Discussing The Hormone Cure and Fertility with Dr. Sara Gottfried – #3

0:27 Charlene Lincoln: Welcome back and today, I am so excited. We’re just huge fans of Dr. Sara so I’m not going to try to contain that too much. Let me just give you a quick introduction to Dr. Sara Gottfried. She’s a mother, wife, physician, keynote speaker and author of three New York Times bestselling books: The Hormone Cure, The Hormone Reset Diet, and her latest book Younger: A Breakthrough Program to Reset Your Genes, Reverse Aging, and Turn Back the Clock 10 Years. For the past 25+ years, Dr. Sara has been dedicated to helping women feel at home in their bodies with functional medicine.

After graduating from Harvard Medical School and MIT, she completed her residency at the University of California-San Francisco. She lives in Berkeley, California with her family.

Welcome, Dr. Sara.

Dr. Sara Gottfried: Thank you, Charlene. Happy to be here.

1:42 CL: Thank you. First of all, I was just re-listening to The Hormone Cure and I have to say if you’re listening to this, please get a copy of it right away and give it to your girlfriends and have it on your nightstand because it’s essentially a manual for being a woman. Right?

SG: Yeah. Well, we don’t come with an operational manual. I think it is a reference manual. It’s what I came up with and what I would say in my office over and over again to the women who would come to me and say “I can’t get pregnant.” “I don’t want to have sex with my husband.” “I’m tired but wired. I’m racing from one task to the next.” So this book is really the top 7 hormone imbalances that women have and it maps onto fertility of course.

2:42 CL: I feel like it speaks to all of us on some levels and every time I hang out with a group of women, we’re all in our late 40s and I hear them talk, they’re all so confused and they’re comparing signs and symptoms. Now, I’ll tell them to just read this book, it will give you such an understanding. Because of all the conferences and different hormone lectures I’ve gone to, I feel like it puts it in this beautiful package. You speak to us in a very relatable language like you’re a beautiful best friend who’s highly intelligent and has done so much research. The best of all is you’ve come from a place of walking in those shoes which I think makes a huge difference. You’re like, “No, I’ve experienced these things and this is what I’ve done about them.” It’s not all about bioidentical hormones. There’s a lot in the middle that can be done to really be your best self, right?

SG: For sure. That’s kind of the philosophy of functional medicine. At its simplest, what are the nutritional deficiencies, what are the nutritional excesses. And here I’m defining nutrients in a very broad way, not just vitamin D and how are you doing with thyroid hormone. But how’s your spiritual life? Are you getting fed in terms of your mental immunity? So yes, I think that’s a good way to look at it.

I joke sometimes that I’ve had every hormone imbalance that a woman can have. I haven’t gone through menopause yet but I have struggled with these top 7 hormone imbalances and I know what it’s like and what comes up for so many women is this sense of being betrayed by your body. I think struggling with subfertility or infertility really brings woman up against that feeling of “Wow, I always just trusted that I’d be able to get pregnant when I was ready to. Why am I suddenly confronted with this struggle?”

5:06 CL: You’re trying to avoid getting pregnant by doing birth control pills for years and things like that, right? You were mentioning the 7 imbalances. That’s a great jumping-off place. Can we talk about what those imbalances are?

SG: Sure. So I start off pretty simply with the hormonal Charlie’s Angels. So I think of this as the three hormones which you really want working on your side. You don’t want them working against you. So those are estrogen imbalance with progesterone and we can talk about how this relates to fertility if you like; thyroid, and the big kahuna, cortisol. Because cortisol is what controls all the other hormones in your body, it’s the top priority. So if you are monomaniacally making cortisol like I was through my 30s, you’re going to be causing problems with your other hormones. In the book I also talk about the issue with testosterone and insulin. So the top 7 are basically high and low cortisol, low thyroid, estrogen dominance or low estrogen, both of which, all of this can relate to fertility. High androgens. So we keep going from there.

6:35 CL: So you were talking about low and high cortisol.

