James Maskell:
Hello and welcome back to the Big Bold Health Podcast. We are charting a new world of health independent of disease with my co-host, Dr. Jeffrey Bland. Doc, it’s great to be back here with you.
Jeffrey Bland:
Likewise. Thanks James.
James Maskell:
So, when we decided to interview female leaders transforming health, Jeff and I made a list and Dr. Sara Gottfried was right on the top of that list. And unlike all the other people that were on the list, this is the first time we’ve met. So I’m really happy and honored to be with you, both of you. Dr. Gottfried is a best-selling author, is a researcher, physician, and doc, you’ve been dedicating the last two decades to educating and really transforming women’s health.
Jeffrey Bland:
Can I say something quickly?
James Maskell:
Yeah.
Jeffrey Bland:
Yeah. I don’t want to break the continuity, but Dr. Gottfried also is a remarkable person in terms of her educational background that tells you something about her and her perspective. Not only having had her medical degree at Harvard Med School, but having a degree in engineering and the whole nature of bioengineering at MIT. So you know she’s got the highly developed left and right hemisphere of her brain. This is a very unique talent that she brings into her worldview, her practice, her advocacy. And there are very few people in the world that I would select to want to have as a quintessential example of women’s health and women’s health advocacy other than Dr. Gottfried, she’s a remarkable person.
Sara Gottfried:
Thank you.
James Maskell:
Well you said it better than I. So, Dr. Gottfried, to the question, what was it that really got you fired up to sort of made an impact in where you’ve gone so far and where you’re going in the future?
Sara Gottfried:
Well, it didn’t start with women’s health. It actually started with a grandmother who was diagnosed with Alzheimer’s disease. And at the time I was getting a PhD in bioengineering. And I just realized that the medical system had completely failed her. And so while I was working on the vascular, the angiogenic response in cancer at the time, I realized I could have so much more of an impact if I went to medical school. So I dropped out of the PhD program and applied, got into the Harvard program and that’s where I started to realize that there’s a massive gap, research gap, when it comes to women’s health.
Sara Gottfried:
And there’s various threads in our historical framework for that. In some ways I think that’s less relevant. What matters is the future. So what I realized also is that the research gap has led to a massive knowledge gap. So, my ambition, my big, bold hope is to close that gap.
Jeffrey Bland:
So I would say from my observation of what you’re doing is you’re making positive progress in achieving that objective. You are an opinion leader who’s stopping people’s talk so they can listen to what you’re saying. And you’re educating by example, which is the most useful way of educating. We can learn in different ways. Part of it is in our head, part of it is in our heart, and the best is when we combine those two and you do them well. Both those… that combination. So, maybe you could just quickly share a little of your own personal experience because I think that helps to contextualize your advocacy in your position.
Sara Gottfried:
Sure, sure. Well, let’s go back to my grandmother. So we know that women are diagnosed with Alzheimer’s disease at twice the rate of men. We don’t understand why. We don’t understand, is it hormonal, is it gender differences, is it differences in brain structure? And so that’s what initially got me motivated. But the more that I learned about women’s health and these gaps with men’s health, the more that I realized it’s not confined to Alzheimer’s disease, of course, it relates to anxiety, depression, autoimmune disease. There are so many conditions that women face at a much higher rate than men and we have no idea why that is. So, in terms of personal story, it sounds like you have something in mind, Jeff.
Sara Gottfried:
A lot of what motivated me, especially toward precision in personalized medicine, was listening to your tapes. Going back to the 1990s.
Jeffrey Bland:
Oh my word.
Sara Gottfried:
And hearing about… You have this level of scholarship when it comes to understanding the human body, understanding its signaling pathways, that made so much sense to me. And it really married my love of engineering and kind of the engineering mind that I have with an approach to medicine that was head and shoulders above what I was even learning at Harvard Medical School. So, that’s what really got me motivated. And from a personal perspective, I joke sometimes that I’ve had every hormonal problem that a woman can possibly have short of menopause.
