Hormone Mastery: Navigating Perimenopause, Cortisol, and Weight

# Menopause Expert: Belly Fat Grows During Menopause! Your Estrogen Levels Are Controlling You!
# https://www.youtube.com/watch/0GQozcTPyO0

00:00:00.560 3 to 75% of women do not get the
00:00:03.360 treatment for pmenopause and menopause
00:00:05.359 that they deserve And women are asking
00:00:07.279 why is it that I can’t manage stress the
00:00:09.120 way I once did why do I have this belly
00:00:10.960 fat that appeared out of nowhere and my
00:00:12.880 usual techniques for how to deal with
00:00:14.240 that aren’t working why would I rather
00:00:16.079 mop the floor than have sex with my
00:00:17.840 husband but there’s more than 100 plus
00:00:19.840 symptoms that women aren’t aware of But
00:00:21.840 you believe many of the symptoms of
00:00:23.439 menopause are avoidable Yes And let’s
00:00:26.560 get into that Dr Sarasal is the Harvard
00:00:28.960 trained physician and hormone expert
00:00:30.880 who’s unlocking the science and simple
00:00:32.880 tricks behind feeling your best no
00:00:34.800 matter your age Most people have
00:00:37.440 imbalanced hormones Think of them as
00:00:39.600 text messages that your body sends to
00:00:41.600 keep everything functioning optimally
00:00:42.879 But for example out of the 40,000 people
00:00:44.719 I’ve tested and treated around 90% of
00:00:46.960 them have a problem with their cortisol
00:00:48.559 hormones And if my body’s making too
00:00:50.079 much cortisol what is the harm it’s
00:00:51.680 associated with more belly fat We know
00:00:53.600 that it shrinks the brain in women but
00:00:55.840 not men It’s associated with depression
00:00:57.840 but also if you’re someone who’s making
00:00:59.760 a lot of cortisol you’re going to make
00:01:01.680 less testosterone and that leads to a
00:01:04.000 whole host of serious problems And what
00:01:05.840 about trauma does that impact your
00:01:07.280 hormones oh yes And one of the ways to
00:01:09.520 measure trauma is the ACE test It’s a
00:01:12.159 validated questionnaire and they found
00:01:14.000 that people who had one or higher ACE
00:01:16.080 scores had a greater risk of 45
00:01:18.240 different chronic diseases And my score
00:01:20.560 is 6 out of 10 But those ACEs are living
00:01:23.520 on in your body And you went on a
00:01:25.360 journey to heal yourself Yes With
00:01:27.280 lifestyle medicine not a pharmaceutical
00:01:30.080 Tell me about that journey
00:01:33.200 This has always blown my mind a little
00:01:34.799 bit 53% of you that listen to this show
00:01:37.439 regularly haven’t yet subscribed to the
00:01:39.600 show So could I ask you for a favor
00:01:41.439 before we start if you like the show and
00:01:42.880 you like what we do here and you want to
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00:01:45.920 can do just that is by hitting the
00:01:47.280 subscribe button And my commitment to
00:01:49.119 you is if you do that then I’ll do
00:01:50.799 everything in my power me and my team to
00:01:52.640 make sure that this show is better for
00:01:54.000 you every single week We’ll listen to
00:01:55.920 your feedback We’ll find the guests that
00:01:57.680 you want me to speak to and we’ll
00:01:59.360 continue to do what we do Thank you so
00:02:04.040 much Dr Sarah Zal what is it that you do
00:02:08.560 for people i’m a
00:02:11.000 physician so I work in academic medicine
00:02:14.560 I do research for people I teach and I
00:02:18.000 take care of patients So that’s the
00:02:20.560 official BBC answer And the unofficial
00:02:24.080 answer is I’m a healer And what does
00:02:27.280 that mean a healer because that’s a
00:02:29.200 broad term So that could mean many
00:02:30.480 things
00:02:32.160 It means that my
00:02:35.000 task is to connect to your innate
00:02:38.480 healing
00:02:39.560 capacity and to work with you to
00:02:42.080 activate it And who do you do that for
00:02:44.800 so I do it for professional athletes
00:02:48.599 executives
00:02:50.519 and everyday people And when you say
00:02:54.920 healing if someone came to you and they
00:02:56.959 said “How do you heal people?” What
00:02:59.840 would your answer be my answer is I
00:03:02.560 don’t heal people That’s
00:03:06.200 uh to me that’s a patriarchal way of
00:03:09.120 thinking about it
00:03:10.879 What I do is I work with someone who’s
00:03:14.400 got the capacity to heal and we work to
00:03:17.440 be in the service of that So it’s not me
00:03:22.000 providing something that they don’t have
00:03:24.200 already It’s more understanding what
00:03:26.959 some of the obstacles might be to their
00:03:28.720 own healing Understanding what would
00:03:32.000 allow them to be the best version of
00:03:34.879 themselves to feel fully alive And what
00:03:37.920 was your training so can you talk me
00:03:40.480 through your sort of academic journey
00:03:43.280 sure So my training is as a
00:03:46.280 bioengineer I did the Harvard MIT
00:03:49.360 program which is designed to train
00:03:52.560 physician scientists
00:03:54.920 So the um ethos of this particular
00:03:59.200 program was to train the future
00:04:03.159 researchers and um academic
00:04:06.920 physicians so that we could move the
00:04:09.599 field forward And all along I was really
00:04:14.000 interested in how do you bring the best
00:04:16.959 of conventional medicine together with
00:04:19.560 more ancient ways of thinking about the
00:04:22.400 body things like aya from India or uh
00:04:27.440 traditional Chinese medicine How do we
00:04:29.600 take these wisdom traditions and use
00:04:31.759 that to inform mainstream medicine so
00:04:35.120 that’s the type of care that I learned
00:04:37.280 how to do I became a
00:04:39.639 surgeon I did primary care after I
00:04:42.880 finished a residency in obstetrics and
00:04:45.400 gynecology But I also realized pretty
00:04:47.680 early on that I wanted to take care of
00:04:49.120 men too So I’ve done that for about the
00:04:52.960 past 15 years and I would say that that
00:04:57.840 training in bioengineering and a comfort
00:05:00.720 with big data and with um optimizing
00:05:05.520 data sets to improve whatever the goal
00:05:07.840 is like performance or having the most
00:05:11.120 the best conversations you can have on a
00:05:14.440 podcast That’s what gets me excited
00:05:18.080 How many people do you think you’ve
00:05:19.280 treated or seen or worked with directly
00:05:21.520 in your career probably about 40,000
00:05:28.160 And and if you had to try and summarize
00:05:30.320 maybe the top three or five things that
00:05:32.080 you’re doing for
00:05:33.639 them what would you say well number one
00:05:36.800 would be
00:05:38.039 hormones Hormones are the portal that
00:05:40.400 most people start with me Um it’s a way
00:05:44.160 of thinking
00:05:45.400 about what drives what you’re interested
00:05:49.080 in Most people have imbalanced hormones
00:05:52.880 I haven’t detected that you do yet but
00:05:55.759 most people have an issue say with
00:05:58.560 cortisol either making too much of it or
00:06:00.800 too little or even both within the same
00:06:02.800 day And it affects energy It affects
00:06:06.400 mitochondria
00:06:09.759 So I would say the number one thing I
00:06:12.080 help people with is their hormones
00:06:13.840 Getting their hormones back into balance
00:06:15.840 Starting first with lifestyle medicine
00:06:18.319 not a pharmaceutical So that includes
00:06:21.199 breath work which I think is one of the
00:06:23.039 most
00:06:23.720 underutilized tools that we have in
00:06:27.400 health Number two would
00:06:30.600 be nutrition but taken to the next level
00:06:34.479 not what you might think of that a
00:06:36.720 nutritionist would advise you but what
00:06:40.280 specifically is the ideal food plan for
00:06:43.039 you for your goals So whether you’re a
00:06:46.800 entrepreneur and podcaster an investor
00:06:50.319 or you’re a professional basketball
00:06:52.800 player or you’re a woman in pmenopause
00:06:56.000 at age 42 what’s the optimal nutrition
00:06:59.120 for you and we can measure that and we
00:07:02.080 can look at the interaction of your
00:07:04.759 genetics together with what you’re
00:07:07.520 eating to see how we could personalize
00:07:12.360 that Number three I would say
00:07:18.039 is
00:07:20.919 prevention And prevention has been a
00:07:23.840 hard thing to sell It’s um you know a
00:07:27.280 lot of people just don’t want to invest
00:07:30.560 in prevention and yet I take care of
00:07:34.240 people who are in this continuum from a
00:07:38.160 state of health often to a state of pre-
00:07:40.720 disease like pre-diabetes as an example
00:07:44.000 and if they don’t do something about it
00:07:45.840 they then move on to diabetes So I like
00:07:49.039 to intervene there as early as possible
00:07:51.840 to reverse
00:07:53.240 disease and most of that is
00:07:56.520 lifestyle So those are the things that I
00:07:58.800 tend to work with I do a lot of
00:08:00.160 metabolic health because it’s so
00:08:03.199 critical for the energy that you feel
00:08:05.199 each day You have a very diverse
00:08:08.280 experience as a doctor/healer
00:08:13.680 feels like you’ve really had a lot of
00:08:16.000 sort of reference points in your career
00:08:17.599 that you’ve drawn upon and ultimately
00:08:19.599 you became the director of precision
00:08:22.720 medicine at the Marcus Institute in
00:08:24.720 Philadelphia That’s correct Precision
00:08:27.479 medicine that term How does that differ
00:08:31.199 from conventional medicine
00:08:34.640 it’s quite different So conventional
00:08:37.679 mainstream modern
00:08:39.799 medicine I believe is broken I feel like
00:08:43.279 there are so many people who are failed
00:08:44.959 by our current medical system especially
00:08:47.680 people with chronic disease things like
00:08:50.000 diabetes autoimmune
00:08:51.959 disease So
00:08:54.600 with mainstream medicine generally what
00:08:58.320 happens is that you develop a condition
00:09:01.279 say a high cholesterol and you get
00:09:03.760 treated with a pharmaceutical say a
00:09:05.839 statin And what we know is that we have
00:09:09.680 to treat about 100 to 200 people for one
00:09:13.040 person to benefit So that I would define
00:09:16.399 as imprecision medicine Whereas
00:09:19.519 precision medicine is where we
00:09:21.920 understand you as an individual We look
00:09:24.560 at your genomic blueprint We look at
00:09:26.800 your biomarkers We look at your
00:09:28.800 wearables data to
00:09:31.000 determine NF1 experiments where you
00:09:33.680 serve as your own control and figure out
00:09:36.000 what’s going to be the most effective
00:09:37.440 for you depending on what your goals are
00:09:40.080 NF1 you mean where that individual is
00:09:42.240 the study they are the experiment That’s
00:09:44.240 correct You’re not looking at broad
00:09:45.440 sample sizes What is wrong with
00:09:47.279 conventional medicine you use the term
00:09:49.279 that it’s broken What is wrong about
00:09:51.760 that approach
00:09:53.519 there’s a few things that are wrong One
00:09:56.080 is
00:09:57.959 that it has become medicine for the
00:10:02.440 average And when you look at scientific
00:10:05.320 evidence and you rank order it what’s
00:10:09.200 considered the highest form of evidence
00:10:11.279 is the randomized trial But the
00:10:13.440 randomized trial is mostly around using
00:10:16.560 a pharmaceutical So in the example I
00:10:19.680 just gave using a statin to help someone
00:10:22.880 with their cholesterol maybe help
00:10:24.560 prevent a heart attack the number one
00:10:28.040 killer The problem is we then based on
00:10:32.720 randomized trials come up with medicine
00:10:35.440 for the
00:10:36.279 average And it’s not
00:10:39.640 about optimal health It’s not even
00:10:42.720 centered around health It’s centered
00:10:45.320 around okay heart disease number one
00:10:47.760 killer How do we help people prevent it
00:10:50.320 oh lifestyle medicine prevents 70% of it
00:10:53.279 Well we’re not going to do that because
00:10:54.480 we can’t make money off of it There’s no
00:10:56.880 profit motive So we’re going to focus
00:10:58.800 instead on these pharmaceuticals Oh
00:11:01.000 GLP1s That sounds like a good idea Let’s
00:11:04.000 try that and solve problems with GLP1s
00:11:07.600 So to me there’s many layers to why the
00:11:10.880 health care system is broken but one key
00:11:14.079 area is that 70% of the diseases we’re
00:11:17.360 facing right now are utterly preventable
00:11:20.240 with lifestyle medicine 70%
00:11:23.600 You used the word hormone balance
00:11:25.440 earlier on Um and you said that that’s
00:11:26.800 the portal in which people often find
00:11:28.880 you I really don’t know much about
00:11:30.720 hormones and it’s not necessarily
00:11:32.880 something that the average person thinks
00:11:35.040 that they can do much about I think
00:11:36.959 because it’s not easy to measure our
00:11:38.240 hormones is it well you can measure it
00:11:40.399 in the blood So it’s it’s not that hard
00:11:43.279 to measure hormones but I think there’s
00:11:45.839 there’s a way that in mainstream
00:11:48.720 medicine we’re taught to tell people
00:11:51.360 that their hormones vary too much and so
00:11:53.760 it’s not worth measuring Yeah that’s
00:11:56.399 what I’ve heard before It’s what you’ve
00:11:58.240 heard But then if you’re a woman who’s
00:12:01.120 34 and you’re trying to get pregnant and
00:12:04.399 you’re having trouble in that situation
00:12:07.120 we’ll measure every single hormone We’ll
00:12:09.200 look at thyroid cortisol testosterone
00:12:11.279 estrogen progesterone the control
00:12:13.680 hormones like follical stimulating
00:12:15.480 hormone And
00:12:17.320 yet somehow in that situation testing is
00:12:20.639 more reliable but it’s not in this other
00:12:23.079 situation That doesn’t make sense That’s
00:12:25.200 double standard Why did you choose this
00:12:27.480 career what What is it about you your
00:12:30.639 childhood your life that sent you down
00:12:32.320 this road i would say it was growing up
00:12:36.079 with a fair amount of trauma
00:12:39.639 And you know the what I’ve learned about
00:12:42.639 trauma is it’s less about what actually
00:12:44.560 happened to you It’s the way that it
00:12:46.000 became embedded in the system of your
00:12:48.560 body So for me my parents got divorced
00:12:51.440 when I was really young I grew up in a
00:12:53.440 way that I became a helper And I
00:12:55.839 realized that by being
00:12:58.920 um someone who was really looking out
00:13:01.360 for others and tuning into their energy
00:13:05.680 and helping them achieve their goals
00:13:08.880 that kept me really safe And so there’s
00:13:11.600 a way that
00:13:12.680 that it was very resonant for me to
00:13:15.680 discover medicine
00:13:19.040 And one of the things we know about
00:13:20.639 people who go into medicine is
00:13:22.680 that people tend to have a fair amount
00:13:25.360 of trauma that leads to becoming a
00:13:29.839 helper in this way What was that trauma
00:13:34.480 so there’s a lot of different ways to
00:13:36.000 measure trauma One of the ways that I
00:13:38.240 find helpful is something called the
00:13:39.839 adverse childhood
00:13:41.560 experiences So ACE for short I think
00:13:45.040 I’ve got it here Oh do you it’s a
00:13:47.440 questionnaire So my score is six out of
00:13:49.720 10 So childhood divorce my parents got
00:13:53.040 divorced when I was about a year old
00:13:54.880 That’s one out of the six Other things
00:13:57.920 are abuse neglect
00:14:00.959 um emotional abuse physical abuse having
00:14:03.600 a parent with a substance use disorder
00:14:06.560 So things that you know it’s not a
00:14:08.639 complete list but it’s a validated
00:14:11.040 questionnaire that was used in the
00:14:14.199 1990s and found among people who are
00:14:16.880 middle-aged you’re not quite yet
00:14:18.560 middle-aged but for people who are
