Gottfried, a beautiful Harvard Medical School graduate, board-certified gynecologist, and yoga teacher, looks like an advertisement for healthy living and convincingly pushes women to make lifestyle changes rather than immediately asking for conventional prescription drugs to treat problems such as depression. To make her points, she cites studies. Otherwise, she is careful to insert “in my opinion.” For example, she does not like the form of progesterone sold as Provera, because she believes it causes “terrible mood problems” and “removes sex drive in both men and women.” Occasionally, she words her sentences too casually: “Estrogen is actually a group of sex hormones responsible for keeping women juicy, joyous, and jonesin’ for sex.” Goodness. And some of her advice may seem too hard to live by. Still, most of her tips are solid and helpful: break a larger goal into smaller ones, eat like your great-grandparents, cut out white foods, and move more. A glossary of terms and several appendixes should help anyone who wants to understand hormones and the female body. A valuable title for any middle-aged woman. --Karen Springen
Review
“The Hormone Cure is a breakthrough hormone guide—entertaining, persuasive, hilarious. I’ve not seen this content anywhere! Get to the root of your issues: low energy, fatigue, low sex drive, anxiety, weight gain. This book is gold.” -- Marci Shimoff, author of Love for No Reason
“The Hormone Cure is the playbook for your mojo, your mind, and your bootie. With every chapter I thought, "So THAT's how that works." I wanted to call every girlfriend and give them the goods on how to glow...now and always” -- Danielle LaPorte, author of The Fire Starter Sessions
“Never before have I read a book and shouted, ‘Oh my God, that’s ME!’ Managing hormones is the most important issue of women my age. I don’t just want to read Sara Gottfried, I want her to be my doctor, my friend, and my sister. -- Ayelet Waldman, author of Red Hook Road and Bad Mother
“A cogent, hilarious, wise explanation about why women feel the way they do at different times in their cycles—and sensible advice, too. Dr. Gottfried is Dr. Weil and Dr. Northrups’s love child—part of the new conversation about hormones.” -- Adair Lara, author of Naked, Drunk, and Writing
“Gottfried is a rare breed of physician who can discuss both progesterone replacement and the power of chanting. Her engaging and well-researched book offers women an excellent resource for the wild ride from peri to menopause.” -- Daphne Miller, MD, author of The Jungle Effect: Healthiest Diets from Around the World
“This wonderful book transforms how we approach women’s health issues, and will help you understand how to achieve hormonal equilibrium if you suffer from fatigue, depression and other endocrine-based neuropsychiatric symptoms.” -- Jay Lombard, DO, author of Balance your Brain, Balance your Life
“If I could recommend just one book to women about hormones and perimenopause, The Hormone Cure would be it. Dr. Sara Gottfried is a genius, compassionate and wise, not to mention a first-class writer. Read this book!” -- Jonny Bowden, Nutritionist and author of Living Low Carb
“Dr. Sara is smart, she’s hip, and yet she’s pure Harvard! Learn how to make your hormones hum. Run, don’t walk, to buy this book—for yourself and your friends. The life you save may be your own.” -- Hyla Cass, MD, author of 8 Weeks to Vibrant Health
“A magnificent book! Every woman needs to read it, and every doctor.” -- Louann Brizendine, MD, Author, The Female Brain and The Male Brain
“Don’t accept the hormonal hell of being tired, stressed, fat, never in the mood for sex. Dr. Gottfried gives you an effective, easy-to-follow plan to balance your hormones and become lean and energetic. Stop settling, reclaim your sexy!” -- JJ Virgin, author of Six Weeks to Sleeveless and Sexy
“Occasionally a book comes along that’s perfect for its time-on topic, written with authority. Such is the book by Sara Gottfried, MD. It is a definitive integration of safe and effective approaches to the management of menopause.” -- Jeffrey Bland, PhD, author of The 20 Day Rejuvenation Diet Program
“Thoughtful, poignant and devilishly irreverent, The Hormone Cure is the book you need for lasting health from head to toe. Dr. Sara turns your hormones into allies that create the life you want to live. Women, get this book!” -- Jamie Dougherty, Integrative Health Coach and Official Nutritionist/ Wellness Coach for Clif Bar
“How many years did I suffer in hormone hell? If I only I had Sara's wisdom sooner. This book is going to help save the world—because too many women's gifts are smothered by hormone imbalances, preventing us from doing our great work.” -- Jennifer Louden, author of The Life Organizer: A Woman’s Guide to a Mindful Year
“Dr. Sara is bridging the chasm between the woman who wants to take action to feel better and the encapsulated medical body of knowledge. Dr. Sara hunts the core issues women are wrestling with and answers the essential question: 'What the hell is wrong with me & what can I do about it?' I am making this book required reading.” -- Ana T. Forrest, Founder of Forrest Yoga and author of Fierce Medicine: Breakthrough Practices to Heal the Body a