SG: Yeah. So high and low cortisol, estrogen high and low, low progesterone which together with estrogen can lead to estrogen dominance, low thyroid, high testosterone. I think that’s about 7. We’ll throw insulin in there too.

6:55 CL: And insulin. Something in your book that I was just listening to recently, you were saying that most hormonal imbalances start at about 35. Well, that’s where a lot of women are trying to conceive these days so that’s kind of an interesting time in our lives where we want to reproduce and then our body is going through all these changes. Is there kind of a typical pattern that you see in today’s modern woman? I know that is not one size fits all, but what kind of patterns are you seeing that are creating fertility issues for women?

SG: That’s a great question. There’s a few patterns. One is stress. Stress is such a big issue and it certainly was for me. I didn’t realize there was a cause to stress until I became a mother. I didn’t struggle so much with fertility but both of my sisters did. Many of my cousins that are kind of in my cohort struggled with polycystic ovarian syndrome. So I have a lot of infertility in my family and I’ve taken care of women, thousands of women with infertility.

But I think what happens at 35, it’s not that 35 is some magical cliff that you start to fall from. It’s more that there’s a gradual process that occurs before that. I hated learning this when I went through my obstetrics and gynecology residency at UCSF, but what I was taught was that 24 was the ideal age to have a baby. I hate that kind of data because the way that we look at it from an epidemiologic perspective is that if you’re too young, if you’re a teenager and you’re getting pregnant, you have a high risk of something called preeclampsia (high blood pressure and spilling protein in your urine). You also have that at the other extreme where you’re in your late 30s or 40s. So just kind of putting all the chronic disease together and the diseases of pregnancy, 24 is this magical age.

So 24 is a pretty good age in terms of being a hormonal specimen that is ideal. But what happens is that you’re depending on how you manage cortisol, depending on how you kind of dance with stress. If you’re someone like me who had a high level of perceived stress, when I was 35 and struggling, I went to my primary care doctor and said, “Listen, I’ve got PMS. I’m kind of bitchy and I need some help.” And he went straight to offering me an antidepressant and, “Oh, why don’t you take a birth control pill because that solves every hormonal problem a woman has?” Not true. Causes way more problems than I think it’s worth. That’s a side conversation that we can have. But what I did was I left his office kind of furious and had that righteous indignation that I think fuels a lot of people to take the mess of their lives and translate it into a message. That was certainly fuel for me.

But I went to the lab and I found that my cortisol, my stress hormones were three times what they should have been. So they should have been here and they were way up here. What happens in that situation is that if you’re making cortisol in your adrenal glands, you’re not going to make as much progesterone. Progesterone is really essential for getting pregnant and having a normal ovulatory cycle where you ovulate each month and kind of have a normal process of aging with your eggs, and it leads to other problems too. For me it led to insulin resistance, high insulin levels and I was about 25 pounds overweight at the time. I had no idea that I had insulin resistance. No idea. I checked my insulin and it should be about 5, and my fasting insulin was in the 20’s. What was happening was that high insulin was directly toxic to my ovaries and led to a high testosterone level. So I had this combination, just in that sense in your 30s, around age 35, it’s very common to have all three of these Charlie’s Angels affected. So, I had high cortisol, I had low progesterone and estrogen dominance as a result. Then my thyroid was slowed down for a couple of reasons. I had high mercury. I also had trouble converting T4 (the inactive thyroid hormone) into T3 (the active thyroid hormone). Then I had this issue with insulin.

So that’s a very common story for people who are in their mid-30’s, but the typical thing that happens around 35 to 40 is that you begin to run out of ripe eggs. And I don’t say that from a scarcity place where tick-tock, you got to try right now. I’m not into that fear-based, fear-mongering way of looking at fertility, but more from the sense of yeah, we’ve got a limited supply of ripe eggs and at some point it’s going to be harder to get pregnant. And as you start to run out of ripe eggs, your progesterone isn’t as high and your estrogen starts to climb higher and so you have estrogen dominance and that’s true for about somewhere around 70 to 80 percent of women over the age of 35.

