Dr. Joe Tatta: Welcome to the Healing Pain Summit. My name is Dr. Joe Tatta. I am pleased to have Dr. Sara Gottfried with me. Today we’re going to be talking about the hormone reset diet. Dr. Sara Gottfried is the New York Times bestselling author of the hormone cure, as well as the hormone reset diet. She’s a Harvard trained physician and board-certified gynecologist who teaches natural hormone balancing so women can lose weight, detoxify and feel great. Dr. Gottfried lives in Berkeley, California with her husband and two daughters. You can visit her online and learn more at Sara Gottfried, md.com Dr. Sara Gottfried. Welcome to the Healing Pain Summit.
Dr. Gottfried: Hey Joe. So happy to be here.
Dr. Joe Tatta: So you and I have been here before. We’ve talked about how important it is to reset your hormones and get your hormones in balance to not only alleviate chronic and persistent pain, but also other chronic diseases. So talk to me about the book. How did it come about?
Dr. Gottfried: Well, the book, the hormone reset diet, my second book came out of publishing my first book and hearing from women that they wanted a more prescriptive plan. They wanted, you know, like, tell me exactly what to do. I’ve got a lot of protocols. So my first book, the hormone cure, but I had a lot of women who wanted to lose weight. That was sort of the main symptom that they had related to their hormones being out of whack. But you know, what I found is that one of the best ways to reset your hormones with your food. And so that’s what this book is about.
Dr. Joe Tatta: Excellent. So it’s a food-forward approach to healing and chronic health healing chronic health.
Dr. Gottfried: Right. And it’s, you know, it’s, it’s not just for people with weight loss. I think there’s, there’s often hormones that are misfiring, especially when you have pain when you have chronic inflammation. So it’s, you know, I want to cast a wider net.
Dr. Joe Tatta: So starting, let’s talk about inflammation for a couple of minutes. So if you had to kind of pinpoint just one hormone, I know it’s difficult to talk about seven, but just one hormone to regulate, what would it be? As far as inflammation is concerned?
Dr. Gottfried: I definitely say cortisol because cortisol is like the, um, the kingpin. I was like, it’s the hormone that controls all the other hormones in the body or at least most of them. And you have the system. I’m going to geek out here for a minute with your jokes. I know you’re good with that. We have a system called the hypothalamic-pituitary, both in the brain, hypothalamic pituitary adrenal, thyroid, good NATL access, and that’s just the control system for your hormones. And when cortisol is out of whack, it tends to disrupt your other hormones as well. And cortisol is crucial to life. It’s really essential, whereas many of the other hormones are not quite as important. And so your body has this priority of focusing on cortisol and if your cortisol is off, you’re more likely to have inflammation. Metabolic syndrome, things like fibromyalgia, pain syndromes, difficulty with wound healing and healing injuries. So that’s the hormone I’d focus on.
Dr. Joe Tatta: So what are people doing wrong in their life that puts them down kind of a negative pathway. Ricardo, Saul starts to become dysfunctional.
Dr. Gottfried: Well, you know, I, I often go to my own case here because I was a poster child for dysregulated cortisol in my thirties I struggled after the birth of my children. I’ve got two kids and I was working, it was a full time working mom and I still remember, you know, seeing patients all day long, working in the Orr, you know, like bent over the pelvis trying to operate, seeing patients in the office and then coming home and then working my second shift with my kids. And it, it just was a time of tremendous stress. And the point here is that I was thinking my way into a total mess with cortisol. And I think that’s probably the most common situation that people find themselves in. You know, they, they come up against stress. The most common time for stress is basically in your mid-thirties up until about age 50 and they don’t have the tools to really be able to cope with it, you know, in, in more of a Ninja way. So when I was struggling, I had a lot of problems. I had some low back pain, I had PMs, I had, you know, no libido and I had this extra weight that I couldn’t get rid of. I had a lot of belly fat. And so that’s what got me started on this path of how to fix your hormones naturally starting with cortisol.
