294: Dr. Sara Gottfried – Brain Body Diet, Start To Surrender, Reset With Intermittent Fasting

Sara: 76% of patients complain of memory loss as they get older. I don’t think that’s normal. I’m not taking that sitting down. I feel like that’s actually a symptom of a bigger problem.

Jesse: Hello and welcome to The Ultimate Health Podcast episode 294 Jesse Chappus here with Marni Wasserman and we are here to take your health to the next level.

Marni: Each week, we’ll bring you inspiring and informative conversations about health and wellness, covering topics of nutrition, lifestyle, fitness, mindset and so much more.

Jesse: And this week, Doctor Sara Gottfried is back on the show. She’s a wife, mother of two incredible young women, friend, scholar, seeker, Yoga Teacher, Harvard educated MD with 25 plus years of experience, board certified gynecologist, and author of three New York Times bestselling books, The Hormone Cure, The Hormone Reset Diet and Younger. Today we’re discussing her latest book, Brain Body Diet.

Marni: It’s always a pleasure to have Sara on the show. She is by far one of our favorite guests because she’s just so down to earth, so real and so knowledgeable. So make sure you go back and listen to episode 144 and 164 and I hope you’re excited for today’s show because we really get into a story of something that Sara experienced which led her to write this book, The Brain Body Diet, and we talk about what happened and it was actually a head injury. So we get into that. We talk about symptoms of brain toxins, how do we fix the broken healthcare system, left brain versus right brain, what heart math is the healing benefits of Kundalini Yoga. What is your body weight set point and how inflammation plays a role in depression. So many good talking points. So excited for you guys to hear this conversation. Here we go with Sara Gottfried.

Jesse: Hello Sara, welcome back to the podcast. It’s so great to chat with you again.

Sara: Thank you. So happy to be here.

Marni: We love having you on the show. This is round three and we’re so excited about your new book, The Brain Body Diet. And before we get into the details of the book, Sara, I want to talk about how this book came to be and it started with an accident. You fainted, you smacked your head. What happened? What were you going through at this time?

Sara: Yeah, you know, I was filming a TV show. I was doing what I think a lot of people do, which is ignoring that conversation that’s supposed to be happening with my body and I was standing at the end of the day in a kitchen. I was surrounded by some friends in the health space and I think what happened was as we were trying to figure out what to have for dinner at 10 o’clock at night, I just became hypoglycemic so my blood sugar dropped. And what’s your brain does in a moment like that is it just shuts everything down, almost like a reboot on a computer. So I fainted, I hit my head and ended up having these kind of movements that look like a seizure. I had a pretty severe concussion and as I started to recover from that I realized, oh my gosh, this connection, especially between the gut and the brain is so essential to health and it was something that I hadn’t paid attention to until I got smacked upside the head.

Jesse: While you talk about having a concussion, talk about some of the other signs and symptoms you had at the time.

Sara: Well, it was a time where I was pushing really hard in my career. I was traveling a lot. I wasn’t spending a lot of time with my family and I would say that that kind of workaholic tendency that I have was running the show. So I had symptoms of this. I had inflammation that didn’t resolve. I had, I was probably drinking a little too much I had blood sugar instability, which I now know is responsible for 60% of cognitive decline as you get older. I had some symptoms of what I think of as brain toxins, meaning that, you know, I was over the age of 40 and I was starting to have something called anomia, which is where your mid conversation, you’ve got a word on the tip of your tongue and you can’t quite access it. And so you choose the second best word. And so I realized that I was actually full of two things, primarily. Obesogens the kind of toxins that make you fat, that are responsible for disrupting the metabolic pathways that control how fast or slow you burn energy and calories. And then I also had dementogens, which are those toxins that can really rob you of intelligence. So those were some of the symptoms I had. I also had some other symptoms, like a tendency toward anxiety that happened after a course of antibiotics. I had a few other things that we could kind of drawn on to this.

Marni: So it must have come as such a shock to you to not only be in a place that you’re at in your career, knowing so much about the body, knowing about health. And then just to have this, the shakeup literally happen. So what were your emotions like after this trauma happened to your body?

Sara: It was interesting because you know, I was told by my healthcare team, my neurologist and other doctors that I needed to lie in a dark room and just be quiet and try not to stress myself out. In the way that I would translate that guidance is that we have no idea what to do with you. Like you have inflammation in your gut and in your brain and there’s nothing we can offer you. So go lie in a dark room. We can’t think of anything else to do for you. And so lying in that dark room, I had a lot of realizations. I realized first that this approach that I’ve had to health, which kind of starts with hormones, with hormone balance was important, but it wasn’t sufficient. There was missing pieces, especially the gut brain axis. And it also got me to look at how hard driving I was. How, you know, kind of the chronic stress I was experiencing was poking holes in my gut lining, was leading to increased intestinal permeability, was leading to, you know, kind of this frat party in my body of inflammation and then inflammation in my brain and some of these symptoms that I’m describing. But as I was lying there in my bed, I also started to hangout with my daughter’s in a different way. So you asked about my emotional state and I would say it was a place kind of surprising of contentment. You know, where I would talk to my daughters about what was happening for them each day at school, and instead of rushing to solve the problem, you know, as if I were Oz. Instead we just kind of sit with them and talk about it and talk it through and connect to the emotional experience because I couldn’t do much else. So it, it just got me to kind of reflect on how hard driving I was. And then of course, it’s not about me. Ultimately it’s about our broken healthcare system. It’s about the health of others. It’s about the ways in which these things are showing up for the patients that I care for, the patients that are listening to your podcast. It’s about how we fix this broken healthcare system. So that’s kind of a long answer to your question, but the emotional state was one of, oh, another educational opportunity, you know, said without snarkiness like here we are again. There’s more that I need to learn.

Jesse: And Sara, I know you talk about before the injury being really left brain dominant and after the injury, during the healing, it was like there was an activation of your right brain or a quieting of the left brain or both. So talk about that a little bit.

