experimenting with different supplements and different behavioral regimens and I've kept charts since I was 19. Oh you're like my patient i-i've been sort of Obsessed by this and I would say
Everybody, if you can afford it and at the time actually I had to save up Insurance, wouldn't cover it. Get some basic blood work done. So you have a reference
to it as soon as possible because even you know, the we've been talking about these women over the life cycle. I wish I knew what my insulin was when I was a teenager I which I wish I knew what my fasting insulin was. I really wish I knew my postprandial insulin-like in my teenage years in my 20s and my 30s. Well, I knew it in my 30s starting
At 35.
Are you a fan of continuous glucose monitors.
The hugest most gigantic fan of see GM's. I've never seen any tool that I've ever used in medicine change Behavior. The way that see, GM's do,
wow, why do you think they are so effective at changing Behavior? I've tried one and I really liked it, I learned that in the sauna, my insulin, my blood glucose goes up, probably by a bit of dehydration. I learned what kind of foods work for me? Which don't, I thought it was fascinating learned how every Behavior you could possibly.
Imagine use your imagination, impacts blood glucose totally, totally fascinating to me, including how to wake, wake up, stirring the middle The Night vs. 1 versus none impacted, blood glucose, the next morning. Fascinating for a data junkie. Like me, it was like, I was in heaven, why do you think they are so effective in changing behavior? Is it because of that, that people can see that real-time control liked each scan and like, oh, that's the, that's the sandwich. I
think it's, I think it's many things. I think it's
Generally the Enchantment of
learning about your own chemistry and biology. I love that.
And I think for me what I've seen, you know, I feel like doctors are basically marketers like sacred marketing like our job as a physician is to convince people to do something that we think is good for them based on the best science. But we can't just say here, I wanted to fill this prescription for a CGM. You have to Market it. You have to say, I think this completely
Lee changes the way that you approach your pre-diabetes. I think this could dramatically affect your risk of Alzheimer's disease, if you're so worried about that your mother has. So our job is Physicians is to be that sacred marketer. So see, GM's are one of my tools that I think are so crucial. So enchantment number two. Yeah, it's the real time effect. So if you go get your glucose and Insulin measured or maybe you do like a two-hour glucose challenge test, where you look at glucose,
Insulin at the fasting point one hour later, two hours later or more frequently that does not have the same kind of behavior affect as having continuous data, where you can say, okay. I drove to see you Andrew from my place in Berkeley and it was stressful. It was trench really raining and I know my glucose was elevated. Like I think really understanding what the meat eaters are of your glucose control,
Is essential. Now that said it's also kind of a later effect. I mean, I'd rather know your insulin and we know from the Whitehead Whitehall study that insulin, especially postprandial, insulin fasting, insulin to can change years and years before you get a change in glucose. So that's more for pre-diabetes and diabetes. So I think those are the main reasons why I think it's such an important tool.
Third thing, is it democratizes data?
Which you do too. I mean, incredible, how you do that with your podcast? But I think one of the most hopeful and exciting things that I'm seeing right now in the health space is that we're going from this patriarchal relationship where doctors hold the power and are The Gatekeepers add data to patients and clients having much more access to that enchantment about their own,
Own chemistry and their own biology. So to me that is so exciting. Like for me to be able to, I've got, you know, probably 100 patients that are in a data stream with me where we're looking at their glucose and I can. I mean I'm on sabbatical so I'm not doing this so much anymore, but I can call a patient. Be like, why is your glucose so high? Like what did you do? Oh is my birthday. I had a piece of birthday cake like that kind of
Collaboration that also is teaching the patient to be their own clinician. To me, that is a loop of benevolence and integrity that I think is essential to creating Health. We've got a disease care system, we need the democratization of data to become a health based system. Amen. To that a million times over. We share that sentiment. I think until it
At a deep level. I think the pandemic actually assisted in harm to many things, but it assisted in people's understanding that, no magic, fairy nor the government, nor any anyone was going to arrive at their door, with a kit of things, to make them healthy, right? The provide sunlight movement, sleep, and all the various aspects of nutrition. No nothing. Nothing that it everyone has to have access to first and foremost and then Implement those things as best they can. Speaking of which
Each and kind of circling back to this idea of people in their late, teens, 20s 30s and onward. If you had a magic wand and you could give two or three don'ts or to make it personal. If you could go back in time and erase certain behaviors, what would the don't category, B? You can tell us more than two or three, but if the goal is to maximize vitality and Longevity and those are not always
Is parallel to one another, certainly not the same thing sometimes, orthogonal, but let's just say, fertility, being a proxy for vitality and Longevity. I think people sometimes forget is that fertility isn't just about people want to conceive children. It's also, it's a, it can serve as a proxy for vitality and Longevity. So what would you like to see patients? Let's focus first on female patients, but if it extends to male patients as well, what we like to see them not do? Yeah or do far less of
I really
Like that. So I would say a few things, I'll just headline them and then we can go into detail number one sleep. I do want to diverge from you a little bit on some things but sleep is probably not one of
them though. Well feel free I mean you're the one that worked 100. You know, other words honor and I don't know, 20 hours a
week maybe much that lets
I can't imagine unless unless you lived in a different reality than I do, you know. And there are times in my career where I was pulling all-nighters and sleep-deprived, there's just hit. I don't recommend it but I did it. I hope you don't do that.
No longer if I can avoid it, but there were years many years where it was like, all right, here we go. And I'm quite Adept at it for one cycle. Yeah, but two nights I kind of start to fall apart totally.
Yeah. So I would say sleep, alcohol, High, perceived stress, and I love to talk about maybe the data on telomeres and what we know. So you'd
like to see people get enough sleep so don't don't
despair. Yeah, not all of these are concordant so not enough.
Sleep. Too much alcohol, too much perceived stress.
Eating the wrong Foods, toxic relationships.
And isolation and the number 6.
Not moving enough or not moving and exercising in a way that really fits with your body. Hmm.
So let's start with that one actually says because it's such a and then work backwards, that's interesting. I think nowadays people appreciate the need for quote unquote cardio. I know that the the exercise physiologist cringe and dissolve into a puddle of Tears when I say that but getting the heart rate up over some period of time longer than 10 minutes.
