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What if you could get more of what you want in life? But not through pushing, forcing, or pressure.
You can.
When it comes to money, time, and energy, no one’s gonna turn away more.
And Kate Northrup, Bestselling Author of Money: A Love Story and Do Less and host of Plenty, is here to help you expand your capacity to receive all of the best.
As a Money Empowerment OG who’s been at it for nearly 2 decades, Kate’s the abundance-oriented best friend you may not even know you’ve always needed.
Pull up a chair every week with top thought leaders, luminaries, and adventurers to learn how to have more abundance with ease.
We experience more trauma at an earlier age, more sexual trauma. We're 14 times more likely to be raped than men. And then the third is a little more selfish. Just finding that in my own experience, even as a physician, as I've struggled through different stages of life.
Kate Northrup:I am so excited for today's episode. It was really, really special because I got to spend the entire day in the home of Doctor. Sarah Gott fried Saul, who's the author of The Autoimmune Cure and also Women, Food, and Hormones, and many others. She is a groundbreaking women's health doctor who really understands the connection between our traumas, our emotions, and our physical health. The part right at the beginning of the show made me emotional because I asked her why she cares so deeply about healing women's bodies, and her answer really surprised me and was actually incredibly personal to me.
Kate Northrup:So you'll have to listen in to find out what that was. We talked so much about hormones, vitality, fertility, both literally and metaphorically. We talked about boundaries, over functioning, how to let go of that, how to have better sex, more orgasms, how to live a juicier life on so many levels. So this episode is a really special one. It was really meaningful for me personally, from a legacy perspective around women's health and I know you are going to love doctor Sarah Gottfried Saul.
Kate Northrup:Welcome to Plenty. I'm your host Kate Northrup and together we are going on a journey to help you have an incredible relationship with money, time, and energy and to have abundance on every possible level. Every week, we're gonna dive in with experts and insights to help you unlock a life of plenty. Let's go fill our cups.
[voiceover]:Please note that the opinions and perspectives of the guests on the Plenty podcast are not necessarily reflective of the opinions and perspectives of Kate Northrop or anyone who works within the Kate Northrop brand.
Kate Northrup:Thank you for being here, Sarah. Well, at your house. On my podcast. I'm so happy to be here.
Dr. Sara Gottfried Szal:So good.
Kate Northrup:Thank you. Thank you for your work. I'm so excited to dive in. So my first question is, what is it about women's health for you that makes you inspired to keep going deeper and deeper and serving on the level you serve. Why do you do this?
Kate Northrup:Three things. The
Dr. Sara Gottfried Szal:first is your mom. I have to say, I was I was in college in the eighties, and she had a PBS special where she was talking about women and women's health and the objectification of women, kind of the ultimate objectification when they're on an operating table and can't even speak for themselves. And I felt like she had a way of talking about women and women's health that deeply inspired me. Got me to go to medical school. Wow.
Dr. Sara Gottfried Szal:So that was number one. Number two is just the the health hazard that it is to be female in our culture right now. And some of those are sex differences, things that are biological, but a lot of them are socially constructed. The way that we have more emotional labor, we have more stress, We experience more trauma at an earlier age, more sexual trauma. We're 14 times more likely to be raped than men.
Dr. Sara Gottfried Szal:And then the third is a little more selfish. Just finding that in my own experience, even as a physician, as I've struggled through different stages of life, that I was dismissed by our health care system. Even with all the effort that we've put in
Kate Northrup:Yeah.
Dr. Sara Gottfried Szal:Over the past thirty plus years that I've been practicing, in some ways, we're worse off. And so that that's what gets me to jump out of bed in the morning. It's got that, you know, that feeling of, if I'm being dismissed, if I'm being gaslit, and I'm a physician, then there are millions of women that are still being dismissed and gaslit. It's insane.
Kate Northrup:I as It is. As a nonphysician, as someone who was raised by two of them, the very few experiences I've had in the traditional medical system, you know, both of my births and since my husband has had a variety of accidents and injuries, and I go in there, and I am, I mean, I am such a pain in the ass, and like with the births, I was coming in in an ambulance with my first birth, telling them no to everything, No, I wouldn't let them put an IV in me. No, I wouldn't, whatever. You know, all of that while I'm ten centimeters, pushing into the whole thing. And I'm like, if I am having this much trouble advocating for myself with the depth of knowledge and the courage that I have and the galvanization that I have, women are fucked.