Sara: Yeah, it’s interesting. You know, this idea of left brain versus right brain is debated in scientific circles. There’s a Nobel laureate who did a lot of work on this, and so I definitely think that there’s something to it. Yes, I was very analytical and hard driving, you know a graduate of Harvard and MIT and a bioengineer. Those were all very left brain dominant. And I would say even though my hormones were in pretty good balance, my left and right brain, were not in good balance. My sympathetic nervous system, the on-button for your nervous system and the parasympathetic nervous system, were not in good balance. And so as I was lying there in the dark, I didn’t do it for too long because it’s pretty boring. But while I was lying there, I, I started to, you know, have more creativity. I started to connect more to my emotional world as I was describing with my daughters. My husband and I, you know, he was so used to me pushing so hard. Which is kind of exhausting as a spouse. You know, I’m thinking of you guys, you just got married about a year ago and I know you’ve been together for awhile. But you know, often your spouse can really reflect what the next steps are in your evolution. And what my husband found was that, oh wow, his wife showed up again. So here I was with this head injury and post concussion syndrome and yet I was more present and loving and connecting to him than I was in the previous 15 plus years of marriage. So that’s what I mean by this shift from, I wouldn’t even say it was from left brain to right brain. I would say it was from left brain to be more balanced between the left and right side.

Jesse: And I know this injury happened in 2015 and your recovery was about a year. So we’re in 2019 now. Do you find a lot of those changes are still taking place today or have things kind of reverted back to the way they were before?

Sara: That’s a good question, especially with the book launch. I think that they have endured and I’m always interested in change management and like what are the endurable changes? So I would say some of the changes, especially in that first year as I was performing rehab and kind of figuring out, okay, how do you heal your brain after an injury, whether that’s from hitting it or from toxins or you know, from having gut issues for years. So I had these changes that were kind of forced upon me in that first year, but many of them I ended up choosing. So especially that reset between the left and right brain. I enjoyed the creative aspects so much that I decided to structure my day in a different way and that has endured. Certainly the connection with my family, my daughters and my husband and my girlfriends like that has stuck. I’m very interested in how we quantify health and I would say my health wasn’t great at the time that I hit my head. And so as I quantify health going forward for myself and for others, I think we have this sacred opportunity to really decide, okay, this is what I’m going to emphasize. Like these are the three priorities that I’m going to really understand and manifest in my life going forward. So many of those changes became priorities, maybe even biological imperatives.

Jesse: So what would you say to somebody who realizes listening to this, that their left and right brain don’t feel unbalanced and other than them having to go through so they don’t have to go through an injury like you did to have this epiphany. What can they do to start balancing that out right now?

Sara: Well, I think the book is about how to reset that balance between left and right brain. The tricky part for me as a scientist is we don’t have a lot of data about how to strike a balance between the two. So the best I can do is to look at the science on say the gut brain axis and how an imbalance in your gut microbial life or increased intestinal permeability known more clinically as leaky gut. How those things map onto kind of turning on the flood lights in your brain, causing this level of inflammation that leads to anxiety and depression. And you know this addictive tendencies like I had the workaholism. Also memory loss, early memory loss over the age of 40. So I think in terms of how do you rebalance the left and right brain, I think it, it starts with the intention. It starts with kind of an analysis of, okay, how much balance do I have? Where are there gaps that I want to address? How is the imbalance potentially affecting my relationships? Like minded in my marriage and as a mother and even as a writer and as a speaker. Like I think it’s really important that people who are writing books have that they walk the talk, you know, that they have an experience of changing their health and that they’re speaking from a place of authenticity and not just theory. So yeah, that’s what I would say in terms of rebalancing left and right brain.

Marni: I think it’s also a matter of zooming out of your life a little bit. You know, for all of us who are in the health space or people who are listening that are immersed in health, we’re so focused usually on, you know, one thing at a time potentially, you know, whether it’s diet or exercise. But I think, you know, with reading your book and hearing your story, it’s about really zooming out and looking at all these facets of our life and how they interplay and looking to the future. How can we prevent things that could be looming and that could be affecting our brain health and our body. So yeah, just a little word for the listeners just to really kind of look at the whole picture and, and take inventory of your life as a whole.

Sara: Yeah, I love that Marni. You know, we tend to get kind of stuck in our domains, you know, for me I would say hormones and weight loss and you know, especially female weight loss and metabolic flexibility. That was kind of the zone where I was working for a few decades. I never thought about concussion. I never thought about traumatic brain injury. I just felt like, especially as a functional medicine doctor and a gynecologist that that it wasn’t part of my scope so this accident forced me to look at it. But I, I think you’re right that it’s broadening that perspective. So whether you’re a fan of Keto or your focus is gut health, whatever it is, I think having that broader perspective is really essential. Take an inventory as you described because I think that’s the key to quantifying health and then for then mapping, okay, what do I do to improve my health going forward?

Jesse: And Sara, something else you learned on your healing journey is that the brain is not the control center for the female body. It’s actually the heart. So I’d love for you to talk on that a bit.

Sara: Yeah. Let me just make a quick side note here that I love your questions so much. Yeah know I just, I feel like Jesse and Marni, you go the extra mile with your homework. You read the book so carefully, you care about the science. You are so much a part of the solution with our broken healthcare system and I just so appreciate it.

Jesse: Well, thank you for that Sara, much appreciated.

Marni: Thank you.

Sara: So yeah, this was a realization that I had a while ago and I think it especially started to become true for me as I was recovering from this head injury, because women in particular are kind of taught to live from the neck up. Like we’re really taught to focus on analytics. How can we be in some ways, like more male. The feminine principles are often not part of the equation, especially when it comes to ambition and drive and career. And so what I realized as I was healing and I started to look at the science, is that if you just look at adrenal function. Which I think is such an important homeostatic mechanism in the body, and you look at how the brain talks to the adrenals, which is the hypothalamic pituitary adrenal access, or if you want to go broader, it’s the hypothalamic pituitary, adrenal, thyroid, gonadal axis. And I would say that the adrenals don’t listen to the brain as much as they listened to what the heart tells the brain. And so this is the basis of heart math. This is the basis of I think really stepping into your wisdom, stepping into your intuition, having that heart sense, that heart connection with other people and even among people who have a high level of stress, often it’s the heart that can help you buffer the health consequences of high stress. So we know that this is true. I mean this is well researched by the HeartMath Institute. It’s been my experience with taking care of patients for the past 25 years. And maybe you guys have experienced this too.