In order to generate cardiovascular health circulation. So, and resistance training of some kind, maybe flexibility what do you mean by Body phenotype or and
exercise. I'll speak from personal experience. So what I did through I mean I gave up my twenties to Medicine
And during that time, I occasionally got to the gym. You know what, UCSF on Parnassus. You could go to the gym and then as soon as your beeper went off your back into the hospital, but I didn't exercise much. I had do remember Nordic tracks. I had a Nordic Track in my house and that was that was like, it what I believe because for me, the primary outcome that I'm interested in is cardio, metabolic health. So when it comes to exercise, what I really feel
Feel if we're going to be at a population level.
I feel that about a third cardio 2/3 resistance training is based on my synthesis of the literature, the best combination. And I think there's, you know, as you described with your sign study, I think there's a minimal effective dose, which for a population is about 150 minutes. I think most of us need a lot more than that, as per week over week, but I think, you know, for me,
Because I have a phenotype that produce a lot of insulin, kind of, depending on how I'm on my game. I've a lot of glucose so I have to exercise a lot more to dispose that glucose. So I think you then have to move from medicine for the population or prescriptions for the population to what works for the individual.
I think that recommendation is fantastic. I think resistance training. Well, let me put it this way. I'm neither a trainer nor physician but I've seen in family members that were doing
I wouldn't say a lot of cardio but just cardio there, when they add resistance training, everything in terms, including their biomarkers have improved dramatically yes. As in particular, for female members of my family,
well, one of the one of the mediators that I think is important, especially for people who do what I call, chronic cardio, which is what I did is cortisol. So we know that Runners, specially marathon runners people who do a lot of cardio.
And don't do much resistance training, they tend to have much High cortisol levels and you can buffer that with vitamin C. Vitamin C can decrease the effect but chronic cardio doesn't always serve people. So quick, personal example, when I first started measuring hormone panels in myself, I went to my physician and I said, I'm 35, I've had one kid. I want to have another kid. I've never been so exhausted in my life.
I just feel like I'm pushing a rock up the hill. I've got this belly fat, that I don't like and I don't wanna have sex with my husband. So what do you think? What can we do about this? And he offered a birth control pill and an antidepressant goodness. So I left him and I went to the lab and I ran a hormone panel and my cortisol was three times when it should have been. My insulin was in the 20s. I was fasting my glucose was 105.
I've my thyroid was mildly abnormal, my progesterone was low and that set me on this course of realizing that what I was doing as a physician taking care of, especially of women was not getting to, some of these root causes that are so essential and I would say I had to start first with cortisol at that time. I was running for miles three times a week, four times a week that was just racing my cortisol further.
So that was not the right exercise. For me, I needed more adaptive exercise. I start doing Pilates or yoga that help to lower my cortisol. I mean, it started me on, you know, changing the way I was managing perceived stress and it also changed my supplement regimen,
could we talk about that? And what with the mummy you said lowering cortisol? Thought of the two supplements that come to mind are ashwagandha, which I think can potently reduce cortisol? But I've heard some recommendations about cycling it
And I've always wondered about time of day for ashwagandha intake because sort of quote, unquote, want cortisol elevated in the early part of the day. Yes, we know this. We know, you do not want cortisol. Peaking later in the
day, no, you do not interfere
asleep, interferes with sleep, and then the other supplement is rhodiola. Rosacea. Do I am I pronouncing that
correctly? Yeah. So rhodiola is very effective. It's been shown in multiple randomized, trials to lower cortisol. So that could be very
effective. What's or do. See I've started taking
Recently, by the way and I made a huge mistake. I like to make the mistakes first. So then my audiences don't make them. As I was taking it. I heard it was an adaptogen. So I thought I'll take it before resistance training, but of course, you want the cortisol Peak during resistance training because that's going to set in motion, the Adaptive response. So, I started to get later in the day and it's really improved, I would say my late day second half the day cognition, this is subjective to be fair. I just feel like I'm in a more even playing of attention in the second half of the day.
So you're describing an N of 1.
Experiment which is data it. Well it is not anecdotal. So I was taught at Harvard Medical School that the hierarchy of evidence starts at the lowest with expert opinion you know case studies, then you've got cohort studies and you've got observational data. That's prospective, then you have randomized trial. But the highest quality evidence of all, is the end of one experiment where you serve as your own control. So what you're describing with Rhodiola,
Le I would frame that as an end of one experiment, we have a washout period and you compare before and after and I'd like to measure some other metrics to see if there's an effect, including your cortisol. So rhodiola has been shown in multiple randomized trials to reduce cortisol. The other thing that I think is super effective is phosphatidyl serine. PS4 short fish, oil also more modestly reduces cortisol.
Ashwagandha is interesting. So in my first book, the hormone cure
which I read by the way you did. I was hoping that was the one you really did. I read it and it's spectacular and I thought going into it, I had this like, you know, let's just call it what it was is come male bias. Like is there going to be anything in here for me? Because I'm I don't have ovaries and you know is it's gonna be and it was immensely informative. So thank you. Yeah, I have very fond Recollections of the walks. I took listening to it and then I own the print version too. So I like to
I switch back and forth. So thank you for that. It's a it's a super book for anyone to
read you. Yeah, I so appreciate that. So in chapter 4 you may or may not remember that ashwagandha, at least the time that I wrote that book ashwagandha is data is not great, but lack of proof is not proof against so with ashwagandha, most of the data comes from thousands of years of using it in ayurvedic medicine and it's considered again. Not my science hat. It's considered a
Adaptogen, so that it's potentially helpful when you are high cortisol phenotype like. I was like, I sometimes still M or low cortisol.
I haven't found that in my patients, although I'll give you one exception. So ashwagandha is mostly based on animal studies. There is not as much human data but it is used a ton in Integrative Medicine. The there's one supplement that I found to be incredibly helpful for people who tend to have high cortisol at night and that's called cortisol manager by integrative Therapeutics
I don't have a second supplement manufacturer that makes something similar. It's their number one selling supplement because it's so effective. Is it a cocktail of several think? It's a combination of phosphatidyl serine and ashwagandha.
