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Hey, it s Yuri and welcome to this Fat-Loss Summit interview. I m really excited today to bring to you my good friend Dr. Sara Gottfried.



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Dr. Sara Gottfried Hey, it s Yuri and welcome to this Fat-Loss Summit interview. I m really excited today to bring to you my good friend Dr. Sara Gottfried. In this interview, Sara is going to talk about
Dr. Sara Gottfried Hey, it s Yuri and welcome to this Fat-Loss Summit interview. I m really excited today to bring to you my good friend Dr. Sara Gottfried. In this interview, Sara is going to talk about why what s happening inside your body from a hormone perspective could be the reason you re having a tough time losing weight and how specific hormones could be sabotaging or stopping your ability to lose weight. If, for whatever reason you think you ve been working out the way you re supposed to, eating well, but something is still not clicking, you re still not losing the weight, then the answers could be in this very interview. Just in case you don t know who Sara Gottfried is, she is a Harvard-trained medical doctor and a two-time New York Times best-selling author for The Hormone Cure and The Hormone Reset Diet. Most importantly, though, she s somebody who actually battled with her weight for a number of years, until she figured out that what she was doing was really stopping her from her body s ability to lose weight itself. This was a number of years ago, and she s talked about this in numerous different occasions and settings in her books, on her videos. If you re a woman who s struggled with your weight, Sara can definitely relate to that because she s been through that, and she s figured out how to really reset your hormones in a really simple fashion so that you can experience easier weight loss, but probably more important, just to feel the way you really want to feel. Even if you re a man, there are a lot of important takeaways from this interview. For instance, did you know that a lot of men have higher-than-normal estrogen levels? Well, what is that doing to your ability to lose weight? Well, you ll find out in this interview. Let me just give you a tip: It s probably not a good thing if you ve got too much estrogen in your body whether you re a man or a woman. Sit tight, grab a green juice, and let s jump in to the interview. Yuri: All right, here we are. I m really excited to have my good friend Dr. Sara Gottfried in the hot seat in today s interview in the Fat-Loss Summit. Sara, welcome to the Fat-Loss Summit. Sara: Hey, Yuri. Hi, everybody. Yuri: How are you doing? Sara: So good. Yay! I m happy to be here. Yuri: It s great to have you on board. It s always great to connect because you re one of my secret weapons as it pertains to hormone-related issues with respect to weight loss. That, as we both know, is a huge issue holding a lot of people back. 1 Before we dive in to that, tell me a big thing that a lot of people don t know? What s a mistake you re seeing people make when it comes to losing weight? You ve gone through your own journey, and you ve battled with your weight issues. What s something that maybe you did in the past that you re seeing a lot of your clients and patients make at this point in time? Sara: Well, I would say I think a lot of us are still held back by the calorie myths, this idea that calories are what you have to pay attention to. It was something I was told by my own doctor when I was struggling with baby weight in my 30s. He just told me, Exercise more and eat less. You know it; it s simple math! This still pervades all of conventional medicine. I would say the correction is: Calories matter, but hormones and nutrients matter more. I think that s the biggest mistake people make. You ve got to really consider all three of those. Yuri: And do calories at all affect our weight, or is it the quality of the foods that we re eating? For instance, a lot of people think that carbs are the devil, but they re actually pretty important for thyroid hormone. Is it a calorie thing, or is it more of the actual quality or type of food that we re eating? Sara: I would say it s not either or. I think the nutrients really matter, which is what I think you re getting to. I think another mistake that people make is they think, I m so sick of this weight that I have. They make a radical vow on a Monday, usually, that they re going to give up carbs or maybe go into nutritional ketosis. Just as you described, when they give up carbs, maybe they start to slow down their thyroid function, because that can raise cortisol to completely remove your carbs or get it down to 20 grams a day. It can also interfere with your adrenal function, which I think is a really important piece to pay attention to. I also think that women and men are very different when it comes to carb requirements. I think women, in general, tend to need around 50 at a minimum sometimes 75; the window is different for each person on up to about 150 grams a day. You have to realize, you have to have a