Marni: Yeah, we’ve done heart math before and I’m glad you brought that up. We haven’t talked about this in a while on the podcast. So can you just describe what heart math is and how you’ve integrated into your life?

Sara: Sure. Heart math was almost like the portal through which I started to pay more attention to heart rate variability. So heart math is kind of the, I don’t know their tagline, but unofficially what it does is it helps you measure heart rate variability, which is the time between each of your heartbeats. So I’ll circle back to that in a moment. What heart math does is it helps people improve their heart rate variability to the point where they have greater coherence, which I would say is that heart brain, adrenal connection, having an access that really serves you instead of works against you. So say if you have a heart rate of 60. That it’s not one beat every second, it’s one beat, 1.05 seconds, and then 1.1 seconds and then 0.92 seconds. And the amount of variability you have between each of your heartbeats is called heart rate variability. So I first learned about this in about 1989 that’s when I was back at medical school. And the cardiologists were really interested in this because it could predict your cardiovascular function. And I love that heart math kind of went deep in terms of the science to really understand, okay, if you have someone who doesn’t have great heart rate variability, how do we help that person improve it? How can we give them some techniques, you know and they have a couple of different devices that you can use to improve their heart rate variability and we know heart rate variability tracks with a number of other outcomes. It’s one of my favorite ways of quantifying health because it’s so easy to measure now. You can do it with a chest strap with a heart monitor in an app like SweetBeats on your iPhone. I have a lot of ways that I measure heart rate variability. I used an Oura ring to measure it at night cause I think nighttime is kind of a, a very honest way of looking at heart rate variability. I also measure it during the day with my Apple Watch series four. I have a WellBe bracelet. Okay. I sound like a total nerd as I go through these lists, but I, I just think heart rate variability is such a great measure of stress, especially for those of us who have lost that conversation and you know, they just like block out the stress and they don’t have a sense of how stressed they are. They don’t have a sense of how high their cortisol is and how that’s leading to, you know, problems with insulin and glucose and leading to hole’s getting poked in there gut wall. So I’m a huge fan of heart rate variability. I don’t use heart math as much as I used to. I would say it went through a couple of years of training. I used to use the emWave and then I use the app that they had for the iPhone. I use some of these other devices to measure my heart rate variability during the day and at night.

Marni: Yeah, we’ve used Inner Calm, that’s the one that attaches to your ear plugs into your phone. So that’s the app that I’ve used before and you’re inspiring me to get back into it because it is such a great practice and I always feel so good after a session. But other than tracking it through apps or you know, different trackers, are there other ways through yoga? I know you’re a big fan of Kundalini Yoga. Are there other ways that we can regulate our heart rate without a device?

Sara: Oh, you can certainly do it. I was talking to a friend of mine yesterday and he was so funny. I was talking about what’s going on and how busy I am and how I need a vacation. He said, have you heard of this thing called meditation? I love that he said it that way because we need that kind of reminder like we all need to have our list of go-to things that really help us with the stress response system with recreating that balance between the sympathetic and the parasympathetic nervous systems with the, what I think of as the sympathetic parasympathetic access. So yes, Yoga does it. You know, I couldn’t go to my vinyasa classes. I’m trained as a vinyasa teacher. I couldn’t go to those classes when I was recovering from my concussion. I couldn’t even stand on one leg. And so I started going to Kundalini because a lot of the practice is seated and a lot of it is focused on your nervous system. So I just found it incredibly healing. But I would say any sort of contemplative practice where you’re developing that objectivity and what I think of as the witness self is going to help you with heart rate variability.

Jesse: Now we’re going to take a quick break from our chat with Sara to give a shout out to our show partner, Perfect. Keto.

Marni: The MCT oil powder is one of the most brilliant products. This is one of the products that Jesse and I have on hand all the time. I used to use the oil personally, but now I’m really drawn to the powder because I don’t have any digestive issues when I consume the powder. So really depends on the person. Some people are more sensitive, but for me the powder works great and the other benefit is that it really makes your drink super creamy. So whether you’re making a hot drink like an elixir or a smoothie it adds a kick of frothiness in there. And just so you know both the oil and the powder give your brain a boost. It is great for cognitive function, great for focus, great for energy. So if you haven’t tried the MCT oil powder from Perfect Keto, give it a try. You’re going to love it. It’s delicious. It comes in vanilla, it comes in chocolate, and my favorite is the unflavored because I can put it anywhere I want and combine whatever flavor I want.

Jesse: As listeners of our show, you get 20% off your first Perfect Keto purchase, so make it a great one and to take advantage of this deal, all you need to do is go to ultimatehealthpodcast.com/perfectketo. Again, that URL is ultimatehealthpodcast.com/perfectketo. Perfect Keto products ship worldwide, free shipping in the US. Go and get yourself some MCT oil powder today. You won’t regret it.

Marni: And now a shout out to other show partner Organifi. Sleep as you guys know is so important. When you go to sleep, it’s a chance for your brain to restore itself. And it’s super vital that we get into a deep nourishing sleep. And some people may have a challenge getting into sleep. Maybe you can’t calm down at night, maybe you can’t put your mind to rest. So sometimes we need a little bit of help. And that’s where the Turmeric Gold comes in. This is such an amazing product to help your body wind down. It allows your nervous system to go into a calm place. It’s got adaptogens like turmeric and reishi, which would really help for a deep restorative sleep. So if you haven’t tried this product yet, it’s not only delicious, it’s very soothing, very calming. It’s described as a hug in a cup. All you do is take a scoop of it, put some hot water in it and sip it down. So I recommend having that about two to three hours before you go to sleep and it’s going to help prepare you for an awesome night’s rest.

Jesse: As a listener of our show, you get 20% off the whole Organifi lineup. And to take advantage, all you need to do is go to ultimatehealthpodcast.com/organifi, again that URL is ultimatehealthpodcast.com/organifi and Organifi ends in an I. Go order yourself some Turmeric Gold and add it to your nighttime routine. And now back to our chat with Sara. Sarah, can you just take a couple minutes and talk about Kundalini Yoga and what that is. I know a lot of the listeners have probably practiced and know what Hatha Yoga is and I know that’s the original Yoga you learned back from your great grandmother as a child and then practice with your mom, but talk about Kundalini Yoga and how it’s different.