Kate Northrup:Yes. Like, how is this possible? And so when you say in certain ways it's gotten worse, can you tell me more about that, what you're seeing?
Dr. Sara Gottfried Szal:Well, there's so many ways that it's worse. I mean, we've known about women being dismissed and gaslit for a long time. And I even remember going to the doctor with my grandmother. And sometimes my grandfather would come along, and I remember the physician speaking directly to my grandfather. We think she should take this medication.
Dr. Sara Gottfried Szal:We think that she should stop doing this. She's got a heart condition, and so here's what we're gonna do. Right. As if she wasn't even there.
Kate Northrup:Talking to her about her in the third person.
Dr. Sara Gottfried Szal:That's right. So I witnessed that growing up. And now I look at things like women 40 going through perimenopause and menopause. What I see is that the knowledge gap has actually gotten worse. The research gap, we hope, is starting to close, but the truth is it is incredibly slow.
Dr. Sara Gottfried Szal:Most of the funding still goes to mens health, or it funds research that includes men, and the data are assumed to apply to women until proven otherwise.
Kate Northrup:Which we really have no idea. We have no idea.
Dr. Sara Gottfried Szal:And, you know, what I what I see now is that women going through perimenopause menopause, seventy three to seventy five percent of them don't get the care, don't get the treatment that they need. Yeah. So that has has worsened. And then I would say more related to cultural changes, like what's happened with our food supply, what's happened with Mhmm. Toxic exposures that women get more of because we we use more skincare and more makeup.
Dr. Sara Gottfried Szal:Women now have a rate of autoimmunity that has skyrocketed. So I wrote about that in my latest book, but I I think that's one of those areas that's worsened. And some of it is biological. So some of it is related to having an X chromosome. We tend to react more to vaccines and to infections.
Dr. Sara Gottfried Szal:We go through things that men don't go through, like pregnancy, postpartum, perimenopause, menopause. But then there's also these sociocultural differences that we can do something about.
Kate Northrup:Yeah.
Dr. Sara Gottfried Szal:And that includes, you know, the greater emotional labor, more caregiving, more there's a way that we're expected to be all things. And we often overfunction, overwork, overcare at the cost of our own health.
Kate Northrup:Yeah. So what do you think for women? A lot of women in our community are around my age? You know, just like kind of the way it goes. Right?
Kate Northrup:And we have you know, 35 to 55 is kind of like the the range, but many of our folks have just sort of, like, come along and grown up with me. And so and so I'm wondering you know, my girlfriends and I are talking a lot about perimenopause, a lot about all sorts of things. So I have a bunch of questions for you. And so that, you know, hopefully, at least whoever's listening to this can help close that gap of that seventy three to seventy nine percent or whatever you said of not getting the care that they need.
Dr. Sara Gottfried Szal:Right.
Kate Northrup:First question is this. What can we be doing during our reproductive years preventatively to really set us up for the best experience possible in the transition from perimenopause to menopause?
Dr. Sara Gottfried Szal:I love this question because I've got two younger sisters, and and they asked me that question as I was going through my training. And I I really appreciate it because when you're in your reproductive years, there's a way that you or at least I did. I thought about menopause as being this cliff I was gonna fall off of, like, after 50. So I didn't even think about it. Right.
Dr. Sara Gottfried Szal:Like, it just wasn't even a consideration. But it's during your reproductive years that you wanna be tracking stress and not just a subjective feeling about it, but measure that cortisol. Get a sense of the balance between your sympathetic nervous system, the on button, and your parasympathetic nervous system, the, you know, rest and digest, feed, and breed part of your nervous system. So heart rate variability is a great way to measure that. Yeah.
Dr. Sara Gottfried Szal:Looks like you've got a ring on
Kate Northrup:where you're measuring it. And I wanna ask you about HRV because mine has tanked in the last year, which is weird because I actually feel so over so not basically, like, before July of this past summer, I was sick nearly every single month for a year and a half, and I've done a lot of work on that. And I am proud to say I have not been sick since July.
Dr. Sara Gottfried Szal:Oh, good.
Kate Northrup:Yeah. I feel amazing. I feel like the best ever, and yet my HRV is still lower than it was the entire year previous. I'm like, is it having an aftershock? And I was talking to my girlfriend about it last night, and she was like I was like, what do you do about that?
Kate Northrup:And I'm like, why is that? And she's like, because you're stressed. And I'm like, You know? And and my friends wouldn't say if they were talking about me, they wouldn't be like, oh, Kate is such a stress bucket by any means. I'm so happy.