13:14 CL: The pattern that you were describing and you said one key thing that was ‘perceived’ stress. I think that that’s a very, very important word. You probably had a lot of balls in the air, you’re a physician, you’re a mother, you’re writing books and things like that. But you don’t even have to be doing that. It’s that perceived that we’re all under. Because you were saying in your book sometimes just making your kid’s lunch would kind of frazzle you out. Me too. And they don’t eat it and that makes me mad. But anyway, yeah, so we’re like living this life where we have all this perceived danger. You watch the news and something that happened across the country and you’re feeling like it’s a threat to you, and so those are really affecting us as women and driving up those cortisol levels and then eventually what happens, depleting the cortisol at a certain point too. So when you talk about that kind of wired and tired feeling and then say that that’s been going on for a few years and then maybe you’re trying to conceive and you’re at 39 or 40 years old, you have that wired and tired. Your career go, go, go and now what are you feeling like? You’re relying on coffee a lot or some type of stimulant to keep you going.

SG: Yeah, that’s a common pattern. I don’t like the language of adrenal fatigue. I like to be much more precise about what’s happening in the body. I think of it more as the control system for your hormones is out of whack. So that control system is what I refer to as the HPATG and that just stands for two parts of the brain, hypothalamus and pituitary, which then talk to your adrenals, so HPA axis. But they also talk to your thyroid and to your gonads, to the ovaries in women and testes in men. So the HPATG gets out of whack. And you’re exactly right. A lot of people don’t have this dialed in. They’re not checking their cortisol like I was. But instead what they notice is, “Oh, I need two cups of coffee now to get going. And it doesn’t seem to be working as well and I’m not sleeping quite the way I used to. It’s hard to wind down so I have a glass of wine.” That’s kind of the way that it starts.

Or depending on your vulnerabilities, depending on your genetics, what I see is that there’s some women who primarily start to have symptoms related to fertility. There are other women who have symptoms related to digestion. There are other women who have more somatic symptoms, maybe like migraines or like some sort of pain syndrome, fibromyalgia for instance. That tends to be more on the kind of chronic HPATG dysfunction line where longstanding, high perceived stress leads to depleted cortisol levels over time and leads to that more fibromyalgia picture.

So people manifest in different ways. You’re in acupuncture, that’s right, Charlene? So you have ways that you think about this from a Chinese medicine perspective. But we all have our different vulnerabilities and I think the key is to take whatever symptom that we’re confronted with, whether it’s the coffee that’s not quite working anymore or that tired but wired feeling. And to really understand it, to translate it into okay, what’s the wisdom, what’s innate intelligence is my body trying to tell me?

17:08 CL: It’s tricky because I’ve been there too and you’re not functioning fully. Your tank is like 20 percent full. So even to figure that out, to kind of get in touch with it at that time, that’s really the challenge or that’s kind of what you’re up against at that point going, “what direction do I go?”

SG: Yeah, it’s a huge challenge. What I was taught to do as a board-certified gynecologist is that if you’re a woman and you’re trying to get pregnant, try for a year and if it’s not working, go see your doctor. And if you’re over the age of 35, try for six months and if it’s not working, go see your doctor. And I want to call bull**** on that. I think if it’s not happening or you feel like something is off, go see a collaborative clinician much sooner than that. It takes a village. Get a team approach to addressing some of these root causes and underlying concerns.

I happen to be a physician scientist so it was easier for me to kind of map out okay, here’s what’s going on with my hormonal dashboard and figure out how to address it. But of course, a lot of people don’t have that as part of their background. So that’s where working with someone collaborative like you is where we need to go next.

18:40 CL: It depends on where someone is in the country and who they’re working with because I think you were talking about it in the book, a lot of conventional doctors don’t even really recognize cortisone-type patterns unless it’s like a Cushing’s disease or something else. So say that a couple are trying to get pregnant, they’re 35+, they’re dealing with some hormonal changes, kind of what’s the first step that you’re thinking of and maybe that you need to even direct your doctor. I know there’s a lot of independent labs now and that you could send in saliva samples and get cortisone tested. But what’s the action plan or what should they be thinking of as first steps?