00:14:20.399 middle-aged 40 to 65 they found that
00:14:23.600 people who had higher A scores one or
00:14:26.240 higher they then had a greater risk of
00:14:28.480 45 different chronic diseases
00:14:32.480 How important is it for us to understand
00:14:34.560 our early upbringing and our trauma if
00:14:36.800 we are to heal as adults because you
00:14:38.480 said there that if you score high on
00:14:40.399 this ACE score this trauma score this
00:14:43.680 childhood trauma system sort of
00:14:45.360 questionnaire then as an adult you’re
00:14:47.279 more likely to get a variety of
00:14:48.639 different diseases So do we need to heal
00:14:52.000 our bodies in some way to avoid getting
00:14:55.120 some of those diseases yes And that’s
00:14:57.680 the critical question
00:15:00.079 So if you know that you have an elevated
00:15:02.880 A score and there’s a lot of people who
00:15:04.560 have a score of zero about 40% of men
00:15:08.160 about 30% of
00:15:09.639 women and what we know is that if you’ve
00:15:12.959 got this greater risk for 45 different
00:15:15.600 chronic conditions there’s a way that
00:15:18.079 those ACEs are living on in your
00:15:21.720 body unless you’re addressing them And
00:15:25.279 it’s the living on in your body that we
00:15:27.839 want to pay attention to So for some
00:15:29.920 people it’s their immune system and it
00:15:32.959 leads to more allergies more histamine
00:15:37.519 overload more um food intolerances maybe
00:15:42.839 autoimmunity where their immune system
00:15:45.199 is attacking their own tissues maybe
00:15:47.360 autoimmune disease There are other
00:15:49.360 people who have more nervous system
00:15:52.120 dysregulation Maybe they’ve got anxiety
00:15:55.600 or depression or post-traumatic stress
00:15:58.560 disorder mental health issues And for
00:16:01.440 other people it could be more endocrine
00:16:04.240 They’ve got chronic cortisol problems
00:16:06.320 which is hormones Yes
00:16:09.440 How did that manifest in your physical
00:16:11.360 health so I didn’t start to detect this
00:16:14.720 until my 30s But what I found was
00:16:20.600 that I
00:16:22.440 had
00:16:24.360 depression I had premenstrual
00:16:28.199 syndrome I had my first baby when I was
00:16:31.040 32 and I couldn’t lose the baby weight
00:16:34.720 And as all of this was happening and I’m
00:16:37.120 a physician I went to my doctor for help
00:16:40.959 And he suggested that I go on Prozac for
00:16:45.199 the depression and the mood issues which
00:16:46.959 is an anti-depressant pill a selective
00:16:48.800 serotonin reuptake inhibitor that I go
00:16:51.360 on the birth control pill because I
00:16:53.199 sounded hormonal and that I start
00:16:55.600 exercising more and eating less So that
00:16:58.720 was his treatment and that’s typical
00:17:00.560 mainstream medicine treatment But I
00:17:03.360 wasn’t satisfied with that I felt like
00:17:05.919 that doesn’t seem right And I left his
00:17:08.799 office and went to the lab ordered my
00:17:11.280 own hormone panel and found that my
00:17:13.839 cortisol was three times what it should
00:17:15.679 have been So there’s the optimal range
00:17:18.480 for cortisol in the blood It’s about 10
00:17:21.520 to 15 in the morning 6:00 to 10 in the
00:17:23.439 afternoon And mine was 30
00:17:28.960 I also looked at my fasting glucose and
00:17:31.919 insulin and I had pre-diabetes in my 30s
00:17:35.679 I had no idea No one was checking for
00:17:37.760 this So I’m answering your question
00:17:40.080 about how these ACEs showed up in my
00:17:43.000 body We know that adverse childhood
00:17:45.840 experiences linked to blood sugar
00:17:48.000 problems and a greater risk of
00:17:49.679 pre-diabetes and diabetes which I had We
00:17:52.720 know that they linked to chronic stress
00:17:56.320 and cortisol problems high perceived
00:17:58.720 stress whether the stress is there or
00:18:01.559 not It also led to as I started using
00:18:06.679 wearables low heart rate variability the
00:18:09.760 time between each of my heartbeats And
00:18:12.480 that’s a measure of the sympathetic
00:18:14.000 nervous system fight flight freeze fawn
00:18:16.799 versus the parasympathetic nervous
00:18:18.400 system which is where healing occurs And
00:18:21.760 you went on a journey to heal yourself
00:18:23.760 Yes Tell me about that journey
00:18:29.039 So in my
00:18:31.880 30s this is a huge epiphany for me
00:18:34.720 because I realized that I wasn’t trained
00:18:37.120 I wasn’t
00:18:38.440 educated even though I had an
00:18:40.720 outstanding education I wasn’t trained
00:18:43.520 to help with
00:18:45.000 this No one taught me about cortisol
00:18:48.720 problems and how to manage that I mean I
00:18:50.880 was taught about the extremes of Cushing
00:18:53.919 disease- which is really high cortisol
00:18:56.160 levels and Addison’s disease which JFK
00:18:59.520 had and it’s when your adrenals in your
00:19:02.880 back above your kidneys don’t make
00:19:04.520 cortisol So I was taught about the
00:19:06.400 extremes but I wasn’t taught about all
00:19:08.640 the people who kind of live in the
00:19:10.160 middle with problems with their cortisol
00:19:13.440 So this is when I started to take the
00:19:16.640 scientific literature and apply it to my
00:19:21.240 situation because I wanted to feel
00:19:23.360 better I felt old before my time and I
00:19:27.679 had a lot of belly fat and I was on this
00:19:30.000 path of aging at an accelerated clip So
00:19:33.440 I did it to help myself but then I also
00:19:36.080 wanted to help my patients and it felt
00:19:38.160 like I needed to go deeper and
00:19:39.960 understand what can we do to treat the
00:19:43.600 trauma and also to treat the more uh
00:19:47.640 proximal measurements that we’re making
00:19:49.919 like with cortisol with heart rate
00:19:51.600 variability with blood sugar
00:19:55.200 So what was step one for you
00:19:58.720 step one was awareness Okay And I had no
00:20:01.679 idea These are not things that most
00:20:03.600 doctors are checking for It’s pretty
00:20:05.760 crazy that you’re a doctor but you don’t
00:20:09.160 know this part of
00:20:11.799 health I mean how are you going to help
00:20:13.760 anybody if you don’t fully understand
00:20:16.640 health from a more sort of holistic
00:20:18.160 perspective that’s a critical point So I
00:20:21.440 was taught at Harvard that if you have
00:20:24.880 blood sugar problems if you’ve got
00:20:26.320 pre-diabetes and
00:20:27.720 diabetes the treatment is lifestyle It’s
00:20:31.440 the most effective to change the food
00:20:33.840 that you’re eating to increase your
00:20:36.200 exercise to um manage your stress in a
00:20:40.559 different way And yet I wasn’t taught
00:20:42.960 how to help my patients do any of those
00:20:44.880 things I was taught how to prescribe a
00:20:47.120 medication for it like metformin or some
00:20:50.559 other treatment but I wasn’t taught how
00:20:52.720 to do lifestyle medicine I had 30
00:20:54.320 minutes on
00:20:55.559 nutrition So yes it is pretty crazy They
00:20:59.120 gave you 30 minutes on nutrition Yes
00:21:02.080 During which training this is medical
00:21:05.000 school and I got about the same amount
00:21:07.600 on pmenopause and menopause
00:21:10.919 Really i mean that explains a lot Yes it
00:21:13.600 does about the medical system So step
00:21:15.360 one was awareness What was step two step
00:21:18.720 two
00:21:19.799 was what does the science tell
00:21:22.679 us and if we take what the science tells
00:21:25.679 us usually applied to a population that
00:21:28.640 then sets us up for step three which is
00:21:32.480 end of one experiments trying things on
00:21:35.320 yourself and then measuring That’s right
00:21:38.640 When we think of cortisol which was the
00:21:41.120 first sort of marker that you saw was
00:21:44.039 elevated we think of stress So we think
00:21:47.200 we get cortisol if we’re stressed So my
00:21:49.120 brain my my very naive brain said “Well
00:21:51.280 you just need to be less stressed
00:21:54.039 Sarah So you should just go on holiday
00:21:56.640 and then your cortisol will come down.”
00:21:59.360 I used to think that too And then I
00:22:00.960 would come back from the holiday and I
00:22:02.799 would still have cortisol problems
00:22:07.320 So stress is part of it but cortisol is
00:22:10.480 really interesting These hormones that
00:22:12.960 we’re talking about estrogen
00:22:14.240 progesterone
00:22:15.559 testosterone cortisol insulin it’s not a
00:22:19.480 democracy Like they don’t have equal
00:22:21.919 footing Cortisol is more like a dictator
00:22:25.360 especially if it’s out of whack So you
00:22:27.600 need cortisol to live Whereas you could
00:22:30.000 live without testosterone estrogen
00:22:32.159 progesterone
00:22:33.760 can’t live without insulin But cortisol
00:22:36.080 is critical in terms of helping you with
00:22:38.640 your immune system helping you with your
00:22:40.400 blood sugar and just managing the stress
00:22:45.240 response So it’s not quite as simple as
00:22:48.159 thinking your way out of a high cortisol
00:22:51.440 or a low cortisol And there are ways
00:22:54.000 that your body can become stuck in a
00:22:58.000 particular pattern of making too much
00:23:01.080 cortisol or making not enough cortisol
00:23:05.200 And if my body’s making too much
00:23:06.480 cortisol and my levels are too high what
00:23:08.480 is the what is the harm the harm
00:23:12.280 is it’s associated with
00:23:15.320 depression It’s about 50% of people with
00:23:18.640 high cortisol 50% of people with
00:23:21.000 depression have high cortisol It’s used
00:23:24.080 by some
00:23:25.240 psychiatrists as a suicide
00:23:28.760 marker It’s associated with more belly
00:23:31.440 fat And so the fat receptors the fat
00:23:36.240 cells in your belly have increased
00:23:38.799 receptors for cortisol So it’s a way of
00:23:41.120 growing your belly fat We know that it
00:23:44.080 shrinks the brain in women but not men
00:23:48.480 starting in midlife starting in your 40s
00:23:50.720 It’s not an old age thing And this has
00:23:53.200 been shown a couple of different ways
00:23:55.039 There was a study from the University of
00:23:57.360 Texas in San Antonio showing that women
00:24:00.159 in their 40s with high cortisol have a
00:24:03.120 shrinkage of total brain volume And then
00:24:05.679 Lisa Moscone at Cornell also just showed
00:24:08.799 in a study looking at men and women that
00:24:11.360 women with high cortisol also have
00:24:13.120 shrinkage of their total brain volume
00:24:16.320 and they start to have a difficult time
00:24:20.080 using glucose as fuel in their brain
00:24:23.600 which is going to result in what kind of
00:24:26.000 behaviors well it makes you tired It
00:24:29.520 gives you slow brain
00:24:31.400 energy And I can tell for the most part
00:24:33.679 you don’t have that But if you do have
00:24:35.840 it there’s a way that you kind of your
00:24:38.640 brain slows down You feel foggy You’re
00:24:40.960 not able to multitask and kind of keep
00:24:43.520 up keep up with everything Is there a
00:24:45.760 link between cortisol and uh trauma oh
00:24:48.960 yes
00:24:50.480 What is that link so for people who
00:24:54.440 experience toxic stress or trauma what
00:24:58.320 typically happens is cortisol goes up
00:25:01.200 That’s part of the alarm Yeah The body’s
00:25:03.440 stress response What we know is that for
00:25:06.559 people who’ve got more serious exposure
00:25:09.440 to trauma and they have post-traumatic
00:25:11.760 stress
00:25:12.840 disorder those people have probably gone
00:25:16.159 through a period of high cortisol and
00:25:18.000 now they can’t keep up anymore and they
00:25:20.400 are in a low cortisol state
00:25:23.919 What are the things in in the world at
00:25:26.000 the moment that are messing up our
00:25:27.279 hormones because the subject matter of
00:25:29.279 hormones has become increasingly popular
00:25:31.679 and I know that there’s hormones like
00:25:32.880 cortisol which we’ve talked about um
00:25:34.640 testosterone estrogen progesterone um
00:25:37.520 insulin glucose What are the what are
00:25:40.240 the big things that are like messing up
00:25:41.679 our hormones at the moment if if I
00:25:44.320 because I want to make sure my hormones
00:25:45.679 are in check Um so I’m a guy I’m sure
00:25:49.760 that there’s you know some of these
00:25:50.880 hormones are more like things like
00:25:52.559 estrogen have I think more pertinent to
00:25:54.400 women but No it’s important for men too
00:25:57.039 Oh really so estrogen and progesterone
00:25:58.880 are incredibly important for men and
00:26:01.840 it’s you know it’s involved in uh bone
00:26:05.799 strength Progesterone is involved in
00:26:08.080 sleep in men So the levels are lower in
00:26:12.400 men and your testosterone is about 10
00:26:14.240 times higher But in women and men
00:26:18.320 they’re all
00:26:19.559 important So what’s messing with our
00:26:21.760 hormones i would
00:26:23.640 say toxin
00:26:26.360 exposure So there’s endocrine disruptors
00:26:29.440 There’s more than 700 known endocrine
00:26:32.080 disruptors Things like bisphenol A um
00:26:36.320 like the plastic lining that you see in
00:26:38.559 cans or in uh plastic containers water
00:26:43.039 containers There’s um skin care products
00:26:46.720 which women are exposed to more things
00:26:49.440 like moisturizer and makeup and other
00:26:51.840 things that contain um endocrine
00:26:54.640 disruptors like parabens and
00:26:58.520 um there’s flame retardants that we get
00:27:01.919 exposed to So there’s a whole class of
00:27:03.919 endocrine
00:27:05.159 disruptors and
00:27:07.320 then it feels right now like we are more
00:27:11.200 disregulated than I’ve ever
00:27:13.960 seen And I’m not
00:27:16.440 sure what the cause is I don’t know if
00:27:19.279 it’s the
00:27:20.520 post-pandemic experience or part of what
00:27:23.600 we’re experiencing in the United States
00:27:26.000 with the change in leadership
00:27:29.600 It just feels like there’s this hum of
00:27:32.919 dysregulation that I haven’t seen over
00:27:35.440 my career
00:27:37.600 Are you noticing that are you seeing
00:27:39.120 that in your patients and I see it in my
00:27:41.480 patients I see it in their wearable data
00:27:45.840 I see it in heart rate
00:27:48.120 variability I see it in the cortisol
00:27:50.720 levels that I’m measuring
00:27:53.679 You asked if I’m noticing that I mean
00:27:55.279 the more digital the world has become I
00:27:56.880 think I’ve seen more dysregulation and
00:27:58.559 we’re obviously moving further in that
00:28:00.480 direction at rapid speed especially with
00:28:01.840 things like AI now and
00:28:04.399 um algorithms getting more smart and
00:28:06.559 addictive Yes So I I see that Also
00:28:10.159 there’s just been a change
00:28:11.799 in I think the algorithms the social
00:28:14.159 media algorithms will compete with
00:28:15.360 themselves to to see who can hold you
00:28:16.960 the most And to do that they have to
00:28:18.399 kind of grab your attention and the
00:28:20.159 easiest ways to grab your attention is
00:28:21.760 by showing you things that are probably
00:28:24.559 disregulating Yes it’s an attention
00:28:27.720 economy and the cost in that fight for
00:28:31.919 attention is that often the nervous
00:28:34.080 system becomes more disregulated
00:28:37.039 So if you had to come into my life and
00:28:39.520 you had to optimize my life to make sure
00:28:41.279 that all my hormones were in check you
00:28:44.399 would get rid of plastics and and toxins
00:28:47.360 from my everyday life my bathroom um etc
00:28:51.919 I’d look at your skin care I’d look at
00:28:53.919 your cleaning products I’d look at your
00:28:57.440 air
00:28:58.520 quality I’d probably install a couple of
00:29:01.120 air filters if you don’t have that I’d
00:29:04.159 want to know about your stress because
00:29:06.720 you’re someone who performs at such a
00:29:08.720 high level and I would assume that you