Kate Northrup:I love my life and whatever. So I'm like, what do I do? So what do I do?
Dr. Sara Gottfried Szal:There's a lot to do. So this is where I get excited, Kate, because when I work with patients, when I work with clients, like, these are the kind of experiments that we do
Kate Northrup:Yeah.
Dr. Sara Gottfried Szal:Where I I'll take someone, as you described, with a lowish heart rate variability, or maybe you've got a baseline from before July that was better. And now you see that there's a trend going the wrong direction. Yeah. There's a lot of things that can affect heart rate variability. So that, you know, that those two halves of the autonomic nervous system.
Dr. Sara Gottfried Szal:I think of the sympathetic nervous system as fight, flight, freeze, fawn, and then stay and play is the parasympathetic.
Kate Northrup:Stay and play one.
Dr. Sara Gottfried Szal:I like it too.
Kate Northrup:But I also heard you just say feed and breed, and I I don't know that I've heard that before. So I like that
Dr. Sara Gottfried Szal:one too. We like all
Kate Northrup:of it.
Dr. Sara Gottfried Szal:And, you know, what we want it's not that you wanna stay in one or the other. You but the healing happens in the parasympathetic. And so you want this fluid balance between the two. And, ideally, kind of a fifty fifty split between the two. And with wearables like an aura, you can actually track that.
Dr. Sara Gottfried Szal:Yeah. The number one most powerful thing I've seen with heart rate variability is alcohol. Oh, I don't drink. But for other people, this is good. So for you, this
Kate Northrup:just an listen up. She just said the number one thing she sees is alcohol, and I think that's a really important thing to mention because we don't need to get into it today. But, like, obviously, it is so embedded in our culture as just, like, okay. And for so many reasons, it's not great for our health. It's not great for our emotional lives.
Kate Northrup:It's not great for really many things. And now you are telling me it is not great for our nervous system, which makes perfect sense. So even though that's not my thing, I'm glad you said it.
Dr. Sara Gottfried Szal:It's especially bad for women. There are, you know, hormonal factors, other issues that make women more more vulnerable Yeah. Toward alcohol. Yeah. And then what we see from the data is that one or two servings of alcohol can affect your sleep for seven to eight nights.
Dr. Sara Gottfried Szal:And so the way that it impacts your heart rate variability
Kate Northrup:So if you're drinking even every week, you're never sleeping.
Dr. Sara Gottfried Szal:Right? So a lot of people, you know, they'll just drink on the weekend. So it's it's got this really important global effect. What I like to do is to notice when is your heart rate variability improved.
Kate Northrup:Mhmm.
Dr. Sara Gottfried Szal:So for instance, when I go to Costa Rica, my heart rate variability doubles to triples.
Kate Northrup:That sounds so nice. It's really lovely.
Dr. Sara Gottfried Szal:I can just I can feel it in my body
Kate Northrup:right now.
Dr. Sara Gottfried Szal:May need to try the experiment.
Kate Northrup:Great. Maybe the Costa Rica experiment?
Dr. Sara Gottfried Szal:Yeah. So I've got a retreat there in July. Okay. There's something I think there's something just so alive about the
Kate Northrup:Yeah.
Dr. Sara Gottfried Szal:The land and, you know, 3% of the biodiversity in the world is there. So I I always like to notice these geographic changes. So when I go to high altitude, Mexico City, Denver, my HRE is horrendous. Yeah. Horrendous.
Dr. Sara Gottfried Szal:Sense. So we wanna be watching those kind of things. I find, for instance, when I microdose on mushrooms, that my heart rate variability is greatly improved.
Kate Northrup:Oh, really? Yes. That's cool. Okay. Noting that.
Kate Northrup:Thank you. Putting it on the
Dr. Sara Gottfried Szal:list. It's an immunomodulator.
Kate Northrup:Yeah. I've done a little bit of that, but not in any sort of organized fashion, and so that's good. That's good to know. Yeah. So for did you just say?
Kate Northrup:It's a
Dr. Sara Gottfried Szal:It's an immunomodulator.
Kate Northrup:It's an immunomodulator.
Dr. Sara Gottfried Szal:Okay. So it can modulate your the matrix of your body, you know, not just creativity, not just
Kate Northrup:I know that we're gonna come back to your list because I really want it. But why do you think that is about mushrooms just from, like, on a spiritual energetic level? Oh my gosh.
