Summary of Huberman Lab Podcast Episode: Optimizing Female Hormone Health for Vitality & Longevity with Dr. Sara Gottfried
Podcast: Huberman Lab
9 min. read
— Description —
Discover the shocking health hazards faced by women and how to address them Learn about the importance of blood work, continuous glucose monitors, and essential supplements Find out how to maximize vitality and longevity through sleep, stress management, and exercise
Plus, uncover the truth about hormone replacement therapy and its impact on brain function Dont miss out on this valuable information from Dr Sara Gottfried.
Optimizing Female Hormone Health for Vitality & Longevity with Dr. Sara Gottfried
Table of contents
Key Takeaways
- “Being female is a health hazard; we have twice the rate of depression, insomnia, we’ve got 3-4x increased risk of multiple sclerosis, we’ve got 5-8x the risk of thyroid dysfunction.” – Dr. Sara Gottfried
- Mainstream medicine is still silo-based; as long as this is true, there’s very little collaboration and addressing of network effect
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Do blood work as soon as possible! Knowing & monitoring your bloodwork may change the arc of how you take care of yourself
- Continuous glucose monitors are an excellent way to learn about yourself and address behavior changes – it teaches the patient to be their own physician
- To maximize vitality and longevity: sleep, avoid excessive alcohol, address perceived stress, be mindful of eating well, avoid toxic relationships, move intentionally in ways that work for your body
- Ranking most useful supplements for the general population (but remember, start with high-quality food first): fish oil, magnesium, vitamin D
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Exercise tips: balance routine to 1/3 cardio + 2/3 strength training
- Note, high levels of cardio can increase cortisol levels!
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Early hormone replacement therapy should be strongly considered! The decline in estrogen which starts around 40-43 seems to be the driver behind cerebral hypometabolism (decline in brain function)
- “Hot flashes and night sweats are a biomarker of cardiometabolic disease – they are a biomarker of increased bone loss, they are a biomarker of changes in the brain. So many of the symptoms that occur in peri-menopause are not driven by the ovaries, they’re driven by the brain.” – Dr. Sara Gottfried
Introduction
- Dr. Sara Gottfried, MD, (@DrGottfried) is a Harvard-trained, board-certified gynecologist and clinical assistant professor of integrative medicine & nutritional sciences at Thomas Jefferson University. Dr. Gottfried specializes in hormone health, vitality, and longevity using precision/personalized approaches.
- Andrew Huberman and Sara Gottfried take a deep dive into all things related to the optimization of female hormone health, including hormones across the lifespan, fertility, and birth control, microbiome health, insulin management, leveraging nutrition and exercise, managing stress, and much more.
- Host: Andrew Huberman (@hubermanlab)
Role Of Genetics In Hormone Health
- It’s essential to understand broad details of mother, grandmother, and great-grandmother (if possible): menopausal age, puberty age, pregnancy ease or difficulty, pregnancy age, trauma, fibroids, reproductive system disorders
- The age of first period is getting younger and younger as each decade passes
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Biomarkers to monitor:
- In teenage years: cortisol
- Estrogen and progesterone aren’t as useful at this stage because it’s more common for the period to be atypical
- In your 20s: estrogen, progesterone, testosterone
- An imbalance of estrogen and progesterone can put you at higher risk of fibroids and gut disruption (estrobolome collection of bacteria in the gut metabolizes and circulates estrogen)Nice reference point is the top half of the normal range
- In your 40s and 50s: coronary artery calcium score (for men and women too; CT scan of chest; can be self-ordered for about $250) With an unlimited budget: estrogen, progesterone, testosterone, DHEA, metabolites of estrogen, stool analysis
- If you have the income to do it, get your AMH levels measured
- In teenage years: cortisol
- Everyone should know their ACE score to assess childhood trauma which greatly impacts health outcomes
- Unfortunately, it’s different to preemptively get a hormone panel covered by insurance unless you’re trying to get pregnant
- Day of cycle to test biomarkers: day 21-22 for someone in their 20s; day 19-20 for older women because the cycle typically becomes a little shorter
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Intake of vegetables is an important predictor of breast cancer, likely because of polyphenols
- What to do if you or someone you know flat out won’t eat vegetables – at the minimum, try to have a smoothie a few times per week and blend in some vegetables (consider adding refrigerated steamed broccoli because it has little taste)
- Huberman Lab Hormone and Support Bundle
Microbiome Health
- Gut differences by sex: the gut is about 10 feet longer in women than men, and women deal with a much higher rate of constipation than men
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Constipation signals something deeper is going on and needs to be addressed
- Anecdotally, it’s a natural woman’s tendency to literally keep things in and tight and close to the body
- By definition, constipation is not having a bowel movement for three days – but that’s crazy! No one will be comfortable
- New working definition: if you don’t have a bowel movement every day and are empty fully, you are feeling constipated
- Tip: reduce perceived stress! Try 5-minutes of physiologic sigh (two deep inhales through the nose, one long exhale through the mouth)
- Step 1: consume more vegetables
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Scientific evidence for use of capsule probiotics is underwhelming
- If you take a course of antibiotics, it could be helpful to use probiotics
- The use of prebiotics and polyphenols is more supported than probiotics
- We really don’t know the specific pattern of bacteria needed for a healthy microbiome because it will vary greatly from person to person depending on diet, genetics, activity level
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How to know whether you have nutritional deficiencies:
- Stool sample if working with a physician