00:29:13.200 found the right level of stress where
00:29:15.360 it’s not so little that you’re not
00:29:16.880 productive but it’s not to excess to the
00:29:19.760 point that there’s a cost to it
00:29:21.279 physiologically
00:29:23.080 Yeah And then and I’d want to look at
00:29:25.919 your food I’d want to know how much
00:29:28.559 protein you’re consuming Are you getting
00:29:30.960 the right amount of carbohydrates seems
00:29:32.960 like you are Are you utilizing those
00:29:35.840 well what’s going on with the continuous
00:29:38.080 glucose monitor how are your nutrients
00:29:40.720 what’s your vitamin D things like that
00:29:43.840 You’re a big fan of continuous glucose
00:29:45.360 monitors aren’t you i am I think it
00:29:47.919 gives real-time feedback immediate
00:29:50.080 feedback on the food that you’re eating
00:29:52.559 I’ve seen nothing else change behavior
00:29:54.880 like a continuous glucose monitor And
00:29:57.200 for anybody that doesn’t know it’s the
00:29:58.880 little patch you put on your arm and it
00:30:00.399 tells you your blood sugar levels in
00:30:02.240 real time straight to your
00:30:04.520 phone
00:30:06.039 Sugar is sugar the
00:30:09.080 enemy i don’t think sugar is the enemy I
00:30:11.840 think the enemy
00:30:13.320 is the way that we eat it to access the
00:30:16.799 way that we use it to change our
00:30:19.039 emotional state
00:30:21.200 And we know people who have adverse
00:30:23.520 childhood experiences they’re more
00:30:25.600 likely to have disordered eating They’re
00:30:27.520 more likely to have problems modulating
00:30:30.399 the amount of sugar they
00:30:32.679 consume When you’re treating patients do
00:30:35.039 you focus heavily on their blood sugar
00:30:37.679 levels i do because I think it’s an
00:30:40.399 important indicator of the way the
00:30:43.360 biochemistry of the body the metabolism
00:30:45.360 is working It tells me about their
00:30:47.520 mitochondria It tells me about the way
00:30:50.320 that they’re producing
00:30:51.960 energy ATP by ATP This compound this um
00:30:57.840 this measure of energy that you produce
00:31:00.799 inside of all of your cells which is
00:31:03.279 called ATP ATP
00:31:05.840 And that ATP then drives what it drives
00:31:09.520 our everything we do ATP is fuel So it
00:31:13.600 allows you to feel like you’re fully
00:31:15.559 energized especially when you wake up in
00:31:17.600 the morning And are there any
00:31:19.039 supplements that I should be taking if
00:31:21.200 I’m trying to optimize my hormonal
00:31:22.640 balance well I’d have to look at your
00:31:25.440 total picture but most of us
00:31:28.679 inherit somewhere around 5 to
00:31:31.559 seven genomic
00:31:34.559 um vulnerabilities and often we want to
00:31:37.760 work around those So for instance for me
00:31:41.200 my vitamin D receptor sucks It just
00:31:44.559 doesn’t work very well So I have to take
00:31:46.960 increased levels of vitamin D to keep
00:31:49.919 the um kind of the baseline amount of
00:31:52.799 vitamin D in my system normal So we
00:31:55.679 would want to look for those We’d look
00:31:57.039 at your genomics to
00:31:59.240 see what’s your relationship to B
00:32:02.120 vitamins With the stress that you manage
00:32:05.120 do you have a a deficit with B vitamins
00:32:08.159 for a lot of men it doesn’t show up
00:32:09.840 until around age 40 So this is a good
00:32:13.120 time for you to do a baseline When you
00:32:15.279 look at people’s biomarkers and their
00:32:18.159 blood samples what are the things that
00:32:20.399 you like typically always see that are
00:32:22.919 deficient because I’m sure there’s
00:32:24.880 things from a social level that we’re
00:32:26.559 just all kind of getting wrong
00:32:29.200 Vitamin D is common So somewhere around
00:32:31.440 70 to 80% of people don’t have enough
00:32:33.679 vitamin D And one of the things that I
00:32:36.399 think is so important to realize about
00:32:37.919 vitamin D is that it’s got 400 jobs in
00:32:40.000 the body One of them is keeping your
00:32:43.440 boundary in your gut intact So keeping
00:32:47.600 tight junctions working so that you
00:32:50.000 don’t have leaky gut So vitamin D is a
00:32:53.440 common one I had an executive that I
00:32:56.000 took care of on Tuesday and he had a
00:32:58.720 fasting glucose of
00:33:01.640 102 which is in the pre-diabetes range
00:33:05.279 No doctor has pointed this out to him
00:33:07.799 before He had uh his cholesterol was
00:33:11.919 starting to climb His blood pressure was
00:33:14.799 borderline not high enough to require a
00:33:17.399 medication
00:33:19.000 but at the point where we want to turn
00:33:21.679 that ship around before he needs a
00:33:23.880 medication He had a level of
00:33:26.000 inflammation in his
00:33:27.960 body that was causing aches and pains
00:33:32.640 and
00:33:34.039 um kind of like this silent condition
00:33:37.760 that um wasn’t working well for him So
00:33:42.559 there’s a couple ways to measure that
00:33:44.000 For him his homocyine was elevated It
00:33:46.240 was
00:33:47.240 14.7 And that’s a that’s one that’s
00:33:49.919 really easy to measure in a basic panel
00:33:52.399 What we want with homoyine which is um
00:33:55.679 heart specific inflammation we want that
00:33:58.399 to be 5 to 7 And when it’s elevated that
00:34:01.840 tells us that often part of the
00:34:05.120 biochemistry in the body your
00:34:06.600 methylation is not working well
00:34:08.800 Methylation is just where you add a
00:34:10.320 carbon and three hydrogens to a molecule
00:34:14.000 And it’s a way that we turn
00:34:16.560 uh genes on and off And so in this
00:34:19.679 person’s case he wasn’t getting enough B
00:34:22.960 vitamins methylated B vitamins So we
00:34:26.079 started him on a supplement to help him
00:34:27.839 with that So that’s a common one His
00:34:30.320 testosterone was good so didn’t have to
00:34:32.719 address that This guy was about 52
00:34:37.280 Um his cortisol was good He was the
00:34:40.159 chief financial officer of a company
00:34:42.000 back east Well he had a number of things
00:34:44.879 on his genomics that we needed to pay
00:34:47.119 attention to What was interesting about
00:34:49.599 this guy Steve is that he was an athlete
00:34:54.000 He played football in high school and
00:34:57.880 college He had this identity as an
00:35:00.400 athlete but when he came to see me at
00:35:02.800 age 52 he was barely exercising
00:35:07.440 He would lift weights maybe once a week
00:35:10.320 He would go swimming for about 30
00:35:12.160 minutes once a week And so he wasn’t
00:35:17.320 leveraging disposal of glucose the way
00:35:20.240 that he could be the way that he used to
00:35:22.800 when he was in his 20s So a big part of
00:35:27.040 understanding what made him tick was to
00:35:29.520 reaffirm this identity as an athlete and
00:35:32.240 to use that to address this metabolic
00:35:36.800 crisis that was starting to happen in
00:35:38.640 his body before it was too late
00:35:42.320 cuz he’s got too much glucose and he’s
00:35:44.079 not doing enough with it That’s right So
00:35:46.640 his body is having to store it and
00:35:48.960 getting inflamed
00:35:50.800 and he said “You know listen it’s been
00:35:53.359 the Christmas holidays I had a lot of
00:35:55.520 pound cake I had some cocktails You know
00:35:58.800 maybe that’s part of the problem.” But
00:36:00.720 we had measured his hemoglobin A1C which
00:36:04.480 is a threemon summary of what’s
00:36:07.280 happening with your glucoses And the
00:36:09.520 problem predated Christmas So we needed
00:36:12.800 to get them into action around exercise
00:36:16.720 Getting back to hormones I really want
00:36:18.960 to um close off on this subject of
00:36:20.880 cortisol because I know that that’s such
00:36:22.560 a important hormone I’ve heard you say
00:36:25.280 before that you believe that uh cortisol
00:36:28.000 is the most critical hormone to get into
00:36:29.880 balance You want to focus on cortisol
00:36:32.640 really first and foremost So someone
00:36:35.200 like me is there anything else I need to
00:36:37.280 know to get my hor my cortisol levels in
00:36:40.160 balance and also what percentage of the
00:36:43.200 population do you think have their
00:36:44.400 cortisol out of whack
00:36:47.720 h so we don’t have data on the numerator
00:36:51.520 or the
00:36:52.920 denominator and my patient population is
00:36:58.000 enriched with people who’ve got cortisol
00:37:00.359 problems So out of all of the people I
00:37:03.400 test somewhere around 90% of them have a
00:37:06.480 problem with their cortisol And that
00:37:08.520 includes professional
00:37:10.839 athletes because at least in the US like
00:37:13.760 basketball
00:37:15.079 players they travel a ton They play
00:37:18.079 backto-back games They’ve got a cortisol
00:37:21.280 load a stress load that is pretty high
00:37:25.040 even for someone in their 20s or 30s
00:37:28.160 who’s used to high
00:37:29.960 performance So the number is high If I
00:37:34.079 had to look at the general
00:37:36.680 population it would be a total
00:37:38.640 speculation I would say somewhere
00:37:41.000 around 30 to
00:37:43.400 50% And what do you do about that if
00:37:45.760 you’re an athlete and you’ve got
00:37:46.880 elevated cortisol levels
00:37:49.599 I think there’s a number of different
00:37:52.480 things There’s the top down approach
00:37:55.200 which is cognitive kind of like what is
00:37:57.920 my prefrontal cortex how can I leverage
00:38:00.480 that to work with this and then there’s
00:38:02.960 more of a bottomup approach which is
00:38:05.280 using your senses to create safety and
00:38:09.280 to change the cortisol signal kind of
00:38:11.839 the alarm in the way that it goes off in
00:38:13.599 the body So breath work is really
00:38:16.079 important for that Meditation
00:38:19.040 um different forms of
00:38:21.640 movement dancing you know rhythmic
00:38:24.839 movements walking hiking
00:38:28.160 Running’s a little tricky because um
00:38:30.640 that can be a stress response and it can
00:38:32.640 raise
00:38:33.400 cortisol Um so I would say for a
00:38:38.480 professional
00:38:40.359 athlete what I usually recommend is um
00:38:45.960 meditation regular meditation and
00:38:48.480 finding what’s a really good fit for
00:38:50.079 them Because you know for some people
00:38:54.440 mindfulness-based stress reduction is a
00:38:56.720 good fit but that doesn’t fit for
00:38:58.359 everyone Other people like resonance
00:39:00.720 breathing like a 5-second inhale
00:39:02.960 7-second
00:39:04.839 exhale six breaths per minute Doing that
00:39:07.920 for 10 to 20 minutes That can really
00:39:10.079 help to create balance between the
00:39:11.839 parasympathetic nervous system and the
00:39:13.520 sympathetic nervous
00:39:15.000 system For some of my athletes it’s a
00:39:18.079 supplement So if they’ve got high
00:39:21.079 cortisol one of the things I often do is
00:39:23.440 to give them cortisol manager which is a
00:39:25.599 supplement that includes ashwagandha and
00:39:29.520 phosphatidal serereine And it’s been
00:39:31.839 shown to lower cortisol levels So if
00:39:34.720 they’re traveling and they have to take
00:39:36.000 a plane back to Philadelphia after an
00:39:39.200 away game cortisol manager can help them
00:39:42.560 manage the cortisol I found a supplement
00:39:45.599 called I can’t pronounce the name
00:39:46.960 properly but riol Oh rodeiola Rodeiola
00:39:51.040 Yes Rodeiola is an
00:39:52.920 adaptogen So it’s a it’s an herbal
00:39:56.160 therapy that’s been shown to help with
00:39:58.000 cortisol Lowers cortisol Yes And I was
00:40:01.599 reading that it increases your focus
00:40:03.040 potentially Yes it does Do you prescribe
00:40:05.680 that to athletes i do So generally what
00:40:09.440 I try to do with most of my athletes is
00:40:11.440 have them take a supplement either first
00:40:13.680 thing in the morning or before they go
00:40:15.200 to bed It’s harder to do it during the
00:40:16.960 day And so I tend to start with cortisol
00:40:19.839 manager because I think it’s got the
00:40:21.200 best data but rdea is also a good choice
00:40:23.920 and I have prescribed that Is it easy
00:40:26.560 for people to change in this regard to
00:40:29.760 get them to make a set of different
00:40:31.520 decisions i think we’re at a time of
00:40:32.720 year where a lot of people are thinking
00:40:33.839 about changes and a lot of people are
00:40:36.880 failing repetitively every year at the
00:40:39.760 changes they say they want to make Is it
00:40:43.440 easy to get someone to change i would
00:40:46.640 say behavior change is the hardest thing
00:40:49.119 that we do as humans I think there are
00:40:52.079 ways that
00:40:53.839 uh adverse childhood experiences tend to
00:40:57.359 set a pattern that’s very hard to break
00:41:00.960 But I see people change their behavior
00:41:03.520 all the time And I think part of it
00:41:06.240 depends
00:41:08.200 on what’s the pain of staying the same
00:41:11.760 if it’s high enough to motivate you and
00:41:14.319 to help you you know not take the shot
00:41:17.760 or two of tequila that has been your
00:41:20.160 downfall in the past If um you have
00:41:25.200 something that keeps you accountable and
00:41:27.760 has like the Hawthorne effect like a
00:41:30.079 continuous glucose monitor I think that
00:41:31.920 can also be very helpful as if someone
00:41:34.240 was watching you because my patients
00:41:37.200 with their continuous glucose data I am
00:41:39.599 watching them I’m scanning them
00:41:43.839 But does doesn’t that mean that in order
00:41:46.160 to change some people just need a bit
00:41:47.680 more pain
00:41:49.920 i would say people have a different
00:41:51.680 level of pain that motivates change Have
00:41:54.960 you ever seen a situation we were
00:41:56.480 talking about this a couple of couple of
00:41:57.680 weeks ago where when you’re trying to
00:41:59.839 help someone you actually end up
00:42:01.200 propping them up and because you’re
00:42:04.560 intervening to stop them experiencing
00:42:06.880 the pain that they might otherwise you
00:42:09.200 end up harming them because you’re
00:42:11.040 preventing them from going to that place
00:42:13.400 where you know they call rock bottom
00:42:16.280 where self-motivated change would occur
00:42:20.079 It’s a good question I think there’s
00:42:22.000 there’s a fine line
00:42:25.480 between motivating and also speaking
00:42:28.880 your truth about what you’re willing to
00:42:30.640 tolerate say in your partner or a friend
00:42:33.520 or family
00:42:34.760 member and also enabling or
00:42:39.430 [Music]
00:42:41.000 um being
00:42:43.560 codependent And so you have to try to
00:42:46.400 find that line I mean one of the things
00:42:47.920 I found over my career and it took me a
00:42:50.079 while to learn this is that if someone
00:42:52.800 has denial about what they’re doing and
00:42:56.079 how it’s affecting their relationships
00:42:59.359 their health their ability to work say
00:43:02.800 drinking too much having a sticky
00:43:04.480 relationship with
00:43:06.119 alcohol it’s not my job to break through
00:43:09.119 their denial They have to do that That’s
00:43:11.920 their work Now I can
00:43:15.560 say alcohol has no health benefits
00:43:18.960 Here’s what it does Here’s what it does
00:43:20.640 to the female brain Here’s what it does
00:43:22.079 to the male brain Here’s what it does to
00:43:25.680 um break the boundary in your gut and
00:43:28.160 cause leaky gut Here’s all of the
00:43:31.440 unoured effects of it But it’s not my
00:43:34.400 job to break through their denial They
00:43:36.720 have to do that
00:43:38.640 And that’s very hard especially if you
00:43:40.319 have a family member or a a friend or a
00:43:44.280 partner who is doing things that are
00:43:46.960 harming themselves So what do you
00:43:48.640 consider your job to be if you are a
00:43:50.240 friend or a family member
00:43:53.119 your job is to determine what your
