What I would say is hormones are the primary difference between men and women. And if you want to feel your best, if you want to serve your mission, hormones need to be on track. They need to be the windature back. So when you've got your hormones and balance, what happens. You sleep well, you age more slowly, You're more interested in sex, your mood is more stable, You're less likely to have anxiety or psychological distress. That was
doctor Sarah Godfried, scientist, researcher, and best selling author. Doctor Sarah, as she likes to be called, has an innovative, amazingly effective approach to women's health, an approach that can help women deal with stress, get more energy, and even achieve our healthiest weight. I'm Kim Azarelli and this is Seneca's Conversations. Today we'll bring you the first episode of a special two part conversation with doctor Sarah Godfried about women's health
from our series Seneca's one hundred Women to Hear. Doctor Sarah is a Harvard trained MD. She's had four books on the New York Times bestseller list. Her most recent is Women, Food and Hormones. Today, doctor Sarah is going to tell us why women's physiology is different and what that means for our health. As she says, we're not just men with breasts. That distinction has an impact on women's metabolism, and a healthy metabolism, she says, is the key to a healthy life. Doctor Sarah, it's so great
to have you with us. Just want to really thank you for doing this and personally thank you for writing the book, which has actually had a huge impact on my life since I've read it over the past couple of weeks. It's my honor, you know, this is this is my mission, this is my service to improve the metabolic health of women in the world. So you are
the author of several books about women and wellness. You're a gynecologist and a scholar trained at Harvard and MIT, and you're dedicated to busting a myth and that my being that being a woman means that you'll always feel overwhelmed, tired, burnt out. But you say that we need to look at women in wellness differently. First, why do we need
to approach women's health differently than we do men's health? Kim, That's such a great question, and I love that we're starting with that mythbusting because there's a tradition, particularly in medicine, of studying men and assuming that what we learn applies equally to men and women. That's just not true, as women were just not you know, men with breasts, our immune system, hormones, metabolism, brain, the way our brain works, the way that estrogen regulates the brain, even our stress
response is unique. So we require a different approach than what the standard is for men. So when it comes to medical care, which is where my area of expertises, we see not just sex differences which are biological, such as hormone differences, but we also see gender differences which are socially constructed. And a good example here is the number one killer of both men and women, which is
heart disease. And there's some disparities between men and women, you know women for the most part, men are experiencing less mortality associated with heart disease women are not. Women are actually having an increase in prevalence, especially younger women in each group of thirty five to fifty four. And if you look at things like the symptoms that women experience with cardiovascular disease, if you look at a woman who's having a heart attack as an example, they don't
have the classic symptoms that men do. So rather than the crushing chest pain that feels like an elephant is sitting on your chest, that radiates down on the left arm, women have more subtle symptoms. They've got smaller coronary arteries, they have symptoms that are more vague, such as neck pain, shortness of breath, nausea. And what then happens is that women often get misdiagnosed and they get sent home from the emergency room when they present with these symptoms that
end up being a heart attack in progress. Incredible, it's an incredible thing. And then if we take it one step further, the gender of your doctor matters. So there was a really fascinating study just published a couple of years ago showing that if you're a woman and you present the emergency room with symptoms of a heart attack, if you see a female physician, your survival is two to threefold higher than if you see a male physician. Wow.
