I grew up with a great-grandmother who was a bit of a radical,” says Sara Gottfried, MD. “She practiced yoga and slept on a board.” She also lived to be 97, passing away peacefully in her sleep.
This example taught Gottfried that health solutions aren’t always going to be found in a bottle of meds — and inspired her to look deeper when she faces challenges of her own.
Gottfried is the author of the New York Times bestseller The Hormone Cure. Board-certified in obstetrics and gynecology, she studied at Harvard Medical School and the Massachusetts Institute of Technology. Today she runs her own integrative-medicine practice, the Gottfried Institute in Berkeley, Calif. She’s also a practicing yoga instructor.
But she wasn’t always so supremely healthy. Stress-related issues first struck when Gottfried was in her 30s. “I was working as an OB-GYN in what I call the world of ‘McMedicine,’” she recalls. Handling up to 30 patients a day, she eventually hit a wall.
Mentally and physically depleted, and struggling with mysterious weight gain, she went to see her own doctor. He gave her the usual advice: Eat less, exercise more. And take some antidepressants.
“My problem wasn’t depression,” she says. “My problem was feeling stressed out, and I had a hunch it was causing a hormonal imbalance.”
Sure enough, when Gottfried tested herself, she found that her cortisol, estrogen, and thyroid levels were out of sync. It took four weeks of concentrated work to reset her body.
The experience inspired her to leave her HMO job and open her own functional-medicine clinic. Her core health philosophy, dubbed the Gottfried Protocol, focuses on a three-step method for balancing hormones naturally. “I believe that it’s far easier to reset your hormones than it is to live with the misery of them being out of balance,” she explains. “I think that’s an important message for people who feel overwhelmed.”
Experience Life | What hormonal imbalances do you see most in women?
Sara Gottfried | They typically involve what I call the “hormonal Charlie’s Angels” — namely, cortisol, thyroid, and estrogen. These are the most important hormones for women, with cortisol being the control system. When cortisol is off, it also throws off your estrogen and your thyroid. Based on the quantitative surveys I’ve done in my practice, 91 percent of women struggle with their cortisol levels. There are very few who don’t. Most of them simply have too much stress: They’re running task to task. They feel tired but wired.
EL | Please explain why cortisol is such an important master switch in the body.
SG | As long as your perceived stress is not out of control, then cortisol is doing what it’s supposed to do: raising your blood pressure and blood sugar when you need it and modulating your immune system.
But if you’re running around with this sense of emotional and psychological threat, then cortisol works against you. It makes your body feel like it’s in survival mode: It gives you sugar cravings, slows down your thyroid so that you store more fat, makes you puffy and more likely to retain fluid. It doesn’t allow you to use progesterone to help you calm down. So it leads to all sorts of other downstream problems.
EL | What lifestyle changes can people make to counter that dynamic?
SG | You have to find ways of hitting your stress-reset button — and that’s a very individualized prescription. What works for me may not work for you. I do yoga, I meditate every morning, but each of us has to seek out our own solutions.
For some people, letting a square of dark chocolate melt on their tongue for five minutes is a meditation that really helps. And dark chocolate, especially 80 percent cacao or higher, lowers your cortisol levels.
So there are lots of different lifestyle tweaks. I can’t say, “Here’s the top five things you must do.” It’s more important that you want to be invested, that you explore and develop a list of things that are effective for you.
EL | Do small interventions help?
SG | I’m a big fan of the incremental steps that add up to big transformations. And I’m constantly searching for what is the minimum effective dose of a given intervention. For me, for example, 25 minutes of meditation is the minimum effective dose. I think it’s important to suss out the right dose for you.
EL | How does one sort that out?
SG | You have to experiment. Pay attention to the result you get from doing a little more or a little less of a particular thing.
If you are trying out meditation or yoga, for example, start with five or 10 minutes, then ask: “Am I getting at least a partial response here? And if so, would a larger dose generate a better response?” Then adjust accordingly. There’s the direct benefit of figuring out the right dose over time, but there’s also the value of observing yourself in an objective way. That alone is part of the practice. There’s something about that objective observation of one’s own experience that is hugely valuable when it comes to resetting your hormones.
EL | How long does that take?
SG | It depends on how far gone you are. There’s an initial repair phase, and then there’s the phase to sustain the benefits. Generally, I would say it takes a minimum of four weeks for that first phase. Most people take somewhere between six and eight weeks. And if you’ve been pushing the pedal to the metal for five years, it’s going to take longer.
EL | Does excess cortisol cause hormonal problems for men, too?
SG | Oh yes. That’s a big part of the epidemic of andropause and low testosterone we’re seeing now in men starting in their 30s. When you manage your cortisol, it helps you make more testosterone. If you’re hyperproducing cortisol, whether you’re male or female, you’re going to make less of the sex hormones. It’s just the way biochemistry works.
EL | What advice do you offer people in talking to their doctors about hormone balance?
SG | It’s a collaborative relationship. You have to decide if this doctor is worth sticking with based on how well the relationship is meeting your needs. Don’t just turn over your power. If you’re not feeling heard and cared for, stand your ground or leave. There’s no reason to accept the old-school version of patriarchal medicine anymore.
EL | Any other hormonal advice?
SG | For men, one of the most balancing things is to be around women. There’s a lot of data showing that married men have the best longevity and health. Interestingly, from a hormonal perspective, it doesn’t necessarily help women to be around men. It helps women to “tend and befriend” and to be around another woman who is taking care of herself.
I think the main thing is, people need to manage their hormones the way they manage their retirement plans, because they’re intimately linked. You’re not going to be around to enjoy your retirement unless you are actively managing your hormones today.