00:43:56.079 boundaries are what you’re willing to
00:43:57.920 tolerate to stay in relationship
00:44:01.359 And that’s you know that’s where
00:44:03.240 interventions play a role where you
00:44:07.599 confront the person and
00:44:10.040 say “I’m really worried about you Here’s
00:44:13.839 what I’m witnessing I really feel like
00:44:16.240 you need to approach this in a different
00:44:18.240 way Are you willing?” But it’s a
00:44:20.880 consenting process You don’t do it for
00:44:23.760 them
00:44:27.280 What’s your experience
00:44:29.599 well I just I just have so many you know
00:44:31.520 because these days I can help people a
00:44:33.040 much more than I could 10 years ago
00:44:35.200 whether it’s financially or in other
00:44:36.880 ways And so it’s often tempting when
00:44:39.760 someone in my life is struggling in some
00:44:41.359 way to just intervene with some kind of
00:44:44.319 crutch Yes And I’ve actually seen over
00:44:47.200 the last like 15 years that the best
00:44:49.760 things that I’ve ever done for some of
00:44:51.200 my friends wasn’t an intervention It
00:44:53.040 wasn’t paying for something for them or
00:44:54.960 taking care of something for them It was
00:44:57.599 being honest with them and
00:44:59.720 then being there as they figured it out
00:45:02.640 themselves And often it was actually
00:45:04.560 removing my crutch which meant that they
00:45:07.680 would fall a little bit and then climb
00:45:10.960 themselves out of the ditch to a very
00:45:13.920 good life So I just always think about
00:45:15.760 that that a lot of us through love or
00:45:17.800 through the fact that we can often end
00:45:20.240 up propping people up in our lives and
00:45:21.599 we’re actually doing them a disservice
00:45:22.800 because we’re kind of inhibiting their
00:45:24.319 own natural growth journey I agree with
00:45:27.599 that And I would I would also say that
00:45:30.800 what you just described is holding a
00:45:34.560 mirror to someone in a way that is very
00:45:40.040 loving but also clear It’s a clean
00:45:44.440 mirror and it’s very different than just
00:45:48.000 loaning them the money Yeah And then
00:45:50.480 being there for them as they stumble and
00:45:52.800 struggle and try to make things
00:45:55.040 different You you talked earlier on
00:45:57.440 about the executive that you checked um
00:46:00.000 recently You said his testosterone
00:46:02.160 levels were intact Yes
00:46:05.040 At what age should I be thinking about
00:46:08.000 my testosterone levels or should I be
00:46:09.520 thinking about them all the time cuz I
00:46:10.640 kind of see it as something that I need
00:46:12.079 to worry about when I’m when I get a
00:46:13.359 little bit older into my 40s and 50s
00:46:16.720 It tends not to decline until about age
00:46:19.359 40 but I would say do a baseline now
00:46:22.240 Okay so a baseline biomarker assessment
00:46:24.800 would be
00:46:25.800 worthwhile And you know one of the
00:46:28.079 things we found during the pandemic was
00:46:31.359 that um the National Basketball
00:46:34.640 Association was playing in a bubble They
00:46:37.040 were playing in Florida and the players
00:46:40.319 cut off from their families and kind of
00:46:42.240 stuck in Florida for a period of
00:46:45.160 time They had low testosterone levels
00:46:48.319 and these guys normally have pretty high
00:46:50.079 testosterone levels
00:46:52.280 So there can be specific situations that
00:46:55.839 can affect your testosterone level What
00:46:58.319 was it that was affecting those part of
00:47:00.160 it was just
00:47:02.040 being in a hotel in a bubble unable to
00:47:05.800 leave cut off from their community their
00:47:09.520 family their friends their usual ways of
00:47:12.560 blowing off steam I imagine they’re they
00:47:15.760 didn’t measure their cortisol but I
00:47:17.359 imagine it was probably higher than
00:47:18.960 normal And women have testosterone too
00:47:22.400 but you said I think earlier that men
00:47:24.000 just have 10 times more testosterone Men
00:47:26.000 have more but it’s the most abundant
00:47:28.560 hormone in the female body Women are
00:47:30.800 exquisitly sensitive to it It’s the most
00:47:33.599 abundant hormone Yes Higher
00:47:36.240 concentration than estrogen or
00:47:37.680 progesterone About 15 to 70 nanogs in a
00:47:41.720 woman That’s what I read on WebMD Yes
00:47:44.560 that’s that’s a pretty good level And in
00:47:46.720 men 300 a,000 nanogs Yes I like to see
00:47:51.440 it somewhere around 500 to a,000 And
00:47:54.319 what would be
00:47:55.400 a sign that I had low testosterone if
00:47:58.560 I’m a man
00:48:01.200 belly fat
00:48:03.040 Gynecomastia What’s that that’s when you
00:48:05.839 have breast development Okay mood
00:48:08.560 changes mood swings uh irritability
00:48:14.240 uh
00:48:16.599 depression cardiovascular changes
00:48:19.839 erectile dysfunction decreased libido
00:48:23.839 What about in a woman so if a woman has
00:48:25.760 low testosterone what are the symptoms
00:48:28.000 we see in a woman they’re similar So um
00:48:32.559 both sexes have fatigue That’s very
00:48:35.119 common Decreased libido They might be
00:48:37.920 working out at the gym and not seeing a
00:48:40.119 response They might have some hair
00:48:42.920 loss And testosterone in women has a few
00:48:46.319 unique features Like one of the things
00:48:48.240 we’ve seen looking at MBA students
00:48:51.599 students who are getting a masters in
00:48:53.119 business administration is that the
00:48:55.440 women with higher testosterone tend to
00:48:57.599 be more comfortable with financial
00:49:00.040 risk I believe it also tracks with
00:49:03.040 confidence and agency We have less hard
00:49:06.480 data on that But those are some of the
00:49:08.960 things that I see It’s a hormone of
00:49:10.720 vitality in both men and women So if a
00:49:12.800 woman is low testosterone she might be
00:49:14.720 less confident have less motivation less
00:49:17.520 agency less willing to take risks less
00:49:20.720 sex drive What if she has high tes
00:49:22.960 testosterone levels too high So high
00:49:25.920 testosterone tends to track with
00:49:28.319 polycystic ovary syndrome It’s the most
00:49:31.119 common hormone imbalance that women have
00:49:34.319 It leads to
00:49:35.559 infertility Um it leads to increased
00:49:38.800 hair growth in places that you don’t
00:49:40.319 want it So that can include like your
00:49:42.800 chin and between your
00:49:44.760 breasts It can lead to
00:49:47.640 um insulin resistance in some but not
00:49:51.599 all but somewhere around 70% of people
00:49:53.839 with PCOS have insulin
00:49:55.880 resistance So it leads to symptoms of
00:49:59.440 excess androgen acne heretism
00:50:03.440 It also is associated with problems with
00:50:06.720 the
00:50:07.880 mitochondria It’s also linked to
00:50:11.200 disregulated stress
00:50:13.000 response That’s something we see with
00:50:15.040 people with PCOS So if I’m a man or a
00:50:17.760 woman and I want to get my testosterone
00:50:19.520 levels in order and I don’t want to
00:50:22.240 inject myself with testosterone are
00:50:24.400 there natural ways easy ways for me to
00:50:27.200 get my testosterone balanced
00:50:29.839 it depends on how off it is First place
00:50:32.960 to start is your cortisol because
00:50:35.119 cortisol has this
00:50:39.559 um interdependent relationship with
00:50:42.480 other hormones So if you’re someone
00:50:44.640 who’s making a lot of cortisol you’re
00:50:46.800 going to make less testosterone So
00:50:49.359 someone who’s got a high level of stress
00:50:51.280 like I was talking about the NBA players
00:50:53.359 in the bubble maybe their stress was
00:50:56.240 high and their cortisol was high and
00:50:57.599 that was why their testosterone was
00:50:59.200 lower
00:51:01.040 So then if I’m a woman with polycystic
00:51:03.680 ovary syndrome and my testosterone is
00:51:06.160 high doesn’t that mean I want to
00:51:07.920 increase my
00:51:09.559 cortisol no In that
00:51:12.440 situation what we know is that food is
00:51:14.880 probably the most important factor with
00:51:16.960 someone with PCOS And inside of 7 days
00:51:20.559 by eating a lower carbohydrate diet you
00:51:23.440 can change your testosterone level So
00:51:25.839 you can lower it significantly within
00:51:28.559 seven days within seven days So exercise
00:51:32.800 I’m currently eating like a ketogenic
00:51:34.880 diet so my carbohydrate level is
00:51:36.480 extremely low Does that mean my
00:51:38.480 testosterone levels are going to be low
00:51:41.200 not necessarily because you’re not
00:51:42.960 someone with PCOS So it’s not quite
00:51:45.440 translatable across sex and gender But
00:51:49.599 for you with a ketogenic diet what we
00:51:52.319 typically see is that insulin levels are
00:51:55.359 lower So it does seem to help with
00:51:56.880 metabolic health
00:51:59.040 It can cause some thyroid dysfunction So
00:52:01.920 it’s worth tracking thyroid We know that
00:52:05.280 people on a ketogenic diet sometimes
00:52:08.160 have increased inflammation There are
00:52:10.640 some people who are super responders and
00:52:12.400 they just do super well with ketogenic
00:52:14.240 diet but some people have about a 10%
00:52:17.079 change in their LDL their so-called um
00:52:21.520 bad lipoprotein So if you stay on it for
00:52:25.200 more than four weeks I generally
00:52:26.800 recommend that you look at some
00:52:28.000 biomarkers
00:52:30.160 Let’s talk about estrogen then because I
00:52:32.319 I was under the impression that um only
00:52:35.280 women had estrogen but you’re telling me
00:52:36.880 that it’s an important hormone for men
00:52:38.319 as well It is Why is it so important for
00:52:41.280 for both sexes what does it do well I
00:52:44.559 would say it’s more important for women
00:52:46.319 because it regulates the entire female
00:52:49.599 body
00:52:51.319 So we have estrogen receptors throughout
00:52:54.880 our body Um when women there’s two
00:52:58.880 different life stages where estrogen is
00:53:01.280 low The first is
00:53:03.160 postpartum So if you give birth to a
00:53:05.520 baby you go from skyhigh estrogen levels
00:53:07.760 down to almost nothing when you deliver
00:53:10.240 your baby and you deliver your placenta
00:53:12.640 And so for a lot of women when they’re
00:53:15.480 postpartum maybe they’ve got mood issues
00:53:19.440 um they’ve got fatigue that is more than
00:53:22.720 just the sleep
00:53:24.599 deprivation This can be a preview of
00:53:26.720 coming attractions in pmenopause and
00:53:29.480 menopause So it’s a window of
00:53:31.440 opportunity that can tell you about the
00:53:33.200 way estrogen works in your body So for
00:53:36.400 the female body estrogen has hundreds of
00:53:39.520 jobs It keeps her joints lubricated We
00:53:42.079 know that frozen shoulder is a really
00:53:44.000 common uh diagnosis in women who are in
00:53:47.200 pmenopause and menopause because the
00:53:49.040 estrogen receptors just aren’t getting
00:53:51.280 the estrogen They’re not having
00:53:52.640 molecular sex between the estrogen and
00:53:54.720 the estrogen
00:53:56.760 receptor So estrogen is really critical
00:53:59.920 in women It regulates mood
00:54:03.960 um breast development development of
00:54:07.559 hips It’s a lubricant for your joints Um
00:54:13.359 it’s also really critical for your skin
00:54:16.480 When estrogen goes down you make less
00:54:18.960 collagen and that’s why women notice
00:54:21.200 that their skin ages And in men it’s a
00:54:24.400 little bit different The dynamic range
00:54:26.559 is more narrow And what we generally
00:54:29.280 want with men is for you to have enough
00:54:32.359 estrogen to serve some of these bodily
00:54:36.520 functions like with keeping your bones
00:54:39.520 strong um but not too much
00:54:44.720 Does it have a role in weight
00:54:47.079 distribution in my body so where are the
00:54:50.559 fat stores and stuff so in men I don’t
00:54:53.520 know I don’t know the answer to that
00:54:55.359 I’ll have to look it up and get back to
00:54:56.800 you But in women yes absolutely So one
00:54:59.760 of the things that happens for women
00:55:02.480 over the age of 40 is that they
00:55:05.680 typically become insulin resistant Their
00:55:08.400 cells become numb to insulin And what we
00:55:11.920 know is that they gain about five pounds
00:55:14.640 of fat and they lose about 5 pounds of
00:55:16.880 muscle every decade after age 40 So
00:55:20.960 there’s this redistribution of fat to
00:55:23.760 your point where they they deposit less
00:55:28.640 at their breasts in their hips and their
00:55:30.400 buttocks and more at their
00:55:32.920 abdomen Does that happen in
00:55:36.359 men i think there’s some version of it
00:55:38.960 in men but I just would have to confirm
00:55:40.960 that
00:55:42.800 And is that inevitable
00:55:45.400 no no no You have a choice
00:55:49.520 So for women I think what’s important is
00:55:54.040 to
00:55:55.559 understand what what are your estrogen
00:55:58.480 levels that are associated with your
00:56:00.079 best function And that’s why I think
00:56:02.000 baseline testing can be so helpful to
00:56:04.400 know where your thyroid is right now
00:56:05.839 your cortisol your testosterone
00:56:08.640 um to know where you are with your
00:56:10.319 metabolic health so that when you’re in
00:56:12.880 your 40s you can look back and say “Okay
00:56:15.040 I was in a state of optimization I want
00:56:17.760 to go back to something similar to
00:56:20.200 that So for women what I would say
00:56:23.559 is right now 73 to 75% of women do not
00:56:29.119 get the treatment for pmenopause and
00:56:31.119 menopause that they deserve They’re not
00:56:34.160 being offered for instance hormone
00:56:36.680 therapy and that has to change But
00:56:39.760 hormone therapy can help to reverse this
00:56:42.880 so that you are more likely to
00:56:47.079 um not have some of these body
00:56:50.000 composition changes as you get
00:56:52.359 older And it’s not just hormone therapy
00:56:54.880 I would say it’s beyond hormone therapy
00:56:57.359 It’s estrogen progesterone testosterone
00:56:59.520 but it’s also heavy
00:57:02.359 weightlifting It’s cardiovascular
00:57:04.400 fitness It’s disposing of the glucose
00:57:06.880 properly eating the right foods
00:57:10.400 disposing of the glucose properly Yes
00:57:12.559 What do you mean by that so if you’re
00:57:15.119 you know like when I was in my 30s my
00:57:18.559 fasting glucose was very high It was in
00:57:21.200 the pre-diabetes range And so I needed
00:57:24.160 to change the way that I
00:57:26.599 was burning through glucose like using
00:57:29.920 it with exercise
00:57:33.359 So disposing it’s like an input output
00:57:36.559 equation where you’re inputting with
00:57:39.440 your food and you’re outputting with
00:57:41.680 your exercise and you want to get a good
00:57:43.599 match between the two and muscle
00:57:46.720 resistance training strength training is
00:57:48.480 the optimal way to dispose of glucose
00:57:51.280 right i think it’s a critical way I mean
00:57:53.280 what we know with strength training is
00:57:54.720 it builds muscle and so the more muscle
00:57:57.920 mass that you have generally the better
00:58:00.319 your metabolism
00:58:02.480 This one change has transformed how my
00:58:05.119 team and I move train and think about
00:58:06.799 our bodies When Dr Daniel Lieberman came
00:58:09.119 on the diio he explained how modern
00:58:11.440 shoes with their cushioning and support
00:58:13.760 are making our feet weaker and less
00:58:15.760 capable of doing what nature intended
00:58:17.359 them to do We’ve lost the natural
00:58:19.520 strength and mobility in our feet And
00:58:21.359 this is leading to issues like back pain
00:58:23.920 and knee pain I’d already purchased a
00:58:26.400 pair of Viva barefoot shoes So I showed
00:58:28.319 them to Daniel Lieberman and he told me
00:58:29.920 that they were exactly the type of shoe