And if you look at male patients who present with a heart attack at the emergency room, there's no difference whether you see a male or a female physician. Now that I would say is more socially constructed. That's a gender difference. But this just gives you a little flavor of how women are not just smaller versions of men or men with hips. We've got our own physiology that we really need to be mindful of. Well, we are so grateful that you've written this book, Women, Food and Hormones,
and really grateful for your contribution to metabolic health. So, in a nutshell, if you can say that, what do you think right now in today's times is key to improving women's health. Well, it's a complicated question, isn't it. I'll try to keep it as simple as possible. I would say what comes to mind first is awareness, knowledge, and ownership, and I'd love to dive a little deeper
into those. But embedded in this increased awareness about some of the sex and gender differences and knowledge about your own body, and then ownership is that you're thinking about your metabolism. In fact, I want you to think about it as much as you think about your retirement account, because your metabolism really is your retirement account. So i'd
say awareness, knowledge, and ownership. What I see with a lot of women, and I take care of both men and women, and I think this is particularly true even for very empowered women, is that often they are empowered in so many areas of their life, you know, whether they're a lawyer classically trained like you are, or they're in the corporate world, and yet they outsource the ownership of their own health. So they outsource it maybe to a doctor that they see once a year, or maybe
they see a doctor more frequently. And what I want to change is that ownership. I think the more that you understand about your own physiology, which frankly is totally enchanting, the more you understand about that, the more you own it and realize that, you know, if you look at a visit to a doctor or twice a year, that's like less than point zero one percent of your time, Why would you outsource your health to this person that
you spend so little time with. What I think is increasingly relevant right now as healthcare is changing, as we have the ability to monitor ourselves more, is that we've got this democratization of data and we're able to understand things like what's going on with my metabolism, why is my weight on the bathroom scale going up? What's happening with this belly fat that I'm suddenly seeing why am
I so tired? And so the more that you can own that and develop the awareness and the knowledge, I think, the better off you're going to be, the better that you're going to improve your own health as well as for other women. Well, you know that you've completely turned
me onto this whole way of thinking. I do feel like having this access to data about yourself, as you said, awareness and knowledge about what constitutes yourself and then you know, the ability to act on it is a very empowering thing. I know it has been for me. We're at such a crossroads right now when it comes to understanding your own biology. You know, this was not the case ten years ago. We've now got things like, you know, I've
got a smart watch on my wrist. I've got a ring on my finger that measures my stress levels and my readiness each day in my sleep. I've got an implanted continuous glucose monitor. Right now, about fifty percent of Americans have wearables that they're using. Ten years from now, we expect that about fifty percent of Americans will have
implantable wearables. So we're really in this environment of dramatic change when it comes to each of us understanding our own physiology and not having to outsource that to a doctor. I mean, that's a very exciting concept. To be more intimately involved with your own biology. At least for me, has been pretty game changing because I have not been the person who was very focused on my physical health certainly, and I was that person who was kind of checking
in once a year or when sick. So I think this mindset that you're recommending is really really powerful. So what are the benefits of looking at women's health through the lens of hormones. In your book, you talk a lot about hormones. Why is that important? Well, hormones drive which are interested in. They are these chemical messengers that I think of them almost like a text message in the body. So they typically are made at a distant organ.
So for example, in your neck, you've got the thyroid gland that makes thyroid hormone that then gets spread through the bloodstream to every cell in your body, and it's one of the key drivers of metabolism. But taking a step back, what I would say is hormones are the primary difference between men and women. And if you want to feel your best, if you want to serve your mission. Hormones need to be on track. They need to be the windature back. So when you've got your hormones and balance,
what happens. You sleep well, you h more slowly, you're more interested in sex, your mood is more stable, You're less likely to have anxiety or psychological distress. And so I think it's really essential to understand how core the concept of hormones is, particularly for women. I think it's more of an issue for women were more complex hormonal beings than men are, and it's really important to kind
of take on this piece of your health. So part of your work has been devising the Godford Protocol, which I think is really really powerful, and you lay it out in your book, and part of that is using information about hormones and many other things to reset your metabolism. Why is this important right now? When women have been dealing with the challenges of COVID, of working from home while parenting, of homeschooling. What about this moment makes this
particularly important? Kim? We were stressed before the pandemic, and I think what's happened is that all of us are noticing this increased load of stress. You know, the way I think of it as a physician is that it's a cortisol load. Cortisol is the main stress hormone. It can either be on your side helping you feel energized. Each day, you're supposed to peak your cortisol within thirty minutes of waking up and then have this gradual decline
over the course of the day. But what's happened during the pandemic is that many of us have been traumatized. Depression is about threefold higher than it was pre pandemic. There's certainly the quarantine fifteen, the increased weight that some of us have noticed. But what I think about is the deeper issue of what's going on with metabolic health.