conversation with your body to figure out, Here are the carbs that I need to be able to function optimally and get that body fat to the ideal range. Yuri: That s very different from what a lot of low-carb diets are prescribing, where they re saying to have less than 50 grams a day. Sure, you ll lose weight like that maybe in the short run but that s probably setting women up for not a good road ahead. Sara: Exactly right. I would even say there s this whole group of low-carb refugees that I tend to see. They did what they were told to do. They went low carb; maybe they went less than 50 grams a day, or even 20 grams, as is recommended in the ketosis diet. Many of them report that their thyroid starts to slow down, they have hair loss, they stop getting their periods. The hormonal system requires a certain amount of nutrients micronutrients and macronutrients and that can begin to fall apart if you re not dialing in these nutrients the way that we need. 2 Yuri: That s amazing. For those of our viewers and listeners who don t know what ketosis is, can you just explain what that is very quickly? Sara: Sure. Nutritional ketosis is where you are changing your macronutrient ratios so that you re burning fat. You re shifting from being a sugar burner to being a fat burner. The typical ranges that you see for nutritional ketosis you know, people like Jimmy Moore talk about 85 percent fat in terms of the percentage of calories from macronutrients. That s a lot of fat. Yuri: That s a lot. I don t even know if you can compose a good-tasting meal with that amount of fat. I don t know. Sara: Well, not only good-tasting, but also nutritionally sound. Yuri: Exactly, yeah. Sara: When you re up that high in terms of fat, you re going to start to lose out on some of these micronutrients. And, certainly, you re going to lose out on some of the fiber that you need. The idea is to have a moderate amount of protein and low carb. Now, I have a confession here. I just tried nutritional ketosis for three months as an experiment because I m always trying to check this out. My husband did it with me. He lost 15 pounds of fat on nutritional ketosis. I gained 1 percent fat, and my weight went up. It s one of those things where I think women are disadvantaged when it comes to things like nutritional ketosis. It just doesn t provide those nutrients that we need. Yuri: And how did you feel during that time? Sara: What I liked about it was that I wasn t hungry. When you re a sugar burner, you re hungry all the time. I have, genetically, a predisposition to basically be a fat diabetic; like 200, 250 pounds and blood sugar that s just all over the place. I was interested in trying to control my blood sugar. I just did a bunch of testing yesterday to see if that got better with ketosis. My sense is that it probably didn t. I definitely liked not feeling hungry, and I liked the mental acuity. I d check my blood ketones every day to make sure I was in this reference range of about 1.1 to 2.0 millimoles a day, but it did nothing in terms of my fat mass. Yuri: That s interesting. I remember we had a conversation a couple months ago. I think you said there were few, if any, scientific papers on the Paleo diet in women. I don t know if that was coming from you or somebody else. 3 I have no problem with the Paleo movement. I think eating more real foods is great, but when the conversation becomes carbs are the devil or never have grains or never have carbohydrates again, it becomes very misleading, especially as you ve just shown, that, for women who generally want to lose weight more than men do, it can become a very confusing landscape. Sara: I think that s right. I m not sure if I m the one who said that about Paleo. I think there are a number of good, randomized trials looking at low-carb diets, mostly men, but also women as well. There are some Paleo-style diets; some of the best ones are done by Terry Wahls. One of the things that she found and I think you and I have talked about this in the past is that for women who are trying to lose weight on the Paleo diet, they usually hit a wall when they have a body-mass index of about 23, and they can t get any lower than that. That s really interesting to me, and that s something that she s seen over and over in her practice and I have found that as well on Paleo. I found that Paleo, for me, was too much red meat, even the grass-fed, wild type of meat, probably because of my tendency toward estrogen dominance, which is true for about 70 to 80 percent of women over the age of 35. We know that red meat raises your estrogen load, and eating more plants, more vegetables, decreases your estrogen load. I have to eat more fish, more vegetables; that s a much better fit for me. Just to dial in this body-mass index point a little bit deeper, I love to hang out at a body-mass index of about 21, 22. Twenty-two is what s really proven to be associated with health span and your best outcomes. If you re too skinny, if you re too low in terms of your body-mass index and this doesn t even capture fat, which is important here too you re just