00:58:31.760 that would help me restore natural foot
00:58:33.680 movement and rebuild my strength But I
00:58:35.119 think it was planttoicitis that I had
00:58:36.559 where suddenly my feet started hurting
00:58:38.000 all the time And after that I decided to
00:58:39.760 start strengthening my own foot by using
00:58:41.520 the Vivo Barefoots And research from
00:58:43.280 Liverpool University has backed this up
00:58:44.799 They’ve shown that wearing Vivo Barefoot
00:58:46.640 shoes for 6 months can increase foot
00:58:49.040 strength by up to 60%
00:58:51.520 Visit
00:58:53.240 vivobarefoot.com/doac and use code
00:58:56.040 dac20 for 20% off That’s a
00:59:01.880 vivobarefoot.com/dac Use code
00:59:03.960 DOAC20 A strong body starts with strong
00:59:07.640 feet What role is fiber playing in all
00:59:10.319 of this because a lot of people are
00:59:11.359 talking about fiber at the moment and
00:59:12.640 saying that we’re fiber deficient Oh we
00:59:15.440 are for sure I mean the average American
00:59:17.680 gets somewhere around 14 grams of fiber
00:59:20.640 a day And we’re meant to have about 30
00:59:23.359 to 35 40 grams a day Our paleolithic
00:59:27.200 ancestors got even more than that 50 to
00:59:29.760 100 grams a day So we are not getting
00:59:32.960 enough fiber It’s critical for blood
00:59:35.520 sugar stabilization So is protein intake
00:59:38.799 But getting fiber from real
00:59:41.720 food you know eating sufficient
00:59:43.839 vegetables We know from the microbiome
00:59:46.839 studies that you want about 25 to 35
00:59:50.720 different species of fruits and
00:59:53.200 vegetables in a week to be able to feed
00:59:56.079 your microbiome
00:59:58.640 And what role is the microbiome playing
01:00:01.200 in my hormone function it’s playing a
01:00:03.920 huge role So your microbiome is one of
01:00:07.760 the control functions for estrogen
01:00:10.640 levels and maybe testosterone
01:00:13.079 levels So there’s a birectional
01:00:16.599 relationship Steve
01:00:19.640 where there are three bacteria in the
01:00:22.400 gut that can um take estrogen and make
01:00:28.000 it keep recirculating
01:00:30.640 So you’re meant to produce estrogen and
01:00:34.319 then use it and then either poop or pee
01:00:37.200 it out But what happens with some people
01:00:39.680 if they’ve got these bacteria is they
01:00:42.640 keep recirculating the estrogen like bad
01:00:45.960 karma And so those people tend to have
01:00:48.319 higher estrogen levels It tends to be
01:00:51.280 associated in men with this greater risk
01:00:53.760 of um metabolic dysfunction prostate
01:00:57.839 cancer and in women it’s associated with
01:01:00.960 more breast cancer and endometrial
01:01:02.799 cancer
01:01:04.319 And that a lot of that starts and is
01:01:06.000 caused by the gut microbiome Yes And the
01:01:09.160 microbiome their favorite food is fiber
01:01:12.480 So the way that you keep your microbiome
01:01:15.200 your microbes happy and healthy is to
01:01:18.559 feed them a fair amount of fiber What
01:01:20.960 What kind of foods have high fiber is it
01:01:23.599 like broccoli and stuff yes So broccoli
01:01:27.040 Brussels sprouts
01:01:29.240 cauliflower
01:01:30.839 cabbage kabi
01:01:33.440 What do you
01:01:34.760 eat and like how do you live so I’m a
01:01:38.440 sensualist So I love food I love the
01:01:41.520 taste of food I love the smell of food I
01:01:43.760 love the look of food I had a history of
01:01:46.640 disordered eating I had anorexia as a
01:01:49.040 teenager and bulimia through my 20s and
01:01:52.839 30s But now I have a more neutral
01:01:56.000 relationship with food I have worn a
01:01:59.040 continuous glucose monitor almost
01:02:01.359 continuously for the past seven years
01:02:04.000 And so I know a lot about the foods that
01:02:05.920 serve me the best So usually for
01:02:09.720 breakfast I love eggs And
01:02:13.160 so I eat fresh eggs usually scrambled or
01:02:18.480 um lightly
01:02:19.960 boiled I like to have that with greens
01:02:22.720 or some other leftover vegetable from
01:02:24.799 the night
01:02:26.119 before I eat a lot of vegetables I aim
01:02:29.520 for somewhere around a half pound to a
01:02:31.839 pound a day So that’s divided between um
01:02:36.640 salads the vegetables I have at dinner
01:02:40.160 um a smoothie I put vegetables in
01:02:42.240 smoothies along with a protein powder I
01:02:45.040 eat a lot of cruciferous vegetables I
01:02:47.920 have sluggish detox pathways I know that
01:02:50.079 genomically and I know it from my
01:02:51.520 biomarker testing What does that mean
01:02:53.920 means
01:02:55.000 that maybe it’s related to my
01:02:57.200 sensitivity I’ve got my I don’t make
01:03:01.680 sufficient glutathione which is um one
01:03:04.799 of the ways that you detoxify It’s an
01:03:06.480 antioxidant in your body And
01:03:09.480 so
01:03:11.319 I like to to close that gap by making
01:03:15.920 sure that I’m getting
01:03:17.400 sufficient cruciferous vegetables I eat
01:03:20.240 a lot of broccoli sprouts What do you
01:03:22.799 think of the keto diet i’m a fan of the
01:03:25.440 ketogenic diet because in your book
01:03:27.280 there’s this chapter called the keto
01:03:28.640 paradox Yes
01:03:31.200 What are your thoughts on keto well what
01:03:33.760 I find with keto is that men tend to do
01:03:36.640 better on it than women And what I found
01:03:40.160 with women is that maybe related to
01:03:42.559 hormones and their sensitivity they have
01:03:45.119 more thyroid dysfunction They have more
01:03:47.280 menstrual irregularity Somewhere around
01:03:49.280 45% of women that are on a classic
01:03:51.920 ketogenic diet So women tend to have
01:03:55.039 more issues with the ketogenic diet
01:03:57.280 takes them longer to get into ketosis
01:03:59.599 than it does a man Even if you the
01:04:02.400 average man if they fast for somewhere
01:04:05.119 around 14 to 16 hours they start to
01:04:08.480 produce ketones and for women it takes
01:04:11.119 longer takes more like 18 to 20 hours
01:04:15.599 So probably that’s related to fertility
01:04:18.720 and evolutionarily there’s some pressure
01:04:21.520 for us to not go into a ketogenic state
01:04:24.079 but it makes it harder for women to get
01:04:26.559 into ketosis and stay in ketosis Is
01:04:29.280 there a danger to women doing ketosis
01:04:31.200 because you said me um their periods are
01:04:33.920 going to become irregular Not
01:04:35.280 necessarily I think depending on how you
01:04:37.920 do it you know a lot of the data that we
01:04:39.440 have on the ketogenic diet is in
01:04:41.839 populations that don’t apply to you or
01:04:43.839 me because the bulk of the data that we
01:04:46.799 have is in people with seizure
01:04:49.240 disorders So they’re different It’s a
01:04:51.599 different population and they’re also on
01:04:54.240 a form of the ketogenic diet that is
01:04:57.039 very strict You know no more than 10 to
01:05:01.359 20 grams of carbohydrates day So I think
01:05:04.480 you can play with your carbohydrates and
01:05:07.520 find out what your carb threshold is so
01:05:10.160 that you can remain in ketosis get the
01:05:12.960 benefits of all the phytonutrients that
01:05:14.960 you can get from
01:05:16.280 vegetables and play both sides so that
01:05:20.000 you get the health benefits you get the
01:05:22.359 metabolic function improvement you get
01:05:25.359 the uh lowering of insulin without some
01:05:29.200 of the side effects What are the side
01:05:31.200 effects the main ones that I see are the
01:05:33.760 thyroid dysfunction Yeah
01:05:36.480 Uh sometimes there’s a a rise in
01:05:38.640 cortisol in people who are really
01:05:40.559 limiting their carbohydrates And then it
01:05:43.280 can also affect serotonin so that people
01:05:45.839 don’t sleep as well on a ketogenic diet
01:05:48.480 Now some people love that They go on a
01:05:50.079 ketogenic diet and they’re like “Oh I
01:05:52.000 only need to sleep six or seven hours a
01:05:54.559 night.” But over time if you need more
01:05:58.000 and it’s the serotonin that is at the
01:06:00.960 root of why you’re not sleeping as well
01:06:03.599 that can cause a problem Is there
01:06:05.599 anything else that the keto ketogenic
01:06:08.160 diet might be doing to my hormones like
01:06:09.760 my testosterone or my other hormones
01:06:11.760 that is worth noting because I’m super
01:06:14.480 you know I’m wondering whether to stay
01:06:16.720 on the ketogenic diet for a long period
01:06:18.480 of time I typically do it for a couple
01:06:19.680 of weeks a year but I’m I’m wondering if
01:06:21.440 this is something that I could do for
01:06:23.119 like a year or maybe longer So I think
01:06:26.319 if you stay on it for more than a few
01:06:28.160 weeks you want to check your biomarkers
01:06:30.319 and you just want to make sure that it
01:06:31.599 agrees with the intelligence of your
01:06:34.000 body So do some molecular profiling and
01:06:36.880 see if it’s a good fit Have you seen
01:06:38.640 people that stay on it for years and
01:06:40.160 have biomarkers yes Okay
01:06:43.680 And I think what’s important to
01:06:46.160 understand is that exercise performance
01:06:50.079 some sometimes can be adversely affected
01:06:53.599 by the ketogenic diet And that might be
01:06:56.319 an interesting experiment for you to do
01:06:58.240 like with your running and your 5K time
01:07:01.200 What a lot of athletes do is if they
01:07:05.359 want to experiment with a ketogenic diet
01:07:07.359 say they’re a cyclist and they’re trying
01:07:08.960 to get their weight down so that their
01:07:11.440 um power is up what what they tend to do
01:07:14.880 before a race is they add carbs back two
01:07:18.319 weeks before the race so that they’re
01:07:21.280 they’re filling their glycogen stores
01:07:23.520 And so that that’s another piece that
01:07:26.240 you may want to be tracking is your
01:07:27.760 exercise performance If I’m trying to
01:07:30.319 lose weight is there an optimal approach
01:07:33.839 to take because the ketogenic diet has
01:07:35.680 been the fastest way I’ve I’ve ever
01:07:37.280 discovered of losing weight quickly But
01:07:39.280 if you’re a man or woman trying to lose
01:07:41.520 weight specifically like that annoying
01:07:43.039 weight the belly fats those kinds of
01:07:44.640 things If someone comes to you and says
01:07:46.720 that what what do you say to them
01:07:49.520 what I like about the ketogenic diet for
01:07:52.000 weight loss and I’m really careful about
01:07:54.160 weight loss because it’s problematic
01:07:56.240 It’s problematic And I think body
01:07:58.960 shaming is a big problem And so I’m
01:08:00.960 really careful about this But when it
01:08:03.599 comes to a ketogenic diet what I like
01:08:05.280 about it is that ketones are really
01:08:08.839 satisfying So they increase your satiety
01:08:12.480 and I think it’s much more effective
01:08:14.880 than trying to limit your calories and
01:08:19.600 be in a calorie deficit So with a
01:08:21.839 ketogenic diet usually you do a calorie
01:08:24.238 deficit but you’re producing ketones
01:08:27.198 which are making you feel more satisfied
01:08:29.359 so you’re not standing in front of the
01:08:30.799 refrigerator wondering when the next
01:08:32.399 time is that you can eat
01:08:34.600 Mhm And what about
01:08:37.158 fasting you know there’s been a lot of
01:08:39.198 talk about autophagy and doing these
01:08:40.560 kind of long fasts to heal the body
01:08:42.880 What’s your perspective on that i think
01:08:45.198 there’s a time and a place for fasting I
01:08:47.198 think these ways of activating some of
01:08:49.920 the benevolent um pathways in the body
01:08:52.960 can be very good for you So it can be
01:08:54.960 good for mitochondria It can be good for
01:08:58.399 uh your hormone balance It can help you
01:09:00.238 with insulin as an example So you asked
01:09:03.198 about someone who was wanting to lose
01:09:05.520 weight and also wanting to address belly
01:09:07.520 fat I would say that’s a situation where
01:09:09.759 you really want to pay attention to
01:09:11.399 insulin So fasting can get you that So
01:09:14.719 can a ketogenic diet Often we combine
01:09:18.319 the two because you can induce
01:09:22.279 ketosis faster by doing intermittent
01:09:25.839 fasting together with a ketogenic diet
01:09:29.120 Is the ketogenic diet like a form of
01:09:31.120 fasting
01:09:33.520 you could think of it that way I mean I
01:09:35.520 would I would say it allows you to fast
01:09:37.600 and it makes the behavior change easier
01:09:41.630 [Music]
01:09:42.839 Um you know the thing about fasting is
01:09:46.479 there are some people who are really
01:09:48.000 good at it and it doesn’t raise their
01:09:50.238 cortisol It doesn’t induce a stress
01:09:52.319 response And then there are other people
01:09:54.158 who get very stressed with a ketogenic
01:09:57.760 diet or with fasting And so part of it
01:10:00.480 is is trying to get a sense of your own
01:10:04.600 response to the food that you’re eating
01:10:07.360 to see okay what suits me the best how
01:10:10.000 do I feel the best where is my cognitive
01:10:13.120 function at an optimal level what helps
01:10:15.920 me with brain fog what helps me with
01:10:18.640 allergies or whatever whatever symptoms
01:10:21.199 you’re tracking you know one of the
01:10:23.120 things we know with ketones which are
01:10:25.920 produced you know your body as you well
01:10:28.400 know is this It’s like a hybrid car that
01:10:33.199 can flip between burning gas which is
01:10:36.480 like glucose in this analogy or electric
01:10:40.640 which in this analogy is ketones The
01:10:43.679 thing about ketones is they’re they not
01:10:46.159 they’re not just a satiety molecule that
01:10:49.520 makes you feel satisfied They also have
01:10:53.000 anti-inflammatory aspects inside of the
01:10:55.280 body So they’re an important signaling
01:10:57.600 pathway There’s a reason why your body
01:10:59.360 produces ketones Now do you want to do
01:11:02.080 that for a
01:11:04.280 year we’d have to see We’d have to look
01:11:06.640 at your biomarkers You know the the
01:11:09.120 normal way that your genome developed
01:11:12.000 was to flip in and out of ketosis based
01:11:15.760 on the food supply And now that food is
01:11:18.840 abundant most people are not going into
01:11:21.280 ketosis Been able but being able to
01:11:23.520 switch back and forth can be very
01:11:25.600 healthy for you when people come to you
01:11:27.920 and they’re asking questions about
01:11:29.040 hormones these days you must have seen
01:11:30.560 in your career a shift in interest um on
01:11:34.320 the subject of hormones but but also a
01:11:37.120 certain a certain area of hormonal
01:11:40.239 health that people have a greater
01:11:41.440 obsession
01:11:43.000 with Of all the sub the subjects we’ve
01:11:45.760 talked about today relating to hormones
01:11:48.000 what is it that people are most
01:11:49.199 interested in right now
01:11:52.080 i would say for women it’s permenopause
01:11:58.080 And for anyone that doesn’t know what
01:11:59.199 permenopause is when does that begin and
01:12:02.239 what is it typically begins between 35
01:12:05.600 and 45 for women And it’s the age at
01:12:09.600 which your
01:12:11.480 ovaries start to run out of ripe eggs
01:12:14.640 And the mitochondria in your eggs are
01:12:16.320 not working the way that they once did
01:12:18.560 And so your ovaries are aging and that
01:12:21.600 leads to changes in your hormone levels
01:12:24.640 So a lot of people think of pmenopause
01:12:26.960 is mostly being a hormonal situation A
01:12:29.600 change in estrogen progesterone maybe
01:12:32.440 testosterone And what I think it’s
01:12:34.480 important to realize is it’s much
01:12:36.239 broader than that It’s your metabolic
01:12:38.920 system It’s the way that your brain is
01:12:41.280 responding to glucose It’s your immune
01:12:44.640 system It’s a time when more women have
01:12:47.520 the experience of autoimmunity and