Sara Gottfried:
And so, I’ve had sort of one issue after another. I didn’t have difficulty getting pregnant, but once I was postpartum, I had postpartum depression. I couldn’t lose the baby weight, which I think happens to so many women. They gain 20 pounds with their first baby. They have another baby, they gain another 20 pounds. And before they know it, they have metabolic dysregulation. And that’s at the root of so many of the conditions that we’re talking about. So I would say, my personal challenges have led me to the next step in terms of helping women understand their bodies, get informed about their function and get empowered about how to step into action.
Jeffrey Bland:
Yeah. And you’ve done that so remarkably. And I think part of that impact you have is your openness and truthfulness and there is a sense that this person is speaking a central truth. There is no kind of peripheral garbage here. This is a core truth. How have you gotten yourself comfortable to be able to create that truth-saying identity in a marketplace that often tries to channel us into some kind of persona?
Sara Gottfried:
Great question. I think… One of the things that I encountered in conventional medicine is that you don’t share your story. You stay focused on the patient’s story. And I think that’s really important. But I also really believe in Brené Brown, who talks about vulnerability as the path to wholeheartedness. And I would even say that vulnerability, kind of sharing your vulnerability along with credibility is the key to helping people realize their own vulnerability. And then to start to change their behaviors in the direction of better function, better outcomes, better health.
Sara Gottfried:
So, the most recent challenge that I went through was, I diagnosed myself based on genomic testing with a gene that puts me at about a 3-5x increased risk of breast cancer and a 2x increased risk of colon cancer. And so I made the decision after trying to modulate my estrogen pathways to have a prophylactic mastectomy.
Sara Gottfried:
So I went through that procedure. But here’s what was surprising, I took a month of antibiotics for the first time in my life. And after I finished that month of antibiotics, and I turned this into an N-of-1 study if you want to hear more about that, I felt anxiety for the first time in my life. And I also gained weight. I gained about 15 pounds without changing what I was eating. So remarkable change in the signaling pathways in my body, ended up getting diagnosed with small intestinal bacterial overgrowth. And that set me upon this path of really looking at, okay, the gut-brain axis, it really came alive for me in a way that it wasn’t as relevant before.
Sara Gottfried:
So that’s an example of kind of my most recent personal challenges, which I see not as a victim, but as, okay, this is the next step in my path. Something that was previously unknown to me or not known well enough that I need to understand better. Because if I struggle with it, if I struggle with anxiety and with insulin resistance as a result of what’s happening in my gut microbes, certainly other people are going through that too. Not just women, but men too.
Jeffrey Bland:
Yeah. Can I just, I want to turn this back to you, but I just want to take just a half a moment to honor you, because what you just said is not easy to say. It’s even maybe more difficult to go through, and then it’s more complicated to try to understand, and then communicate. And what you did in that sound bite is truly courageous. And I think it’s what then creates in other people the opportunity for them to be courageous about their health. And when we talk about Big Bold Health, the reason we chose “big bold” is I think it requires us to step up and be more bold about our health.
Jeffrey Bland:
We often feel that we’re a victim and we have no control. And well woe is us if we got bad genes or the bad luck in life, and we’ve just kind of got thrust into this condition of not feeling well and there’s nothing we can do. To step up and be bold, to be the advocate of ownership of our health, to create this new ‘we’ or new ‘us’ is really quite a remarkable courageous thing to do. And your advocacy can help spawn many other individuals to take that step. So, thank you.
Sara Gottfried:
Thank you.
Jeffrey Bland:
It’s huge. So James, I’m sorry I interrupted.
James Maskell:
Well, you have multiple New York Times best-selling books and each one kind of evolves into the next one. And obviously you have your own experience. You have the research that evolves and then you have obviously, patient care. What were some things that led to this latest book and things that you felt that you wanted to share that you hadn’t shared up until now?
Sara Gottfried:
Well, there were a number of things. Certainly this experience with SIBO, small intestinal bacterial overgrowth, was huge. And I had another epiphany. You could even say I got hit over the head with another epiphany, which was in 2015. I was with a group of clinicians. We were filming a TV show in San Diego and we went all day long, not eating and drinking and taking care of our bodies. And I fainted at the end of this. We were standing in the kitchen trying to figure out what to eat for dinner at 10 o’clock at night.