at greater risk of other problems, such as osteoporosis. Twenty-two, 23 is kind of considered the ideal, and all my clothes fit at a body-mass index of 22. A lot of women want to be a little bit lower, and I think Paleo tends to work better for men again, probably because of this estrogen issue. Yuri: That s great insight. Let s dig in to the hormones here. There are a lot of hormones in the body; they re very misunderstood by a lot of people. Usually, when people think they re eating right, exercising well, and still can t lose weight, they re like, What s going on? Usually, it s probably physiological, something inside related to hormones, which you talk about in your books. What s going on? What are the hormones that people need to know about as it pertains to losing weight? Sara: I love to talk hormones. Yuri: Hence your books on hormones. Sara: Mostly because I ve had every hormone problem a woman can possibly have, so I speak from experience, as well as loving the scholarship. The hormones that I think are most important are estrogen, insulin, leptin, cortisol it s kind of the neglected one that I always want to bring in to the conversation growth hormone, testosterone, thyroid. There s a longer list here ghrelin, adiponectin but I think those are the key ones for people to pay attention to. 4 Yuri: I want to bring up growth hormone and testosterone for a second. For me, they re like the holy grail I want more of that good stuff but for women, I don t know if you ve found this, but I have, where they re almost scared of those hormones; they think if they have too much of them, or just even speaking of them, they re going to turn into the Incredible Hulk. Can you talk about why those are important hormones, especially for women, to consider for their overall health, as well as their ability to burn fat? Sara: The biochemistry can make your eyes glaze over, so I like to make these hormones come alive. I think of testosterone as being this hormone of vitality. It s sort of what allows you to be big in the world and to have agency, that sense of your power. It s the hormone of confidence, sex drive; it s also involved in your muscle mass, your lean body mass. I think it gets sort of mislabeled and categorized as the sex-drive hormone. Women have less than men about 10 to 20 times less but that means we re exquisitely sensitive to it. Just as with men, for women, you want all these hormones, including testosterone, to be not too high but also not too low. You want to be in this sort of Goldilocks range so that when you go to barre class or you go to the gym and you do some burst training with weights, you actually get a response. A lot of women, especially as they get older, over the age of 40, when testosterone starts to decline, they feel doughy. They start to notice the fat more. Their arms are like sausage casings when they put some clothes on, and they re like, This won t do! I ve got to do something about this. We often find you ve been stressed out for 15 years and your cortisol is burned out, your adrenals aren t working, and your DHEA is low that s the mother of testosterone you re not making enough testosterone anymore. We ve got to get you into that normal range again. Growth hormone is a little bit different. I would say both of these are considered shady characters right now in terms of the science because it s not as rigorous as it is with some of the others, and there s kind of a backlash right now, especially with testosterone, but with growth hormone as well. I think from the anti-aging movement, where a lot of people started injecting themselves with growth hormone as they got older, thinking it would be this holy grail that would keep them younger and keep their muscle mass and the belly fat from forming. I m not a big fan of injecting yourself with growth hormone, but I am a fan of those lifestyle tweaks that help you keep the growth hormone, just as with testosterone, in that Goldilocks position, where it s not so low that you re exhausted, depleted, you have a lot of belly fat, and you re aging fast, but it s also not so high that you re starting to have side effects from it and maybe even an increased risk of cancer. Yuri: What are a couple of those lifestyle tweaks that can increase both testosterone and growth hormone to normal levels? Sara: What I m really excited about when it comes to growth hormone is burst training. We know that high-intensity interval training, or burst training, is a very effective way of raising growth hormone. This was a huge paradigm shift for me. You probably knew about this way before I did, Yuri, because you re more fit than I am. 5 Yuri: I don t know if I knew about growth hormone back in the day, but it s interesting because all of the people we ve had in the Fat-Loss Summit, the recommendations in terms of exercise have all been the same. Moving away from the long-duration cardio, doing stuff like you just mentioned higher intensity. If you re watching this, hopefully you re getting the message by now. Sara: There s consistency here. Yuri: Exactly. Sara: I was one of those