About the Author
Sara Gottfried, M.D. is a Harvard-trained integrative physician. A board-certified gynecologist, Gottfried believes in treating the root cause of disease, not just the symptoms of the problem. A recognized yoga instructor, Gottfried teaches workshops and online e-courses to help women cultivate their sexy, vibrant, vital selves. She has been featured in Yoga Journal, Glamour, Diablo, and Natural Health. She is also the medical-expert featured in the award-winning film YogaWoman. She lives in San Francisco with her husband and two children.
Excerpt. © Reprinted by permission. All rights reserved.
The Hormone Cure INTRODUCTION:
WHY HORMONES MATTER
I’m a doctor who treats women’s hormones. I use the best evidence to discover the root causes of hormone imbalance. Then I apply a science-based correction for hormone balance. Every woman has unique hormonal needs, and I meet these needs by leveraging whatever it takes: nutrition, botanical remedies, critical precursors (essential ingredients to make brain chemicals and hormones) such as amino acids and B vitamins, ancient methodology, and bioidentical hormones. I believe that weight gain, mood swings, fatigue, and low libido aren’t diseases that can be “cured” with a quick injection or a pharmaceutical. Most of these problems can’t be permanently solved by eating less or exercising more. They are hormonal problems. They mean our bodies are trying to tell us that something is wrong. And with a rigorous strategy—methodical, repeatable, scientifically supported—those problems can be resolved.
That’s why I’ve designed a system I call The Gottfried Protocol, a step-by-step, integrative approach to natural hormone healing that emphasizes lifestyle design first and foremost. It’s based on decades of research, my education at Harvard Medical School, my own experiences with hormonal imbalances, my belief in peer-reviewed, well-performed randomized trials to support my recommendations, and what I’ve learned from patients over the past twenty-plus years of practicing medicine. The Gottfried Protocol engages only the top hierarchy of scientific evidence and has been proven in scores of women in my practice.
I’ve spent my career taking care not to overpromise. After all, I’m a physician, bioengineer, and scientist. In fact, I’m rather conservative medically. Unlike most books on hormones that come from the alternative-health world, this book takes a data-driven approach to integrative medicine. But because I’m also a yoga teacher, The Gottfried Protocol integrates the new brain science that proves how ancient methods such as mindfulness and herbology provide lasting change. Add to that what I’ve gleaned from more than two decades of caring for thousands of women, listening carefully to their stories, and observing and continuously tweaking how they respond to our work together. I’m confident that if you follow the advice in this book, you will feel better, reclaim the bounce in your step, and bloom as you were intended.
The Unfair Truth
Many women don’t know that hormonal imbalances cause them to feel crummy. My patients come to me distraught, complaining of relentless irritability, fatigue, poor stress resilience, irregular or painful menstrual cycles, dried-out vaginas, lackluster orgasms, and low libido. Many women feel their bodies have turned against them. In my years of clinical practice, I’ve seen it all: Women who would rather mop the floor than have sex with their husbands. Women who worry they can’t perform as well as they used to on the job because of brain fog. Husbands who plead with me: “Help me find the woman I married.” Women who are tired, unhappy, and perpetually overwhelmed.
It’s not fair but it’s a fact: women are much more vulnerable to hormonal imbalance than men. An underactive thyroid affects women up to fifteen times more often than men. According to national polls, women feel more stressed than men: 26 percent of women in the United States are on a pill for anxiety, depression, or a general feeling of being unable to cope, compared with 15 percent of men.
Why such a gender difference? For one thing, women have babies. Pregnancy amplifies the demands on the endocrine glands, which release hormones such as estrogen, testosterone, cortisol, thyroid, leptin, growth hormone, and insulin. If you lack the organ reserves to keep up with amplified need, you may suffer; in fact, organ decline is measurable before symptoms begin to show. It’s not just pregnancy, as evidenced by the childless women I see in my practice. Women are exquisitely sensitive to hormonal changes. And they’re susceptible to the stresses of juggling multiple roles.
Never heard of organ reserve? Here’s the skinny: Your organ reserve is an individual organ’s inherent ability to withstand demands (such as grueling schedules, trauma, and surgery) and to restore homeostasis, or balance. As you age, reserve declines: healthy young people have a reserve capacity that is ten times greater than demand. After age thirty, organ reserve decreases by 1 percent per year, so that by age eighty-five, organ reserve is a fraction of the original capacity.