Dr. Joe Tatta: Hmm. It’s interesting because a couple of weeks ago I was reading an article in the journal of physical therapy and they talked about how thoughts alone can change the cortisol pathway. So when patients are coming to us, you know they must go skeletal pain, they have all sorts of pain, you know there’s a, sometimes the biomechanical problem, but other times it’s more of a chemical problem. The thought alone can change that entire pathway. So talk to us a little bit more about how stress influence or you know, mental stress influences some of those hormones.
Dr. Gottfried: Well you’ll have to send me that article cause I’m always, I always love to like gather the data so that I can convince all my colleagues in conventional medicine that this is a real thing.
Dr. Joe Tatta: It’s a really good one. Let me tell you, I’ll send it, I’ll definitely send it to you.
Dr. Gottfried: Please do. Because, uh, I think many of your clients also come up against this, which is you hear about things like adrenal fatigue or you know, trouble with cortisol signaling in the body, high cortisol, low cortisol or even a combination of the two within the same day. And a lot of conventional doctors will just be like, I don’t know what you’re talking about. You know, that’s some alternative mumbo jumbo. I don’t believe it. And yet there are thousands of studies that document this problem and I see it in, Oh, about 95% of the patients that I work with. So what happens, you know, I’m glad you kind of raised this point about biochemistry versus biomechanics because when we think about pain, I always approach it from a functional medicine standpoint, which is to look at the whole matrix of the body, not with you know, an eye only on the hormones or in your case.
Dr. Gottfried: And I only on the biomechanics, like we want to look at the whole integrated system. That’s such a crucial part of functional medicine. What are these seven different systems that work together? Where are you off, you know, are you having problems with cortisol? Are you too high in the morning? Like I am? Are you someone who’s a breast cancer survivor? And you have the inverted pattern where you’re too low in the morning, too high at night, can’t sleep. So there are many different patterns you can have with cortisol. And I think the key here is just to test yourself and to see where you are, especially if you have some of those symptoms of cortisol being dysregulated.
Dr. Joe Tatta: So I guess the question begs now, why is it that the traditional medical community has been so slow to kind of adopt some of the more functional tests that really could point people down the path of health?
Dr. Gottfried: And I know that’s all I know. It’s a tough, tough question. No, it’s, it’s a great question. And I, I think, um, you know, this is, this is sort of my mission to help convert those that I trained with because I went through conventional training myself and I’m not blaming these guys because I know what it’s like, you know, to sit on your butt in medical school for Oh 18 to 20 hours a day and you know, they just, they learned a particular way of looking at the body and functional medicine is relatively new. It’s something that you know, was developed in the 90s. It’s a more integrative way of looking at the body. You could argue, well people doing been doing functional medicine for thousands of years, look at traditional Chinese medicine, look at aryuveda. But the truth is this more mainstream way of thinking about the body in terms of a system and not just a silo, you know, like go see the gastroenterologist if your gut is in trouble, go see the orthopedic surgeon.
Dr. Gottfried: If your knee is bothering you, like this more integrated way of looking is new. So that’s, that’s one obstacle is that physicians are pretty conservative as a group in terms of adopting new things. And it’s also pricey. So a lot of insurance companies don’t pay for it. You know, some of the testing that you can do. Yes, some of it is paid for by insurance but not all of it. And so that brings it out of the reach of some people who would like to try functional medicine or benefit from it. And then I, I think there’s also a, there’s a bias in conventional medicine and I, you know, I have some of the spices as well, that they only want to do things that are evidence-based. And I feel that way too. Like I feel like we’ve had a long of not using evidence based strategies in medicine. You know, if you look at all of the medications that are prescribed, only about 15% are supported by randomized trials. So there’s this bias against anything that doesn’t have really good support in front of it. And functional medicine is building that evidence. But it’s taken awhile. You know, we’ve got Mark Hyman for instance at the Cleveland clinic who’s leading the charge and collecting that data. But it hasn’t been done in a large systematic way such that it was conventional doctors to our side.