So tell me more about phosphatidyl serine. I am familiar with it for. It's been mentioned by some guests that were on the Tim Ferriss podcast, long ago, for other reasons, I think related to sleep. Yes. And maybe that's another reason why you like it. But before we move on from rhodiola, is there a dosage of
Viola rosacea that
you so I would refer people to my book because the randomized trials and the doses that were used are in there. So I can't remember with rhodiola, although I took it this morning to prepare to be with you,
we can look it up and put out show note
captions. I can remember the dose with phosphatidyl serine because I take that regularly so 400, 800 mg is the typical dose for PS. And what's interesting is that in the randomized, trials that we're done.
400 mg was more effective than 800 mg
interesting. I've found that for several supplements that the lower dose, was more effective. Yes. Yeah. I want it, doesn't matter what those were. And so when you say PS, you were referring to by the way, folks not PCOS, just because we're scientists and clinicians are familiar with and Military, very familiar with acronyms. Phosphatidyl serine. PSO 400 800 mg 400 being more effective taken later in the day or lead. A does it matter?
It depends on when your cortisol is high. So for
me, I tend to, you know, what's the pattern for cortisol, typically it rises to its peak 30 to 60 minutes. After you get up, then it has this gradual kind of asymptotic decline until you go to bed. So if you're someone like me, who Peaks, like way crazy high, I don't do that anymore. But that's what I used to do. I need to phosphatidyl serine in the morning, for people who are high at night who have what's known? As a
Flat cortisol pattern, or inverted pattern, you want to take it at night and the flat pattern just quick sidebar is that that's associated with a number of conditions that most mainstream Physicians. Don't know about. So a flat pattern, where it's low in the morning and it's high at night is associated with anxiety, depression, decreased survival from breast cancer. That was studied at Stanford by David Spiegel does that he was my class.
Close even collaborator. Even on the breath work study that
we do. Interesting. Yeah,
he's our associate chair of Psychiatry now it's a wonderful human being has amazed has been a guest on this podcast and I'm now fantasizing about a conversation that includes a panel of Incredible Minds, like you and David from the clinical side. So in any case, yeah, the late shifted cortisol, not
good, not good. And it seems to have the worst
Immune Downstream issues of any of the cortisol patterns. So that's really important to know about it because it then maps to things like it's related to PTSD. So that's the pattern. We see like in vets who have got PTSD, as well as others it maps to autoimmunity, it maps to fibromyalgia.
I was told that one in 12 people.
Have are heterozygous so one mutant copy or hypo morphic for some, some mutation in adrenal related genes of congenital. Adrenal hyperplasia. Is that true? And if so, that means that 1 in 12, people walking around, are cranking out far too much cortisol, or not enough cortisol, or the course, I'll system is already skewed in a direction that makes life more challenging at the levels were talking about. Did I hear that correctly? Because that one in 12 is not a
More
number. It's not a small number, it fits with what I see clinically. I mean, I want to see that ADA just to see what does that mean and could you modulate it with environmental influences? But it certainly fits with what I see, you know, I was taught once again in mainstream medicine that in terms of adrenal function,
It's very binary how most clinicians think about it. You either have Addison's disease and you don't make enough cortisol, or you've got Cushing's or crushing Wade, pattern, and you make too much cortisol, and anything in the middle is normal. And my experience is that he'll know like there are those of us like me who make a lot of cortisol I don't have Cushing's. Maybe I've got one of these, I wouldn't call it a mutant Gene, I would call it more of a vulnerable Gene.
And so maybe I have one of those. Maybe that's part of the reason why I make, you know, two to three times what I should
be. I'm aware of certain groups of individuals from within the military sector that have, there's a more frequent occurrence of
Some mutation in CCH can be congenital. Adrenal hyperplasia, not necessarily two copies which will if people looked at up they're going to go oh wow, there's all these phenotypes and but sort of hyper morphic type things that you don't less than or too much cortisol. And they are very good at staying up, multiple days per night, right? Multiple nights in series so they can pull all nighters very easily. Yeah, they can push harder when most people would quit everyone thinks. Well, that's a great phenotype to have but guess what?
It's because they hyper produce cortisol. Yeah. And so that's interesting. And I think if we were to panel medical students and graduate students, and you were to look at, you know who's pulling excessively long hours who's stressed out a lot even outside of Academia in medicine, and pushing, pushing pushing really hard, I think the ability to push and not crash. We think of it as adaptive but in some sense, it's maladaptive over a series of years, which is where we're you described
earlier. Yeah, it's such a good point because
You know, you in some ways you want to select for that in certain professions like in the military like in medicine.
But I would wonder if for those folks about the downstream consequences of producing so much cortisol,
it's got to be detrimental for their health. It's got to be a long run and you see that,
but even the data shows that if you're someone like me, who makes a lot of cortisol, higher rates of depression, like 50% of people with major depression have high cortisol levels, higher rates of suicide, much more metabolic dysfunction. We know that trauma is an example maps to an increased risk.
risk of glucose metabolism issues and certainly High cortisol does that because it's one of the jobs of cortisol is to manage a glucose and it's
it kind of sets you up for this one number five which is toxic relationships. You know, someone who hyper produces cortisol. It's hard to live with someone like that. It's also I would say people that have this let's just call it biological resilience. It's not always adaptive because you can stay in bad circumstances longer the ability to crash provided. It's not suicide or life life destroying or you know, long Arc of
Of pause and the requirements are you take two years off from work or school or something the ability to keep pressing on as a double-edged sword. What's that way? I want to make sure in staying within the this conversation because you mentioned phosphatidylserine, we talked about rhodiola rosacea Ash, we talked a bit about ashwagandha, you've also talked about Omega-3s and fish oil in particular. I'd love to know your favorite sources of these. I think nowadays, there's more General acceptance that getting these
Essential fatty acids is important. Do you have a threshold level? I've sort of G. I've encouraged podcast listeners to consider depending on what they're eating to try and get a gram of EPA or more per day. Does that seem excessive? And what are the real data on epa's? Because then the cardiovascular experts always hit back and say, oh no you know it's not good for cardiovascular health and then you all it's better than antidepressants and other studies and they go no. So I feel like if you
Want to make your life difficult. You want to raise your cortisol, you go on Twitter and you say something positive about Omega-3s in fish oil and and you learn a lot. What are your thoughts on Omega-3s? I take a lot of them. I've always been a big fan.