Sara: Thank you for that. You’re so kind to like refer back to my family and what a memory you have clearly have no neuroinflammation, Jesse. I love it. Kundalini is based on Hatha Yoga. It’s got kind of a different approach and in some ways I think it might even be better for removal of toxins. The idea with Kundalini is that instead of going through sun salutations as an example, which is what we do in vinyasa or power yoga, the postures are part of this kriya. And the kriya is a combination of usually breathing and chanting and flexing and extending the spine and the kriya has a specific intention. So there’s been some leaders in the Kundalini movement who have developed these kriyas, you know, what I love about Kundalini is that anyone can do it. Even if you’re a total beginner, you’re going to get something from a Kundalini class. I recommend that you practice with a teacher and even if you’re an advanced Yogi, I think there’s something for you too. So I found Kundalini Yoga to be incredibly helpful. You know what I was surprised to learn as I started to practice more Kundalini, and I kind of found my teachers and community here in the Berkeley area, is that Kundalini was named a top 10 fitness trend in 2017 by the Washington Post. So I just love that it’s a fitness trend like this 25 year old practice is a fitness trend. How cool is that?

Jesse: And Sara, I know what it’s done for you is allowed you to stop digging into this endless inventory of all the problems that exist in life and instead you’re able to focus on the solution. So talk about that.

Sara: You know, I was really delighted as I was writing Brain Body Diet to read the work of Carl Jung who considered Kundalini to be this blueprint for reconnecting the brain body, you know, for what he described as higher consciousness. So it helps to focus on the solutions instead of dwelling in the problems. He described it as a method of psychic hygiene, which I think is really kind of a helpful concept. It’s something we don’t think about enough in the US it’s this way of really reintegrating the self. And I think when you do that, when you step out of these habitual patterns that tend to make us focus on the problem and tend to make us focus on what I saw myself, was it like a victim typology? Then you’re able to be freed up again with that left right brain balance to think about solutions to really like let the solutions wash over you and to have some wisdom about discerning what’s going to be a good solution for you. So that’s what I love about it. You know, what Jung talks about is this re-definition re-integration and that’s what I found. So I think he practiced it. He had an experience of it and I think there’s thousands of Kundalini practitioners who have experienced that too.

Jesse: And Sara, something else you learned through your healing journey after the brain injury was surrender. And I think there’s just such an important topic we bring up and share. So talk about how that became part of your healing journey.

Sara: Yeah, surrender is kind of a paradox. I feel like the way that I always achieved and succeeded over the course of my life has been through pushing hard encountering obstacles, figuring out my way through if that didn’t work, pushing harder. And that’s not necessarily the healthiest or the most wise approach. You know, I was raised in a Western system and I think that hard driving approach is part of, you know, sort of our American dream, but in the east there’s this concept of surrender as a source of strength. Surrender, not in a passive sense, but more, more realizing the delusion that we have of control. So whether that’s your health or your relationship. Or my husband has a bit of a delusion with control when he goes to his Kung Fu classes. He’s got a bit of delusion of control when he does a century on his bike. I have the delusion of control in so many places in my life. And so when you realize that we have this delusion, you start to let go of it a little, you start to surrender. You start to like let go of that grasping that tight hold. It’s amazing to me how the universe responds, how the body responds, how the brain body connection responds. So that’s what I mean by surrender.

Marni: I love it. And it’s such an important message because so many of us go through our day where we’re so in our head and trying to control everything. Jesse and I are very much control freaks in our own ways and we do. We try and you know, meticulously master everything that happens in our day and a lot of it works, but a lot of times we realize that it’s the stepping back and allowing and realizing that life has a greater plan always and to trust that I think trust comes into that too is just trusting that something is always going to work out in the way that it’s supposed to.

Sara: You stated it beautifully. I think it is about allowing and letting go. I think that was a big part of the lesson that I had after my head injury. Sometimes we don’t do it willingly. My understanding of surrender, a lot of it came from this injury that, you know, I didn’t have a lot of choice over it, but it helped me see how much grasping I had in my life, how that was translated into adverse health consequences. I feel like that’s kind of a crass way of scoping it out. But I think it’s important to see that, you know, the way that we heal is in the parasympathetic nervous system. The way that we heal is by activating this surrender process. The way that we heal is not necessarily control and mastery that works up until a point. But for most of us with what we want over the course of our lives with a, you know, a sense of purpose and meaning and vision, there has to be a place for surrender.

Marni: And all of this came to a very good place for you because it pushed you to create The Brain Body Diet, which is your new book, which is amazing. And I want to get into some of the protocols that you’ve laid out so well in your book and I think this a good place to get into. So the first one is about removing toxins. Let’s talk about what these toxins are. What are the common ones affecting our brain? How can we start to remove them?

Sara: I love Brene Brown’s idea that stories are data with soul. So I’ll tell a quick story here. When I went through this process with my traumatic brain injury, I then a couple of years later had my first surgery. So this was in 2017 as I was writing this book, I took a month of antibiotics for this surgery. I tried to negotiate with my surgeon. I couldn’t get out of it. And when I finished this month of antibiotics, I had anxiety and also a level of insulin block or insulin resistance that I’d never experienced before. I gained 15 pounds, hadn’t done anything different. And so as I looked at this anxiety and I looked at this weight gain, I started to wonder, okay, could the antibiotics have played a role? So I looked at the literature and I was shocked to find that one or more courses of antibiotics increase your risk of anxiety by 15 to 44%. They increase your risk of depression by 23 to 56%. They increase insulin resistance, they increase obesity and diabetes. And so that’s just one example of, I would say, a category of toxins. We don’t think of antibiotics in that particular category, but I would say your food can be toxic. One of the things I did as I was trying to heal from this experience with the antibiotics was to measure my glyphosate levels. So glyphosate is the main ingredient in roundup, the weed killer and herbicide. And we know that glyphosate disrupts the integrity of the gut lining. So I found that my glyphosate levels, even though I mostly eat organic, were super high. So the levels that I had in my urine, were in the 98th percentile. So that’s another example of a toxin that we get exposed to. Presumably you get exposed to it by eating foods that are genetically modified. But I think increasingly we’re getting exposed in other ways too. So that’s one category is toxins we get exposed to through our food. Another, is medications. And there’s also heavy metals. There’s these dementogens and obesogens that we talked about earlier, things that disrupt insulin and other brain pathways. So those are some of the categories that we’re trying to get rid of.