SG: Well, I’m a fan of trying to do whatever you can within your insurance parameter. So I think going to your primary care physician or to your obstetrician-gynecologist whether that’s a physician or a nurse-practitioner is the place to start and ask for a hormone panel. There are some basic things that you can test early on. Pretty much anyone who’s trying to get pregnant, they’re not going to argue with you about doing a thyroid panel. They might argue with you about the full panel that I would like every woman to have which is not just the TSH (thyroid-stimulating hormone) but a free T3, a free T4, maybe even a reverse T3 so that we can look at the rule of stress in your thyroid function. I would take that even further and like to do some genetic testing to see are you someone who converts the inactive T4 to the biologically active T3 because there’s a couple of genes that can make your labs look normal but you’re actually not converting very well, and that can really affect your ability to ovulate.

So I think starting with a hormone panel, if you can get them to do a morning cortisol test like 8:00 in the morning, that would be ideal. We want that to be between 10 and 15. TSH for someone who’s trying to get pregnant, we want between about 0.3 and 2.0. That’s the conventional standard. I even want it lower than that. I’d like 0.3 to about 1.5. And all of these numbers are in my book. I’ve got a list in the back of The Hormone Cure for the labs that you want. And then, pretty much any conventional clinician is not going to argue with checking your fasting blood sugar and maybe even a fasting insulin. It’s a very typical metric that we do on someone who’s trying to get pregnant. And so we want fasting insulin to be less than 5, that’s optimal. Because I don’t want you to be average, I don’t want you to be like 95% of the US. I want you to be optimal in terms of getting pregnant.

21:29 CL: Yes. A very, very good point.

SG: Then in terms of estrogen and progesterone, again, most conventional clinicians are willing to do especially if you’re around age 35 or older, they’re willing to do a day 3 FSH and estradiol. So that’s valuable and they may even be willing to do a day 21 or 22 progesterone level. So that’s kind of a basic panel that I recommend that people start with. You mentioned doing direct-to-consumer lab testing and I think that’s valuable as well. Let me just add to that conventional panel. Doing a total testosterone is what a lot of clinicians will do. I like to do a free and bioavailable testosterone too screening for polycystic ovarian syndrome or some other cause for high androgens as a reason for blocking fertility. So that’s kind of a basic hormonal panel that most people are able to get through their insurance. If you’re not able to get that from your conventional clinician then I would say find a new one. Go to a new OB-GYN who understands what a hormone panel is and understands that the optimal ranges for someone who’s trying to get pregnant is different than kind of the average reproductive age woman.

22:47 CL: I think that that’s so helpful for someone to write down that and have that conversation and just make sure that those basic things are checked. Also, I know that there’s two schools of thought as far as testing hormones like blood serum or saliva. Do you have any feedback on that?

SG: Yeah. Well, I usually start with blood testing because it’s the language of conventional medicine. I’m a bridge builder. I really like to when I get a referral or when I’m seeing a patient who’s got, you know, pretty much everyone has some conventional doctors involved in their care, I like to send them reference letters and referral letters and describe what I’m doing and their lab work. So the problem with saliva testing is that it’s used in a research setting like it’s used especially with research studies looking at stress and has been validated for that purpose.

It’s helpful because a blood test is like a 10-second snapshot while a needle is in your vein which if you have a needle phobia is not very accurate. But a saliva test is usually you collect saliva over a period of time like 5 minutes, 10 minutes, and it’s often at 4 points during the day like when you first wake up in the morning before lunch, before dinner, before you go to bed. So it gives you a sense of the pattern of cortisol over the course of day which is supposed to be peak in the morning within an hour of waking up and then a slow decrease over the course of the day. So saliva testing gives you more information but for speaking kind of that universal language of conventional doctors, I tend to start with blood testing.

You can also do urine testing. They do a lot more urine testing in Europe than we do here in the US. I happen to like the dried urine testing, it’s called the DUTCH Test because it tells you about metabolized cortisol, not just your free cortisol that’s in your saliva, but how you’re metabolizing it. It also can tell you about estrogen metabolism. I’m not sure how important that is with trying to get pregnant but for women who are concerned about breast cancer risk and endometrial cancer risk and endometriosis, then estrogen metabolism becomes a lot more important.