Yeah. So this is where I personalize. I think some people need more than others. And what I do is I measure your level. So this gets back to nutritional testing. So for you, I would suggest an Amiga Quant or one of my favorite cardio metabolic
Panels is to do a Cleveland Art lab. So I think they give me the most reliable information, not just for lipids and subclasses, and, you know, NMR fractionation, but it also gives me an insulin resistance score. It gives me levels of Omega-3s.
Great, will provide links to these different sites, so that people.
But one quick thing about that, the whole story is not a mega threes and taking fish oil. So the work of Charlie's Sirhan at
the Brigham is showing that the way that we resolve inflammation,
Our understanding of it is really I think in the learning to crawl stage. And so if you look at the omega-3, six pathway in the body fish oils can help, you know, kind of push the reactions in a particular direction, but typically they're not enough for the resolution of inflammation. Now, what most people do, including my MBA players is they pop and ibuprofen or something like that when they've got inflammation. That's got
Lots of other side effects that are not so good for you. And we know in terms of the resolution of inflammation that taking something like ibuprofen, reduces the amplitude of inflammation by about 50%, but then it potentially blocks the complete resolution of inflammation. So, there's these new supplements that you may have heard of called specialized Pro resolving mediators. There's a lot of different supplement companies that make them and that combined with fish oil. See
To be the best combination and what I do for athletes who've got kind of a normal aches, and pains of the training load, they have is all combined, a little aspirin, small dose just like, 81 milligrams or two of those baby aspirin together with fish oil, plus specialized for resolving mediators and there's some that are NSF, they're certified for sports. But the dose, I would say with my patients, some of them only need.
1000 mg your G that you mentioned for the population. Some of them need 6 G together with spms so I think it has to be personalized.
How young is it okay? For people to start taking Omega threes, for instance, young women and their teens in their 20s and their 30s young guys in their 20s and 30s. Should they take fish oil? If just as a assuming, they're not going to get anything test.
Nothing about the college student who is really into biomarkers. That sort of thing. Will go do some us but many people won't but they want to do the right thing so they'll try and drink a little less. Hopefully hopefully they won't smoke hervey. Please don't smoke or vapor. The idea that vaping is ok. Select we had a little episode so bad so bad for everything we're talking let's and that that's like exactly so just you know of what they'll hopefully they'll try and avoid those things. Hopefully they'll avoid hard drugs. Hopefully there will void getting any STIs if they do.
That we resolve them quickly. Hopefully. Yes. So but they might say, oh well, okay. I'm willing to, you know, take some magnesium or take some phosphatidyl serine buffer, my cortisol, eat some vegetables. Should they consider taking fish oil as a kind of across the board in ocula Tory thing.
So I'm going to rank order these. I would say fish oil yes I think 1000 mg is General recommendation is good but I also have a food first philosophy so my preference would be that they're having salmon or some kind of Smash fish and there.
Matt as the primary source of their Mega threes and then the days that they don't have fish, I recommend it. Probably twice a week that they take fish oil then I would put magnesium next since so many people are deficient. Then I'd probably put vitamin
D. What? How many IU vitamin D per day?
Well, you keep asking me this, like, for the
population. Well, for the, let me put it this way for the, Lay's, for the lazy person or, and this is an or not an and, or the person who
Just doesn't have the finances to go. Get measured. Yeah, levels measured because as you know, our audience is a huge range. We've got people who can have tons of disposable income. That listen is B, we have beloved no disposable income.
So 1000 to 2000 and now showing its, but my, you know, what I do is I dose to a serum level that's between about 50 and 90 great. And so, I have a vitamin D receptor snip. And so I need to take about five thousand a day to get to what I need. A lot of people don't need that.
and, you know, there's some supplements that
I don't know if they need. So you mentioned. Phosphatidyl serine for someone who's a college student and their cortisol is completely normal. They're wasting their money on PS. They don't need it. They might need it later, but they don't need it.
Now, I'd like to make sure that we Circle back to birth control in particular. Oral contraceptive, birth control.
And we should touch on iuds perhaps a little bit more, but what are your thoughts on sore? Pure estrogen birth control. Is what I learned when I was in college is that birth control is basically tonic estrogen. So, constantly, taking estrogen estrogen, women are taking estrogen so that they don't get the estrogen priming of progesterone. You're not getting any ovulation and I've known women that have been taking oral contract that took oral
Reception is like estrogen pills basically for 5 10. 15 years are their long-term consequences of this as it relates to pregnancy. PCOS menopause. What if so what are some of those consequences? What are your concerns? What do you like about oral contraceptives? What do you dislike about
them? I like how balanced you ask that question. So women, who take oral contraceptives. As long as you're describing, like
10 years or longer, we call those Olympic oral contraceptive users in terms of benefit. I think that especially when they first came out and even now it gives women reproductive choice and That's essential. As you may know, our reproductive Choice has been declining recently. So I'm a big fan in that regard and we've got a lot of data to show both the risks and also, the benefits of it. So, I'll speak first into the benefits because
I'm going to get on a soapbox a little bit about the risks. So we know that it reduces the risk of ovarian cancer. So there's something about this idea of incessant ovulation, that is not good for the female body. So if you look at for instance, women who are nuns, who don't take oral contraceptives and they have a period, every single month of their reproductive lives. They have a greater risk of ovarian cancer.
So if you look then at women who have several babies and they've got a period of time when they're pregnant that, they're not ovulating and then they breastfeed for some period of time. They have a lower risk of ovarian cancer. So oral carpets contraceptives, help with reducing ovulation and reducing risk. We know that if you take the oral contraceptive for about five years, it reduce your risk of ovarian cancer by 50% and that's significant because
We're so poor at diagnosing, ovarian cancer early, there's really no method that's really effective. We use CA 125 and ultrasound screening, especially in women who are at greater genetic risk. But even that often we diagnose it, you know, in a later
stage, maybe just because that statement is going to highlight. For a number of people, the question of what are some of the simple earliest symptoms that people can recognize without a blood test. So is it ovarian cancer? Is it going to be
pain?