Jesse: And what would you say to somebody who wants to assess in this area and see where they’re standing? I know there’s a lot of different things that fall under the category of toxins, but how do we go about assessing our current situation?

Sara: Well, you could certainly use the questionnaire that I have at the beginning of the chapter on toxins. I tried to have it represent some of the best validated scales that we have. When it comes to measuring your toxic burden, there’s also more objective ways of measuring. You can measure your body burden. You can look at how many valiates you’re excreting, you can look at Bisphenol A. There’s a lot of different ways of measuring. One way that I tend to use that often is ordered as part of a regular clinician exam is to look at your liver function. So there’s an enzyme called ALT that can tell you about toxic exposure and what we want with the ALT is in women we want it to be less than 20 and in men we want it to be less than 30 so that can be kind of a poor man’s quick way of assessing toxic load and that I would say the questionnaires are also really helpful.

Jesse: And you talked about going on antibiotics leading up to your surgery. I’m just curious when you were in that situation and for other people who are in situations where antibiotics are warranted, what’s the best way to prepare for that and what’s the best way to rebuild the gut microbiome after going through that?

Sara: Yeah, I would say that’s the eight million dollar question. Like it’s such a good question. I wish that for such a simple question, we had a simple answer. I think if you look at the science, the best data that we have in terms of healing the gut and preparing for a course of antibiotics and then rehab afterwards, the best science that we have is to feed the good microbes with prebiotics. So I’m really impressed with the data on prebiotics. This includes you know, foods that have certain vegetable fibers like asparagus and artichoke and chicory and you know there’s a list of them in the book, those feed the good microbes and I think you want to have diversity, but you also want to have a good population of healthy protective microbes. So prebiotics help you with that. You can take them before a course of antibiotics and then afterwards the data on probiotics is a little slipperier. There’s definitely data showing that certain strains of probiotics will help with increased intestinal permeability. There’s data showing that if you take replacement probiotics within the week after you finish a course of antibiotics, that that can be helpful. There is some limited data showing that probiotic foods can be helpful, but it’s not necessarily that you eat Kimchi or Sauerkraut and those bugs stick around in your gut, you know, for weeks on end, it’s more that they have kind of this 24 hour transit period. They create other benevolent factors when they’re in your gut. So I think there’s a few different strategies here. I would say prebiotics are the most proven.

Marni: We’re big fans of prebiotics. We include them regularly in our diet. So let’s get into the next protocol because lowering your body weight set point. So firstly, what is our body weight set point?

Sara: Yeah, I love talking about this because I think there’s so many symptoms that patients have, whether it’s weight gain or anxiety or even addictive tendencies. And we don’t think about the brain body connection. We think about it just from a body perspective. So that’s what I want to change. I want to change that mindset. So when it comes to your body weight set point, there’s this gauge that you have in your brain. It’s called the adipose stat and it regulates your fat mass. So you can think about it kind of in a simplified way as a temperature gauge or a thermostat. But instead of regulating your temperature, it regulates your food behavior and your energy use, which means how you burn or store fat so that you’re adjusting your body fat. So quick example is you go on a calorie restricted diet, and I don’t want anyone to do this, but say it’s the 90s and that’s still the prevailing approach for weight loss. You go on a calorie restricted diet, what happens after some length of time, you know, seven days, 10 days, two weeks is that your adipose stat will compensate for the loss of fat mass. It, it’ll make you incredibly hungry. So it does that through a number of different appetite hormones. But that’s an example of the regulation that occurs in your body. And part of the problem with the adipose stat, which is mostly located in your hypothalamus in your brain, is that it can become wonky. So there’s certain toxins that can affect the function of your adipose stat. It’s almost like you have a thermostat that’s working well, but then you leave a window open and then the thermostat just can’t regulate the temperature. So you can have a similar sort of thing happen with the adipose stat.

Jesse: So if our body weight set point is off, what’s the first step to getting it back on track?

Sara: Well, this is where I think hormones become a really important part of the story. I would say toxins are a through line when it comes to brain body diet, especially taken out the brain trash, the things that can make the adipose stat not work optimally. I think it’s really important to take a look at your hormones. You can assess them with the questionnaire that I have in the book, but what are the hormones? The hormones are things like insulin of course, because that is the primary hormone that regulates whether you burn or store fat. Leptin, which is the hormone of satiety. It’s (inaudible), the hormone of hunger. Those two kind of work in concert. So Leptin makes you put the fork down (inaudible) makes you pick up the fork. It’s also estrogen, which is hugely involved in appetite. It’s thyroid, which is involved in metabolism, cortisol and Adiponectin. So those are some of the hormones that you want to be addressing and there’s specific ways that you can adjust these. You know, one of my favorites that kind of crosses through most of these hormones is intermittent fasting. It’s one of the best ways to reset insulin. It’s been shown to help with a number of other hormones as well, and it helps you detoxify. So there’s a long list of how intermittent fasting, that metabolic rest that you get every night. I recommend a 16/8 protocol, or at least slowly on ramping to 16/8. It’s amazing to me how that can help you clear toxins and it can also help you with some of those brain parts that often are ignored with some of the diets that are popular today.

Jesse: So for 16/8 just to clarify that 16 hours that the person would be fasting and then eating in an eight hour window.

Sara: That’s right. And I can tell you, you know, from taking care of patients for awhile, I have some patients who hear about 16/8 and they are just off and running. You know, they’re like me, they just, they get it. They understand that this is important and they started the next day. And then I have other patients who were just like, are you kidding me? I will starve to death. I can’t go that long. Like, I’m not going to wait to have my breakfast, I don’t want to eat dinner that late. And so there are people that you know, we can gradually on ramp. What I find with pretty much any diet, and that includes the eating strategy of time restricted feeding is that men always do better than women. Women tend to have these kind of nuances that need to be addressed. And so I tend to go with a slower on ramp, especially with women who object or just feel like, you know, this is not something that’s going to work.