"Gottfried takes a comprehensive look at the most common physical and emotional ailments affecting women and explains why a hormone imbalance may be at their root. Her premise is simple: when a woman’s hormones are in sync, she’s a powerhouse, but when they’re out of whack, they wreak havoc on her body and mind. The book is both fun and an informative read [and] Gottfried’s take on the female body is eye-opening and empowering." ― Spirituality and Health
"Gottfried, a beautiful Harvard Medical School graduate, board-certified gynecologist, and yoga teacher, looks like an advertisement for healthy living and convincingly pushes women to make lifestyle changes rather than immediately asking for conventional prescription drugs to treat problems such as depression. Most of her tips are solid and helpful...A valuable title." ― Booklist
About the Author
Sara Gottfried, M.D.,is a Harvard-educated physician and board-certified gynecologist who treats the root cause of problems, not just symptoms. A nationally-recognized yoga teacher, Gottfried teaches women how to balance their hormones naturally. She has been featured in Yoga Journal, Glamour, and Cosmopolitan magazines and in the award-winning film, YogaWoman.
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.
Hormonal Crosstalk
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 studies. In my practice, 85 percent of my recommendations are supported by such trials—and the other 15 percent are sufficiently low risk (such as a vitamin or a shift in mind-set) that they are unlikely to cause any problems.
A New Paradigm
Mainstream medicine is marvelous for broken bones and works wonders with a life-threatening bacterial infection or heart attack, but we’ve lost something as we’ve become increasingly technical, specialized, and downright vocational. In this country, the average appointment with a doctor is seven minutes long. Seven minutes. But I believe that women’s health issues, lifestyle choices, and symptoms are complex and take time to decode. That’s why an appointment in my medical practice is fifty minutes or longer.
As you probably know, the problem in mainstream medicine isn’t lack of spending. U.S. healthcare costs are a whopping $2.5 trillion per year and rising. Yet 70 percent of costs are spent on diagnostic procedures and treatments that could be avoided through better lifestyle choices. Increasingly, our population is hormonally imbalanced and overweight, and the root cause is tied to how we eat, how we move, missing nutrients, age-related changes, and, increasingly, exposure to environmental toxins called endocrine disruptors. Nevertheless, a lifestyle-based approach has been unsung and undervalued by most mainstream health practitioners, which is particularly shocking when you review the science and realize just how effective lifestyle design can be when applied to hormones, mood, longevity, stress-related problems, and prevention of disease.
Most prescriptions are not a “cure.” In my opinion, most conventionally trained doctors haven’t a clue about how hormones wreak havoc on a woman’s physical and emotional state; the effects of these imbalances fly beneath their radar. The inclination is to write a prescription—too often for the antidepressant du jour. Not only can antidepressants cause weight gain, stroke, low sex drive, preterm labor, and infant convulsions, but recent data link antidepressants with breast and ovarian cancer. As if these adverse effects weren’t enough, I see no evidence that prescriptions for mental-health maladies offer a cure. Yes, there is a time and a place for prescription medication, and some people urgently need such medication. But I find that mental-health prescriptions are handed over too readily, when the root cause and contributing factors, such as neuroendocrine imbalance, have not been fully explored. A cure restores health, but most prescriptions are not a cure—they merely mask symptoms. When you address original causes of poor health and neuroendocrine imbalance, you are far closer to a cure than at the bottom of an expensive pill bottle.
There must be a better way. Ten years ago, when I still worked in the trenches of conventional medicine, before I spun off to start my own integrative medicine practice, I figured there had to be a better way to fill the gaps that women encounter between what we struggle with and what mainstream medicine offers. I discovered that the most important gap was adrenal function. Your adrenals are the tiny little endocrine glands on top of your kidneys that secrete several stress hormones, including cortisol and DHEA. In my medical training, I learned about tumors of the adrenal glands, and what to do if a patient had an extreme excess of cortisol (Cushing’s syndrome) or complete failure of the adrenals (Addison’s disease). I had been trained to identify the weeds and dead plants, but not to look for the early and subtle signs of ailing to come. Your adrenals may just be the most important plants in your garden for us to nurture and help bloom.