So the problem is the symptoms are so big and they're so nonspecific one of the most common symptoms is bloating and we've already talked about constipation. We've talked about how women have this longer track GI tract and so bloating is a really common experience for most women. You cannot bulk symptoms, you know, feeling like your your lower belly is kind of pressed out. So the way that we
Inform women in terms of watching for this is to get regular gynecological exams for women who are at high risk where they have for instance, an ultrasound for some reason, it shows a mass that were concerned about there's way to triage that in terms of what kind of evaluation that they need. And that's a situation where you might get a blood test called to see a 129 ca-125, the yeah. The problem is the symptoms are so big, it could be.
It depends on how big the tumor is. How much bulk, you have what it's pressing on.
So if taking estrogen and thereby reducing the frequency of ovulation lowers the risk of ovarian cancer should women, that are even women who are not sexually active. So they're, they're not actively trying to get pregnant or avoid getting pregnant, but if they're not sexually active, then the probability of conceiving. Unless they go through some IUI or some other route is is very low as far as I know.
That's what I was taught in high school anyway. Would they be wise to suppress ovulation for periodically? Using hormone base contraception just so that they can offset the risk of ovarian
cancer. That's a very rational question. And I would say, that's what mainstream medicine has had at its back to recommend. Oral contraceptives, not just for women who are seeking contraception, but for acne for painful periods.
For really kind of the drop of a hat. They're prescribing oral contraceptives. That's what I was taught to do. But there's so many consequences and I think the issue here is more about consent because
an ob-gyn and I started out as a board-certified OBGYN and I now mostly see men, but I was taught as an OB/GYN to convince women to go on the oral contraceptive and I think a lot of that is pharmaceutical influence so maybe we could talk about the risks and why the answer is no to a
question as we do that could I just ask is the so-called ring the new used to be called the NuvaRing. Maybe that's a brand name but when I was in college, it was all this discussion about
Ring. All right, by both men and women for reasons that don't belong on the podcast, use your imagination folks. So is the ring, obviously, it's not oral, it's not oral hormone contraception, but it's hormone based write the rate is releasing estrogen locally as opposed to taking it orally. But would you would you slide it under what you're about to tell us in terms of the concerns?
So we have less data about the ring. So the oral contraceptive is to hormones. It's ethinyl estradiol.
And it's a progestin. So it's not the normal progesterone that your body makes that your ovaries, making your adrenals make. It is a synthetic form of progesterone and it is the same progestin, similar, same class that was shown to be dangerous and provocative in the women's health initiative. So I'm not a fan of progestins. I do not recommend them for any woman.
Unless the consequence of not taking them is surgery or some other.
You know, I must say it gives them some freedom in some way so I don't like progestins. The NuvaRing is estrogen plus progesterone but it's released transdermally through the vagina. So given the way that it's delivered to the vagina, the doses are lower than what's taken orally. But in terms of some of the risks that I'm about to talk about, we don't know about much of the data.
We think that it's similar, there's probably a spectrum of risk and the NuvaRing is a little more towards the middle, then you know what I'm talking about with oral
contraceptives. Are you ready for that? Yeah, I'm ready for the
risks. Okay? So, like, with almost any pharmaceutical. The oral contraceptive depletes, certain micronutrients, so magnesium. There's certain vitamin B's, that are depleted.
It also affects the microbiome. That data is not as strong, but there seems to be some effect. And there's also an increased risk of inflammatory bowel disease, an autoimmune condition, it increases inflammatory tone. So the studies that I've seen increase one of the markers of inflammatory tone High sensitivity zrp by about 2 to 3 x. It seems to make the hypothalamic-pituitary-adrenal axis more.
Rigid, so that she can't kind of roll with the punches and Wax and Wane. In terms of cortisol production, the way that you can off the birth control pill
It can affect thyroid function. I'm thinking of the slide that I have that has like ten problems associated with the oral contraceptive, but that's what I can remember. Right now,
that's very helpful. And it makes me wonder whether or not, if on the one hand oral contraceptives are protective and women against ovarian cancer. But then they have these other
issues. Yeah, there's one other. I want to mention, please, anytime you take oral estrogen, it raises sex hormone-binding globulin and you've talked to other podcasts.
Us about this Kyle. I think sex hormone-binding globulin, I think of, as a sponge, that soaks up free estrogen and free testosterone. So, when you go on the birth control pill, you raise your sex hormone-binding globulin, it's soaks up, especially free testosterone, and for some women, it's not a big deal. They don't notice much of a difference, but then there's a phenotype may be related to CAG repeats on the Androgen receptor.
Who are exquisitely sensitive to that decline in free testosterone. So this then opens the portal of talking a little bit about testosterone and women. So we've mentioned already that it's the most abundant biologically, the most abundant hormone in the female system even though men make almost 10 times as much or even more than 10 times, it is so important for women. It is essential to so many things, not just sex drive and muscle mass and seeing a response to resistance training.
In but also confidence in agency. And so those women who are so sensitive to their testosterone level, they've got this high sex hormone-binding globulin, their testosterone declines. What they describe is vaginal dryness may be a decline in sex drive but there's also this bigger issue related to confidence in agencies. Even risk-taking from studies that we've done with MBA students that I think is a serious problem.
Maybe the most important out of all of these things is that it can shrink the clitoris by up to 20% 20%,
and that includes the regression of the, of the nerves that innervate the clitoris. Is that? I mean,
that's a very good question as a
neuroscientist. I would think used to teach the neural side of reproductive Health. We need to do a series on Sexual Health, maybe you would co-host that with sir, we could certainly use your expertise I think. Yeah, that's a dramatic, that's a dramatic number.
Yeah, but then, let's go back to the sacred marketing. If I've got a woman that I think should not be on the birth control pill, or maybe just taking it for acne or stake in it because her parents were a little painful. What I'm going to do is say let's leverage. These other ways of making your period, less painful, let's take the message of your painful periods and figure out, okay? It's your inflammatory tone and we give you some fish oil and spms maybe a little aspirin when you got your period. Like let's find some other ways to deal with it then to take
take the oral contraceptive which you have not received informed consent about because it can trick your clit by up to 20%. Now that usually convinces most people to come reversal. The elevation in sex hormone-binding globulin, does not seem to go away. When you come off the birth control pill to me, that is the biggest problem with prescribing oral contraceptives. Now, the data that we have is limited, there's one woman who
Claudia, something something who looked at sex hormone-binding globulin, a year out from stopping the birth control pill and it was still elevated. It wasn't as high as it was when they were on the pill, but it was still elevated. So, your question about reversibility, I don't know if we know the answer to that.