Sara Gottfried:
So I think what happened was probably low blood sugar. I fell, hit my head pretty hard and when I hit my head I had what looked like convulsions. And at that point some of the doctors in the room called 911. So I had this experience of a traumatic brain injury that also got me to realize the essential nature of the integrity of the gut lining, the essential nature of the integrity of the blood-brain barrier, and how I was disrupting it right and left and I had no idea.
Sara Gottfried:
So I decided I wanted to write a book about it because I realized so many of the conditions that I see in my practice, anxiety, depression, addiction, weight gain, early memory loss, brain fog, all of these things are related to that gut-brain access. It’s related to other things as well. The immune system is part of that access. But that was what really motivated me to say, “Okay, even if you don’t have gut symptoms, you might have an issue with your gut-brain access.” Because that’s what happened to me.
James Maskell:
Wow. And how do you translate that into sort of actionable information for the reader?
Sara Gottfried:
Well I think there’s many ways to translate it. I think, and this I would say is my most sacred obligation, to try to make really complex scientific information, understandable, relatable, and actionable. So, I don’t think you can start with a microbiome. I mean I love to start there. I know Jeff loves to start there.
Jeffrey Bland:
Yeah.
Sara Gottfried:
You probably love to start there too. But for most people going about their busy days, the microbiome is not so relevant yet. We can make an argument that maybe it should be. But I think the way you start is, what are your pain points? What are you suffering with? So I know from quantified analyses that I did in my own practice that my patients struggle with mood, stress, weight gain, sex drive, although they’d like to lose weight first before they deal with sex drive. And so I know what the pain points are and I know that there’s proven ways to solve those pain points. So my books frame up against those particular pain points.
James Maskell:
And you mentioned earlier the research doesn’t really reflect for women what’s really going on, there’s some gaps there. What is unique about the female physiology that lends itself to these chronic illnesses that you’ve written about.
Jeffrey Bland:
Can I jump in there?
James Maskell:
Yeah.
Jeffrey Bland:
Because I think that’s a great question and I want to put an addendum to your question.
James Maskell:
Yeah.
Jeffrey Bland:
I had the privilege many years ago of meeting Bernadine Healy. And that was a life changing experience for me. Unfortunately she’s not with us any longer but her advocacy still lives on very, very strongly. And being the first kind of female, strong women’s advocate at NIH really got the whole nature of research to be changed. And when I bring this topic up today with my colleagues, a lot of them are male research or clinicians, and I say, “Do you realize that the approval of drugs starting off in early stage, which are animal trials, are all done on male animals?” Not even getting to clinical studies in humans yet. We’re just on the basic first level development, your kind of your basic science, that they’re done on male animals. And the reason for it is that it’s presumed within basic research that female physiology is too complex.
Sara Gottfried:
Mm-hmm.
Jeffrey Bland:
It’s a wild card. And when I heard that, I mean it was like a two-by-four alongside of my head. I thought, “What!? Because it’s complex, we go to only using male animals and then we eventually go to a drug that’s going to be used in females and males only with male subjects in clinical trials. There is just like no way you can even begin to rationalize this.”
Jeffrey Bland:
So, having met Dr. Healy and seeing her advocacy for the Women’s Health Initiative and that first big research cohort that the results are still forthcoming today. It was a wild card that changed… It wasn’t a wild card, I mean it was an agent of change that changed the whole domain. So your advocacy I see as an extension of Dr. Healy’s advocacy.
Sara Gottfried:
Well thank you. And I’m a huge admirer of Bernadine Healy as well. I think she really got us to turn left finally at the NIH and she is responsible for the Women’s Health Initiative, which was the first, it wasn’t the first randomized trial, but it was the first randomized trial looking at hormone therapy in women for primary prevention of a number of different outcomes. And it ended up showing that hormone therapy, at least conjugated equine estrogen and medroxyprogesterone acetate were dangerous and provocative in many situations.
Sara Gottfried:
And we got a lot more clarity about outcomes. But let’s go back to the 60 years before that where we had Premarin, conjugated equine estrogen, as the number one prescription without ever bothering to do a randomized trial until the HERS trial in 1999. So, I am so grateful for her and the way that she has helped us understand the role of hormone therapy as well as beyond.
