Dr. Sara Gottfried on a Women-Focused Health Plan: Part 2

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're bringing you part two of our conversation about women's health with doctor Sarah Godfried from our series Seneca's One Women to Hear.

In our previous episode with doctor Sarah, we learned why women's physiology is different from men's and what that means for our health. And we learned that a healthy metabolism is the key to a healthy life now, just in time to get the new year off to a great start. Doctor Sarah takes us through her approach to women's health, what she calls the Godfreed Protocol. We'll learn why the protocol works so well for women, how to do it, and how it can make a difference for you, Doctor Sarah.

Great to have you back on the show. Thanks. Obviously, we've gotten to know each other a little bit over the past several months, and I probably watched many of your videos and I pheel I know you very well and have read your book and started on what you called the Godfreed Protocol, which is a four week plan that you've laid out really well in your new book, Women, Food and Hormones. And I just want to say it's working.

It is absolutely working. Yay. That's how I feel. I feel like I have I don't know, so many good things have happened. In fact, this is just anecdotal, but I'm going to stick with it. Someone who lives in my building stopped me on the street yesterday. Actually we ranch each other in the elevator. He saw me on the street and he said, you know, Kim, I was going to stop and say hello. But then I thought, no,

that woman looks too young to be Kim. And I've actually lost quite a bit of weight, but I think feeling more importantly, I just have a lot more energy, and I feel like this protocol is really like the answer. And I'm becoming a little bit of a proselytizer because everywhere I go, I'm like, well, what's your feeding window? And you know, what are your net carves? And so I think we need to tell the world about the protocol so that I'm not just talking to myself and

that people understand all this vocabulary. But Sarah, you wrote this with a very specific goal in mind, which is you've done the research, you've lived the research, and you do believe that there is a difference between men and women. And we all know that there is in terms of hormonal changes and biology, and you've put together what I

think is a pretty genius protocol. So how did you come on this realization that there was a true difference between what men and women needed in this type of In this type of I don't want to call it a diet, because it's not a diet, it's a lifestyle. Well, I would say first, my entire career has been devoted to sex differences, not for the purpose of one up being or one downing one gender or another, but really

for the purpose of understanding both men and women. So this came full circle for me about five years ago when I went on a keytogeneic diet with my husband. He rapidly dropped about twenty pounds. I had some initial success, and then it backfired, it stopped working. I actually gained weight, and that's what got me on this path of looking at Okay, we know there's sex differences, we know there's gender differences when it comes to metabolic health. Let's go

a little deeper. Let's understand why, especially the classic ketogenic diet was not working for me and was not working for frankly, hundreds of women in my practice. So that got me on this path to look at things like the testosterone advantage. We know, for instance, that women have ten to twenty times less testosterone than men, and yet it's still our most prevalent hormone. So it's a hormone

that we really need to be managing and tracking. It's responsible not just for sex drive and muscle mass, but also confidence and agency and so that was one of the first pieces, was looking at some of these hormonal sex differences that were responsible for this difference that I saw with my husband, and there's a long list of them. You know. One is that because men have more testosterone, they have more lean body mass about fifty percent more

than women, they've got lower fat masks. We think women need more fat mask to make hormones because fat is the backbone of the hor months that you make. There's many other differences. Estrogen can sometimes get in the way of success with a ketogenic diet. We also, I believe women may need more carbohydrates for the production of serotonin. So serotonin, as many know, is that neurotransmitter that's responsible for sleep, mood, appetite, and carbohydrates helped to raise serotonin.