Wow, okay. That's yeah, that's a significant statement and something that for consideration related to this, although this might seem not related. It is
Is.
How early do you recommend that women? Go get their follicle number assessed. In other words, to get a size, a sense of the size of the ovarian reserve and their amh levels measured. I'm going to, I'm an amateur Outsider as I say this, but we have an episode on a fertility where I just describe the ovulatory menstrual cycle. Yeah.
And I'm not the best person to answer that. Yeah, well, we can do far out from it.
Okay. Well, I suppose, then from
The perspective of somebody who thinks about fertility in terms of at least congruent with vitality and Longevity with given that it's fairly non-invasive. It's an ultrasound or a blood draw for amh or both. Is there any reason why women would not want to get her? Follicle numberous? Aster her amh levels, assess. Is there any reason why? Because I was shocked to learn that. Most women don't do this until they're hitting their late 30s or early 40s and they either have
And conceived or they suddenly decide that they want to conceive. And I thought, why doesn't every doctor insist that their female patients? Get have their amh level addressed. So that if they need to it's Kris eggs it's like has its
cost. Yeah, so I think if you've got the disposable income to do it go for it
it's not include in a standard blood panel now. Wow.
The only women in my practice who had a mage has done and never looked at their follicle count are women who want to freeze their eggs.
Or in that requires disposable income or they are having trouble getting pregnant. So they are in the reproductive Endocrinology system and they're getting an evaluation. And then there are also the women who have symptoms of early menopause. So premature ovarian insufficiency, which is before age 40
Those are the women that I see getting a tested and I think you're right that it should be offered more broadly. It speaks to the democratization of data again and I think most women don't know that so you're doing a huge service. I think to be speaking into this.
One other point related to that. Is that what I see in conventional medicine is that when a woman asks for a hormone panel and she's not trying to get pregnant, she usually gets told that hormones, very too much, it's a waste of money you don't need it.
Or if you're feeling hormonal, wanted to go on a birth control pill.
Unless she's trying to get pregnant if she's trying to get pregnant suddenly those same tests are very reliable and they get, you know, their their testosterone, the free testosterone, their thyroid panel, they get their estrogen and progesterone. Maybe they get their cortisol, they get their amh. So there's a double standard between those who want to get pregnant, and those who don't and that needs to
end. Yeah, I totally agree as I've learned more about ovulatory cycle and am h.
And, and the intro population of follicles on it's fascinating, it just seems to me. Wow, a relatively straightforward test one, definitely invasive ultrasound, but
I don't consider that. Yeah, it's not about
terribly invasive, but invasive least but the other one, just pure blood test just seems like why wouldn't I wouldn't this be offered a covered by insurance or you know, that anyone that wanted. But now now I understand why you mentioned menopause. Huge topic enormous topic.
We had a guest on the podcast, who's not a clinician who said something in passing. So I want to likely to get this wrong but what they said was that the results of the large-scale trials, on hormone replacement therapy for women, for menopause said something to the effect of. If the hormone therapy was started early enough it was very beneficial for yes. Vitality and health outcomes where as if women went through menopause and then initiated the hormone therapy,
Hormone replacement therapy that it could be detrimental to their health. So first of all, do I recall that statement correctly and then second of all, what sorts of hormones are being replaced? Is it just estrogen? And how is that done? Is it done through birth control. So oral contraceptives. New Rings. What are your thoughts on menopause? When should people start thinking about it and what is the palette of things available? So that we can do an entire episode with you on on this?
This topic in the future, but just to, you know, I get a lot of questions about this. And, and I'm guessing based on everything, you've told me today that there are women in their 30s that while they may be 20 years out from menopause, probably should be doing things now in anticipation of that. Yes.
So we haven't talked about the 30-something, but I totally agree with you. The more, you know, about your phenotype, your hormonal phenotype, when you're in your 30s, you're set up in terms of what to do in the future, especially things like your thyroid.
Estrogen progesterone levels because you can replace to a state of you thyroid. Whatever that is for you, you can replace. I don't usually go exactly back to where the estrogen progesterone levels were, but we can get pretty close. So in your 30s, having a base case I think is really essential. So you spoke to the Women's Health Initiative, which was published in 2002 and we went from a huge number of women taking hormone therapy, too.
To a very small percentage, like in the range of five percent. And that means we've got millions millions of women who are suffering needlessly with things like insomnia, difficulty with their mood, difficulty with sex drive feeling like they are closing the store in terms of sex because they're not on hormone therapy. I would agree with the statement that you made that hormone therapy particular forms that are similar to what your body always made.
When it's given judiciously at the right time, typically within five to 10 years of menopause which is 51 to 52 that it is incredibly safe. So it's a complicated study, the women's health initiative but it was the wrong study in the wrong patients with the wrong medications and with some of the wrong outcomes. So it was power to look at cardiovascular outcomes was not powered.
To look at breast cancer, it was stopped because of breast cancer risk. But what happened in the control arm of the study was that they had an incredibly low rate of breast cancer. And so as a result, they ended up having this increased risk of breast cancer at five years and they stopped the study. Now, the study was done with synthetics, it was done with conjugated Aquinas region, known as Premarin and Roxy progesterone acetate. Those were the so-called
Estrogen and progesterone, those are synthetic hormones. We think, especially the progestin is associated with the greater risk of breast cancer, although the subsequent re-evaluations of the data. Now, 18 years out have shown that this problem with the control group and no increased risk of breast cancer. And for the women who got estrogen, only those who had a hysterectomy the Premarin,
And they actually had a decreased breast cancer risk and decreased breast cancer mortality. So, there's a lot to be said about this. I'm trying to keep it really brief, but if you look at the women 50 to 60, So within 10 years of menopause, they're the ones who seem to have the greatest benefit, so they had decreased subclinical atherosclerosis. So, less cardiovascular disease, they had an improvement in terms of
As of bone, health less progression to diabetes and then over the age of 60, they started to have greater risk of certain outcomes such as cardiovascular disease, myocardial infarction, and so on.
you asked about,
What do I do? And to me, this problem is not just menopause. What's more interesting is to talk about perimenopause. So, perimenopause is the period of time before your final menstrual cycle. And for most women, depending on how it's tuned, you are to the symptoms, it can last for 10 years. So I'm still in perimenopause, it's been like, 20 years because I've been tracking it. So carefully.