You see, in mainstream medicine, we tend to have either/or thinking. Either your liver is working or you have liver disease. Either your thyroid is working or you have thyroid insufficiency. Either your adrenals are working or you have adrenal failure. There is rarely a “middle ground.” The truth is that most of us exist in a wide space between those two extremes, which I call dysfunction or dysregulation. I believe it’s not only worthwhile but ultimately your responsibility (along with the help of a trusted clinician) to intervene before your organs become diseased. Intervention before failure, before insufficiency, is proven to contribute to lasting health and longevity.
How could conventional medicine benefit from ancient traditions? Conventional medicine tends to focus on what’s not working, rather than on what is working. Conventional doctors are trained to fix what’s broken in the body; they focus on removing the bad, whether that’s a diseased appendix or cancer cells. Sometimes the singular focus on “fixing the bad” becomes a self-defeating cycle in which we see only what’s not working. If we widen our lens to see also what is working, we can understand how to best nurture the good, and thereby amplify the beneficial effect. This larger view allows us to work smarter rather than harder. Leveraging your strengths rather than concentrating on your weaknesses creates the most profound and lasting change. A significant body of research supports this kind of strength-based approach.
Pareto’s Principle, applied to hormones. What I’ve observed in my practice is that 80 percent of righting your hormonal balance comes from 20 percent of your efforts. This is an application of Pareto’s Principle, or the 80/20 Rule: a general notion that 20 percent of effort is responsible for 80 percent of the results. In my office, the 80/20 Rule leads to one basic question: what are the most efficient ways to harness your resources and optimize your hormones? Rather than randomly seeking every possible cause for a neurohormonal problem, we first identify the small changes that will have the largest impact.
Many women wind up in my office looking for answers they intuitively know exist but cannot seem to find within the limited scope of conventional medicine. They identify me through a referral from their own puzzled gynecologist; a friend who lost 30 pounds following one of my protocols; an interview I’ve performed on the radio, a speech, or from my blog at http://www.saragottfriedmd.com; or after a despairing online search for information on how to rekindle their sex drive. Once we talk, they often exclaim that they’ve had an epiphany: they’ve finally found a mentor and a partner in health, someone who actually listens and presents them with enlivening, safe, and proven choices.
Use this book as your personal appointment with me to decode your hormonal DNA so you’ll feel and look gorgeous, radically prevent degenerative aging, and rock your middle age, whether that’s several years away or where you are right now. We’ll create a new hormonal roadmap, just for you.
Women Desperately Seeking Answers
I recently worked with a professor of sociology to come up with a quantitative survey of my clients. The survey polled my female patients: 26 percent under the age of forty, 57 percent between forty and fifty-four, and 17 percent fifty-five or older.
Here’s what we found:
• Spare beach floatie? 64 percent of my clients have one.
• Hair loss? Yikes, 40 percent struggle with this.
• Half of my clients feel they’re constantly running from task to task (like a chicken with its head cut off).
• Poor sleep? 80 percent struggle with it at least once per week, and 20 percent every night.
• More than half feel there’s not enough time in the day to accomplish the things they need to accomplish.
• Headaches? Yep, in 48 percent, either menstrual or noncyclic.
• Of my clients, 48 percent have skin problems, ranging from eczema to excessive thinning or prematurely aging skin.
• More than half felt they couldn’t get going at least three or more days of the past week.
• Vaginal dryness (or as inhumanely coined in medical parlance: atrophic vaginitis!) is experienced by 37 percent.
• Fortunately, only 9 percent have high blood pressure.
The numbers don’t end there. These figures reflect the percent of my clients desperately seeking particular results they cannot get from conventional medicine: 91 percent want more energy; 80 percent want a better sex drive; 69 percent wish for better mood; and 26 percent yearn for the end of hot flashes or night sweats.
These metrics show the epidemic plaguing modern women. It’s not just looking good that interests women. It’s feeling good from cells to souls. In my practice, I find that many women initially believe anything short of a prescription drug is a waste of time. Mention the word holistic and they run for cover. But I urge you to stay. Ultimately, you and your family will be glad you did.