So I saw a lot of women I call them my keto refugees who are coming to my practice, and they went on keto maybe with a male coworker or a partner, and had a similar experience to me. But they also noticed they weren't sleeping as well, they weren't deriving some of those benefits that men experience on keto, and so that got me to figure out Okay, how do we work around this? How do we get this

to work for women too? You know, it's so interesting, Like, there's so many things that you've already said that I believe are sort of myths that are really things that I'm learning by talking to you and reading your work and the research. You know, this idea that first of all, that fat is bad, you know, is always something that I think you've kind of educated me on, and this type of research has educated me on. Also the testosterone

myth that you know, testosteronees a guy's thing. I think that's really interesting what you just said, and I'd love to learn more about that. And then also the relationship with carps. So I hope we get into all three of those as you talk to us about the protocol. Yeah, I'd say the myth about fat being bad is one that just will not die. We have so much data now, you know, over the past few decades really showing that fat is essential. You know, seventy percent of your brain

is fat. When you eat fat, it helps you feel more satisfied in terms of appetite. It's also, as I mentioned, the backbone, especially of sex hormones like estrogen, progesterone, testosterone DHA. So we really need to function. The question is how do you personalize the amount of fat. So when I was in medical school and Kim, this was a very long time ago. So nineteen eighty nine, when I was

in medical school, I went off of fat. I did a plant based diet, and my hormones became a hot mess because my estrogen dropped, my breast got smaller, my mood was worse, my cholesterol dropped significantly. We know that's

a marker of depression. So I really believe that we need to have these food groups and we've got to figure out, Okay, what's the right dose of carbs, what's the right dose of fat, what's the right dose of protein, so that you really have that metabolic health that we're after, right, because I mean, the popular culture is avoid fat, skim scam, scam again, this equation of like fat meaning that you're going to be fat well, and it hasn't worked. It's

been a failed experiment. You know, as we have eaten more carbhydrates, especially refined carbs, what's happened is that we've got a higher and higher incidence of diabetes. We know that somewhere around eighty eight percent of the US population is metabolically unhealthy. Many of them don't even know it, and so this advice that came down through the nineteen seventies and eighties to cut back on fat really has

been a misfire. It just hasn't worked. And so a more balanced approach I think is the way to go. But for many women, as they become more balanced, they need to have a therapeutic pulse the way that I describe it in the book. So that's really how I developed the Gutt Freed Protocol to help women do this four week pulse where they can really personalize how much of each of these macronutrients carbs, protein, fat are the best for them. So take us through how it works.

What is the protocol and why do you set it at four weeks? It four weeks because I think it's doable. I also think that when you stay in ketosis longer, there's some risks in terms of your cholesterol as well as your level of inflammation, and so I think four weeks is a pulse that is manageable. The first part of the protocol, the first pillar is detoxification, and I give folks about a week to get into a state

of open detoxification pathways. I think that's really important, especially to flip that switch between burning carbs, which many of us are stuck in I was in my thirties and forties, to burning fat, which is really the goal with ketosis. So that first part is detoxification. I want women to be pooping every single morning. I want to really increase the amount of vegetables. I think we can all agree

that that's healthy. That's the cruciprous vegetables broccoli, hauliflower, russ routes, radishes, etc. As well as the alium vegetables, So that includes onion, scarlet, gleak, the methylating vegetables. Those are the ones that help you inactivate certain hormones like estrogen, and that includes the dark green leafies. So detoxification is the first part. I see in my practice all the time that women just don't

have their detox pathways open. Maybe it's because they're having a glass or two of wine every night, or they're over the age of forty and things just slow down, you know. I think a lot of women notice that as hangovers hitting a little bit harder, affecting their sleep more and so we've got to help out the liver. So that's the first part of the protocol. Then you move into nutritional ketosis, where you're eating with the macronutrient ratio that I found to be the most effective for women.