Dr. Sara Gottfried Szal:Love that question. There's a a more science based answer, which I can get to, but in some ways that's less compelling to me than the personal experiences that I see people have with mushrooms. So mushrooms, psilocybin in particular, it's one of those, sacred medicines that I think my experience of it is that it comes into my system and it cleans. Mhmm. And it helps open Yeah.
Dr. Sara Gottfried Szal:My channel so that I really feel energy flowing through my system. And I know that sounds a little Northern California. But it's
Kate Northrup:that's right on point for this show. It connects you to oneness.
Dr. Sara Gottfried Szal:Yeah. It connects you to this micellial network so that you don't feel as alone and isolated and like you're pushing the rock up the hill. It connects you to higher purpose to a mystical state. Yeah. And the idea with microdosing, different than macrodosing, is that you're taking just a small amount, enough to connect to that web.
Dr. Sara Gottfried Szal:Right. And I really feel that.
Kate Northrup:Yeah. Right. So it's almost homeopathic in a way of like, okay. There's an energetic signature. I mean, of course, I don't know that this is scientific, but there's an energetic signature that you're, taking that then is is shifting the matrix of your body that then is making that connection while you're still able to operate heavy machinery and, you know, go
Dr. Sara Gottfried Szal:on phone
Kate Northrup:calls and whatnot. Okay. Great. Thank you. So microdosing.
Kate Northrup:So coming back, you were we we you were listing out about HRV. Is there anything else that you might say would be helpful for folks who are really experiencing those lower rates than they would like to see with their HRV?
Dr. Sara Gottfried Szal:Look at your relationships. So I've tracked my HRV for about fifteen years. And I can tell you when I was still married and my marriage was falling apart Yeah. My heart rate variability was so much lower.
Kate Northrup:That makes so much sense. Yeah. And how wild that we can track those things now. Right? Like, you know, in previous decades, of course, people could feel that on some level, but to just be able to have the data.
Dr. Sara Gottfried Szal:To have the data and even one step further, there's a a psychotherapist that I really enjoy, Stan Tatkin. And he talks about the psychobiology of relationship. I've had this experience with a couple of of friends who were on the cusp of divorce and trying to figure out if they should stay. And they've met with him, and he observes the psychobiology of the connection. And he can see things like the stress response, the lack of repair that happens when you're talking about something conflictual.
Dr. Sara Gottfried Szal:The, I don't think he's tracking blood sugar, but I am. Yeah. And so low heart rate variability, more difficulty with sleep, not feeling fully recovered when I would sleep at night. And you can measure all of these things. And I and my physiology was different different.
Dr. Sara Gottfried Szal:Blood pressure was higher. Resting pulse rate was higher. My, blood sugar was about 10 points higher.
Kate Northrup:Mhmm.
Dr. Sara Gottfried Szal:So I would say assessing your relationships is important. Sounds like you're very happily married.
Kate Northrup:So I don't know that's married for sure. And, you know, there's something about also mothering young children. Yes. I mean, my kids are freaking incredible, and they're six and nine. So at this point, they're much easier than they were, but it's a lot.
Kate Northrup:And then also just that I right now, I don't I live in a place that is, like, very intense.
Dr. Sara Gottfried Szal:Yeah.
Kate Northrup:And when you were talking about geographically, like, there's just a lot of energy in my neighborhood. It's, like, really urban, and I just don't like it anymore. So that may be a factor. Thank you for helping me identify that.
Dr. Sara Gottfried Szal:Okay. So when I think it's also an age issue. So you were asking about reproductive years.
Kate Northrup:Yes.
Dr. Sara Gottfried Szal:And there was this really interesting study that was performed by Arthur Stone, and they call it the u bend. It was published in The Economist. What he did was he did a a survey of Americans in The United States, and he asked questions related to psychological well-being. And what he found is that among adults, psychological well-being is really high in your twenties. And then it starts to dip in your thirties
Kate Northrup:Uh-huh.
Dr. Sara Gottfried Szal:And your forties. And then it starts to come up again before you turn 50. Interesting. Called the u bend. And when I read about the study, I just was like, thank god someone understands what I'm going through.
Dr. Sara Gottfried Szal:Like, I'm in the u bend. I'm in
Kate Northrup:the nadir. Wow. And and and what do you chalk that up to? What's going on in our thirties and forties that would account for lower rates of psychological well-being? I mean, I have plenty of ideas, but I wanna know.