ORGAN RESERVE AND WHY IT MATTERS
Organ reserve is the capacity of an organ, such as your ovaries, thyroid, or liver, to function beyond its baseline needs. For example, take your adrenal organs. You can test your adrenal (or stress) reserve by injecting a hormone to see if you can double or triple your adrenal gland’s output of cortisol when needed, such as in an emergency. If your adrenal organ reserve is low, your cortisol may not go up as high as needed. Your output is depleted and subnormal. You can do a similar test for your thyroid. Don’t worry about injecting hormones! Depending on your responses to the questionnaires in this book, I’ll guide you through sensible change.
You’ll find that if your organ reserve is full when you get pregnant, your postpartum hormonal roller-coaster ride will likely be a lot smoother. As you age, the same is true: your body bounces back more readily from the stressors of everyday life. However, accelerated aging is associated with low organ reserve and hormone imbalance.
Bottom line: organ reserve is a crucial aspect of longevity—the more you protect and enhance your functional capacity, the more able you are to bounce back from stresses such as illness, environmental toxins, and injury.
Food choices, environment, attitude, aging, stress, genetics, even the chemicals in our clothes and mattresses can affect our hormone levels. Another important influence is how our hormones interact. Remember Diane? Her problem was high cortisol, but the high cortisol blocked the function of other key hormones, such as her thyroid, the queen of metabolism, and her progesterone, the main antibloating hormone that also soothes the female brain. When you target and adjust several hormones simultaneously—the adrenal, thyroid, and sex hormones—you get better results. Many of these root causes, such as the primary role of the stress hormone cortisol in Diane’s case, are simply overlooked by mainstream medicine. Hormonal problems are the top reason I find for accelerated aging, which occurs when the hormones that build muscle and bone decline more quickly than the hormones that break down tissue to provide energy. The result: our cells experience more wear and tear, less repair, and we feel and look older than our age. The goal is to have your breakdown in proportion to your repair, or even better, more repair than breakdown.
Untreated hormone imbalances can have serious consequences, including osteoporosis, obesity, and breast cancer. Clearly, it’s important to tune the body’s hormones to their optimal levels, both individually and in relation to each other.
My Hormonal Story
When I was in my thirties, I worked at a Health Maintenance Organization (HMO) and was preparing to launch an integrative medical practice. My busy husband traveled frequently (he is a green visionary who founded the U.S. and World Green Building Councils). I had two young kids and a mortgage to pay. As if this weren’t stressful enough, monthly PMS made my life miserable. In the week before my period, I had night sweats that disrupted my sleep. My heavy, painful periods came every twenty-two to twenty-three days—and when you combine that with PMS, I had only one good week per month. Throughout the month, I suffered from low energy, a nonexistent libido, and a less-than-sunny attitude. As you might imagine, this was a truly terrible experience, and my entire family suffered.
I was too young to feel so bad. Antidepressants didn’t seem like the right solution. I didn’t want to dampen my dynamic range or mute the texture of my life. I just wanted to feel more alive and charged.
I was lucky. Because of my medical training, I knew what to do. I formed a hypothesis: my hormones were off balance. In med school, I was taught that measuring hormone levels is a waste of time and money, because hormone levels vary too much. But when I thought about how we track hormones such as estrogen, progesterone, thyroid, and testosterone when women are trying to conceive or are in the early months of pregnancy, I wondered why those numbers would be important indications of a woman’s health in one situation but not another? Wouldn’t my hormone levels be as reliable an indicator of my health after my pregnancies as before them? So I drew some blood and tested my blood-serum levels of thyroid, sex hormones including estrogen and progesterone, and cortisol, the main stress hormone. And I discovered what millions of other women face: my hormones were seriously off kilter. I was a frazzled new mom, harried wife, and busy doctor, with significant imbalances in my estrogen, progesterone, thyroid, and cortisol levels.
Despite the lack of nutrition and lifestyle education in the hallowed halls of Preparation H (our nickname for Harvard Medical School), I did learn how to approach a problem systematically. I was taught how to assess evidence and to distrust dogma. But rather than masking the symptoms of my hormone issues, as I had been taught to do (usually with a birth control pill or antidepressant), I wanted to seek the root causes. I sought to uncover what was wrong, as well as why things went sideways for me hormonally. As I struggled with PMS, habitual stress, attention problems, disordered eating, and accelerated aging, I slowly developed a progressive, step-by-step, lifestyle-driven approach to treat my hormone imbalance naturally—that is, without prescription drugs.