Dr. Sara’s Mindmap: Principles of Hormone Balancing
• Recognize the inherent wisdom of the body. Natural order, particularly as it applies to the control of hormone metabolism, prefers equilibrium. When we remove obstacles, we move toward balance. Balance is often a matter of identifying and then removing obstacles rather than prescribing medications. Plus, learning what the obstacles are for you and how to work with them are an essential part of healing.
• Identify the root causes of the imbalance. Sustained health results from treating underlying causes, rather than suppressing symptoms.
• Be systems oriented, proactive, and intelligent about replacing hormones. Work with the control system, located in the brain, rather than replacing every hormone that is low. Focus on what is working as well as on what isn’t.
• Do no harm. Using best evidence, including the gold standard of randomized trials, provides treatments that are proven safe and effective.
• Be an active partner. Make sure you become actively involved in the quest for balanced hormones. The more you invest as an equal partner and participant with your practitioner, the better you will sustain the changes you create together.
The Gottfried Protocol
Science has proven that while your genes control your biology, a rather simple, nondrug formula of nutrient-rich food, targeted supplements to address missing precursors, and lifestyle changes can keep your genes in perpetual “repair” mode. Even if you’re genetically programmed to develop depression or cancer, the way you eat, move, and supplement can alter the expression of your genetic code. This emerging field of epigenomics examines the influence of environmental inputs on genetic expression. Catalyzed by the revelation of the human genome, epigenomics is a fascinating area that informs how genes are modified without changing the DNA sequence—that is, how a gene for obesity, for instance, is modified by eating nonstarchy vegetables versus cupcakes. You’ll read more about how you can leverage epigenomics to overrule genetic predispositions.
Your genes are merely a template. In other words, your body is full of natural mechanisms for repair and healing. When you nourish and augment these built-in mechanisms, you may prevent and even reverse disease.
This is the foundation of The Gottfried Protocol. No matter what the hormonal problem is, the solution starts with lifestyle design, including a nutritious food plan, identifying and filling in the missing precursors to your proper neurohormonal communication, and targeted exercise. Creating a methodology to assess, support, and maintain hormonal balance for myself and my clients took more than ten years. I defined, tested, and refined a progressive, systematic approach that is reproducible and proven.
When I dealt with my own hormone imbalances, my goal was to discover the root causes, to formulate a customized and rigorous fix, and to track my progress. I drew upon many sources, including traditional Chinese and Indian (Ayurvedic) medicine. In The Gottfried Protocol, I combine the latest medical advances and cutting-edge techniques with ancient treatments validated by modern research.
The recommendations in this book are based on this evidence-based integrative approach. This three-step strategy is a sequential system that includes
1. lifestyle design: food, nutraceutical, and targeted exercise
2. herbal therapies
3. bioidentical hormones
Most of my recommendations are available without prescription. When women put an earnest effort into Step 1 of The Gottfried Protocol—and implement a customized food plan; specific supplements that include missing vitamins, minerals, and amino acids; and targeted exercise—they find most of their symptoms of hormone imbalance disappear. If they don’t, we shift to Step 2—proven botanical therapies. After completing Steps 1 and 2, few women need bioidentical hormones (Step 3), but for those who do, the doses and duration of treatment are often lower than if they’d skipped the lifestyle design and herbal therapies.
Sometimes it just takes a small adjustment to induce big changes: I relish the moment a patient realizes that her presumed life sentence of low sex drive can be altered with a particular form of meditation and a maca smoothie.
The Hormone Cure
This book will change your life for the better. By nature I am a skeptical person, but I’ve seen the benefits of The Gottfried Protocol over and over in my own practice. We are conditioned as women to live in such a way that gets our hormones to work against us, and I want to help you adjust your hormones naturally so they are allies. As I’ve witnessed the healing that women experience when their hormones are reproportioned, as I’ve documented both the results and the transformation that occur in everyday lives, I’ve come to believe that The Gottfried Protocol is far more likely to succeed than a prescription medication—particularly a medication that is completely foreign to your body.
The Hormone Cure is divided into two parts. Part I: Educate and Illuminate provides the foundational elements. Chapter 1 offers several questionnaires—checklists to help you identify your main hormonal imbalances. After responding to these questions, you will have a good idea if you are high or low in any of the targeted hormones, and then know which chapters you should read first. Chapter 2 offers an overview of what hormones are, what they do, and how they interact. Chapter 3 describes when it all starts to go awry: perimenopause, which typically begins between the ages of thirty-five and fifty (menopause, on average, occurs at age fifty-one in the United States).