Dr. Joe Tatta: Right. It’s, it’s a similar conversation I have with physical therapist cause I teach them about functional nutrition and they don’t learn that in school. So I’ve been, you know, I’ve been trying to push like this paradigm shifts slowly but surely and they’re starting to pick it up because they’re slowly starting to see that. Okay. Nutrition is kind of the basis of a lot of things. But my question for you would be why should nutrition be the first intervention where people struggling with chronic pain, persistent pain or any kind of chronic disease for that matter?
Dr. Gottfried: Well, you know, I, I really believe in hormonal balance. I think that’s a really important part of this functional medicine approach. It’s not the only thing. It’s only one of seven different systems that we want to pay attention to. But I’m impressed with how much you can change your biology with your nutrition. You know, it makes sense. But I can also tell you, you know, I grew up with a great grandmother who was a bit of a radical, she practiced yoga. She taught me yoga when I was a little kid. She was, um, like a warrior for kale and would show up at her house with suitcases of kale. She was a whole foodist and she really believed that the answer to health is not found in a prescription pill bottle. And so I think the key here is to realize how much power you have over your biology, just with what you’re putting in your mouth.
Dr. Gottfried: You know, are you making nutrient dense choices versus choices that worsen the inflammation that maybe got started with chronic stress. So it’s, you know, the, I kind of think of it as this frat party. You have this frat party that sort of always wants to happen in your body and you can either like get another TEG by eating some pizza or you could choose to eat, you know, some wild caught salmon and some kale and some broccoli and like stop the frat parties, stop that inflammation that’s happening in the body. And the chronic pain signaling.
Dr. Joe Tatta: So with your patients you take a food-forward approach first?
Dr. Gottfried: I do. You know, I also have to tell you, I have a lot of patients who come to see me or work with me online and my detox and they’re like, okay, I’ve got my food pretty dialed in. Like I want you to balance my hormones or you know, give me, give me something that I’ve never heard before. And it’s important to kind of reel that in and say we’ve got to start with the foundation like you, you cannot dramatically change your biology and get out of pain by eating crap and having me tinker with your, I mean, first of all, balancing your hormones is going to be so much harder. And second of all you’re going to have side effects. So I just, I think it’s crucial to dial in the food. So I really agree with you there.
Dr. Joe Tatta: So one of the things I see with patients is a lot of patients are on Synthroid for their thyroid issues. Can you talk to us a little bit about the thyroid hormones and how they relate to obviously inflammation?
Dr. Gottfried: Sure, yeah. You know, I, I’ve worked primarily with women. I, I see guys too. Um, but women are about 20 times more effected by thyroid problems than men. And it’s more common as you get older. So especially after the age of 40 women very commonly have thyroid issues. And what happens in conventional medicine is that if you start to have symptoms, you know, things like fatigue, weight gain, hair loss or hair thinning, your cholesterol starts to climb. Now hopefully you have a doctor who’s going to check your thyroid. I mean, unfortunately a lot of women and men have a doctor who says you’re just getting older, get used to it. But a really crucial step there is to check your thyroid. And if you want to learn more about that, I’ve got a free quiz on my website at Sara Gottfried, md.com and you can see if thyroid is an issue for you.
Dr. Gottfried: So the tricky part is that when you get tested by a conventional doctor, they often use old ranges for what’s considered normal and you want to make sure that you’ve got someone who’s really using the most current optimal ranges for your thyroid testing. Things like TSH, thyroid stimulating hormone, you want that to be between about 0.1 and 1.5 that’s based on the testing where you remove all the people that have a thyroid that’s not working and you’re just looking at people who are euthyroid, who have a normal thyroid. You know about a third of the U S population has hypothyroidism and many of them don’t know it. And so those, you know, those reference ranges that are used on your lab are very old and very outdated. You also want to check your T three and your T four T three is the biologically active form of thyroid hormone.
Dr. Gottfried: And you know, in terms of pain, what I often see with people who’ve got a problem with their thyroid and the most common thing here again is low thyroid function or hypothyroidism, is that their joints ache more, they have more injuries, they’re more puffy. You know, as part of this inflammation story, maybe they have Hashimoto’s where their immune system is overactive maybe from being so stressed or drinking too much alcohol. They’ve got leaky gut and now they have this autoimmune attack where the immune system is attacking the thyroid and that’s led to low thyroid function.