So DUTCH testing I think is helpful. You just basically pee on a piece of paper which I think is easier than saliva testing, and that’s been validated. So start with blood testing. Urine testing is my next favorite. Third favorite is saliva testing.

25:22 CL: Thank you so much. I’m just looking at questions we all kind of came up with as a team, because we’ve all read your books and we’re like, “Oh, I want to ask her so many questions.” What are some of the things that women and men can do to slow down or even reverse some of the effects of aging that may also improve fertility?

SG: That’s a good question. I don’t think I’ve been asked that before. Let me think, we’ll rift together. Well, maybe we could just go through some of the levers of aging and then talk about how they relate to fertility because I think I’m sure they’re related. That’s sort of the nature of the body, that there’s this interdependence among all the systems of the body.

So the levers that I think about are the muscle factor. One of the things that happen starting at 35 is that you begin to lose lean body mass and you start to gain fat mass. It’s on the order of losing about 5 pounds a muscle per decade. So for most of us, that’s not very good news. So unless you’re increasing your exercise from 35 to 40, to 45 and 50, you’re going to begin losing muscle mass. So I think that’s an important factor with fertility just because you want to kind of dial in your fat mass. That’s an important aspect of fertility. You don’t want almost like any nutrient in the body with your fat mass. You want it to be not too low. You think of kind of the female athletic triad of not having a period, osteoporosis, and maybe some disordered eating. So they often don’t have enough fat mass like a gymnast who’s maybe trying to get pregnant.

Then on the other side, you don’t want too much fat because fat is very inflammatory. So once you get above like a 30 percent fat mass, then you start to have greater inflammation in the body. Insulin resistance is one of the number one causes of inflammation and inflammation is the root cause of infertility. So, just as inflammation is a root cause of infertility, it’s also a root cause of accelerated aging.

The second thing is chronic stress. So we talked about this related to your hormone balance and kind of the cause of perceived stress. This is where this data kind of stopped me in my tracks in 2009 when Elizabeth Blackburn at UCSF, a geneticist, won the Nobel Prize for her work on telomeres, those cute little caps on your chromosomes that are a marker of your biological aging as opposed to chronological aging. She did some very cool research where she took a group of moms who had a sick kid in the intensive care unit at UCSF. She compared them to a group of moms who had a healthy kid. She assumed that the women who had the kid in the ICU would have shorter telomeres, they would be aging faster. She was surprised to find that it didn’t matter whether your kid was sick or not. What mattered was your perceived stress. The women who had a high level of perceived stress were aging 10 years faster compared to the women who had a normal amount of stress. I don’t even know what that means. I don’t know anyone who has a normal amount of stress. I know like one person.

29:00 CL: Right. But the perceived stress would be having your child in ICU, so I don’t see like how…

SG: Well, so the point is that there’s lots of women with healthy kids like me who have high perceived stress just because that’s kind of the way they react to the environment. So those people had short telomeres and in fact, I tested my telomeres and I was aging 20 years faster than I should have been.

29:25 CL: During that period.

SG: Yes, that’s what got me to write my book Younger. So that’s another lever. We can go through some of the other levers as well. Another important one is toxins which definitely can accelerate the aging process. Many of them act as obesogens. They make you fat, they disrupt insulin, they disrupt testosterone. They’re endocrine disruptors, disrupt estrogen and thyroid. Bisphenol A is kind of the worst player here, the devil we know. And they can also disrupt fertility. So this is pretty well demonstrated with a number of studies looking at polycystic ovarian syndrome and the higher your BPA levels, the less fertile you are and the more accelerated the PCO picture is.

So this has been mapped to a number of different indicators of female fertility including egg quality. So phthalates are another class of endocrine disruptors, estrogens that can interfere with egg quality and be associated with a greater risk of miscarriage or spontaneous abortion as what we call in medicine.

30:38 CL: For those listening who go, “Oh, phthalates. I’m not familiar.” Like where would I even come across those? What are some common ones? I know that we’re exposed to them all the time but what are some common things that people are coming in contact with?