Dr. Sara Gottfried Szal:Well, maybe we could riff together. I think, you know, they did look at parenting to see if parenting was the cause. I think there are unique challenges that you experience with parenting, but it it's not just parents. No. Because some
Kate Northrup:people aren't parents, I'm sure, who are in this
Dr. Sara Gottfried Szal:study. Right. Right. So I think a lot of it is, you know, identity and trying to understand your gifts and how to share your gifts with the world. I think there's the experience of caretaking, so not just kids, but, you know, maybe your parents.
Kate Northrup:Maybe your parents. And then those are also such big earning years. Right? So there's like that.
Dr. Sara Gottfried Szal:There's a lot of pressure.
Kate Northrup:Career, this is the time. Totally. Make hay while the sun shines. Totally. You know, in your twenties, it's sort of like, anything's possible.
Kate Northrup:And then, you know, it's like 30 and 40 are those years to really go career wise, at least, you know, in our societal conglomerate. And then the fifties, yeah, would be more for some people, of course, not for everyone, but a little bit more of a coasting.
Dr. Sara Gottfried Szal:For sure.
Kate Northrup:Right? Or beginning to be more in your coasting years.
Dr. Sara Gottfried Szal:Yeah. I mean, you think about just dating.
Kate Northrup:Or your harvest years, I should say. Yeah. I
Dr. Sara Gottfried Szal:how old were you when you got married?
Kate Northrup:31.
Dr. Sara Gottfried Szal:Yeah. So I was And I
Kate Northrup:had my first baby at 30, I don't know, 32, 33. Yeah. Something like that.
Dr. Sara Gottfried Szal:Yeah. So I was the same. So my twenties were, like, full of fun.
Kate Northrup:Yeah. Lots of fun. Big adventure.
Dr. Sara Gottfried Szal:Medical school, but otherwise, lots of fun.
Kate Northrup:So it doesn't sound fun.
Dr. Sara Gottfried Szal:True. And then your thirties, you're, like, on task. Like, let's get this show going. Let's find the partner, the life partner. Yeah.
Dr. Sara Gottfried Szal:Right? Right. And how does that fit with a career? The stakes are higher.
Kate Northrup:The stakes are higher. Yeah. Well, I mean, just the experience of, oh, wow. Now I'm responsible for the well-being of this and the survival. So first the survival, then secondarily the well-being of this tiny human, and I don't know what the fuck I'm doing.
Kate Northrup:You know, I thought, just because I wanted to have kids, I thought I would naturally feel like I knew what I was doing. That was not my experience at all. It just like, ah, which does transition me to our conversation that I wanna have a little bit about hormones even though that's a bit of a left turn. But I wanna hear about when do you think during our reproductive years is a good time to start tracking our hormone panels so that we can see changes, and then at what point might adding in some HRT be useful and helpful?
Dr. Sara Gottfried Szal:So, of
Kate Northrup:course, obviously, it's super individual.
Dr. Sara Gottfried Szal:But Well, I think I think you can say generally that you wanna do a baseline. Yeah. You want a really good baseline, especially when you're feeling fantastic. So whether that's in your twenties or your thirties, get an impeccable baseline. Like, look at thyroid, estrogen, progesterone, testosterone.
Dr. Sara Gottfried Szal:Look at cortisol. Yeah. Look at how you're handling stress and how it's moving through your body. Maybe look at anti mullerian hormone, which is one of those hormones that tends to go down as you start to run out of ripe eggs. So get a really good baseline.
Dr. Sara Gottfried Szal:And I would say the sooner, the better. You know, one baseline is good. A couple are even better. It's good to have two points on the line to get a sense of where you were. But this is critical later as you start to move toward hormone therapy or you start to use herbal treatments like cheese tree as a way of modulating your progesterone levels.
Dr. Sara Gottfried Szal:So having a baseline, I would say, anytime in those reproductive years is really important. Great. And then with hormone therapy, I was just talking to my publisher and my agent, and they were both saying that, as women in their mid forties, that when they list some of the symptoms that they're experiencing, which to me are clearly perimenopausal, there's a 100 plus symptoms, and they have them, Their doctors are like, oh, no. You're too young to have perimenopause. You're too young.
Dr. Sara Gottfried Szal:And I'm just like, what? Why is this still happening? Yeah. So there's an overlap between your reproductive years and your perimenopausal years. Quite a bit.
Dr. Sara Gottfried Szal:So we wanna be thinking about that Yeah. Through the process.