It usually gets kicked off by having your cycle. Get closer together so that can happen in your 30s or 40s. You go from 28 days to 25 days. That sort of thing. You may notice that you start sleeping more poorly because progesterone. So important, you talked about that with Kyle, you may notice it as more anxiety, difficulties sleeping and that probably is related to the estrogen receptor. So your Alpha is estrogen receptor. Alpha is NGO. It increases anxiety.
Your beta is associated with a ning xia lytic activity. And then there's a total of about six estrogen receptors. Now there's the G protein-coupled estrogen receptors, and those are mixed anxiety, lytic anxiety Panic. So there's this whole period of perimenopause and what's Most Fascinating to me? And we've got to talk about this either today or another time is that there is this massive massive change that happens in the female brain.
Rain that people are not talking about enough. And so, looking at the work of Lisa, Moscow knee at Cornell from starting around age 40, there is this massive change in cerebral metabolism. So you can do fdg-pet scans, you can look at glucose uptake and there's about on average of 20% decline from premenopause, you know, up to like age 35 to perimenopause.
To post menopause the women who are having the most symptoms in perimenopause and menopause the hot flashes and night sweats, the difficulty sleeping, those are the ones who have the most significant cerebral hypometabolism.
So it's almost like a. I don't want to scare people with this language but it's a low level or let's call it pseudo dimension of
sorts. Yes. It it seems to be a phenotype that you can then map.
To Alzheimer's disease because that's Lisa mosconi's work she's looking at okay? Alzheimer's disease is not a disease of old age, it is disease of middle-aged. What are some of the biomarkers that we can Define? That can tell you what your risk is. I've got a mother and a grandmother with Alzheimer's disease. You can believe I am all over this data and
insulin resistance and huge part of this activity. As we talked about it before, seems to be somewhere in there, which I think when that first, when that idea,
First surfaced, a few people like really but then, of course, right. I mean, the brain is just incredibly metabolically demanding where again, you deprive neurons of fuel sources. They were you make them less sensitive to fuel sources. They start dying, they certainly start firing less, it makes perfect sense. And I think now, it's thanks to Lisa's work work that you've done in a talked about quite a lot, is your books and elsewhere, I think has really, you know, highlighted for people that
Metabolism and metabolomic speech is going to be as important as genes and genome X when it comes right? Dementia, perhaps, especially in women, is it safe to say
that? I think, I think so, because
We believe that the system is regulated by estrogen.
So, the decline in estrogen starting around age, 40, 43 is kind of, the average seems to be the driver behind cerebral hypometabolism the way I describe it. To my patients is it's like slow brain energy. So you walk into a room you can't remember why I liked you just noticed that. You can't manage all the tasks the way that you once could like things are just a little slower and I say that two women are like I have that like help me. So this is then circulated.
Going back to Whi where women are scared to death of taking hormone therapy. And we've got all of these women that are Marching toward potentially a greater risk of Alzheimer's disease. And they have this opportunity in their 40s and their 50s to take hormone therapy, and they may not be offered it, because the typical conventional approach based on Whi is to say, unless you're having hot flashes and night sweats that are severe, I'm not going to give you hormone therapy and I just want to
That out, I would say no, that is not the way to approach it further.
The concept right now in conventional medicine is that hot flashes and night sweats are these nuisance symptoms that we will take care of temporarily, maybe with a little bit of estrogen and progesterone or birth control pill? Because it's given a
lot more that they pass or there's this idea.
Suck it up. Suck it up. Doesn't matter that you're not sleeping anymore, you know? Turn down the temperature in the room. And that's not right. Because hot flashes and night sweats are a biomarker
Of cardio metabolic disease. They are a biomarker of increased bone loss.
They are a biomarker of changes in the brain, so many of these symptoms that occur in perimenopause are not driven by the ovaries. They are driven by the brain.
Yeah, it's the bi-directional crosstalk between the body and the brain keeps, you know, I think is this the resounding theme we had Chris Palmer on here psychiatrist, who's talking about ketogenic diet for totally mental health. I know you. We could have a whole other discussion of and we will I hope if you'll agree to it about nutrition and as a released, or
Own sub specific diets and so forth. But
the and that's a question to whether this problem of cerebral. Hypometabolism, could we solve it with estrogen and or increased metabolic flexibility. So, I just wanted to footnote that.
Sorry to interrupt, you know, please, please interrupt. I know you're a, as long as we're there, I know you are a fan in some instances of intermittent fasting. Time restricted, feeding, and or ketogenic
Diet. Yes. To get cells sensitive to insulin, which is not to say, if I understand correctly which is not to say that. Women need to stay on the ketogenic diet for long periods of time or intermittent fast for. I only time, restricted feeding 48 hours or six hours a day but that by increasing you said, metabolic flexibility Mobility, excuse me. But by increasing cells, sensitivity to insulin and then may be returning to a more typical eating pattern.
Article switching back and forth that might actually beneficial be beneficial to have that,
right? Yeah, I love the pulse so I feel like it's much more physiologic than say going on a ketogenic diet and staying there for years. All of the data that we have on the ketogenic diet is pretty Limited in terms of duration, you know, the the longest players that we have, in terms of the data are the folks with epilepsy and that's just a different phenotype. So I think in terms of microbiome effects diversity, despite
Osa, some of those issues we really don't know in terms of long-term effects. So I prefer with a ketogenic diet that it's used as an end of one experiment and that you do it for four weeks, maybe you measure biomarkers before and afterwards. Maybe look at your stool before and afterwards. We still haven't talked about Miss told us yet, but she could measure your fasting insulin and your glucose. You can just start their due for weeks of Quito clean keto, including vegetables doesn't have to be 57 a day.
And then measure it again, afterwards,
since you measure a mentioned stool testing, yes, what, what is your recommendation about stool
testing?