Marni: And do you have any strategies for people who are transitioning? What can they do if they start to get hungry? Should they just eat something or should they drink more water or any tips just to ease the transition?

Sara: Well, I always go to the science first to answer a question like this. And what we know is that we’re designed, like our DNA evolved to have this period of metabolic rest that’s probably about 16 hours. We know that when you stop eating a few hours before the sun goes down and then you don’t eat again until after the sun comes up, that that’s ideal in terms of your insulin sensitivity. So insulin is going to work a lot better in your body if you follow that particular eating protocol. We also know that there’s the issue of eating for emotional reasons, which I find is something that I’ve struggled with in the past. It’s also an issue for a lot of my patients and so that has to be addressed. I talk about it in the book as hedonic eating, like eating for pleasure versus homeostatic eating, which is eating for fuel. So I think that has to be addressed. I have some patients who say, yeah, but my blood sugar’s too low in the morning. I can’t wait. And so what I say to those patients is, okay, let’s track your blood sugar. Why don’t we get a $20 glucometer and measure your blood sugar in the morning? We can also measure your ketones because for most people, after 16 to 18 hours, they go into mild ketosis. And I think the body is ideally designed to go intermittently into ketosis. So you go into ketosis from the overnight fast, you come out of Ketosis with the food that you eat. Then you go back into ketosis again with the next night. So getting back to your question about okay, what are some tips to make this work? What I started with with a lot of my patients is to have them just do two days per week and what I often find works for them is to aim for and eating window 10 and six so that works for most people, for the people who feel like they have blood sugar issues and we’re tracking their blood sugar, often they have an earlier window, so like between eight and four. I find that that works really well, especially for busy mothers who have adrenal and thyroid issues. You know two days a week is what’s proven to make a difference in terms of weight loss and with the adipose stat. So you can add on from there. I suggest that they don’t do high intensity interval training on those days. It’s much better on those days to focus more on adaptive exercise its not increasing cortisol levels and driving up hunger. Sleep is also a super important part of this process. So I would say two days a week, you know you could start with like a uh, 14/10 approach where it’s not eight hour eating window from the start, but you gradually over a couple of weeks build up to 16/8

Jesse: Now we’re going to take another quick break from our chat with Sara to give a shout out to our show partner Pique Tea.

Marni: Pique tea is one of the easiest and most nutritious teas that you can consume because it’s concentrated tea crystals that come extracted in tiny little packets. They’re full of polyphenols and they’re super easy to use. The benefit is that you can add them, tie their hot water or cold water. It’s got 12 times the antioxidants of tea bags and they source premium tea at peak of freshness there. Organic preservative free, no fillers, no gluten, no grains, no dairy, and they come in so many different varieties, whether you’re into green tea, black tea, white tea, herbal tea, and they also have chaga and reishi elixirs, which is one of their newest varieties. The chaga is good for energy, focus, and helps you feel revitalized and the reishi is good for calming down, sleep, and rejuvenation. So go ahead and check it out, see all the different varieties of tea and pick the ones that suit you best.

Jesse: As a listener of our show, you get 15% off all your Pique Tea purchases and free shipping on orders, $60 or more. And this is for our US listeners only to take advantage, all you need to do is go to ultimatehealthpodcast.com/piquetea again, that URL is ultimatehealthpodcast.com/piquetea and pique is spelled p I Q, u. E. Also be sure and use the code ultimatehealth at checkout to get your discount. Go and load up on your favorite flavor of Pique Tea today. It’s great for taking with you on the go.

Marni: And now a shout out to either show partner Sunwarrior. The Ormus Supergreens is such a great way to start the day without caffeine. It’s a great way to get your micronutrients and your phytonutrients, minerals, and it’s delicious. It’s also insurance that you’re getting in some high quality greens for the day. All you need to do is take a scoop of it, put it in some water and sip on it, whether it’s first thing in the morning or you can do it throughout the day. And little fun fact, we’ve had some questions about what Ormus actually is, so I’m going to give you a little blurb on what Ormus is. Ormus elements are monoatomic minerals protected by nature and volcanic soil and primitive seabeds. Ormus was called the food of the gods by ancient Egyptians recognized for its vibrational qualities to detoxify and nourish the pineal gland, also known as the essence of life. So there you have it what Ormus is and why these greens are so super.

Jesse: As a listener or a show, you get 20% off all your Sunwarrior purchases. To take advantage, all you need to do is go to ultimatehealthpodcast.com/sunwarrior. Again, that URL is ultimatehealthpodcast.com/sunwarrior. Also, if you spend $50 more, you get free shipping, go and get yourself some Ormus Supergreens today. This is a top quality greens powder and now back to our chat with Sara. Okay, and next protocol we’re going to move into here is clearing the brain fog. And Sara, I know after your concussion you had brain fog for about eight weeks. So explain what that was like.

Sara: Yeah, brain fog is interesting. It’s not something that’s recognized as a condition or a disease state in western medicine, and yet I would say it’s the tip of the iceberg when it comes to inflammation in the brain when it comes to that leaky gut, leaky brain connection, that often happens for people. So for me with brain fog, the way that it showed up was some memory loss with not being able to find that word on the tip of my tongue with walking into a room and not really knowing why. I found, especially as the day went on, especially if I was thinking or doing more analytical type of work, that I would have more brain fog towards the end of the day. A lot of people have brain fog after getting chemotherapy going through cancer treatment. It’s a symptom that I don’t want you to ignore even though your clinician might ignore it. I think it’s important to realize that this is one of those situations where you may have inflammation in the brain, you may have neuroinflammation, and so we want to stop it quick. We want to stop it before it progresses into say, early cognitive loss or something worse even Alzheimer’s disease.

Marni: And it’s probably a hard one for people to understand the severity because I think a lot of people every day probably feel like they have some level of brain fog. You know, I can’t remember this or I’m a little bit tired. I didn’t sleep well last night. So at what point do we know that it’s more severe then it is or then maybe a milder case of brain fog, if that makes sense?