So I care about the number on the bathroom scale, but in many ways that doesn't reflect this bigger picture, you know, the picture of complexity of metabolic health and also what's happening with your hormones. But just taking for a moment these challenges that we're experiencing. I just was reading a recent paper showing that depression right now is that twenty eight percent, anxiety, twenty seven percent, psychological distress
fifty percent. Wow. So these numbers are higher than we've ever seen before and before the pandemic, we had a number of surveys that were published looking at, okay, well, what's going on with metabolic health in the US, and we found that only twelve percent of Americans are metabolically healthy. Twelve percent, I mean, that is so low. And what we've noticed during the pandemic is that it's those folks who have a problem with metabolic health that tend to
do the worst with infection with COVID. It now tell us what you mean by metabolic health. Such a good question. So metabolic health the way I think of metabolism, if we start first with that term, it is the aggregate of all of the biochemical processes that are happening in the body. So a lot of people think about metabolism as you know, whether you burn calories slow or fast, and that doesn't quite capture it. It's much more complex
than that. It's looking at all the ways that you produce energy, all the ways that you're mitochondria kind of the power factories and your cells work. It's the metabolic hormones such as the ones that we've talked about already, cortisol, thyroid, but the list includes a few dozen hormones like testosterone, growth hormone, even estrogen imbalance with progesterone insulin. But when it comes to metabolic health, the way I think of it is that it's the way that your body takes
the fuel that you eat. So whatever you had, say for breakfast today, you had a breakfast and then convert set into fuel for you. So some of us are really good at that. Some of us are really efficient, and so they feel kind of steady energy all day long. They could even skip a meal and that's not a big deal. But then some of us are not so
metabolically healthy. We're in that eighty eight percent category where you have a banana, for instance, and your glucose spikes way too high, like maybe up to two hundred, and then it crashes and you feel exhausted. So metabolic health is the ability to use food as fuel to do that very efficiently without a lot of symptoms. And some of the ways that we measure it include looking at things like fasting glucose, fasting, insulin levels, some of these
hormones that we've talked about. You mentioned this briefly, but there is definitely a weight benefit or a benefit of losing weight when you engage in this type of lifestyle. So let's talk about the role of hormones and metabolism in maintaining a healthy weight. Can you briefly outline the components of what you feel as a healthy diet for women and what makes it different from the keto diets
that we hear much about. The key concept here is that food regulates your hormones, and I think that's such an important message if you learn nothing else today, I really hope that she'll come away with a concept about how food creates the backbone of the hormones that you make, and that includes carbhydrates that help you with detoxication. It includes fat, healthy fat, which is the backbone of the
sex hormones, things like cortisol, estrogen, progesterone, testosterone. And it also includes protein, which you need for repairing muscle, especially if you're someone who exercises regularly. So I think the key to think about when it comes to a healthy weight and hormones and metabolism is to connect this relatively new idea that food regulates your hormones to get your
metabolic hormones reset, to get them back into balance. There's three components that I came up with when I was struggling with my own metabolic health, especially in my forties, and I was struggling with a fasting glucose that was starting to climb not to the diabetes range, but to the pre diabetes range. And I found that the three components that are really important are first detoxification. You've got to have that in place first before you try a
ketogenic diet, especially in women. Number two, you then layer in nutritional ketosis, but I've got some particular ideas about how to do that. And then the third is intermittent fasting, because intermitten fasting allows you to eat more carbohydrates, and it's also a backdoor to ketosis. Ketosis is where you're burning fat and you're creating that metabolic flexibility where you can go back and forth between burning carbs and burning fat.
So in your book you cover extensive the role of a ketogenic diet and how your protocol works to create what you call metabolic flexibility. Can you tell us more about the role of a ketogenic diet in women's health. I think when it comes to the ketogenic diet, you know, why is it that I came up with this protocol and wrote this book. Well, what I found is that once again, the ketogenic diet was studied almost exclusively in men.
It was developed by a male physician over a hundred years ago, initially for patients with epilepsy, and more than eighty percent of the research on the ketogenic diet and what it does for metabolic health and also for your waistline is in men. And so I tried kind of the male version of a ketogenic diet, and it was an utter failure for me. So if I was failing at it, I imagine a lot of other women have
similarly failed. And I found that, you know, there's some issues that get in the way, such as the need for detoxication, the way that women tend to go into a stress state more easily than men do. I think that's just a relic of fertility and kind of our greater sensitivity as women to the environment. A lot of women on keto will have difficulties sleeping because they're not getting enough carbydrates to generate serotonin, which is that lovely
brain chemical that's involved in sleep, appetite, in mood. And so there's some issues that women experience on the ketogenic diet where I find that some women do fine, like they don't need any help on classic keto, but I would say the majority, somewhere around seventy to eighty percent of my patients do not do well on classic keto. It needs to be adapted for a woman. And what
are some of those key components that you suggest for adaptation. Well, the first adaptation is to go through these pillars of the program. So detoxication is the first pillar. In what I mean by that is that you're having a bow movement every single day. That's really important because classic keto tends to reduce the amount of stool that you produce. And it also if you restrict carbs too much, it's not feeding those really happy, lovely, benevolent bacteria that you