Dr. Joe Tatta: So you mentioned T3 and T for there for a minute. Um, I know that T4 can be bound at times. You need to kind of free that to get the levels higher. How do you go about doing that naturally?
Dr. Gottfried: Yeah, this is a great point. And of all paths lead back to cortisol. So what happens with T four and T three T four is bound as you just described. And it’s a storage hormone. It’s kind of like the, you know, keep it in the cupboard for a rainy day in case you need it. T3 is the biologically active thyroid hormone free T three and so what you want to do is you want to convert T four to T three so that you have sufficient free T three. Now a lot of women may have a normal TSH but low T3 and part of the problem there is that they’re not converting their T four to T three properly. That’s called a conversion problem. They’re not converting T four to T three. There’s a lot of different reasons for that. You can again look at the food first.
Dr. Gottfried: Um, if you’re low in copper, zinc, selenium, vitamin D, all of those things can lead to poor conversion. If you are a stress case like I used to be, and your cortisol is either too high or too low or kind of a combination of the two each day, that can lead to problems with conversion. Iodine is another problem. If you’re not getting enough iodine from food sources so you can test those things. I tested myself about 10 years ago when my thyroid was slow and I was low in copper. I’m genetically programmed to be relatively low in copper. So I need to take a multivitamin or a mineral supplement every day so that I get sufficient copper. But like with hormones and micronutrients, you can get too much and you can get too little. You have to figure out what’s that Goldilocks position for you.
Dr. Joe Tatta: Excellent. So some great take-homes. As far as thyroid, we’re talking to you, dr. salary Godfried, the bestselling author of the hormone cure and the hormone reset diet. So we’d gone through two hormones. Tell us about the other five that are in your book.
Dr. Gottfried: Oh yeah. So these are the seven hormones that I found to be the most important for having a metabolism that really rocks. It doesn’t just, you know, sputter as you get older, you want to have a metabolism that’s really forgiving and that relies on hormones that are firing properly. So the seven hormones are estrogen, insulin, leptin, which controlled society, your appetite, cortisol, thyroid growth hormone, and testosterone. Now there’s a few other hormones like Raelin, um, and some others, but those are the seven that I found to be the most important.
Dr. Joe Tatta: And why? Why do you start with estrogen first?
Dr. Gottfried: Well, it started with estrogen first in the hormone reset diet because so many women have a problem with their estrogen levels. Guys do too. You know the, the issue here is that you want in a woman, you want the right ratio between progesterone and estrogen. You want like this really nice tango between the two and for guys, you want the right between testosterone and estrogen because as you get older, testosterone declines, estrogen climbs, you’re at greater risk of heart disease, prostate cancer and other problems. So I start with estrogen because I think it’s the one that’s the easiest to fix. You know, one of the keys here is we all get exposed to estrogen pollution. Most of us have a little estrogen dominance, or even if your estrogen is low, you may be making too many of the bad estrogens and not enough of the protective safe estrogens.
Dr. Gottfried: And so what I suggest is getting off of red meat from the keto facilities, the concentrated animal feeding operations that are, that have just a ton of estrogen in them and also giving up alcohol forever. But it’s a big one. But, Oh my gosh, it makes such difference. If you’re someone who’s struggling with pain or struggling with your, your body, you know, one of the things that alcohol does besides raise your estrogen, raise your cortisol, it pokes holes in your gut and it’s gonna make, you know, if you have some pain, it’s going to accentuate the pain. It’s gonna cause more inflammation in your body. And what we want to do is we want to put out those fires. And a key way to do that is to get off of alcohol. Not forever, but do it for three weeks.
Dr. Joe Tatta: No, it’s a great point. And a lot of people turn to alcohol for relaxation, stress relief, even pain relief. And a lot of times, you know, it’s leading you toward intestinal permeability and leaky gut. And it’s not what you want when you’re trying to get on the path toward health. In your book, you talk about the strobe alone. So I know you can be a little scientific with us. So kind of go, go there with us.