That includes sixty to seventy percent of your total calories each day from fat, mostly plant based fat. So there was just a study published by David Ludwig at Harvard showing that if you keep your total saturated fat per day at twenty one percent or less, that's necessitated with

the best cardiometabolic function going forward. So sixty to seventy percent your total calories from fat, a portion of that from saturated fat if you'd like to eat animal fat, twenty percent of your calories from protein, that's a moderate protein diet, and then about the remainder, so ten to twenty percent of your calories from carbohydrates. But those carbs

really need to come from vegetables. And what I advise is that you simplify this by focusing on net carbs, so less than twenty to twenty five net carbs per day, and that allows you to get the fiber that you need to support your hormones as well. As to support the benevolent microbes that are in your gut. So that's the second pillar. The third pillar is intermittent fasting because that really allow allows people to eat more carbydrates. So it kind of depends on what some of your issues

are how long that window should be. I love that you mentioned, you know, those new parlance that you've been using, like with your feeding window. You know, generally what I like is for people to start with about a fourteen hour overnight fast and then a ten hour feeding window. Yeah, that really worked for me. I mean I started actually with sixteen eight, but then I read in your book or maybe in one of our conversations that you know, women don't need to kind of shock the system. It's

better to kind of ease into it. And so I'm switched to a fourteen ten, which is very doable. And I have to say that now I'm not really hungry before that, and I feel weird eating after that, like

it doesn't occur to me. So I feel like my body really appreciates it, actually, and I think that's one thing that I'm learning from this whole experience, which I again I won't call a diet, and I would love to talk to you about diet culture, but you know this lifestyle, like, I feel like my body is happy you're in this mode, so it doesn't feel like I'm being deprived. I feel actually the opposite. That's certainly part

of the benefit of this protocol. You know, it's designed to get you into ketosis so that you have the flexibility to switch your metabolism from burning carbs to burning fat. And the analogy that I often use to describe this as similar to a prius where you can flip the switch between burning electricity or burning gas depending on what

type of fuel is available. So the body is really designed to do this from Stone age times, and many of us just with the availability of food, especially the ease of carbohydrates and the deliciousness of carbhydrates, we tend to overdo it and get too high a dose of carbs, and that's really what gets us into trouble. But once you flip that switch, as you have done Kim, and you start burning fat, then you have ketones in your body, in your bloodstream, also in your breath and in your urine.

And those keytons are not just a marker of how successful you are on this God Freed protocol. But they're also a signaling molecule, so they reduce inflammation. They help you with being less puffy, they help you get rid of excess fluid. A lot of us have fluid retention starting in our forties and fifties, so this is a major downstream benefit of the ketogenic diet. And then you also mentioned energy. I think that's a really important piece

to highlight, because ketones are super energizing. They give us focus and concentration and mental acuity. They help us with appetite suppression, and that's part of the reason why I think this approach is so successful for so many women. I mean it's successful for men too, but for women in particular. There's a way that I think our culture makes us hungry, makes us it's hungry for more, makes us hungry for equality, makes us hungry for soothing, makes

us hungry for greater solace. And what I find is that those keytones really help with satiety, with feeling like Okay, I'm at the end of my eating window, I finished my meal, I'm done, I'm good. I can go focus on other things without food thoughts kind of driving me for hours each day. Yeah, I have to say that, like,

my guilt level around food is pretty gone. Like I don't feel guilty about you know what I mean, Because usually you're like, oh that was fattening or uh, that wasn't so healthy, or you know, like there's always some after effect, and I have to say like, because I'm sticking to the protocol, I'm like, well this is great, like olive oil, yes, avocado, as much as you like, you know what I mean. Like, so the stuff that I'm eating is good for you, and it happens to

be stuff I like. So I feel I don't feel that same feeling of like, I mean, I don't want to put down any particular diet plan, but like you know, when you're on a plan and you feel like you're checking, you're always like did I stick to it? Did I stick to it? Am I sticking to it? I don't feel that way with this. I feel like, oh, wow, like this is complete freedom because I like what I'm eating.