have in your gut. You know another concept that's really changed in medicine, as we used to think of ourselves as these kind of stable human beings without much change. As we get older, you can either accelerate or decelerate the aging process, and increasingly we're thinking of ourselves more as vehicles for the bacteria that we have in our gut. It's kind of an existential change in terms of how
we conceive of ourselves. But when it comes to detoxification, this was really the missing piece for me when I failed KETO the first couple of times. So really focusing on a daily bow movement, getting sufficient vegetable based carbohydrates so that you're able to detoxify and support liver, and that includes some additional nutrients that you can get from food, such as B vitamins, methylating vitamins that help you to
inactivate estrogen. The whole idea with estrogens you want to use it and then you want to get rid of it. You want to poop it out and pee it out. So detoxification is one of those components the nutritional ketosis. It's a little bit more detailed, but it's basically a high fat, moderate protein, low carbohydrate diet, but you have to be careful with women that the fat is not
too high and that it's mostly plant based fat. You want to make sure the protein is sufficient so that it's enough to maintain your lean body mass, especially those of us over the age of forty, and then you want to make sure that the carbs are high enough that you're able to get some of those benefits that we talked about, like making the serotonin and feeding the gut bugs, but also keeping your thigh writ in check, as if you restrict carbs too much, that can actually
raise this intermediate hormone called reverse T three and it can block thy wright function at the level of the receptor. So those are some of those components. I'm so glad that your book includes a very detailed eating plan as well as really great recipe, so I highly recommend that in addition to the eating plan. Are there other basic
components to maintaining metabolic health? Oh, there certainly are. So you know, I like to start first with food because I think that's the biggest needle mover, you know, when you think about your metabolic health, I would say somewhere around seventy to eighty percent of it relates to your food. Food is such an important source of information for your DNA as well as for the microbes in your gut, as well as for your hormones. So I would say food first. But once we get the food dialed in,
there's exercise, mindset, sleep, stress. I'm sure there's some others love purpose meaning, but I think it's really important to realize if we start first with exercise, that a lot of us don't exercise in a way that is consistent with the latest scientific information. And I would raise my own hand here because up until about five years ago, I was kind of a cardio addict. I would just get on the elliptical, get my New Yorker, and just go to town, you know, for thirty to sixty minutes.
And what we now know in terms of cardio metabolic health and really keeping your system supporting you, is that you want about two thirds weight training in one third cardio. That's really the combination that works the best, and people can build up over time. And with mindset, I would
say this is where healing comes in. You know, there's a lot that we can do in terms of managing tactically your hormones and getting your hormones into balance, dialing in your food, maybe using a continuous glucose monitor, but there has to be a healing growth mindset, one that is continuing to generate what we think of as neuroplasticity
in the brain as you get older. That's especially important after the age of forty for women, because we know that neuroplasticity starts to decline, especially as the primary regulator of the female body. Estrogen begins to decline, so it tends to go down sometime around age forty three to forty five, and that's where women, about eighty percent of women, start to notice this slowdown in terms of brain function.
And so I really want to encourage our listeners to be thinking about this healing growth mindset, to be thinking about exercise as well as how you dance with stress, especially as we're thrown externally so many things during the pandemic. And then sleep, I would say sleeps as close to a piano sea as we have, so I would say sleep is a really important place to focus. Well, this is obviously a lot to take in, but once you do take it in, you start asking more and more questions.
And that's why we're so excited to have you on the show. But Sarah, I really want to just thank you for your work and what you're doing. It's really changed my life already, and I hope it will change the lives of many many listeners. Well, thank you so much, Kim. It's been such a delight to hang out with you and get to know you and to witness this unfolding that you've experienced with your own health. Thank you. Thanks
so much for joining us. Thanks. We are so lucky to be able to share this helpful advice from doctor Sarah Gottfried. Here are some of the key concepts from today's conversation. First, it's important to look at women's health through a uniquely female lens and to acknowledge that how we diagnose and treat women needs to be different from the way we diagnose and treat men. Women's hormones are different, our metabolism is different, and how we react to medication
and even food is different as well. Second, as we've heard, a healthy metabolism is the key to good health, and maintaining that healthy metabolism requires thinking about food, exercise, and sleep in a new way. It's not just about what you're eating, but it's about when you're eating it. Of course, exercising regularly, but how you exercise and when you exercise matters, and getting enough sleep is also key. We'll drill down
into the specifics with doctor Sarah in the next episode. Finally, it's important to be aware of how food affects our health. Food regulates hormones, according to doctor Sarah, and the eating plan that works well for a man will often fail for a woman. But when women get the right balance of healthy fats, proteins, and carbohydrates, we can set our
metabolic hormones and maintain a healthy and happy lifestyle. In our next episode, we'll go even deeper into what metabolic wellness means for women and how to make the most of this new approach to women's health. Thank you for listening, and please share today's podcast episode with others in your life. This is Kim Azzarelli, co author of Fast Forward and co founder of Seneca Women. To learn more about Seneca Women, go to Seneca Women dot com or download the Seneca
Women app free in the app store. Seneca's Conversations is a production of the Seneca Women podcast network and iHeartRadio Have a Great Day. For more podcasts from iHeartRadio, check out the iHeartRadio app, Apple podcast, or wherever you listen to your favorite shows.