Eventually, I got religious about fish oil, vitamin D, and important precursors to hormones and neurotransmitters (including amino acids such as 5-HTP, a precursor to serotonin, one of the “feel-good” neurotransmitters, or brain chemicals). For the first time in my life, I faithfully practiced what I preached: I ate seven to nine servings of fresh fruits and vegetables per day. I stopped exercising so hard, in an obsessive attempt to burn calories, and exercised smarter. I began meditating regularly. My weight dropped 25 pounds. I was happier. I didn’t yell at the kids so much. I could find my keys. My energy improved greatly. I was even more open to sex. I knew that I was on to something.
A Word About Evidence
Not long ago, the New York Times ran an article about women injecting themselves with the pregnancy hormone hCG in order to lose weight. As a gynecologist and a woman, I’m fully aware of people trying to inject themselves to thinness. But it stunned me to see the fad had reached a fever pitch—that women will pay thousands of dollars to “treat” symptoms of what are, in truth, hormone imbalances, emotional eating patterns, and nutritional gaps with a shot of pregnancy hormone. In my humble medical opinion, this is absurd.
I’ve pored over the literature on human chorionic gonadotropin (hCG). Since 1954, twelve randomized research studies have shown no benefit for weight loss from hCG. It’s bad enough that the advantages of injecting hCG to lose weight have proven nonexistent, but it’s truly frightening that there are no studies that guarantee the safety of injecting this hormone for this purpose. Yet significant numbers of women are trying it.
Evidence matters. In medical school, I was taught to prescribe Prempro to women over forty who were suffering from hot flashes, night sweats, sleepless nights, anxiety, and/or depression. Prempro is a combination of two drugs containing synthetic sex hormones: Premarin and Provera. (Premarin is a synthetic concoction of ten estrogens—none of which are similar to the estrogens you make in your own body—extracted from the urine of pregnant horses. Provera, a synthetic form of progesterone, can cause depression.) Conventional wisdom claimed this was the miracle combo for hormone-replacement therapy, because it had been shown to reduce heart disease in observational studies, such as one known as the Nurses’ Health Study.
But observational studies are not what I consider best evidence, because the information is gathered from people who are already using a drug, rather than participants chosen at random to take it in a controlled environment, with another group, also selected at random, that is given a placebo instead of the drug. Here is what I believe is the best evidence: the randomized, placebo-controlled trial—one that is designed well, with a large enough sample size to show the effect, if there is one, and ideally more than one trial showing benefit. (If there are three randomized trials showing the same result, then I do the happy dance.)
When randomized, placebo-controlled trials of Prempro finally took place in 1999, the results showed that Prempro increased heart disease. In 2002, another large randomized trial, the Women’s Health Initiative, confirmed these findings. Huge wakeup call: for fifty-seven years, the mainstream medical community had been prescribing synthetic hormones before understanding their true effect on women’s health. Like thousands of other obstetricians, gynecologists, internists, and family-practice physicians, I had been doling out the wrong advice. It was a dramatic turn of events for me: I had to reconcile my belief in “best evidence” with the fact that the method for best evidence was neither taught to nor practiced by most doctors in the United States. The truth is that most prescriptions for hormone problems are not supported by hard science, and that the criteria for best evidence are not evenly applied. The experience taught me to be far more skeptical of hormone therapy and to demand the best evidence before prescribing any hormone, as well as to engage lifestyle changes first. In my practice, as a last resort, I do sometimes recommend hormone therapy in the smallest yet most effective doses and for the shortest duration, as you will see in chapters 4 through 9.
Since 2002, 80 percent of women stopped their hormone therapy. Yet the damage had already been done—women became fearful and suspicious of hormone therapy, as well as the doctors who urged them to take it. This was a very unfortunate outcome for several reasons, including the following: first, women faced far fewer options to manage the hormonal bedlam of perimenopause and menopause; second, the media oversimplified and distorted the results—there was little room to discuss the nuances of the data and how they applied to an older subset of women (average age sixty-six and older); third, a few bad eggs (synthetic hormones) ruined the reputation of all hormones, both synthetic and natural or bioidentical; and fourth, hormones could not have become a more polarized topic. Restriction in choice is never a good thing, above all when it comes to a woman who is feeling mildly or moderately insane from lack of sleep and progesterone in middle age.
Short version: randomized, placebo-controlled trials produce better data. I have robust evidence, based on the best quality of scientific investigation, including validated questionnaires and randomized, placebo-controlled trials, that I can’t wait to share with you. Even today, just 15 percent of the drugs prescribed in mainstream medicine are supported by these stud...
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