Dr. Gottfried: Yeah. Well, I think this is an interesting area when you’re thinking about pain, you know, I really believe the next 10 to 20 years of medicine is going to be all about the microbiota. You know, the set of of bacteria and other microbes you have in your gut, starting with your mouth all the way to your anus and how they’re impacting your body. You know, I just, I heard someone talk about this in an interesting way. He was talking about how the microbes in your body outnumber your human cells tend to one. And so you should think about them as being like these independent contractors that are doing all this work in your body. They’re affecting your pain pathways, they’re controlling your metabolism. They’re determining how much energy to pull out of the food that you’re eating and whether to store that as fat or to actually use it as fuel.
Dr. Gottfried: And so when you think about the DNA of all of those microbiota, your gut flora, that’s called the microbiome, there’s a subset of the microbiome called the struggle ohm that control your estrogen levels. There’s also a subset that controls your testosterone levels. And this is a really interesting new area because we know for some people, you know, women for instance, who have an a struggle, ohm that’s, you know, not quite happy as it could be, have a greater risk of breast cancer and a mutual cancer and ovarian cancer. Men who have a problem with a struggle and we have a greater risk of prostate cancer. So this is something we want to think about. You know, what are you feeding with your food today? What are you, how’s your estrobalome responding to the food that you eat? And then going back to chapter three of my book though, hormone reset diet, we know that red meat tends to raise your estrogen levels. It tends to affect the estrobolome in ways that are not necessarily good. We know that I’m getting off of alcohol can really make a big difference. And so we want to be making those small decisions every day that really support the estrobalome, the microbiome and kind of gets you back on that healing path.
Dr. Joe Tatta: So what you’re telling us is that as an individual, you have control over the health of your gut. Just by the food you’re eating. So my question would be for the, for the people listening, how fast can you expect the change to happen once you change your diet?
Dr. Gottfried: Well, this is the cool part. You know, when I first started fixing my own biology back in my thirties and I was dealing with the, you know, the crazy cortisol and the low thyroid, I was amazed because it didn’t take me very long to fix it once I figured out the root cause, when you look at the data on hormones and the relationship between a hormone in a receptor, which is kind of like a locking key relationship, you can turn around that relationship in 72 hours. So I think that is like amazing because I can do almost anything for 72 hours. So I started looking at this first with insulin. You know, if you think about insulin resistance and the inflammation that comes with that, the increased risk of metabolic syndrome, diabetes, pre-diabetes, which is a lot more common than most people realize. You can fix insulin resistance with your fork in 72 hours and you can turn off that inflammation, you can cool those fires. So the same thing is true with other hormones. There’s some that take a little bit longer to reset. You know, thyroid takes more four to six weeks. But in terms of kind of changing the environment of your body, the matrix of your body, you can do that in 72 hours.
Dr. Joe Tatta: Amazing. So fast without medication.
Dr. Gottfried: Yeah. Yeah. Stay away from the medication. I mean there’s a time and a place for it, but I think a lot of people are taking medications that are maybe not necessary. And their problem is actually hormonal if you look at the root cause. And that’s where I feel like we’ve got a great opportunity.
Dr. Joe Tatta: So my question for you is what is so unique about the hormone reset diet and why would this be the one diet that a woman should choose this year to turn their health around?
Dr. Gottfried: Well, the diet is really designed to reset your gut along with resetting these seven hormones and metabolism. I don’t just think this is a good idea. This is something that I’ve been in my practice for the past 10 years. We’ve had now about 10,000 people go through this program. We find that they lose up to 15 pounds if weight loss is not your goal, the goal could be detoxification, which also helps you with pain and healing from pain. And you know, what I get excited about is some of the markers of inflammation that this particular 21 day diet addresses, we found that it for people who test their blood sugar through the program, they drop their blood sugar on average about 21 points. They lose about four inches off their waist. So I’m not saying it’s a miracle diet, it doesn’t work for absolutely everyone. But if you have your hormones out of whack and misfiring as part of your pain story or just you know, weight gain, it can really make a difference.