Part II: Assess, Diagnose, Treat describes what you need to know about individual hormones. Based on exhaustive research and drawing on my years of clinical experience (plus forty-five years in a female body with seemingly every hormonal symptom possible), I describe the common causes of specific hormonal imbalances and what to do about them.
Part III: The Appendix, offers important reference materials for hormonal balance. I’ve included a summary of The Gottfried Protocol according to root cause, a glossary of terms, a table of hormones described in this book and their jobs, how to find and work collaboratively with clinicians, recommended laboratories for home testing, and the food plan that I recommend to my patients and follow myself.
In reading each chapter, you’ll refer to the questionnaires at the beginning of this book to help you assess your symptoms and perhaps even identify issues that you didn’t know could be related to hormones. I focus on a specific hormone in each chapter: cortisol, estrogen, progesterone, androgens (including testosterone and DHEA), and thyroid. Along the way, you’ll also meet other hormonal characters, including insulin, pregnenolone, vitamin D, leptin, and growth hormone.
You’ll learn what each hormone is, what its job is, what you feel like when it’s functioning properly—and when it is not—and what might have caused the imbalance in the first place. After introducing you to the hormone in question, I dive deeper into the science behind what’s happening in your body to cause that hormone to become imbalanced. Understanding the science is important to some of my patients, while others feel they don’t care about it and just want to know how to feel better now. In this book, you can decide how much science you want to know, or skip past it.
Once we’ve defined your hormonal problem, you’ll find a strategy for what to do. That’s where The Gottfried Protocol comes in; we make a plan instead of taking a shot in the dark. (I’ll let you know when you need to visit a doctor.) Finally, to help you feel that you’re not alone, each chapter contains a few case studies from my files, true stories of real patients: their symptoms, our treatment protocol, and the results.
The Ideal Hormonal Specimen
Picture the Ideal Hormonal Specimen. Her hormones perfectly balanced, she has high energy throughout the day, stable moods, and no food cravings. Her full head of hair is glossy and her skin is clear. She easily maintains her weight and her sexual energy. Colleagues never worry that she’ll weep in the middle of a big meeting or start sweating profusely. Well-intentioned friends don’t gently suggest “seeing someone, a therapist, maybe?”
The Hormone Cure is for the rest of us, the women who haven’t quite reached the status of Ideal Hormonal Specimen—but we aspire to it. I believe the majority of women want to look better, feel better, and age more gracefully. They want to become Ideal Hormonal Specimens.
This book is for women of all ages. A common myth about hormones is that you don’t need to worry about them until menopause. The truth is, many hormone levels, such as estrogen and testosterone, start to drift downward when you’re in your twenties. Some hormones, such as cortisol, may spike too high and pull other hormones offline. Women younger than thirty may not yet feel affected by the aging process, but perhaps they want to get pregnant or avoid the diagnosis of breast cancer their mom just received.
Those in their thirties may feel increasingly tense and overwhelmed, in need of better strategies on how to relax. They may want to prevent the high blood pressure, prediabetes, and accelerated aging that come with chronically high stress levels. Women in their forties and fifties may want to regain some of the buoyancy of their youth. Perhaps they want to wake up feeling restored again, without the brain fog from disrupted sleep. Women in their sixties, seventies, and eighties may want to optimize their cognitive and executive functioning—to improve their thinking, memory, and competitive edge.
The Hormone Cure was born of my passion to help women, one hormone at a time. I don’t want women to suffer; I don’t want them to be underserved by their doctors, miseducated by the media, tired, frazzled, and ashamed. I’m not a magician who can turn back the hands of time and make you twenty-five again, nor do I believe that’s best for you. What I can do is return something you’ve lost: the properly proportioned hormonal organization that provides clarity, confidence, and longevity.
The human body has an innate ability to repair and self-regulate, but that ability often gets bulldozed by the enduring stressors, distractions, and interruptions of modern life. Once you rediscover your body’s ability to shift toward balance, informed by the new science of integrative women’s health and aided by The Gottfried Protocol, you’ll find that it’s easier to move toward balance than to stay imbalanced. Attend to your hormones today, and the process will serve your mood, weight, energy, sex drive, sleep, and resilience for decades to come. 
Cortisol is the hormone that governs your hunger cravings, digestion, blood pressure, sleep/wake patterns, physical activity, and capacity to cope with stress.Highlighted by 234 Kindle readers