01:12:49.280 autoimmune
01:12:50.360 disease So per menopause is this
01:12:53.280 incredibly dynamic time There’s more
01:12:55.440 than 100 plus symptoms that women
01:12:57.640 experience and it makes me crazy I was
01:13:00.239 just talking to my agent and my
01:13:02.560 publisher a couple weeks ago They’re
01:13:05.120 both women in their early 40s and they
01:13:08.239 were having symptoms you know some of
01:13:09.760 those hundred symptoms that are uh
01:13:12.960 characteristic of pmenopause They went
01:13:15.280 to their doctor and said “I’ve got these
01:13:17.280 mood swings I’m having trouble sleeping
01:13:20.320 Having some night sweats Is this
01:13:23.080 pmenopause?” And the doctor said “No
01:13:25.600 you’re too young.” So there’s a
01:13:28.080 knowledge gap There’s a research gap and
01:13:30.000 a knowledge gap and a huge treatment gap
01:13:32.960 for women who are in
01:13:34.679 pmenopause Most women are not getting
01:13:36.719 the treatment that they
01:13:38.199 need So what are they asking about out
01:13:41.360 there asking
01:13:42.520 about why do I feel so disregulated why
01:13:46.400 is it that I can’t manage stress the way
01:13:48.480 I once did why would I rather mop the
01:13:51.600 floor than have sex with my husband why
01:13:54.880 is sex painful all of a sudden why do I
01:13:58.880 have this belly fat that appeared out of
01:14:01.040 nowhere and my usual techniques for how
01:14:03.360 to deal with that aren’t working those
01:14:06.080 are some of the questions that they ask
01:14:07.920 which map to your hormones And what is
01:14:10.000 the youngest you’ve ever seen someone
01:14:11.440 enter permenopause
01:14:13.679 well I see women who have premature
01:14:16.400 ovarian
01:14:17.719 insufficiency which is when you go
01:14:20.800 through menopause before age
01:14:22.760 40 So I’ve seen a fair amount of that
01:14:25.600 You know
01:14:26.760 probably 50 patients over the course of
01:14:29.679 my career It’s relatively rare And then
01:14:31.920 I see women who have early menopause
01:14:34.400 which is when they stop having their
01:14:36.239 periods or they have an FSH level of 25
01:14:40.640 to 30 And FA what’s FSH follical
01:14:43.360 stimulating hormone It’s one of the
01:14:44.800 control hormones for your estrogen and
01:14:46.960 progesterone in the body So if that
01:14:50.080 occurs they have their final menstrual
01:14:51.679 period between 40 and 45 That’s
01:14:54.320 considered early menopause
01:14:57.120 So there’s this really dynamic time
01:14:59.520 where your hormones are wildly
01:15:01.760 fluctuating especially estrogen
01:15:04.159 Progesterone is declining and women have
01:15:07.239 this increase in the symptoms that they
01:15:11.800 experience and no one is really tracking
01:15:14.239 it carefully That’s what needs to change
01:15:18.480 tracking it through their blood samples
01:15:20.800 blood samples
01:15:22.520 and connecting their symptoms to what is
01:15:25.960 happening in their ovaries in their
01:15:28.480 immune system in their metabolic system
01:15:30.960 and putting it together for them and
01:15:32.880 offering them options You believe that
01:15:36.159 many of the symptoms of menopause are
01:15:39.520 avoidable yes Yes And by that I mean
01:15:43.520 using hormone therapy and using
01:15:46.000 lifestyle medicine as early as possible
01:15:49.040 to manage that transition Because when a
01:15:51.199 woman goes to a doctor now that doctor
01:15:53.920 might say “Well you’re you’re getting
01:15:55.199 older This is what happens.” Or they
01:15:57.360 might just completely miss it That’s
01:16:00.280 right Or they might get started on a
01:16:02.640 birth control pill That’s used a lot for
01:16:05.679 women who are in menopause And I don’t
01:16:07.679 think that’s the right solution What do
01:16:10.000 you think of birth control pills
01:16:12.640 i think if they help you avoid
01:16:15.719 surgery they can be beneficial but I
01:16:18.960 think they’re way overused in our
01:16:21.239 culture And most people who agree to a
01:16:24.159 birth control pill don’t receive full
01:16:26.560 informed consent They’re not told that
01:16:30.080 it’ll raise the inflammation in your
01:16:32.000 body by two to threefold It increases
01:16:34.560 your risk of autoimmune disease
01:16:37.120 especially Crohn’s disease
01:16:39.600 It makes your control system for your
01:16:42.600 hormones less
01:16:45.000 flexible It can rob you of testosterone
01:16:48.239 It can lower your free
01:16:50.920 testosterone It can shrink your clitoris
01:16:53.280 by up to 20% I feel like if that was
01:16:56.080 part of the informed consent very few
01:16:57.760 people would sign up for it
01:17:00.560 But who is the birth control pill for
01:17:03.120 then you know I used to think that it
01:17:05.280 was a feminist invention that it was a
01:17:07.679 way
01:17:08.760 of putting your fertility in your hands
01:17:12.719 And I went on the birth control pill
01:17:14.080 when I was 16 But I feel like there are
01:17:18.560 some costs to it that um a lot of
01:17:23.120 teenagers and women in their 20s and 30s
01:17:25.679 aren’t aware of And for me I feel like
01:17:29.040 that awareness is really critical So
01:17:31.840 who’s it for i would say it’s a simple
01:17:34.640 entree into
01:17:36.520 contraception but I would much rather
01:17:39.840 people use things like an IUD or condoms
01:17:44.560 or some other barrier method that
01:17:46.719 doesn’t mess with their hormonal
01:17:49.120 intelligence
01:17:50.640 How are you doing
01:17:52.880 oh quite good Quite good I love that
01:17:58.520 question I went through a divorce two
01:18:01.440 years ago And I feel like you know I my
01:18:05.120 I have two daughters They both went off
01:18:06.880 to college and were out of the house And
01:18:10.560 I realized
01:18:11.960 that my time with my now
01:18:16.199 ex-husband had run its course and we
01:18:20.400 came together to create this beautiful
01:18:22.400 family but we were no longer a good fit
01:18:24.960 for each other So a big part of my
01:18:27.840 spiritual work has been coming to terms
01:18:29.920 with that and
01:18:34.280 um and really getting clear about okay
01:18:39.199 for the second half of my life what is
01:18:41.840 it that I
01:18:42.920 want what is my mission how do I support
01:18:46.679 that how do I only give a whole body
01:18:51.480 yes to um the things that I say yes to
01:18:56.239 how do I whole body yes What does that
01:18:58.640 mean whole body Yes So this is something
01:19:00.159 I learned
01:19:01.480 from one of my mentors Diana
01:19:04.679 Chapman Um she learned it from I believe
01:19:08.640 Katie
01:19:09.960 Hendricks who’s a therapist The idea is
01:19:13.520 that instead of saying yes to things
01:19:16.239 that you’re
01:19:17.320 offered purely from a cognitive place
01:19:20.800 that sounds like a good idea Sounds like
01:19:22.400 a good opportunity Let me do it Instead
01:19:25.120 you check up check in with your whole
01:19:26.960 body You check in with your heart You
01:19:29.280 check in with your your gut Does this
01:19:32.080 really make a difference in the world is
01:19:34.400 this something that’s going to make
01:19:36.120 me jump out of bed in the morning is
01:19:39.360 this something that is worth the time
01:19:41.760 and the
01:19:43.080 effort i’m a little older than you and
01:19:45.760 so I hold these opportunities a little
01:19:48.239 bit differently than I did in the past
01:19:51.440 How long were you married for how long
01:19:52.880 were you in a relationship with your
01:19:54.640 partner we were together for about 22
01:19:57.920 years and married for 20
01:20:00.640 How does one know that it’s not right
01:20:02.840 anymore after 20 odd years
01:20:07.440 well I would love to riff on this with
01:20:09.199 you Okay So I can tell you
01:20:12.760 that part of the challenge in my
01:20:16.080 marriage was that
01:20:20.040 um we had difficulty talking about
01:20:23.960 difficult topics So highly charged
01:20:27.360 topics were tough for us to be able to
01:20:30.120 navigate When we had a conflict or a
01:20:33.800 fight we didn’t repair very well There
01:20:37.760 was a partial repair where you would
01:20:41.120 feel good enough to keep functioning and
01:20:43.040 take care of the kids and do your
01:20:44.800 householder stuff but you didn’t really
01:20:47.320 feel seen or like you cleaned up the
01:20:50.560 pain that was
01:20:53.800 there There was a way
01:20:56.120 that I didn’t feel fully understood or
01:20:59.960 seen And not that I require that from my
01:21:03.040 partner but I I felt
01:21:05.640 like there was a
01:21:09.719 misatunement And I’m in a relationship
01:21:12.080 now where I have those things that I’m
01:21:14.719 talking about And it’s someone that I
01:21:17.600 have known for 30 plus years We were
01:21:19.840 interns together at UCSF
01:21:23.360 And I realize now
01:21:25.880 that you know I came together with my
01:21:28.480 ex-husband and I really am so blessed by
01:21:32.560 the life that we had and um the family
01:21:35.600 that we had
01:21:38.040 but we also had a trauma bond There was
01:21:41.760 a way that his trauma kind of
01:21:43.920 intersected with my trauma and we hung
01:21:46.640 in there for a very long
01:21:49.560 time probably longer than we should have
01:21:53.280 So how do you
01:21:55.480 know i don’t know Stephen I just can
01:21:58.159 tell you
01:21:59.480 that there was a way
01:22:01.960 that our
01:22:05.400 interactions was creating
01:22:08.040 disregulation in my body And I’m not
01:22:10.320 blaming him I you know it’s a two
01:22:14.159 there’s two sides of the street But
01:22:16.480 there was a way that we just we didn’t
01:22:19.000 quite gel together
01:22:22.239 And is that not something that can be
01:22:23.679 prepared through communication and
01:22:25.840 therapy or sitting down and I mean you
01:22:28.080 would hope so but we spent about 10
01:22:30.639 years out of the 20 years of marriage in
01:22:32.719 couples
01:22:34.120 therapy and it didn’t really resolve
01:22:38.000 some of these conflicts
01:22:44.639 We got better at eye statements We got
01:22:46.800 better at saying what we were feeling
01:22:49.600 and not blaming We got better at
01:22:54.040 um going for a walk when we were talking
01:22:56.560 about something
01:22:58.600 difficult But there was still a way that
01:23:01.440 I felt alone and lonely inside of the
01:23:07.320 relationship And I decided I think a
01:23:10.159 fair number of women decide this I
01:23:11.840 decided I was better off alone than to
01:23:14.719 continue in the marriage When people
01:23:17.600 hear that that weren’t in your situation
01:23:19.040 they might think okay so maybe he was
01:23:22.719 preoccupied with something else or he
01:23:26.400 was he worked away When you say the word
01:23:28.800 lonely these are the kind of things we
01:23:30.000 think We think of
01:23:31.320 proximity But you’re saying it I’m
01:23:34.000 guessing it wasn’t proximity
01:23:36.639 It wasn’t proximity I think it
01:23:39.639 was there was a way that we had a hard
01:23:44.360 time expressing love and feeling and
01:23:47.199 receiving
01:23:48.679 love There was an
01:23:50.760 obstacle and some of it was trauma And
01:23:54.080 the good news is there’s a lot you can
01:23:55.840 do to resolve trauma
01:24:01.480 But there was a way that
01:24:04.760 I I got to the point where I couldn’t
01:24:08.639 try any longer I tried for a lot of
01:24:11.639 years and I just couldn’t keep trying
01:24:15.199 When you look back is there something
01:24:17.960 that could have been done further
01:24:20.639 upstream to prevent you getting to this
01:24:23.600 place in your view yeah it’s such a it’s
01:24:27.520 a great question You know one of the
01:24:28.960 things that I’ve seen that has helped to
01:24:30.880 resolve trauma better than anything
01:24:34.199 else
01:24:35.800 is psychedelic assisted
01:24:39.159 therapy It’s a way of looking at your
01:24:41.760 story a way of looking at the facts of
01:24:43.760 your life with
01:24:46.560 um more
01:24:48.199 objectivity and it’s a way of resolving
01:24:50.719 the way that trauma becomes embedded in
01:24:53.199 your system
01:24:54.880 And so I started doing psychedelic
01:24:57.199 assisted therapy about five years ago
01:25:00.960 with the hope that it would help me with
01:25:03.280 my
01:25:04.199 marriage And what I had hoped over time
01:25:07.760 is that I would do my part to resolve
01:25:11.679 the trauma signature in my own body and
01:25:14.560 that maybe we would do psychedelic
01:25:17.120 medicine together as a way of
01:25:19.280 reconnecting to the love that we felt
01:25:21.840 for each other and you know kind of get
01:25:24.000 the noise turn down the volume on the
01:25:28.199 noise and we weren’t able to do that He
01:25:32.080 wasn’t willing to he wasn’t willing he
01:25:34.400 wasn’t open to psychedelics
01:25:38.000 and not everyone is I’m not blaming him
01:25:40.400 for that Um and I think there’s other
01:25:42.800 ways to create healing states of
01:25:44.679 consciousness You know breath work can
01:25:46.719 do it Um a near-death experience peak
01:25:50.400 experiences can do it flow states
01:25:52.639 there’s lots of different ways to create
01:25:54.080 these healing states of consciousness
01:25:56.560 but we weren’t able to get into that
01:25:59.440 healing state together
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01:27:02.000 health That’s zoie.com with code Steven
01:27:05.639 10 One of the things I’ve been told by
01:27:07.760 one of the menopause experts that you
01:27:09.199 mentioned earlier Lisa was that when
01:27:11.760 women get to menopausal a menopausal age
01:27:16.320 when they’re in menopause they often
01:27:19.600 have greater clarity in what they want
01:27:21.199 in their life That’s what she said to me
01:27:23.679 and she said that she we see divorce
01:27:27.000 rates increase during this period of
01:27:29.440 life Is that true it is true It is true
01:27:34.000 Yeah The way it was explained to me by
01:27:36.400 one of my mentors was that when you’re
01:27:39.760 in your reproductive years so
01:27:42.920 premenopause you’ve got a different
01:27:44.800 level of estrogen progesterone and
01:27:46.400 testosterone every day And it makes you
01:27:49.080 accommodate makes you kind of roll with
01:27:51.520 the punches
01:27:53.280 And it sets up this level of
01:27:56.760 flexibility that starts to disappear
01:27:59.920 when you go through pmenopause and
01:28:01.800 menopause And so the way my mentor
01:28:04.880 described it was that the hormonal veil
01:28:08.800 is lifted and you start to speak your
01:28:11.840 truth and not
01:28:13.800 accommodate You speak your truth maybe
01:28:16.000 for the first time about the state of
01:28:18.080 your marriage about the things that
01:28:19.360 you’re happy about the things that
01:28:20.800 you’re not happy about and it does lead
01:28:23.920 to an increased rate of divorce
01:28:28.080 What about your happiness levels does it
01:28:30.000 increase your happiness levels i think
01:28:31.840 it does There’s this really interesting
01:28:34.159 study that um is called the UBend and it
01:28:38.000 looks at psychological well-being for
01:28:40.719 adults
01:28:42.639 It’s highest in your 20s and the very
01:28:45.679 start of your 30s and then there’s this
01:28:48.080 U shape where your psychological
01:28:50.159 well-being goes down I know you’re 32 so
01:28:52.239 I’m a little sorry to break the news to
01:28:53.760 you And then it goes back up right
01:28:56.239 around 50 So psychological well-being
01:28:59.199 goes up again And when I first heard
01:29:02.320 about this Ubend I remember reading an
01:29:04.800 article in The Economist about it It was
01:29:09.040 so validating because it made me feel
01:29:11.120 like
01:29:12.440 oh things are really hard Makes sense to
01:29:15.679 me that we see this through your 30s and
01:29:18.320 40s and then it starts to have this