Kate Northrup:Yeah. So one of the things that I have heard that I think has been a shift over the last decade in the research is that actually beginning some bioidentical hormones earlier can actually enhance our longevity, enhance our long term, even fertility perhaps, and certainly just, like, make us feel better. Whereas before, I felt like word on the street was a little bit more wait as long as possible so that you don't talk your ovaries out of doing their job and don't make them essentially, like, go to sleep too early. I'm what do you think about those things?
Dr. Sara Gottfried Szal:I think the evolution is correct in our thinking about this. So I would say I would be a little more circumspect about the way it used to be Yeah. Which was wait until you're having hot flashes and night sweats. Yeah. And then we'll give you probably synthetic hormones, maybe bioidentical if you really complain about it.
Dr. Sara Gottfried Szal:And that was the main thing that was treated.
Kate Northrup:So Hot flashes and night sweats.
Dr. Sara Gottfried Szal:Hot flashes and night sweats. So that was considered the most evidence based indication for starting hormone therapy. So what we realize now as we know more about the biochemistry of this transition that women go through, we know more about the role of the mitochondria, which are, you know, we think of them as the power brokers inside of your cells. They generate ATP. They generate energy.
Dr. Sara Gottfried Szal:They convert the food that you eat into the energy that you feel during the day. We think that in the in the female body, we know that, your eggs, your oocytes have the highest concentration of mitochondria. And so the place that you start to feel it first is in your mitochondria. So mitochondria in your eggs, as they start to become more impaired, as you get older, you get exposed to toxins, or you've got too much cortisol, we think that estrogen is a really critical factor for keeping your mitochondria young. Okay.
Dr. Sara Gottfried Szal:So that's part of the bridge for why we wanna intervene sooner. The other thing that I wanna think about is with these 100 plus symptoms that women have as they go through perimenopausal menopause, one of the key ones is sleep and sleep disruption. And women may not perceive that they have hot flashes and night sweats, and yet their sleep becomes disrupted. If we're not treating that early, it can become a pattern that is very hard
Kate Northrup:to correct. Right. And then that's almost, because as your sleep gets disrupted and you're long term sleep deprived, then that's going to create all these other symptoms.
Dr. Sara Gottfried Szal:It accelerates the aging process. It makes you more likely to be depressed. Yeah. Makes you less interested in exercise. Terrible.
Dr. Sara Gottfried Szal:Makes you crave carbohydrates. Your insulin goes up. You start to store more fat. Yeah. On and on.
Dr. Sara Gottfried Szal:Yeah. So, yes, we wanna address it as early as possible. So I might have a woman who's 35. She's got progesterone that's starting to decline. Mhmm.
Dr. Sara Gottfried Szal:I'm gonna use some progesterone in that case. Okay. Or offer it. Yeah. We'll have a collaborative discussion about it to see if that improves sleep.
Kate Northrup:Yeah. Absolutely. That's great. And then what are some things? Because regardless of whether somebody wants to actually get pregnant or not, there's such a huge connection between just vitality and life force and energy levels and our fertility.
Kate Northrup:So I think, my humble opinion is that women should be actually doing all the things that fit into their lifestyle to support their fertility more on a metaphorical level. And, obviously, because from a scientific perspective, it is, creating that strong foundation for longevity and vibrancy. And so given that, what can we be doing to support our egg quality whether we are wanting to get pregnant or not in certainly in our reproductive years, but then also as we're making that transition more into perimenopause, you know, past 40?
Dr. Sara Gottfried Szal:That is exactly the right question. Like, how do we support our egg quality, our the aging process of the ovaries? Yeah. And so I like that.
Kate Northrup:How do we support the aging process of the ovaries? That feels really nice.
Dr. Sara Gottfried Szal:Yeah. Yeah. And it's and you're right.
Kate Northrup:Not anti anything. It's like supporting the process.
Dr. Sara Gottfried Szal:That's right. Yeah. And I I think what's important to know about is the things that are working against you. Mhmm. So that includes being a stress case, having too much cortisol, having too much sympathetic nervous system activity relative to parasympathetic.
Dr. Sara Gottfried Szal:It includes overeating certain macronutrients like carbohydrates. It includes underconsuming micronutrients that you need for all of these processes in the body, things like magnesium, vitamin D, glutathione. Mhmm. It includes this is gonna get more into your realm. It includes understanding self efficacy
Kate Northrup:and
Dr. Sara Gottfried Szal:and getting a sense of, okay. These things are not happening to me. They're happening with me and for me and through me. How can I partner with spirit in a way that I feel like I'm invoking your mother here? How can I partner with spirit in a way that allows me to move forward with clarity and with the youngest eggs possible?