Sara Gottfried:
And you’re right, I mean I remember coming to your Thought Leaders Consortium many years ago and talking about how it was presumed even back in the 1930s with Walter Cannon and his work on the fight-flight response. It was presumed in his work on men that the same applies to women and in women it’s more complex. Women tend to fight-flight-freeze. They’ve got this freeze component. They also rise above stress by going into tend-and-befriend. And that wasn’t discovered until the 1990s by UCLA professor Shelley Taylor.
Sara Gottfried:
So what are some of the differences? There’s that difference in stress response. There’s hormonal signaling differences. The major ones being estrogen is the master regulator in women, testosterone in men. We know that there’s various neurotransmitter differences such as with the oxytocin pathway, you have to hug a man three times as long to get oxytocin to spike.
Sara Gottfried:
So there’s a number of different, differences. If you look at the brain, for instance, and I’m a little cautious about saying this because I’m from San Francisco and we’re not quite as binary about sex and gender now, but if a radiologist looks at a brain image, an MRI or a CT scan of a brain, they can tell with 85% certainty whether it’s a male or female brain. And some of those differences include the hippocampus, which is the seat of memory consolidation and emotional regulation. It’s larger in the female, at least up until a certain point, probably the forties. The amygdala, which is the part of the limbic system where you search for threat in the environment, is larger in the male.
Sara Gottfried:
There’s other differences as well, but those are some of the key physiological differences. And then of course there’s sex differences which are biological. And then there’s gender differences such as more responsibility for care-taking, taking care of aging parents, societal and other cultural differences.
Sara Gottfried:
I was just reading a paper this morning about triathlon enthusiasts, and we now know that women participate in triathlons worldwide at about a 25 to 40% rate, which is higher than ever before. And the difference physiologically in terms of outcomes such as how fast you can run in an Ironman distance triathlon is only 7% between men and women. So women are catching up in many ways and I don’t want to talk about this in kind of a one up, one down way because I don’t think that’s very fruitful. I think what’s helpful is to understand these sex and gender differences so that all of our health can improve.
Jeffrey Bland:
Yeah, I think that’s beautifully, beautifully stated. And if I can just bring up a note of history, and I know I tend to now wax back maybe before people want to even think about this but…
Sara Gottfried:
We love it when you do.
Jeffrey Bland:
Maybe. Let me try it on and then you can tell me. So, I had a chance in my younger years to meet a gentleman, Dr. Robert A. Wilson, and he was the author of a book called, Feminine Forever, which in the 60s sold I think several million copies.
Sara Gottfried:
Yes.
Jeffrey Bland:
And I had met him and I have to say quite honestly, the first time I met him, I was really put off by him. Of course, I was a younger guy, he was kind of a senior guy. He was given credit for being the discoverer of Premarin and its positive effect on women’s health and mood. And he had kind of a golden reputation at the time. But I found it to be personally off-putting, quite honestly, and kind of self-absorbed. But the bottom line is when I finally read Feminine Forever, I was disgusted. I mean, I really couldn’t believe it that this book had sold to so many women and I believe it was probably out of a fear-based thing because it used terms, and I’m quoting now, this is not being made up, that women who did not manage their hormones at menopause would be suffering from bovine passivity.
Sara Gottfried:
Yes.
Jeffrey Bland:
That term is in the book, bovine passivity. And that men would have all the reasons to seek out other relationships from that of their wife if they were to be suffering from bovine passivity. I don’t even need to go farther than to just talk about the social and psychological angst I had when I was reading this, to think of how that contextualized the setting in stage of what became the number one prescribed drug for some period of time for the alleviation of symptoms that would keep women from losing relationships or feeling full and productive about themselves.
Jeffrey Bland:
So this legacy of not even medicine, of psychopathology is so deeply rooted. And when I see people like yourself that is advocating this kind of equality and opportunity, now having granddaughters, I only had sons, but now I have granddaughters. I really see this as a tremendous period of positive change. So thank you.
Sara Gottfried:
Thank you. Thank you. I appreciate that. I read Robert Wilson’s book as well and was horrified. But I also would say it’s a product of its time.
Jeffrey Bland:
It was.
Sara Gottfried:
And it’s hard to judge it with sort of today’s sensibilities. But yes, I remember the bovine passivity and it was, the taking hormone therapy was really framed as “Save your marriage.”