people who was doing the chronic cardio. I was on the elliptical or treadmill for ridiculous amounts of time. If I wasn t there for an hour at the gym, I felt like I was wasting my time. I went to Hong Kong and was visiting a friend who was really into this thing called SPRINT 8, as it was known then. The idea was that you did about 90 seconds there are all these different protocols you do 70 to 90 seconds of your moderate pace, and then you go all out hard for between 30 and 60 seconds. You do eight cycles of that. I started doing this, and I raised my growth hormone by more than 50 percent. I definitely think that this is a really powerful way to exercise. And it also fits with the evolutionary perspective. This is what our ancestors did in terms of exercise; they didn t get on a treadmill for hours. Yuri: No, exactly. Hopefully, they don t continue doing so. Sara: Right. No more chronic cardio. Yuri: No, it s almost like the cardio confessional. You have whatever you have to eat the night before or the day of, and you re just like, I m going to go kill myself in the gym. And it ends up being on the cardio machines. You think you re just going to burn away the calories. That s my hope with this summit: to really enlighten our viewers to understand that that paradigm needs to go away, because it s not really serving us. Sara: It s not serving us and it can raise your cortisol. This was my insight when I was in my 30s. I told you about that experience going to the doctor and saying, I m fat. I ve got these twenty-five pounds I can t lose after my babies. He wrote on this whiteboard: Exercise more + Eat less = Weight loss. Then he said, I understand you re running. Can you run more? I was 25 pounds overweight, I was getting injured from running. I was running about four miles five times a week, killing myself. It was so depleting and it was raising my cortisol even higher. I left his office because I was so furious, and I went and tested my own hormones. My cortisol, just at baseline, was three times what it should ve been. I needed to back off. I actually needed to find forms of exercise that would allow me to modulate my cortisol, such as yoga, barre class, Pilates. That was a much better way for me to move. 6 Yuri: It makes sense. And that high cortisol is going to shut down testosterone, as well, based on that whole pathway. As you know, everything is intertwined. Nothing is independent of anything else. Sara: That s right. There are a few priorities I think are important to highlight here. You just mentioned cortisol. I think of cortisol as being the kingpin in both the male and female bodies, but especially in the female body. Women are more vulnerable to stress. Our control system the hypothalamic, pituitary, adrenal, thyroid, gonadal axis gets totally out of whack, and cortisol is the priority. It s going to be made no matter what. Just as you described in terms of the biochemistry, when you are, all day long, making cortisol, your other sex hormones are going to wane. You re not going to make as much testosterone. You won t make as much DHEA. You won t make as much progesterone, which calms us down. And you re also going to slow down thyroid function. When cortisol is too high or too low, that s going to slow down thyroid function. I think that s a really crucial piece. The other hormone that is not a sex hormone, but I think of it as another kingpin, is insulin. I don t know if you mentioned your favorite analogy for insulin yet on the summit, but I want you to say it again. I love your analogy of the bouncer, the nightclub. Can you please do that? Yuri: Sure. Let me get my serious scientific hat on here. When we were back in college, we used to go to the bars and stuff. There s always that one guy, the cool guy who could get us into the clubs. Let s say you re out with a group of 10 friends. You and the 10 friends are these sugar molecules, and you want to get inside the club, which is, let s just say the muscle cell in this case. The problem is that you get to the club, and there s a big lineup. You don t want to wait in the lineup. Then you ve got these bouncers who never let you in to the club because they re so cool. The bouncers are kind of like the receptor site or the entry point into the cell. But here comes the cool friend. The cool friend has the leather jacket on. He s got the $100 bill he s going to slip to the bouncer. That cool friend is insulin. Insulin is kind of like the shuttle to help you get inside the club, and inside the body, it basically is taking sugar out of the blood and helping it get side the muscle, fat, or liver cells. That s the insulin analogy. Sara: I think that s so good. It s my favorite analogy I ve ever heard. Insulin is kind of hard to describe because there are some counterintuitive aspects to it. People know what insulin resistance is that your cells become numb to insulin. You don t have the cool kid there to help you get into the club. But it s still abstract for a lot of people even though one in two Americans suffer with i
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