- Nutritional blood panel: antioxidant, B vitamins, glutathione, magnesium (red blood cell magnesium)
- Labs that offer at-home testing and stool testing: Genova Diagnostics NutrEval, Genova Diagnostics Metabolomix Test, SpectraCell Laboratories Micronutrient Test, Thorne Gut Health Test
- Women should start getting colonoscopies at 50 (though new information may lower the age as it did with men)
Exercise
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Ideal exercise split: 1/3 cardio + 2/3 resistance training
- The minimum effective dose is about 150 minutes per week for the general population but some individuals need more based on insulin resistance
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Marathon runners and people who do a lot of cardio have high cortisol levels
- Rhodiola rosea, ashwagandha, phosphatidylserine (400mg), and Omega-3 (explore measuring whether the right dose for you via Omega Quant Tests) may decrease the effect
- It’s important to address high cortisol – it’s related to depression, metabolic syndrome, unhealthy relationships, compromised immune system, and much more
Polycystic Ovary System (PCOS)
- PCOS is marked by high levels of testosterone and androgens, missed or irregular periods may also present with infertility, weight gain, excessive hair growth, acne
- Poorly understood condition that’s generally difficult to identify until a woman is trying to conceive
- Clinical criteria for PCOS diagnosis: cysts on ovaries, clinical manifestation of hyperandrogenism (such as acne, increased hair growth where you don’t want it), irregular periods (about every 35 days)
- Chronic danger: PCOS puts females at massive risk of cardiometabolic disease later in life
- Anecdotally, it is possible psychosocial conditions may be biasing androgen levels as a response to patriarchy – this has not been studied and of course, wouldn’t cover all women but an interesting direction to study
- For some phenotypes of PCOS, high insulin in the blood (insulin resistant) is driving the overproduction of testosterone
Female Contraception
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Benefits of copper IUDs: non-hormonal, as effective as getting your sperm tied, last for 10 years, have the highest satisfaction rate
- These used to be contraindicated for young women but the opinion has since changed
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Consequences of long-term (10 years+) use of oral contraceptives:
- Note, synthetic progesterone is not recommended unless there is no other option
- Pros: gives women reproductive choice, reduces the risk of ovarian cancer via suppression of ovulation (important because we’re bad at diagnosing early),
- Ovarian cancer is difficult to diagnose because symptoms are vague (such as bloating) – don’t skip gynecology appointments
- Risks: depletes certain micronutrients, increased risk of inflammatory bowel disease, affects thyroid function, raise sex hormone binding globulin (soaks up free testosterone which is a problem for some women – can shrink clitoris by up to 20%)
- If you’re taking oral contraceptives just to alleviate cramps or pain with your period, it may be helpful to find other ways
Menopause
- Early hormone replacement therapy is immensely useful, but you may have to be proactive in seeking it
- The more you know about phenotype in your 30s, the more you can plan ahead
- Menopause symptoms: insomnia, difficulty regulating mood, decreased sex drive
- Hormone therapy given judiciously at the right time (within 5-10 years of menopause) is safe
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The Women’s Health Initiative study which derailed proactive hormone replacement therapy is the wrong study design, with the wrong hormones, given at the wrong time
- As an aside, Peter Attia has also covered this as the greatest failure of women’s health
- Women in their 50s and 60s have the greatest benefit from hormone replacement therapy: decreases cardiovascular disease, improved bone health
- Women over the age of 60: greater risk of certain cardiovascular disease
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Perimenopause: a period of time before the last menstrual cycle, can last for up to 20 years before menopause
- Symptoms: cycle closer together, difficulty sleeping, increase in anxiety, change in the female brain called cerebral hypometabolism (20% decline from pre-menopause to perimenopause)
- Anecdotally, the women who have the worst menopausal symptoms have the highest degree of brain decline
- Symptoms: cycle closer together, difficulty sleeping, increase in anxiety, change in the female brain called cerebral hypometabolism (20% decline from pre-menopause to perimenopause)
- Nutrition: it may be helpful to cycle with a ketogenic diet (4 weeks) to improve insulin sensitivity
Addressing Patriarchy For Female Health
- Patriarchy: generally stated, “power over” – not just men exerting power over women
- Women experience systemic stress on the body as a result of system stress in the environment – but there are different forms related to white privilege, socioeconomic status, etc.
- Typically in society, big strong men tend to be the most powerful
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There’s a huge lack of awareness of sex and gender differences when it comes to structuring clinical trials and other experiments
- Now, no grant will get funded without sex as a biological variable
Articles, Books, Additional Resources
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Articles
- Women: Diet, Cardiometabolic Health, and Functional Medicine (Physical Medicine and Rehabilitation Clinics of North America)
- Continuous glucose monitoring metrics for earlier identification of pre-diabetes: protocol for a systematic review and meta-analysis (BMJ Open)
- Brief structured respiration practices enhance mood and reduce physiological arousal (Cell Reports Medicine)
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Books
- The Hormone Cure: Reclaim Balance, Sleep and Sex Drive; Lose Weight; Feel Focused, Vital, and Energized Naturally with the Gottfried Protocol
- Women Food and Hormones: A 4 Week Plan to Achieve Hormonal Balance Lose Weight and Feel Like Yourself Again
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Other Resources
- Genova Diagnostics Metabolomix Test
- Genova Diagnostics NutrEval
- SpectraCell Laboratories Micronutrient Test
- Omega Quant Tests
- Cleveland HeartLab® Cardiometabolic Disease
- Genova Diagnostics Stool Test
- Thorne Gut Health Test
- “Men are not the patriarchy,” Pat McCabe