Dr. Joe Tatta: And you mentioned prediabetes or diabetes before. Have you seen people’s A1C changed with the diet?
Dr. Gottfried: You know, we haven’t tested A1C because it’s a 21 day program and A1C measures over three months. But I would love to look at that in the future. You know, we’ve got a lot of people who go through this program online with me cause we offer it online a couple times a year and we are now having the majority of the people being ones that are repeating it over and over again. So now I feel like I have the chance to do hemoglobin A1C. So I’m going to add that on next time.
Dr. Joe Tatta: Excellent. And share the results with us please. That’ll be great to hear about it. So I know you’d like to move you like to exercise. Tell us about your weekly exercise routine cause movement is such an important part of be healthy, overcoming pain. What are you currently doing? I know your routine has changed over the years.
Dr. Gottfried: It’s definitely changed. You know, it’s uh, I feel like women have these really delineated life cycle changes that happen and and often your fitness sort of adjusts based on that. And I’m at the stage right now where my kids are a little bit older. I’ve got a 10 year old and a 15 year old daughter. And what works really well for me is to take them to school about 8:00 AM or camp in the summer and then go to bar class. Now I’m a yoga teacher. I’ve been practicing yoga for a really long time and I, I just really love, um, bar fitness. It’s just a way of attending to the core is kind of a combination of pilates and yoga and, um, and bar work and it’s just informed me about my body and gotten me embodied in a way that I really enjoy. And I like group classes.
Dr. Gottfried: I like the accountability. So I do bar class about five days a week and I also do a lot of walking and hiking and sometimes I’ll sprint, you know, I’ll run as part of that hiking or walking, especially if I’m with my husband because as you know, Joe, he’s very competitive. Just a little, I probably do that, you know, like seven to 10 hours a week. So that’s, that’s what I do right now. It’s what works really well for me. It’s interesting because I’m working on my next book and it’s about longevity. I used to be a runner who would log a lot of miles every week and this was in my thirties when I also had a hard time losing my baby weight and I just found that running was making me more inflamed. And you know more about this than I do, you know how hard it is to get the form of running nailed so that you’re not injuring yourself causing problems with your knees or your hips or you know, some kind of misalignment. I’m a heel striker and so I have to really work on that. And it was raising my cortisol… and it was that adjustment. It got me, you know, as I started to look at how that was aging me in an accelerated way, got me to back off and to become a yoga teacher. But then I sort of approached yoga, kind of like the way I approach running and I was doing, you know, Ashtanga, every day had to be 90 minutes or it wasn’t worth it five days, a week and primary series. And
Dr. Gottfried: that doesn’t work well for me. So now it’s, it’s a little bit more of a conversation with my body
Dr. Joe Tatta: and I know to help get people moving more. You started a, it was called just one pose. Is that what’s on your YouTube channel?
Dr. Gottfried: Yes. So you know, when I get up in the morning, I have a morning ritual where I get up and make some green tea and I, I’ll do one yoga pose and a meditation. And so I decided, a lot of people asked me to kind of share what it is I do and the posts that I do each day kind of changes depending on what my body is feeling like. And I, I recorded a bunch of videos and they’re free on YouTube, so it’s called just one pose and it shows you a yin yoga pose that I typically hold for three to five minutes. And that’s a great way to kind of set and seal your intention for the day.
Dr. Joe Tatta: Excellent. So in addition to your YouTube channel, can you tell everyone on the healing pain summit how they can find out more about Dr Sara Gottfried and the hormone reset diet?
Dr. Gottfried: Well, the best place to go is kind of the mother ship. Sara Gottfried, md.com T. O, T, T, F, R. I. E. D. Sara, no H. and, uh, if you want to learn more about the hormone reset diet, my latest book, you can go to hormone reset.com.
Dr. Joe Tatta: Excellent. So please check out the hormone reset diet. Follow Dr. Sara Gottfried’s work. She’s brilliant, and she would get you through the chronic phase of pain and take you on the road to recovery. Thank you for joining us and we’ll see you in the next interview on the Healing Pain Summit.