01:29:20.080 uptick again And I think there are ways
01:29:22.400 to improve your psychological well-being
01:29:24.159 so that you’re not stuck in the Ubend
01:29:26.639 But happiness yes I would say happiness
01:29:30.639 psychological
01:29:32.120 well-being is high again in your 50s
01:29:37.280 I know that there’s so many women that
01:29:39.040 listen to this show Um and I get so many
01:29:41.679 messages when we have conversations
01:29:42.960 about women’s health hormonal issues
01:29:45.520 menopause because women for a long
01:29:48.239 period of time haven’t feel like haven’t
01:29:50.080 felt like they’ve been heard and
01:29:51.679 understood Um they often feel like
01:29:53.600 they’re being gaslit a little bit maybe
01:29:54.960 by their doctors or by some of the
01:29:56.960 information out there So this is quite
01:29:59.440 atypical of me but you know women better
01:30:02.239 than I do and you know what women are
01:30:04.159 concerned about in all seasons of their
01:30:06.159 life what they’re worried about what
01:30:07.440 they’re confused about So I want to just
01:30:09.920 open the floor to you and ask you based
01:30:12.960 on all of the work that you’ve done You
01:30:14.800 know you’ve done work on um women’s
01:30:17.440 hormones diets lifestyle sex drives
01:30:21.360 reclaiming their balance sleep healthy
01:30:23.760 weight for both men and women but I’m
01:30:25.840 asking specifically for women here So
01:30:28.000 with all of that in mind what is the
01:30:30.320 question that I should be asking you
01:30:34.960 how do we do a better
01:30:37.159 job supporting women
01:30:40.159 how do we do a better job supporting
01:30:41.600 women yes How do we do it
01:30:43.560 systemically how do we do it in terms of
01:30:47.920 health care for women but I would say in
01:30:51.280 particular for you with the platform
01:30:53.600 that you
01:30:55.960 have the women’s health gap that we’re
01:30:59.040 facing right now which has only gotten
01:31:01.280 worse over the 30 years of my career I
01:31:04.480 think to ask how do we help women
01:31:08.600 rise how do we make systemic changes so
01:31:12.239 that we don’t have this women’s health
01:31:14.159 gap let’s close the gap How do we do
01:31:16.159 that together
01:31:18.080 i have a question for you
01:31:23.360 Can you guess what the question is i
01:31:25.440 have an idea Go on then
01:31:29.600 So the women’s health gap I believe is
01:31:32.880 rooted in two things Sex
01:31:35.880 differences you know having two X
01:31:37.920 chromosomes versus XY in men hormonal
01:31:41.560 differences these life cycle cycle
01:31:44.000 changes that women go through like
01:31:46.639 postpartum pregnancy pmenopause
01:31:49.440 menopause
01:31:51.520 But then there’s also gender differences
01:31:54.800 which are socially
01:31:56.360 constructed And that includes women
01:31:59.120 having more than their share of
01:32:00.880 emotional labor women having more stress
01:32:04.719 than men experiencing more stress women
01:32:07.840 having more trauma so they have higher A
01:32:10.400 scores than men And it’s led to if we
01:32:15.360 just look at the statistics double the
01:32:17.600 rate of depression double the rate of
01:32:19.520 PTSD post-traumatic stress disorder
01:32:22.000 double the rate of insomnia four times
01:32:24.320 the rate of autoimmune disease nine
01:32:26.560 times the rate of thyroid dysfunction So
01:32:29.600 there’s sex differences that map to
01:32:32.159 those outcomes but then there’s these
01:32:34.320 gender
01:32:35.960 differences in the way that women don’t
01:32:38.880 feel supported the way that they feel
01:32:41.600 conflicted in trying to create work life
01:32:44.280 balance the way that they experience
01:32:47.360 more
01:32:48.920 stress That’s what we need to address We
01:32:51.920 can’t change the biology but we can
01:32:54.920 change the gender differences we can
01:32:57.679 change the socially constructed
01:33:00.000 differences that lead to it being a
01:33:03.040 health hazard to be female
01:33:05.600 Okay So tell me about that then What is
01:33:07.280 it about the socially constructed
01:33:10.000 narrative of what it is to be a man and
01:33:11.520 a woman that
01:33:13.719 is causing unfavorable outcomes for
01:33:16.639 women there’s a lot of things So I would
01:33:21.239 say what we know if you look
01:33:26.280 at the nervous system we know that women
01:33:30.719 tend to have more um imbalance between
01:33:35.360 the sympathetic nervous system and the
01:33:36.880 parasympathetic nervous system What’s
01:33:38.719 that so the sympathetic nervous system
01:33:40.719 is fight flight freeze
01:33:43.679 The parasympathetic nervous system is
01:33:46.320 rest and digest feed and breathe So stay
01:33:49.600 and play is relax chill play Relax chill
01:33:52.800 That’s where the healing happens And
01:33:55.600 we’re not meant to hang out in one or
01:33:57.360 the other We’re meant to have this fluid
01:33:58.960 balance between the two Ideally like a
01:34:02.080 50/50 split And so women tend
01:34:06.199 to in dealing with our culture have more
01:34:09.520 sympathetic
01:34:10.840 activation And so finding ways to
01:34:13.600 address that more stress more stress So
01:34:17.600 at least in the US we do these annual
01:34:19.840 stress reports and we find that on
01:34:22.480 average women have about 10% more stress
01:34:25.199 than men
01:34:27.960 Why is that just because they’re more
01:34:31.920 likely to report it or is there a
01:34:33.679 biological or evolutionary reason why
01:34:35.800 they’re more stressed i don’t think it’s
01:34:38.880 biological I think it’s related
01:34:42.600 to power imbalances I think it’s related
01:34:45.760 to
01:34:46.679 patriarchy I think it’s related to power
01:34:51.239 over So for instance with these A scores
01:34:55.040 the trauma scores the trauma scores we
01:34:57.360 know that women experience more trauma
01:35:00.239 than men about 10% more similar to
01:35:02.760 stress And they also experience trauma
01:35:06.639 at an earlier age compared to men They
01:35:09.520 have much more sexual violence They’re
01:35:12.560 14 times more likely to be raped than a
01:35:14.880 man So there are ways that our culture
01:35:18.080 has allowed women to be
01:35:22.440 violated and that has to end How do we
01:35:26.080 do that i don’t know This is where we
01:35:28.320 need to riff and figure out how do the
01:35:31.679 systems change so that there’s a more
01:35:34.880 equal distribution of power
01:35:37.920 Are women more
01:35:40.280 sensitive so if you put a man and a
01:35:43.280 woman or a boy and a girl in the same
01:35:46.320 stressful environment would they have
01:35:48.560 different
01:35:50.199 biological markers like biomarkers would
01:35:53.600 you see higher levels of cortisol in the
01:35:55.639 woman or higher cortisol levels in the
01:35:58.080 man i don’t know the answer to that My
01:36:00.800 sense is from the work of Elaine Erin
01:36:04.239 who’s done the work on this profile of
01:36:06.400 high sensitivity that it’s about equal
01:36:08.719 in men and women but I don’t know that
01:36:10.400 for sure I’d have to fact check that Do
01:36:13.360 you see higher rates of autoimmune
01:36:15.440 diseases in women or men women
01:36:19.280 Forex Forex Yes 400% more autoimmune
01:36:22.880 diseases and women Yes And what are
01:36:25.600 these autoimmune diseases what’s an
01:36:27.120 example of one so there’s about 100
01:36:29.679 autoimmune diseases It includes things
01:36:31.600 like rheumatoid arthritis multiple
01:36:34.040 sclerosis type 1 diabetes Hashimoto’s
01:36:37.520 thyroiditis which is the leading cause
01:36:39.360 of low thyroid function
01:36:42.320 uh
01:36:44.679 psoriasis there’s a long list And why
01:36:47.840 are women getting these autoimmune
01:36:49.760 diseases 400% more than men we don’t
01:36:52.960 know So the speculation is that it’s
01:36:55.679 related to both biological differences
01:36:59.360 sex differences as well as gender
01:37:01.760 differences So the biological
01:37:03.520 differences include the difference in
01:37:06.719 the levels of hormones the X chromosome
01:37:11.440 Women have more for instance vaccine
01:37:13.679 response compared to men our immune
01:37:16.080 system is more
01:37:19.480 um reactive in some ways than the immune
01:37:23.040 system of men But then there’s also
01:37:25.360 these gender differences these socially
01:37:27.600 constructed differences like women who
01:37:30.480 have a hard time saying no Women who
01:37:33.040 give until they drop who
01:37:34.920 overfunction who are trained when they
01:37:37.679 go through their childhood
01:37:40.360 to take care of others at the expense of
01:37:43.360 their own self-care
01:37:45.920 And so how these interact and lead to a
01:37:49.520 four-fold increased risk in women we
01:37:51.920 don’t entirely know but definitely we
01:37:55.040 see four times the rate in women What’s
01:37:57.760 your view there’s a big debate that’s
01:37:59.360 always raging on about gender roles in
01:38:02.920 society and there’s obviously been a big
01:38:05.040 shift over the last couple of decades in
01:38:06.800 I think actually in part caused by the
01:38:08.639 introduction of the contraceptive pill
01:38:10.400 which has meant that women are working
01:38:12.320 more I think in the western world and
01:38:14.320 these numbers might be wrong there’s
01:38:16.159 less babies being born men and women are
01:38:18.560 having less sex with each other men are
01:38:20.800 killing themselves more often
01:38:23.360 women are having coming into puberty
01:38:25.760 earlier I believe or is it later it’s
01:38:27.360 earlier
01:38:28.320 and then having ch less children and
01:38:31.840 significantly later Funnily I saw a
01:38:34.400 graph yesterday which showed the rise in
01:38:36.800 breast cancer amongst women And actually
01:38:39.199 I think it was actually no it was the
01:38:40.480 rise in all cancers amongst women versus
01:38:43.119 men And the men graph was pretty flat
01:38:45.920 but there was this significant rise in
01:38:48.080 women getting more and more forms of
01:38:49.520 cancer And I was looking through some of
01:38:51.960 the research as to why that would happen
01:38:55.040 And one of them one of the points of
01:38:56.960 research said that because women are
01:38:58.560 having children
01:39:00.280 later that this is in causing a rise in
01:39:03.440 cancer
01:39:05.440 Does that make sense well that has been
01:39:08.000 studied with for instance breast cancer
01:39:10.800 Okay So we know you know there’s a lot
01:39:12.960 of different factors that can increase a
01:39:15.840 woman’s risk of breast cancer One of
01:39:18.080 them is the age at which you have your
01:39:20.560 first baby And so the way that we think
01:39:23.280 of this is that it’s related to estrogen
01:39:26.199 exposure So women who get pregnant and
01:39:30.000 maybe they breastfeed for a year that’s
01:39:32.639 often a period of time like a year and 9
01:39:34.960 months where they’re not exposed to as
01:39:37.600 much
01:39:38.600 estrogen than they would be if they were
01:39:40.800 menstruating during that time And so
01:39:43.520 having babies later seems to be
01:39:45.440 associated with a greater risk of breast
01:39:47.199 cancer The ideal age I was taught when I
01:39:50.239 went through my training for having a
01:39:51.679 baby is
01:39:52.760 24 And I don’t have a single friend
01:39:55.440 who’s had a baby in their 20s Is there
01:39:58.639 something we’re getting wrong with
01:39:59.600 gender roles when you think about our
01:40:00.880 biology and our hormones i really love
01:40:03.760 the the questions I mean they’re thought
01:40:05.880 experiments So yes I do think there’s
01:40:08.159 something we’re getting wrong You had a
01:40:09.920 guest recently who was talking about sex
01:40:11.760 span Oh yeah in the period of time that
01:40:14.239 you’re sexually active and satisfied
01:40:16.880 with sex And I I do feel like we’ve got
01:40:19.760 an epidemic of sexless marriage People
01:40:23.520 who are not having as much sex who don’t
01:40:26.000 realize how important pleasure is
01:40:28.239 especially for the nervous system and
01:40:30.080 for regulation Orgasm is one of the most
01:40:32.800 effective strategies for creating
01:40:35.040 nervous system regulation for dropping
01:40:37.679 into your parasympathetic nervous system
01:40:39.119 for dropping into your parasympathetic
01:40:41.280 And what we know is that
01:40:43.920 um you know with with gender roles and
01:40:48.280 with what’s happened with
01:40:51.880 work we’ve lost some of the polarity
01:40:54.880 between
01:40:56.760 um men and women I mean I imagine you
01:40:59.520 also have listeners who are gay men or
01:41:03.440 uh lesbian couples So I want to be
01:41:05.199 mindful of being inclusive here But I
01:41:07.600 think we’ve lost a lot of polarity
01:41:11.119 And polarity exists in all kinds of
01:41:13.280 relationships as well doesn’t it to some
01:41:14.880 degree it does but sometimes you have to
01:41:16.800 work at it Sometimes you have to create
01:41:19.040 the polarity When you say polarity if
01:41:21.199 we’re talking about heterosexual
01:41:22.320 relationships what is the polarity that
01:41:24.320 you think we’ve lost i would say right
01:41:27.040 now in my 50s I’m having the best sex of
01:41:29.760 my life the best orgasms of my life and
01:41:33.280 there’s a lot of polarity in my
01:41:35.560 relationship And I’ve learned that
01:41:39.600 um this is pretty controversial and edgy
01:41:42.320 so I’m I’m just gonna say it anyway I
01:41:44.880 feel like for women who
01:41:46.920 are professionals who work really hard
01:41:51.119 there are some ways that polarity can be
01:41:54.000 really helpful in the
01:41:56.440 bedroom And here I’m talking about um
01:42:00.000 gender roles and you know understanding
01:42:03.440 sort of what what is satisfying for you
01:42:06.639 sexually and asking for it in your
01:42:11.239 relationship A lot of the professional
01:42:13.280 women that I
01:42:15.000 know they enjoy vanilla sex but they
01:42:18.800 also
01:42:22.119 like a weave of domination
01:42:25.760 to be dominated or to dominate both I
01:42:29.440 mean it’s a personal preference but I
01:42:31.840 think there’s a way that it’s a way of
01:42:34.880 playing with power that I think can
01:42:39.400 be sexually very
01:42:42.760 satisfying What do you think do you
01:42:45.520 think it’s important in sexual
01:42:48.119 relationships to have polarity to have
01:42:51.520 um to have like the feminine and
01:42:54.400 masculine
01:42:55.880 attributes or do you think you both just
01:42:58.639 come to a sexual connection equals and
01:43:01.760 that’s how it should always be i think
01:43:03.760 probably the answer is that everybody
01:43:06.719 has their own favorite flavor of ice
01:43:09.560 cream And I can only speak to my
01:43:12.080 favorite flavor of ice cream which is I
01:43:16.119 like I don’t like vanilla Mhm ice cream
01:43:20.320 It’s not my favorite flavor And I think
01:43:23.679 I do like to be more dominant That turns
01:43:27.760 me on Mhm And I like to vary it cuz I’ll
01:43:31.920 get bored Especially if you’re in a long
01:43:33.520 relationship you got to find
01:43:34.719 some way to spice it up So yes you do
01:43:36.719 I’m buying all kinds of stuff off the
01:43:38.320 internet to try and you know keep it
01:43:40.880 novel and new Okay Now things are
01:43:43.040 getting interesting Oh really yes Well I
01:43:45.600 honestly I’ve landed here in LA and
01:43:47.119 before I even landed I ordered loads of
01:43:48.639 stuff just to be at the house when I got
01:43:49.840 here Fantastic
01:43:52.880 It’s probably because my team are
01:43:54.000 listening but I No but I do because
01:43:57.520 I’m like I have I have to I like try and
01:44:00.480 plan sex to be interesting Yes Which is
01:44:03.840 it’s like a part-time job It is What’s
01:44:06.880 the alternative the alternative is it
01:44:08.400 just fizzles out and gets boring and
