Dr Sara Gottfried - Women, Perimenopause, and Alzheimer's Disease

Evolving Past Alzheimer's

Sara Gottfried M.D. is a mother, wife, Harvard-educated physician, keynote speaker, and author of three New York Times bestselling books, The Hormone Cure (2012), The Hormone Reset Diet (2015), and her latest book Younger: A Breakthrough Program to Reset Your Genes, Reverse Aging, and Turn Back the Clock 10 Years (2017). For the past 25+ years, Dr. Sara has been dedicated to helping women feel at home in their bodies with functional medicine. After graduating from Harvard Medical School and MIT, she completed her residency at the University of California at San Francisco. She lives in Berkeley, California with her family. Dr Sara, shares what she learned from her own journey towards health highlighting how jumping straight to bioidentical hormone therapy isn't always the best option. Dr Sara lays out the issues of hormones in perimenopausal and the implications in Alzheimer's disease. The dramatic hormone shifts in perimenopause into the menopausal transition make women more vulnerable to Alzheimer's disease. We discuss the concepts of bioenergetics, glucose "hypometabolism" and mitochondrial changes in pre, peri, and postmenopausal changes. The premenopausal state is protective against brain changes leading to Alzheimer's. The HPA axis, or the control system for stress and hormone system, becomes dysregulated. Dr Sara describes how symptoms such as anxiety and depression may in fact may not be the diseases themselves, but harbingers of Alzheimer's and cognitive impairment. Dr Sara's Basics for Estrogen and Hormone Balance:

• Food choices: basics of water, increased fiber, magnesium
• Assessing nutrient gaps (organic acid panels, essential fatty acid, oxidative stress panel)
• Assessment of microbiome (looking for infection, dysbiosis, beta-glucuronidase, etc) with Functional stool testing.
• Looking at Estrogen metabolism (estrone, estradiol, estrone)
• • this can be done with dried urine testing and other testing to determine how your body is breaking down estrogen and if it is getting rid of it efficiently
  • stool testing with beta-glucuronidase
• An approach to identifying and actively managing stress and to develop stress resilience
• • Using a the Perceived Stress Scale to assess
  • Measure blood cortisol, dried urine testing
• Core supplementation: magnesium, DIM (di-indolylmethane).
• Advanced maneuvers (of course, in the context of overall lifestyle changes)
• • Phosphatidylserine 300-400mg - in divided doses or all at once or at bedtime
  • Lavela (pill form of Lavender) for anxiousness - can get on Amazon
  • Chasteberry - helps perimenopausal women who still get a menstrual cycle. Helps raise progesterone (a neurosteroid that helps to soothe the female brain). note: this can take 2-4 weeks to see a change
  • • Dr Sara often recommends: "Fertility Blend" brand name

When does Dr Sara move to using bioidentical hormone replacement? after basic lifestyle changes:

• Step 1: Navigate stress (less coffee and alcohol). add flax seeds to a morning shake/smoothie (eg 2 tablespoons)
• Step 2: Chasteberry, Siberian rhubarb, Maca (see Dr Sara's books esp The Hormone Cure for doses and timing and alot more strategy)
• Step 3: Consider bioidentical hormones
• • estradiol patch with micronized progesterone esp for perimenopausal women. she tries to use the lowest dose for the shortest time possible. she see's about 10% of her patients end up going on hormone replacement.

Towards the end of the interview (minute 50) we take a fairly deep dive into using bioidentical hormone therapy in women that are a bit older than perimenopausal ages and the controversy surrounding this issue. Dr Sara also lets the cat out of the bag with a new book on Brain that's coming out soon! listen towards the end of the interview for that. "The Brain, Body Diet" - a Functional Medicine approach. For more information Visit Dr Sara's website at: saragottfriedmd.com Also read her recent article on Women, Hormones, and Alzheimer's.