Kate Northrup:I love that. It's so beautiful. Yeah. Because our eggs are metaphors for our creative life force. You know?
Kate Northrup:They are the living embodiment of that.
Dr. Sara Gottfried Szal:That's right.
Kate Northrup:And so and, you know, like, conception is a freaking miracle. Right? And so to have all those living potentialities inside of us that, you know, have existed since four months gestation inside our mothers, inside our grandmothers' bodies is such an honor. It's such a miracle. So I love that you're bringing in that psychospiritual aspect, that partnering with the divine to say, like, what am I here to create, you know, living or otherwise?
Dr. Sara Gottfried Szal:That's right. And I would even let's add another layer. Great. I feel like some women, probably because of our disease care system and the way that, we've set it up the wrong way, a lot of women look at these symptoms that they experience or start to experience 35, forty, forty five, irritability, the mood swings, the, maybe dryness of the vulva of vagina, not having the energy that they once did, they do look at some of those things happening to them. Right.
Dr. Sara Gottfried Szal:And I think if we shift the way we hold these symptoms and see them more as an initiation and a spiritual process where we're meant to wake up, I think that really changes the way we approach it. Yeah. Right.
Kate Northrup:They're an invitation from our bodies being like, hey. What about this? Yeah. Maybe lean in here. You know, last year, I very bizarrely lost my hearing in my right ear, and there were a number of reasons for it, but I just it wouldn't come back regardless of what I did.
Kate Northrup:It eventually did. But and the hilarious part was I went to the audiologist, and I sat in that booth and did the whole thing. And I came out, and they were like they were like, clinically speaking, your hearing is perfect. Yeah. I was like, that's weird because I can't hear.
Kate Northrup:Anyway, so but I kept asking. I was like, alright. Well, if my body is not having me here out of one full side of my head, surely, I'm being asked to, you know, listen inside. So I just kept saying to my body, hello. What do you want me to hear?
Kate Northrup:What do you want me to hear? And it was it sucked, but it was also great, you know, because I got some really strong messages and invitations.
Dr. Sara Gottfried Szal:And What did your body want you to hear?
Kate Northrup:So the two things I kept hearing were, like, inside, were bloom where you're planted and stop fucking around. And so for me, what that meant was I I had this I have this new book that I'm working on that I was really dragging my foot feet on and getting myself distracted by a million other projects and shiny objects, which is really my kryptonite in this lifetime. And so it was just that. And then the other thing that I was distracting myself with from the work that I was really supposed to be doing was, thinking constantly about moving and obsessing over real estate listings. Amazing.
Kate Northrup:What a time sink that is. Wow. And and my husband, you know, god love him. He was like he was like, babe, you are not allowed to send me any further homes via text until you've written your book proposal. Once you've written your book proposal, I would love to talk to you about our next step and our next move from our fam for our family.
Kate Northrup:But until that time, do not send me another home.
Dr. Sara Gottfried Szal:That's so loving. It's a loving boundary.
Kate Northrup:No. It is. Thank you for that. Thank you for that. Okay.
Kate Northrup:So egg quality, vitality, hormones. I also wanna know what are so so at this stage of the game, like, as you are this world's leading expert on expert on women's health, what are you excited about in terms of new frontiers for women's vitality and thriving?
Dr. Sara Gottfried Szal:Oh my gosh.
Kate Northrup:What should we look forward to?
Dr. Sara Gottfried Szal:Oh, so much. You know, I feel like here's what I notice. There's 4,000,000 podcasts now.
Kate Northrup:Really?
Dr. Sara Gottfried Szal:4,000,000. Wow. And some of the guys that I enjoy listening to the most are Andrew Huberman and Peter Attia and even Joe Rogan occasionally. Mhmm. And there's there's a way that they're giving bro advice.
Dr. Sara Gottfried Szal:Mhmm. It's what they know. Yeah. They're bros. They're bros.
Dr. Sara Gottfried Szal:They're talking about data that's mostly in men. They are not calling out when it's different in women. They're not saying, okay. All of this data that we have on deliberate cold exposure is in men, and we have very little data in women. So I feel like what I'm excited about personally is really understanding health span and longevity Yeah.