Jeffrey Bland:
Mm-hmm.
Sara Gottfried:
“Don’t be a castrated female that drives your husband away.”
Jeffrey Bland:
Exactly.
Sara Gottfried:
So as you described, very fear-based. And I hope now that women can approach decision making about their health, whether that’s hormone therapy or what to do about Polycystic Ovarian Syndrome or endometriosis or even just how to function better as we get older and extend the health span. I hope that they make their decisions from a place of empowerment with their clinicians in a collaborative partnership and not from this place of fear, which I think is unfortunately the foundation of conventional medicine.
James Maskell:
Well, just to go on there, if Jeff’s the past guy, then I’m the future guy.
Sara Gottfried:
Awesome.
James Maskell:
So, if we were 30 years in the future and we’re looking back on let’s say the last 10 years, at the moment that it became clear that chronic disease should be built on exactly what you just shared and not the way that it had gone before that coincides with your work. Isn’t it amazing to think that it was women going to see doctors who practice differently that actually facilitated the whole evolution? Because if you look at 75% of functional medicine patients are women, 75% of functional medicine doctors are women, and that’s women at a certain point just being like, “No more. This is not working for us.” And that journey and the learnings that happened in this community at this time sent us forward into this big, bold future. What do you think of that, Jeff?
Jeffrey Bland:
I’m right on target with you. And I think that’s our advocacy. That’s why we’re here. That’s why we’re doing this. That’s why we’re so fortunate to have Dr. Gottfried.
James Maskell:
And you’ll be 103 when we do that review. So I’m looking forward to that.
Jeffrey Bland:
I hope it won’t be that far in the future. So, as you move now into this next phase with your new book and the advocacy that it will bring and doing the book tour and all those kinds of things, where do you see your trajectory going as a person who is in this universe, as a leader, as an agent of change?
Sara Gottfried:
Well, a few places. I would say certainly research. I’ve got a research project that I’m working on right now looking at women in the ketogenic diet because I believe, based on my experience clinically, that men do much better on a ketogenic diet than women do. Women have, half of them have menstrual irregularity, they have thyroid and adrenal dysfunction. And so I want to figure out how do we make the ketogenic diet modified for women and much more effective because I think it is one of the strategies, not one-size-fits-all, not for everyone, that can really help with metabolic dysfunction.
Sara Gottfried:
So I would say research is one thread. Another thread is education. And I really believe that Nelson Mandela quote that education is a weapon that we have to change these injustices and struggles that we have. And even broader than education is media.
Sara Gottfried:
So I really believe that we are in an intention-based economy. I think economics have really changed over the past few decades. We’re heading toward an exponential global future and we have to be really smart, really wise and also circumspect and responsible about the media that we produce. That’s why I love your podcast. I think it’s really essential that we’ve got impeccable content that we’re sharing with the world, with the 75% of women who are part of this functional, personalized lifestyle medicine movement. But for men as well, I don’t mean to leave men out of the equation. We need everybody.
Jeffrey Bland:
Yeah. Yep. And I think what we’re seeing now is there is some harmonization and if we can unify this energy in such a way it promotes a positive harmonic oscillation, we can create global change. And I think that it’s not going to probably come from the top-down. It’s going to come, as you’ve so well educated, from the bottom-up of people just basically saying, “We’re going to be big and bold about our health, or our children’s health, or our family’s health, or our neighbor’s health, or our global health.” Knowing that a healthy planet is a healthy person and vice versa. All of that resonance can create extraordinary positive change. So you are a strong member of our leadership community that we’re privileged to have. And thank you for sharing who you are and what you are and where you’re going.
Sara Gottfried:
Thank you.
Jeffrey Bland:
Really exciting.
Sara Gottfried:
Thank you so much.
Jeffrey Bland:
Thank you so much.
James Maskell:
Well on that big, bold, bombshell, we’ll finish off today. We’ve been here with Dr. Sara Gottfried. You can find out more about her work, we’ll have links to the latest book in the notes. But thanks, I’m your host, James Maskell here with Dr. Jeffrey Bland. Thanks so much for tuning in to the Big Bold Health Podcast, and we’ll see you next time.