Sara: Well, I would say any sort of brain fog that persists for more than a few days or even a week is something that should be attended to. I also think it’s important as with all of the protocols, you can start with your food. Like it’s amazing to me how many people have food intolerances and that leads to inflammation in the gut, leads to inflammation in the brain, and it leads to the brain fog. So one of the simple things you can do is to start eating for more clarity. And that includes cutting out the foods that tend to be the most commonly intolerant things like gluten and dairy. The list is longer, but that’s a place where you can start. And then you also want to about some of the foods that really help the process. So we know sea vegetables do this. We know that they help to prevent the damage that occurs with air pollution, which we’re learning more about. We know once again that prebiotic foods can be helpful. Eating healthy fiber, controlling your blood sugar, cutting out grains, and also paying attention to electronic screens. I think that’s a rising cause of brain fog.

Jesse: And you also talk about how exercise can impact brain fog. So explain how that works.

Sara: In many ways I think there’s no downside to exercise. It’s as close to a panacea as we have. We know that physical exercise improves your brain function. It helps you focus better. We know strength training is incredibly important. It increases the volume of the hippocampus, the hippocampus is that part of the brain that’s involved in memory consolidation, but also emotional regulation. We know that walking, running those things help to reduce brain fog by working directly on the brain. We know that of course meditation is really helpful for focus and attention, which can counter that feeling of brain fog. So those are some of the things that I think you can use to grow your grey matter into reduced brain fog.

Marni: So let’s get into the fourth protocol. Healing reward, Deficiency Syndrome, and addiction. So you get into a lot about addictive tendencies. There’s a lot of case studies in there. So let’s talk about how this plays a role on our brain.

Sara: Well, I think we live in such an addictive time and it’s hard to kind of separate the biology from the culture that we live in. I used to have this attitude that if I liked something, whether it was exercise or fine wine or even satisfying work, that more was better. And I think as you get older you kind of realize, well there’s a limit to that argument and there’s a way in which our addictive tendencies can get in the way of our most vibrant health. So this particular chapter is about people who have addictive tendencies. I like to think about it not necessarily as someone who is addicted to opioids or someone who has a alcohol use disorder, but to think about it more in terms of what I see in my practice, which I think of as a spread addiction where you have a little bit of addiction and addiction tendencies focused on certain things, so that could be online shopping, could be Instagram, it could be going to spin class. It cracks me up when I go to soul cycle or some other spin class and they asked the audience, okay, who’s doing a double, you know when it’s like you just did spinning for two and a half hours, how is that good? I think we have to again do that inventory and take a look at some of the behaviors that we have. Take a look at our relationship to certain substances such as alcohol, even caffeine, sugar, and to be really honest about are these choices improving my health or are they detrimental to my health? Do I need to change the dose? Do I need to avoid them all together? And a lot of this connects to what sometimes is called the pleasure trap. You know, kind of the dopamine pathway in the brain and it’s amazing to me how our models of addiction and addiction recovery really don’t take this more integrated functional approach of what’s your nutrition, what’s going on with your stress response? Do you have hyperarousal and is that why you’re reaching for a glass of wine or cannabis? I think we need to have this broader, more integrated functional approach to addictive tendencies.

Jesse: And the next protocol you get into is calming anxiety and we already got into anxiety earlier when we discussed you taking antibiotics and your anxiety that came up around that time. So let’s move into the next one, which is emerging from depression and as a clinician working with people, how much of an issue is this these days?

Sara: Oh, well, depression is a major cause of both morbidity and mortality. I was just looking at the data on lifespan in the United States and it was amazing to me that for the past three years, our lifespan has decreased. This has not happened for the past 100 years in a big reason for that is the opioid crisis and also suicide. And so I think of suicide as kind of the one of the extreme outcomes of depression that is not properly addressed and treated. And I don’t think the way that you address depression is to throw the latest selective serotonin reuptake inhibitor or SNRI at it. I think the way that we have to approach it is with this more integrated functional approach where we’re looking at nutrition, we’re looking at movement, we’re looking at sleep, we’re looking at all these different domains that map onto the brain and how much inflammation you have in the brain. So we used to think of depression as being this imbalance of neurotransmitters. And we’ve gotten, I think, much more sophisticated at understanding the gut brain connection and how inflammation plays a role in probably more than half of cases of depression.

Marni: And there’s a big difference between feeling depressed and clinical depression. I think, you know, a lot of us have days where we’re feeling down, feeling sad, and I think if that happens over and over, maybe some people wonder if they’re clinically depressed. What is that distinction from your perspective? How does someone know if they’re really falling into, you know, the deep waters of depression?

Sara: Well, I think the key is to get some help because when you feel depressed, whether that’s two days or two weeks, often you don’t have access to all the resources that can help you climb out. So the way that we define major depression is that you’re having a set of symptoms that lasts for more than two weeks. But you know, I would say don’t wait until you have major depression. I think there are things that we can do before you get to that point. There’s something that I use in the book that I think is really helpful. It’s called the PHQ-9 it’s a series of nine simple questions. You can even Google PHQ-9 to look at these questions and it can give you a sense based on your score, what’s your risk is of depression. But as someone who’s taken care of mostly women over the years, I’m really sensitive to people who have kind of this low grade depression. They may not meet criteria for major depression, but those are the people I really want to help. Well, you don’t want to wait until the disease is diagnosed. We want to intervene as soon as possible, and to me, when you have symptoms of depression, it’s a message, a divine message from the body that’s something is not quite right. So I want to sleuth what those things are and work with my patients to figure out, okay, how do we address them? How do we do it in a sustainable way? How do we do it? Not just with throwing the latest pharmaceutical at it.

Marni: And everything we’ve talked about today and all the protocols laid out in your book really describe, if we take these things into account, if we do yoga, meditate, maybe not all of them, but choose the ones that suit the person. Eat a good diet that’s rich in Omega-3 fats and get an adequate sleep. These are all things that can help to prevent all these things we’re talking about. So getting into the last one, restoring memory. So what are things we can do to keep our memory in check, keep it strong, have good recall, and being able to think more clearly.