I'm feeling a lot better, I'm losing a lot of weight, and I just it's a totally sustainable lifestyle and it's not about diet. I'm so glad you mentioned that, because you know, I think so many of us as women, exist along this spectrum of somewhat healthy to maybe eat, disordered eating with restriction with permission, and it can be tricky to navigate. It can be really tricky to navigate, and so we end up maybe overindulging or eating something that we don't think is the best information to be

feeding our bodies. And then we have that guilt that you're describing, and I think many of us, and I'm talking about myself here, mostly we then serve penance, you know, so we go on a strict diet and minutes about out this white knuckling experience of making sure that you're following it even though you're hungry all the time. And what I love about Keytones and about this particular approach to a ketogenic diet adapted for women, is that it allows you to just let go of that white knuckling,

so you have, as you described, food freedom. And that's so beneficial because that really allows us to concentrate on some of these other things that are so important, like the mission that you serve, Kim, the mission that I hope to serve with changing conversations about women's health. And there's there's something just so delightful about being able to step away from that hunger and from that, you know, kind of constant inner saboteur that's telling us, oh no,

you can't eat that. Oh my gosh, you had way too many bites off that chocolate cake. And so I love that you're allowed to just awigh from that inner dialogue that can be so harmful. Yeah, and it's just too present, right, I think, like that's the whole context of this conversation, which is the focus on women's appearance, women's weight, the way we've all been educated, and so that dialogue, which could be a healthy dialogue, is just too present, I think in the culture in each of

our heads. You know, it's just taking up too much space. And I think your point is so well taken. This frees you from that. And I mean, I'm definitely experiencing that. I never really you don't know me very well, but you know, I'm not really like a very appearance focused person. I'm you know, I'm just so into wanting to do the things I want to do that I just it's just not a big priority in my life. I don't

think about it that much. But even I, who I would say is not that focused on it still had that inner dialogue all the time of feeling guilty and just knowing that I was like, you know, maybe that's not so healthy, Maybe that's like a little fattening. Like it's just those constant things that you just constantly think about, and this it just clears up so much space. And now I'm just I feel like my relationship with food

is much more positive. And you know, my father always told me food, food is fuel, like that's been his mantra, and I was like, yeah, great, Dad, Great. But now I'm like, Okay, I get it. Food is fuel, you know, and it's it's a different way of thinking about it. It is a different way of thinking about it. You know. I think this is really what I hope for women. You know, I want us to move beyond the ways

that we've internalized diet culture. But I would also say that the other end of the spectrum fat acceptance, body positivity. While all of us can get behind the concept of a more inclusive approach to different body shapes and sizes and colors, you know, many of us still want to fit into the clothes that are in our closet. You know, Like I've invested a lot in the clay where I want to fit into them. I don't want to just be a woman who is going through this aching process.

I love aching, but the natural aching process is that women are gaining fat mass as they get older, about five pounds per decade starting in their forties, and they're losing muscle mass again about five pounds per decade, and so you may not even be changing your weight. That's on a bathroom scale, which I think is a terrible marker of metabolic health, but it's the one, you know, It's kind of like shorthand that we use. You know.

What I want is for us to really understand that some of these changes are occurring, and unless you're doing something about it, you can wake up at age fifty five or sixty and start to get these diagnoses that you don't want, like party vasco disease, a heart attack, hypertension, even Alzheimer's disease. So all of this is occurring in the body decades before that scary diagnosis, and I really want for women to understand that you can be empowered to do something about it, and it can be, as

you said, a lifestyle that is not actually difficult. It's it's a way to really grab the reins of your own health and your destiny, like your health span, that period of time that you feel fantastic and you're relatively free of disease. Yeah, I mean, I'm telling you I'm living it because I do feel that if it was just for the weight, there's no way I would do it. I just I'm not motivated enough. You know, I feel

I look good enough. You know, if I am a little, if I'm ten pounds eavier, I'm it's good enough for me. Like I'm not you know, I'm not that type of person. But the idea of being healthier, of feeling healthier, and of the longevity of the health span, that's super motivating to me. And so I'm telling myself, you know, this is just all positive. There's like nothing negative going on in this, you know, and so that is extremely motivating.