SG: So the most common is fragrances. I just went to my daughter’s room before we started our recording today. I saw that she somehow got some like toxic deodorant into her bathroom that has like a fragrance to it. I won’t say what the brand is but, you know, I bought her the organic deodorant and she’s convinced it doesn’t work and so she bought this toxic stuff with her own money. That’s how we get exposed. Often it’s through our skin, it’s through perfumes, it’s through skincare products that have a fragrance. Phthalates are in that, it’s part of that fragrance picture.

31:36 CL: You were talking about Bisphenol A (BPA) which now people are like, “But I’m so aware of that. Everything’s BPA-free.” But they’re kind of a misnomer because then you can get away from BPA but then you’re still using plastics.

SG: Yeah, some of the BPA-free alternatives are just as toxic, if not more toxic than the BPA. So part of the problem here if we look at it from a different perspective is that the chemical industry is kind of like big tobacco. We’re like crash test dummies for big chemistry. So they want to keep their profits up as there’s more of a consumer backlash against BPA, they brought in these other products that are untested. “Buy this water bottle. It is BPA-free,” and it turns out that it is just as toxic as the BPA, if not worse. So that’s not the best alternative. I’ve got my stainless-steel mug of tea here and this is a much better way to go. There’s no plastic in it. You can use a glass container. That’s what I use for all of my food and water. That’s a much better way to go.

But with BPA, another issue is receipts. So there was a study by the Environmental Working Group where they found that 40% of retail receipts including from the most common places in our country are contaminated with BPA. So that’s another common place. When you get asked “Do you want a receipt? Do you want to take it with you?” Say no, that’s toxic, keep it away from me.

33:14 CL: The world is full of pitfalls as far as just trying to navigate the landmine of toxicity. Whole Foods, I guess they say that their receipts are BPA-free. But you don’t even need a receipt these days. Unless you’re paying with cash then. But be aware of that. We were talking about the xenoestrogens. Oh yeah, and like I was at a girlfriend’s house who was trying to get pregnant. And I won’t mention the name either but she had a freshener that rhymes with “laid” and I was like, “I think you really need to…” and she was like, “Oh, I love the scent.” Which I just couldn’t imagine because it smelled so toxic and synthetic to me. Another one that rhymes with “le breeze”, get that out of your car, please.

SG: Yeah, get it out of your car. You know what, I think some people have the approach of “Well, I’m already toxic. Why bother being so obsessed about this?” Other people have a lack of awareness and so I think the message here is to try to spread awareness. I’m a big fan of essential oils. It’s so easy to just buy a cheap diffuser on Amazon and just put some lavender or sandalwood or like some other essential oil in there. it’s so much better for your body to just steam and diffuse an essential oil than to use the air freshener that you mentioned that has phthalates in it.

34:45 CL: Now, we are talking about about stress or perceived stress, so people listening are going, “Yeah, I’m perceiving tons of stress in my life. One of my stresses is that I’m older and I can’t get pregnant,” and that’s a huge perceived stress. So, what are we doing about it? What are some simple guidelines or tips that you can share that have worked for you and your patients?

SG: I’ve got a long list. I became a yoga teacher because I had such high perceived stress. I think that’s really common for people to take up meditation, even go deep with it because we need it so much. There’s a lot of different ways to dance with stress in a different way. Some people do it with exercise. I’m a big fan of burst training because that’s a way to build stress resilience especially when you go hard and then you back off and you go easier and you do that for like a minute on and a minute off. So burst training I think is such a good source. It’s a little tricky for people who are infertile. My sister for instance who’s a big jock, she had to really back off on her exercise when she was trying to get pregnant. So I know a lot of women get told that or they’re told to do something more adaptive. She was told to go to yoga and she picked up kundalini yoga which I thought was really cool. So definitely going to yoga, doing something more adaptive like pilates can be a good choice.

Meditation. I’ve been following this kundalini yoga teacher named Guru Jagat. She’s in Venice, California.

36:31 CL: She’s huge.