Sara: Well, I was shocked to read the statistic that 76% of patients complain of memory loss as they get older. I don’t think that’s normal. I’m not taking that sitting down. I feel like that’s actually a symptom of a bigger problem, which is this level of inflammation, especially between the gut brain axis, which includes the immune system. It includes the microbiome, so there’s a lot that you can do to keep your memory intact as you get older. You can eat for memory. I think intermittent fasting is a really good strategy here. We always encourage people to eat more vegetables. We know that that is associated with less memory loss as you get older. Plant based fat is proven to make a difference. Probiotic foods avoiding sugar and processed foods as things shrink your brain as does alcohol. I also think it’s really important to think about social genomics, meaning that if you’re eating food and you have this experience of social conflicts, social isolation, social rejection that can create even inflammation with the food that you’re eating, even if the food is healthy for you. And so we want to be thinking of the context as well for how you’re eating. There’s certain supplements that I think make a difference here. We know that sleeping 7 to 8.5 hours per night can make a big difference and if I had to get people to pay attention to one thing, when it comes to memory, I would say it’s your blood sugar. Like I want people to care as much about their blood sugar as they do their retirement accounts because it is your best retirement account. If you’ve got normal glucose trafficking or you’re working towards normal, whether you have prediabetes or diabetes, this is going to help you prevent 60% of cognitive decline. So I really want for people to care about their blood sugar and upstream from that how insulin is working in their body.

Jesse: And when it comes to blood sugar, what are some of the top ways to make sure that’s in check? Is it eating snacks in between meals and making sure that we constantly have food in the system? What do we do to keep it in a good range?

Sara: So I’m not a big fan of constantly having food in the system because I think we evolved to have metabolic rest. I think that we were designed to eat two to three meals a day and not be snacking constantly in between. Now that works for some people who have a really disrupted glucose metabolism. I think the key when it comes to blood sugar is to measure and track your blood sugar. So looking at your fasting glucose, your Post Prandial Glucose, you can do that with the $20 glucose monitor. You can also look at hemoglobin A1c which measures your blood sugar over the past three months. Although about half of it is your more recent blood sugar. And we also know that making your muscles hungry for glucose is such an important part of this equation. Sedentary lifestyle, more stress, all of those things will cause more problems with blood sugar. For me, the easy win is intermittent fasting. Like it’s amazing to me how many of my patients are successful at intermittent fasting. Back in the days when I used to try to get people to do calorie restriction, you know maybe 2 to 5% of them could do it. Even with me cheerleading them like crazy, but when it comes to intermittent fasting, 90 to 95% of them are successful. So I think that’s one of the kind of easy wins when it comes to fixing your blood sugar.

Marni: I know so much about, we’re talking about today is applicable to women. That’s your area of specialty. But in terms of men, I can assume that again, so much of what we’re talking about, would it be applicable to them as well? There’s a lot of these protocols that they can do and take part in. Obviously there’s going to be some differences with hormones and how their brain works. So any comments on that, on how any men who are listening to this episode, what their main takeaways could be or how they can absorb this information?

Sara: Well, you know, men are so interesting to me and I would say pretty much all of the protocols apply to men as well. The unfortunate truth, at least for women, is that men are more successful at these protocols. There’s just simpler biochemistry, especially in terms of sex hormones. But what I also know about men, even though they have lower rates of anxiety and they have lower rates of depression and Alzheimer’s disease and insomnia compared to women, is that they often don’t seek medical care for it. And so I would, you know, make a shout out here for men too. Make an appointment with that collaborative clinician, you know, work with someone as a guide. Maybe start with your blood sugar because we know that, you know, many men have blood sugar issues and they don’t even know it, but it can show up as brain fog. It can show up as a decrease in productivity, it can show up as erectile dysfunction. And so I want for men to get the help that they need. And when I talk about anxiety, you know in the book for instance, I talk a lot about the ways that women describe anxiety. So that’s overwhelmed, you know, feeling like you’re churning, feeling like you just can’t get beyond the the worry wake up at 4:00 AM and you’ve got rumination. We know for men, anxiety shows up differently. It shows up as back pain, headaches. And so I just really want to encourage the men to pay attention to those symptoms they have. Like don’t medicate it with beer, don’t medicate it with more exercise. Get the help that you need.

Marni: Love it. Great way to wrap up. But before we do, one last question we love to ask our guests is let us ultimate health mean to you.

Sara: Well I love being asked this for the third time because I think my answer is different. You know, for me, ultimate health is a combination of emotional health, physical health and physiological health, including that blood sugar that we just talked about. It’s also spiritual and social health. It’s about homeostasis and said points. For me, ultimate health is really quantifying it for myself and for other people personalizing it so it’s really relevant and we understand what the drivers are. Person to person. I would say that’s ultimate health to me.

Jesse: I love it. Great Way to wrap up and Sara, the new book is Brain Body Diet. It’s already out so listeners can go and grab a copy. It’s a fantastic read and we just want to thank you for coming back on the show. This has been great.

Sara: My deepest pleasure. So fun to be with you guys.

Marni: Thank you Sara. We love having you. Wow. What a power packed episode with Sara. We hope you learned so much about your health and specifically your brain and if you loved today’s episode, please let us know over on Instagram. Give us a tag and @ultimatehealthpodcast tag Sara @saragottfriedMD. Let us know what you think. We collect all of your stories and on Fridays we do a share and we are very likely to share yours so let us know. We love the support. Thank you guys.

Jesse: For full show notes be sure to head over to ultimatehealthpodcast.com/294 we have links there to everything we discussed in a nice show summary, so be sure and check that out. And we also have a free worksheet for this episode and we’re doing one for each and every episode now, so be sure and head over to our show notes and download that before we let you go. I want to give some love to our editor and engineer Jay Sanderson over at podcasttech.com Jase does such a great job with the show. We really appreciate it. And this week’s fun fact about Jase is that he feels so lucky that Edith, his wife, is the best cook ever. He loves her food. Jase, I can totally relate. Marni is the best cook ever as well, and we are just such lucky guys. Have an awesome week. We’ll talk soon. Take care.

Disclaimer: This is a raw transcript and it may contain some errors. To listen to the complete audio interview, go to ultimatehealthpodcast.com/294.