01:44:09.679 then it’s the same And um but also I
01:44:12.560 think I play with distance because of
01:44:14.800 the way my schedule is So I don’t see my
01:44:16.719 partner for a couple of weeks and then
01:44:17.840 we see each other and then we go away
01:44:19.679 again And so it kind of keeps it a
01:44:21.600 little bit more novel and stuff and
01:44:23.520 interesting I try and make sure that I
01:44:25.520 stay attractive Part of I told her I
01:44:27.920 said part of the reason I go to the gym
01:44:29.040 every day is because we signed a
01:44:32.639 contract Mhm Not a real contract but we
01:44:35.119 signed a contract when we met each other
01:44:36.320 that we’d stay attractive and that’s
01:44:37.600 intellectually attractive that’s
01:44:38.560 physically attractive it’s whatever So
01:44:41.360 so yeah I think a lot about it That’s
01:44:44.040 fantastic It’s a good strategy And I
01:44:47.280 appreciate how you are being very
01:44:50.520 intentional about your sex life Is this
01:44:54.159 in part why you knew the old
01:44:55.600 relationship wasn’t working yes
01:44:58.800 Just fizzled It fizzled And I’m a very
01:45:03.199 sexual
01:45:04.199 person Eroticism really matters to me
01:45:08.400 And to not have that be front and
01:45:11.159 center felt like a death
01:45:15.119 And you tried to revive keep alive Yes
01:45:20.239 People can relate I know this because I
01:45:23.520 see much of the feedback I get on the
01:45:25.280 episodes where we talk about sex People
01:45:27.520 often are
01:45:28.679 struggling with a dying whimpering sex
01:45:34.840 life Again I ask
01:45:37.639 you is there anything that can be done
01:45:40.960 is it
01:45:42.360 prevention is that is that the key here
01:45:45.040 or is it about making sure you’re in a
01:45:47.360 relationship with someone who’s sexually
01:45:49.119 open-minded
01:45:51.360 and I also I guess the third question
01:45:52.800 here would be was it ever good
01:45:56.000 so let me feel a way into answering your
01:45:58.880 questions I feel like
01:46:01.000 there’s there’s some sex differences too
01:46:04.159 Um biological differences
01:46:07.000 between
01:46:08.520 what the male sexual response and the
01:46:11.600 female sexual response and that needs to
01:46:14.880 be understood I feel like when you have
01:46:18.159 sexual dysfunction in a relationship
01:46:20.400 it’s a couple’s issue It’s never one
01:46:22.560 person or the other It’s it’s a couple’s
01:46:25.040 issue that you want to address as a
01:46:27.400 couple What we know is that men are a
01:46:31.280 little simpler there tends to be desire
01:46:36.600 um you know uh this physiological change
01:46:39.920 that occurs in terms of blood flow and
01:46:43.440 an erection and and then there’s a um
01:46:47.040 plateau phase and then orgasm
01:46:51.080 ejaculation we can talk about separating
01:46:53.679 ejaculation from orgasm in a minute but
01:46:56.719 in women it’s more complicated so that
01:46:59.600 was the masters and Johnson way of
01:47:01.679 thinking about the the sexual response
01:47:03.920 Master St Johnson Masterson and Johnson
01:47:06.800 and now we know sorry Masterson Johnson
01:47:09.840 they were sexyologists that published
01:47:11.920 this particular model Yeah And it wasn’t
01:47:14.400 until maybe 15 20 years ago that
01:47:17.360 Rosemary Basson at the University of
01:47:19.520 British Columbia found that women have a
01:47:21.760 different response It’s more circular
01:47:24.400 and it has to do
01:47:26.679 with feeling
01:47:29.719 um emotionally
01:47:32.520 connected in order to be
01:47:36.199 receptive to having sex with their
01:47:39.040 partner Whereas men in some ways do the
01:47:42.520 opposite And I’m curious if this is true
01:47:44.719 for you They need to have sex in order
01:47:47.280 to feel emotionally connected Women
01:47:49.600 actually need the emotional connection
01:47:51.800 first to be
01:47:54.280 receptive to sexuality And so this leads
01:47:58.000 to a lot of disconnect and it includes
01:48:00.800 things like how many times in the past
01:48:03.360 week did you empty the dishwasher there
01:48:05.440 are things that create emotional
01:48:07.280 connection that a lot of men don’t
01:48:10.520 realize And then for women they often
01:48:14.320 don’t feel
01:48:16.440 um like they they the sexual
01:48:22.119 response will not happen unless they
01:48:24.960 feel emotionally
01:48:26.679 connected And this was part of the
01:48:28.719 problem in my own marriage was that I
01:48:30.719 didn’t feel that emotional connection I
01:48:32.719 tried really
01:48:34.040 hard to establish that emotional
01:48:37.560 connection but I didn’t have it
01:48:41.440 I have it now Is it related to the
01:48:43.440 newness of my relationship
01:48:45.320 maybe And knowing that knowing about the
01:48:48.800 emotional
01:48:51.560 connection in some ways changes your
01:48:55.080 homework as a man Do you know what makes
01:48:59.199 your girlfriend feel emotionally
01:49:00.800 connected
01:49:02.320 quality time Deep questions Yes
01:49:07.719 Um the conversation cards Oh yes Tell me
01:49:13.119 about that Well we sell these
01:49:14.639 conversation cards on this show You can
01:49:16.719 check in the uh description below if you
01:49:18.560 want to buy them But basically at the
01:49:20.000 end of the conversations on this podcast
01:49:22.239 the guests write a question in this
01:49:23.840 diary in front of me for the next guest
01:49:26.800 And then these all become Yeah thanks
01:49:29.440 These all become conversation cards
01:49:32.440 Unlock deeper levels of connection Open
01:49:35.600 up to open up Level three is the the
01:49:38.639 more deep questions So Oh I like it Um
01:49:41.040 this I’m probably a level three person
01:49:43.679 You’re a level three person I would
01:49:45.119 imagine You strike me as a level three
01:49:46.840 person You really do But those kinds of
01:49:49.119 things So like deep um deep questions
01:49:51.600 and spending time and then that’s it Can
01:49:53.600 I see some of those level threes yeah
01:49:55.280 here are all your level threes What is
01:49:57.760 the most important thing we haven’t
01:49:58.800 talked about that we should have talked
01:50:00.920 about is there anything else
01:50:04.800 sleep is something we didn’t talk about
01:50:07.040 when we think about the impact sleep has
01:50:08.719 on our hormonal
01:50:10.199 balance Is it important my gosh Sleep is
01:50:14.000 as close to a panacea as we have When
01:50:16.880 you say panacea you mean like the holy
01:50:18.560 grail it is the holy grail It is so
01:50:21.040 critical for functioning You know what I
01:50:23.679 see taking care of a lot of executives
01:50:25.440 is that they think that they’re the
01:50:27.760 exception that they don’t need 78.5
01:50:30.960 hours of sleep every night But only
01:50:33.679 about 2% of the population has the short
01:50:36.080 sleep gene The rest of us need
01:50:39.800 to optimize our sleep to the best of our
01:50:43.719 ability So what we know is that it
01:50:46.480 affects your hormones inside of 24 hours
01:50:49.600 One bad night of sleep raises your
01:50:52.159 insulin raises your cortisol the next
01:50:54.560 day makes you more hungry makes you more
01:50:57.760 likely to crave carbohydrates
01:51:01.520 So just like you can create a negative
01:51:03.679 cycle you can create a positive cycle by
01:51:06.000 optimizing your sleep I’m a big fan of
01:51:08.719 wearables
01:51:10.679 because especially if you wake up in the
01:51:12.960 morning and you don’t feel flush with
01:51:15.199 sleep and fully restored and fully
01:51:17.000 recovered you want to understand the
01:51:19.280 metrics How much deep sleep did you get
01:51:22.000 how much REM sleep how many
01:51:24.400 interruptions did you have did you snore
01:51:27.600 what was your heart rate variability was
01:51:29.920 what was your respiratory rate so I feel
01:51:33.040 like sleep is one of those lifestyle
01:51:36.119 factors that we need to optimize
01:51:39.679 On my ketogenic diet I noticed that my
01:51:42.000 heart rate variability seems to go lower
01:51:44.480 which is scary Do you see that a lot
01:51:47.119 when people do kind of these kind of
01:51:48.560 more restrictive diets and they’re in
01:51:49.840 ketosis there can be I mean I would look
01:51:52.400 at some of the other variables as well
01:51:54.639 And one of the things I really like is
01:51:56.400 they eat sleep Have you used that at all
01:51:59.840 yeah I have Um the mattress Did it help
01:52:03.119 you with HRV
01:52:05.400 i believe it did Um I I don’t have the I
01:52:09.280 had the results at the time but I was
01:52:10.560 sleeping really really good on it Um I
01:52:12.639 still use my Whoop which hashtag ad I
01:52:14.719 still use my Whoop for um my HRV Mhm
01:52:18.639 What are the things that you aim at when
01:52:20.239 someone comes to you with low HIV a lot
01:52:21.840 of people want to improve their HIV We
01:52:24.480 kind of see it as this holy metric now
01:52:26.480 Sure Well I start with alcohol So we
01:52:29.280 know alcohol makes your HV decline not
01:52:32.719 just for one night but somewhere around
01:52:35.040 seven to nine nights That’s why I quit
01:52:36.960 alcohol Yes My h it just killed my the
01:52:39.440 first time I put my whoop on and I saw
01:52:40.719 the impact it had on my HRV I thought
01:52:43.440 I’m not doing that again And that’s
01:52:45.520 exactly the kind of behavior change that
01:52:47.360 I get excited about So when you see the
01:52:49.520 metrics and you see the reflection of oh
01:52:51.920 my gosh my physiology is so much better
01:52:54.560 off of alcohol and there’s better
01:52:56.800 choices than alcohol you want to make
01:52:59.360 that swap and the behavior change
01:53:02.920 sticks So I
01:53:05.159 like I like grounding So I find when I
01:53:08.480 get in the ocean when I get in streams
01:53:10.639 with bare feet when I walk on the sand
01:53:13.520 that improves my HRV The country that
01:53:16.719 seems to improve my HRV the most is
01:53:18.639 Costa Rica There’s something about the
01:53:20.159 aliveness there My HRV doubles to
01:53:22.560 triples really Micro doing mushrooms
01:53:25.280 also raises my
01:53:27.080 HRV quite significantly
01:53:30.719 We have a closing tradition on this
01:53:31.840 podcast like I said where the last guest
01:53:33.280 leaves a question for the next guest not
01:53:35.360 knowing who they’re leaving it for And
01:53:37.199 the question left for you
01:53:39.239 is what do you do every
01:53:41.960 day to make a better brain and better
01:53:46.480 world
01:53:48.840 m what I do every
01:53:51.560 day when I’m home in Marin County is I
01:53:56.400 go outside when I wake up in the morning
01:53:59.760 and I look at the I live on the ocean
01:54:03.119 and I look at the horizon like I trace
01:54:07.199 my eyes along the
01:54:09.800 horizon and I just was looking at the
01:54:12.400 data on morning sun because I didn’t
01:54:15.679 quite believe it like It supposedly it
01:54:18.239 helps you with your circadian rhythm It
01:54:20.159 helps you with sleeping better It helps
01:54:23.280 you with melatonin
01:54:26.040 production It helps you with mood It’s
01:54:28.239 got all of these benefits And some
01:54:29.760 people say you only need five or 10
01:54:31.840 minutes of morning sun That’s sufficient
01:54:34.560 And so I started looking at the data and
01:54:36.880 you actually need more than that like
01:54:39.119 you start to see a benefit around 30
01:54:40.920 minutes but you need um you still keep
01:54:45.719 improving some of these outcomes with
01:54:48.719 longer like up to two and a half hours
01:54:51.280 So the thing I do every day is I get
01:54:54.080 morning
01:54:55.639 light and I trace the horizon and I look
01:54:58.719 at nature and I remind myself that
01:55:02.880 nature is the best way to
01:55:05.239 regulate that helps my brain
01:55:09.840 Sarah thank you Thank you so much for
01:55:11.840 doing the work that you do You’re an
01:55:12.800 incredibly intriguing person in many
01:55:14.239 respects and you’re clearly helping so
01:55:16.400 many people in so many wonderfully
01:55:17.920 important ways Um I highly recommend
01:55:20.080 everybody go and check out the books
01:55:21.280 that I have in front of me There’s I
01:55:22.400 mean there’s there’s quite a few of them
01:55:23.840 I think there’s six in total I’ve got
01:55:25.920 three here The autoimmune cure healing
01:55:29.040 the traumas and other triggers that have
01:55:30.880 turned your body against you is the book
01:55:33.119 that I’m going to um highly recommend I
01:55:35.119 think this is the the new one and I’ve
01:55:36.400 interviewed Paul Conte who writes the um
01:55:39.119 recommendation for the the book on back
01:55:40.960 of this I’ve also got another book here
01:55:43.040 called The Hormone Cure which is all
01:55:46.239 about reclaiming balance sleep and sex
01:55:47.920 drive maintaining a healthy weight
01:55:49.040 feeling focused vital and energized
01:55:50.480 naturally and one of the books that I
01:55:52.800 was referencing as we were going which
01:55:54.000 is Women Food and Hormones a four-week
01:55:56.159 plan to achieve hormonal balance lose
01:55:58.000 weight and feel like yourself again If
01:56:00.560 people want to know more from you they
01:56:02.239 want to hear you You have a new podcast
01:56:03.920 right yes Where do we go to listen to
01:56:06.080 your podcast my website is
01:56:09.880 sarahzalmd.com and the podcast is called
01:56:12.159 Treated with Dr Sarah That’s Sarah Zal
01:56:15.520 spelled S Z A L That’s right And the
01:56:19.280 podcast is called Treated with Dr Sarah
01:56:23.199 Thank you so much Thank you so much
01:56:25.040 Stephen
01:56:27.199 We launched these conversation cards and
01:56:28.639 they sold out And we launched them again
01:56:29.920 and they sold out again We launched them
01:56:31.280 again and they sold out again because
01:56:32.639 people love playing these with
01:56:33.920 colleagues at work with friends at home
01:56:36.159 and also with family And we’ve also got
01:56:37.920 a big audience that use them as journal
01:56:39.599 prompts Every single time a guest comes
01:56:41.760 on the diary of a CEO they leave a
01:56:43.920 question for the next guest in the diary
01:56:46.239 And I’ve sat here with some of the most
01:56:47.440 incredible people in the world And
01:56:48.800 they’ve left all of these questions in
01:56:51.119 the diary And I’ve ranked them from one
01:56:53.679 to three in terms of the depth One being
01:56:56.159 a starter question And level three if
01:56:58.800 you look on the back here this is a
01:57:00.159 level three becomes a much deeper
01:57:02.400 question that builds even more
01:57:04.159 connection If you turn the cards over
01:57:06.560 and you scan that QR code you can see
01:57:09.280 who answered the card and watch the
01:57:11.679 video of them answering it in real time
01:57:13.840 So if you would like to get your hands
01:57:15.199 on some of these conversation cards go
01:57:16.960 to the diary.com or look at the link in
01:57:19.199 the description below This has always
01:57:21.040 blown my mind a little bit 53% of you
01:57:23.840 that listen to this show regularly
01:57:25.440 haven’t yet subscribed to the show So
01:57:27.520 could I ask you for a favor if you like
01:57:29.040 the show and you like what we do here
01:57:30.159 and you want to support us the free
01:57:31.760 simple way that you can do just that is
01:57:33.280 by hitting the subscribe button And my
01:57:35.199 commitment to you is if you do that then
01:57:36.960 I’ll do everything in my power me and my
01:57:38.800 team to make sure that this show is
01:57:40.239 better for you every single week We’ll
01:57:42.159 listen to your feedback We’ll find the
01:57:43.920 guests that you want me to speak to and
01:57:45.679 we’ll continue to do what we do Thank
01:57:47.280 you so much
01:57:50.940 [Music]
01:57:59.800 Oh hey
01:58:08.150 [Music]