And then thinking that you know, you could be I mean, I love when you talk about an end of one because this idea that it's personalized, it's you know, it's a personalized approach, and you have to know what works for you. You know, you start to sort of feel that you feel like what works for you, it doesn't you know, being able to just understand how your body

reacts to things is very very motivating to me. Just I think it may be that moving from this sort of I don't want to say imprecise medicine because I think that's probably unfair, but I would say maybe generalized medicine and first segmenting out men versus women, that's a

huge step in the right direction. And then I think what you're doing, and I think the movement that you're a kind of part of is doing is telling us all like, okay, you should know you And I think that that's a very motivating way to think about health. It is motivating. And I would even say that imprecision medicine is a term that's used quite frequently for the way that medicine has been practiced for over a hundred years.

And by that, I mean when someone has a depression and they get diagnosed with depression, they often get started on an antidepressant. And yet we know with most of the available antidepressants right now, that you have to prescribe to about ten patients for one patient to benefit. When it comes to statins, you know, one of the most common drugs that are prescribed in US medicine, you have to again prescribe about fifty patients with the statin for

one to benefit. So this is in precision medicine. We know that the way that you react to food is different from the way that I react, and the way that you can really personalize it. The way that you can step into precision medicine is to really understand, Okay, what's going to work the best for me? Because there

is no one size fitsal diet. There isn't and this book is really more about a template for determining how to personalize diet so that it really supports you and supports what you want your health for and whatever metrics make the most sense for you in terms of measuring your health. So for some people, that might be their body weight on the bathroom scale. For others, it might their body composition, the percentage of body fat or their fat mouse that they have, or their lean body mass.

For some people it might be there fasting glucose or their average glucose as you've been playing with with your continuous glucose monitor. So there's so many different ways that we can define it. But I think this point about precision medicine is so important because we've always practiced medicine for the average, and I don't want to be average, and I don't want you to be average. I want

us to be optimal. I want us to really have you know, that best possible health, the best possible mitochondria, you know, those power factories that are inside of ourselves, which, by the way, start to faulter after age forty in women eighty percent of women, but not in men, especially in the brain. And that's why so many women notice that they have this mental slowdown. Their brain just slows down a bit in terms of memory, in terms of word finding, in terms of multitasking after age forty. So

what do we do about that? That's a metabolic problem. One thing you can do about it is to feat your brain keytones. That works really well for the majority of my patients. So, Sarah, I have to thank you for this. I mean, just this introduction to the protocol is hugely helpful because I'm learning a lot and it's a little bit of a new language. But once you know the language, you can really be freed. So I

highly recommend the book Women, Food and Hormones. But Sarah, I really want to just thank you for your work and what you're doing well. Thank you so much, Kim, It's been such a delight. There is so much to learn from doctor Sarah about the interplay between women's health, food, and hormones, but here are some of the key concepts

we can take with us today. First, one of the things that makes the Godfreed Protocol so effective is that it's a ketogenic diet tailored specifically for the needs of women, and it overturns a lot of the myths we've been trained to believe. In the Godfreed Protocol, fat is good for you, guilt is bad, and you can stay on this plan without ever feeling deprived. Second, change can happen and faster than you think. You can see a big difference after just four weeks of being on the protocol,

says doctor Sarah. Finally, the Godfreed Protocol allows women to build a new, more positive relationship with food. The diet culture encourages women to adapt a mindset of constraint and frankly, guilt, but the Godfreed Protocol encourages us towards a mindset of abundance, encouraging us to eat foods that will make us feel good and live healthier without the guilt. To learn more about the Godfreed Protocol, go to Sarah Godfried dot com and check out her new book, Women, Food and Hormones.

Thank you for listening, and please share today's podcast episode with others in your life. This is Kim Azzarelli, author of Fast Forward and co founder of Seneca Women. To learn more about Seneca Women, go to Seneca Women dot com. 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 Podcasts, or wherever you listen to your favorite shows.