So my recommendation, this is again in the field of if you have the disposable income. So I usually start with Genova because they've got a good copay system with insurance. That's what I typically use. So I usually do there one day stool test where you have to go digging through your stool and set it off to the slab. That's in North Carolina, I usually do the one day unless I'm concerned about parasites. In that case, I tend to do three days. I do that for people who travel a fair amount and go to
Places where there's greater risk or they just have got symptoms. Another test that I do a lot is because I was like to mention two Labs is a test by one Java T. And this is much more of a data wonk type of task. Because it's powered by a, I was designed by a guy who's got inflammatory bowel disease, and he is a, he's a PhD
Deep phenotyping bioinformatics guy, who wanted to make this really easy. So the test is is Under the Umbrella of thorn and these call it got bio. They might have another name for it and they just improved it so that it's a wipe instead of digging through her stool and so my athletes will do it. Now they were not so into digging through their stole before. Is anybody
really? No one is. I don't want the answered. I know the answer. I prefer to that.
But that's a super interesting test because it's you get much more dense. Data the issue is with apologies to my friends at Thorn. The issue is that their recommendations end up being Thorn supplements so that can be very easy for people who want to, you know, connect the dots.
That's not always the way that I like to do it.
First of all, three things you shared with us, an immense amount of knowledge. And in that first statement, I also want to apologize because I threw at you, the entire lifespan of female lifespan reproductive Health, contraception diet microbiome so many things. But I first, I just want to say, you've taught me a tremendous amount.
Including I think something that most people including myself have not thought about enough which is the psychosocial impact on things that we're all familiar with constipation bowel movements what we eat what we avoid. I have to say really a huge thank you for that because it's not something that's been discussed on this podcast before so of know that brainy communicates with body psychology and biology or linked but I think this is the first time that anyone is
Ever directly linked circumstances and biology and psychology, and such a concrete way. So that's the that's the first thing. And I speak for many people in that second of all, we barely scratched the surface of your knowledge and which is both frustrating for me because I always want to learn more and I know many other people do as well. But also very very exciting because with hopefully without much persuasion we can have you back on to talk about things that all like me.
I know you're working with men now. Men's Health, some particulars around pair. I think there's more for us to explore in terms of PCOS, menopause, contraception and all of the above. But then something that you and I were talking about off camera before we started, which I think is a really important factor that ties back to this issue of trauma and stress and the bi-directional relationship between biology and psychology. Hopefully someday we won't even separate those two which is
The use of specific medicines including plant medicines. Yes. And how that can influence over all Health, which no doubt will include Hormone Health. So, I say all of that for two reasons, first of all, to queue up the we won't even call it a part two, but a sequel to the to this, which I'm gratified to hear that. You'll join us for that. And then also to just really extend a huge thank you. The amount of knowledge that you shared is is immense and is going to be very, very useful and actionable for
Or four men in terms of their thinking and their actions and for women in particular, today's discussion in particular for women in terms of how to think about their health and biology, how to think about their psychology and the environment that all of them submitted. And I just want to say an enormous, thank you,
thank you, Andrew. I so appreciate that. And I so appreciate what you offer to the world in terms of a way in a way to understand physiology and how to craft a architect, a better life.
Life. Can I just add one last thing because I shouldn't talk about it since we didn't get to the 40s and the 50s and those list of biomarkers. So I feel like if people if women went away with one thing today it would be to do a coronary artery calcium score by age, 45 and sooner, if you've got premature heart
disease, how is that taken?
So it's a CT scan of the chest you can self order it. Like, I think it's Stanford Hospital, you can solve for it.
ER, it last time, a patient checked, it was $250. So, again disposable income but it tells you, it almost gives you this fork in the road in terms of how much you need to pay attention to cardio metabolic Health as a woman, and it's a 45 for men too. So if you haven't had one, if you had one, no, you need one, it's gone, cortisol CAC. Great. So I'll run all that by you. It's really essential and it's um,
Yeah, it's it's so fascinating because you know, there's some women who have a zero so my score zero and that's great. So often you can just keep doing what you're doing but if you're 45 and you're starting to be elevated or you've got, you know, maybe you've got PCOS or you've got some other biomarkers tanning you in this direction toward the number one, killer really
It's nine out of the top 10 killers in the u.s. that allows you to really start to make changes. And I think it's essential to know that data. It's not, it's probably not going to be offered by your doctor. Certainly Peter T, is going to offer it, but most conventional doctors are not going to do it. And then the last thing I want to say
before you mention Ed. So if I were to go to my doctor and I just say I want to a cardiac calcium score, that's what
people were nari artery calcium score Tac. Ok. So
One here that and know that if you're 40 or older and maybe if you're 45 45 or older get get it.
So the last thing is and this is for men and women is your a score so adverse childhood experiences knowing you're a score is so essential in terms of a baseline for how much trauma your system, your Pine system endured when you were a kid and we know that childhood trauma, whether it's abuse or neglect or you,
Having an alcoholic parent that maps to disease in middle age. And I can give you so much Insight. I'll give you an example. I've got a patient who had an elevated coronary artery calcium score? Who does everything right with her food? I think it was her. Trauma, that elevated, her CAC when she was 45. So, I think an a score knowing you're a score,
Starting as a teenager like knowing it and knowing how to work with that is really essential.
There are certain people, they are exceedingly rare, but you are one such person that when they speak knowledge just comes from, comes out of them. And it's incredibly useful and helpful knowledge. So, thank you. I'm going to get both of those things. Good. And I highly recommend everyone else pursue ways that they can get those or if they can't get them that they, you know, your mark those as things to get at the point where they can obtain.
When sufficient disposable income, it sounds like that, the health, the detriments to health that those can offset would be well, worth the cost,
totally. Thank you.
Thank you for joining me. For today's discussion, all about female hormone, Health, vitality and Longevity with dr. Sara Gottfried, if you'd like to learn more about dr. Gottfried's work. Please, check out her social media channels, we provided links to those in the show. No captions. In addition, please check out one or all of the doctor Gottfried's.
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Is essential, if you want to design a supplement regimen that is both cost effective and the most biologically effective supplement regimen. That's very hard to do with blends of supplements, it's very straightforward to do with single-ingredient formulations. Also momentous supplement ship internationally, which is important because we realize that many of you reside outside of the United States. If you'd like to see the supplements discussed on the human Lab podcast, you can go to live momentous beldo u.s. so that's live momentous.com hubermann. Thank you. Once again for joining me for today's discussion.
Russian all about female hormone. Health vitality and Longevity with dr. Sara Gottfried and last but certainly not least, thank you for your interest in science.