SG: She’s huge. She had a beautiful line where she said “make out with meditation” just like find a way to fall in love with it, find a way to really have it be embedded in your day and like be something super yummy that you look forward. I feel that way about meditation. I didn’t always. But I need help with meditation. So I’ll be totally vulnerable here. I wish that I could just sit on a cushion and do 30 minutes and feel like that was a really good fit for me. It’s not. I have some mornings where I have a gene called the COMT gene, it’s called the explorer gene, that’s like the nice spin on it which means I’m always looking for the shiny new object. So sitting still is not easy for me. I’m kind of low in dopamine. So what I do is I use a Muse headband, so it’s something you can get on Amazon. It’s basically like a technology assist for those of us who are challenged by meditation. It doesn’t cost a lot. It’s a couple hundred dollars and I just use my iPhone. It’s a clinical-grade EEG machine so it gamifies meditation. So as I meditate and I get into a calm state, it plays ocean sounds. You can kind of choose what nature sound you want to listen to and if get distracted, the sounds get louder. As I get more calm, the sounds get quieter and then I start to get birds chirping the longer that I stay calm. You get to the point where you’re just like, “I want more birds! I want more birds!” So you get into this more calm state and I love that kind of lineup, that alignment of gamification and doing something that’s really good for your body and it’s been shown to lower cortisol levels. It doesn’t take much. Only 20 minutes, 3 days. Three to 4 days makes a big difference in terms of your cortisol levels.

Chanting, yoga. There are some supplements too like fish oil has been shown to lower cortisol. I’m a little careful about using herbs. You may know more about this than I do but for someone who is trying to get pregnant, I’m a little careful about using herbs. But for someone who has high cortisol and it’s affecting their ability to make progesterone, one of the herbs it’s been shown to improve fertility is Chasteberry. That’s been shown in a randomized trial at Stanford to raise your serum progesterone levels and also increase the rate of live birth. I don’t know of any drug that does that. That’s a pretty powerful herb.

39:16 CL: I’ve just sort of restarted incorporating just upping my vitamin C and doing the fish oil and kind of having that as like a little drink with some Himalayan salt just to kind of sustain my adrenals through the day. And your book kind of prompted, “Oh, right. That was something that really worked well for me. Okay, I’m going to do that.” Because you made me kind of question taking a bunch of glandulars which I was sort of relying on. “Okay, I’m going to do this and see how that feels.”

SG: Sometimes simple can make a big difference. Vitamin C is one of those it’s maybe a little less sexy than some of the other supplements out there but it is tried and true. It raises progesterone levels as little as 1000 mg a day. 750 mg a day has been shown to raise progesterone levels and it helps you with your cortisol levels. So you’re getting a 2 for 1. It’s a very good nutrient to focus on.  

40:11 CL: Yeah, absolutely. Is it accurate that it’s non-toxic at higher levels? Because you were recommending in your book 2000 milligrams that it’s been shown to be safe at high levels?

SG: Yeah, and I don’t even consider that high level.

40:26 CL: Oh, because it can go up, yeah.

SG: A lot of people take much more than that. The issue when you start to get more of it is that it can cause a loose stool, kind of similar to magnesium. So you just want to be watching what’s happening with the transit time of your stool.

40:42 CL: That’s okay. A lot of women are constipated, right?

SG: Well, if their thyroid is not working and that’s why you’re constipated, we need to address that too.

40:52 CL: So I want to respect the time. We are kind of wrapping up towards the end. Can I ask that we have a part 2 because actually there’s so much more that I kind of want to pick your brain on. Can we do that another time?

SG: Sure. Yeah, of course.

41:08 CL: Thank you so much. I just feel like we’ve gotten so much value and your books are invaluable. Just thank you for being a doctor and just kind of being a shining light. I wish all doctors were like you, they’re not. But at least you have your books and you’re educating the masses. We appreciate it so much, we’re so grateful.

SG: Thank you, Charlene. Thank you for what you do. I appreciate it.

41:36 CL: Thank you, Dr. Sara.

SG: All right. Thanks, everybody.