Dr. Sara Gottfried Szal:From a female perspective. So that I'm super excited about. I'm excited also I mean, this sounds a little bit warped. When we think about the nadir, when we think about this u bend, I want solutions. I want real solutions, and I wanna work together with other women to come up with how do we say to the woman who's overfunctioning, who's overworking, who's overextended and burnt out and say, darling, here's what actually works.
Dr. Sara Gottfried Szal:Here's what works in women. Here's what's been studied. You don't have to be part of some, you know, uncontrolled medical experiment like we keep doing to women over and over again. Here's data that actually supports and points us in a direction
Kate Northrup:Mhmm.
Dr. Sara Gottfried Szal:To help you. Yeah. So that's what I'm excited about. I'm also excited about launching a podcast, doing that again. Congratulations.
Dr. Sara Gottfried Szal:I'm super excited. Excited to have you on it. And I I feel like there's a way that you can either pontificate on a podcast and sort of have people eavesdropping in, which is kind of a masculine way to do it. Mhmm. Or you can take your audience with you Yeah.
Dr. Sara Gottfried Szal:Which is what you do in your podcast. And that's a very different form of service.
Kate Northrup:It is a different form of service, and I'm so excited for you to be doing that. And I have a couple of questions. One is, are you going to be writing that book on health span and longevity from a for women?
Dr. Sara Gottfried Szal:Yes.
Kate Northrup:Okay. Great. Can't wait to read it. I will be waiting with bated breath.
Dr. Sara Gottfried Szal:It's due in two months.
Kate Northrup:Oh, my oh gosh. Okay. So you're writing it right now? Yes. Okay.
Kate Northrup:Okay. And then when we'll just have you back on the podcast. Perfect. If you'll let me come sit on your couch again, and we'll talk about that. And then my second question is for you.
Kate Northrup:What was it that worked for you in your own life to stop overfunctioning in that nadir that you could say to a woman like, this is what actually works. This is what I did. This is how I made that shift.
Dr. Sara Gottfried Szal:It's such a good question. Number one, the whole body. Yes. So I learned this from a coach, Diana Chapman, and she learned it from Gay Hendrix and his wife, I think, Susan Hendrix. Katie.
Dr. Sara Gottfried Szal:Katie Hendrix.
Kate Northrup:I freaking love them. Yeah. Katie Andrix. On the Internet. Right.
Kate Northrup:Haven't met him in person yet, but I'm looking forward to it.
Dr. Sara Gottfried Szal:Well, she was mentored by them. Mhmm. And this idea of a whole body yes, I think this is foreign for a lot of women. Yeah. The idea is that you don't just give a cognitive yes.
Dr. Sara Gottfried Szal:Like, oh, yes. That sounds like a good idea. It sounds like it's good for my family.
Kate Northrup:Goals. And how it would look and pleasing
Dr. Sara Gottfried Szal:the people. Right. Mhmm. You check-in with your entire body. And so I was taught to check-in with my heart, to check-in with my gut.
Dr. Sara Gottfried Szal:Mhmm. But I would add, we also have to check-in with the vulva.
Kate Northrup:A 100%. A 100%. Or as mama Gina would say, the pussy.
Dr. Sara Gottfried Szal:Yes.
Kate Northrup:Yeah. A 100% because, like, if that's where life comes from, how could that not be the best place to make decisions from?
Dr. Sara Gottfried Szal:For sure. And it's amazing what truths come from the vulva. Yeah. So that was a huge for me. That's great.
Dr. Sara Gottfried Szal:And what I realized is that I've spent a lifetime up until a couple of years ago saying a partial yes, saying a a lot of cognitive yeses, and the and then dragged the rest of my body along for the ride. And that has to stop. So the whole body yes you know, you and I are at different life stages. My kids have just they're both out of the house. They're launched.
Dr. Sara Gottfried Szal:And that opens up a whole new portal. I mean, you think about I think about, BKS Iyengar, how he talks about, you know, kind of being as an adult, you're a student, and then you're a householder, and then you're a forest dweller, and then you're a sadhu, kind of a spiritual renunciate. And so I'm in the forest dweller phase. You're in the householder phase. And so really acknowledging that, my role sort of day to day as a mother has shifted.
Dr. Sara Gottfried Szal:Yeah. You know, I'm much more of a guide Right. And, not quite a peer, but our relationship has changed. Not always the case. You know, I still get emergency phone calls.
Kate Northrup:For sure.
Dr. Sara Gottfried Szal:But that foresweller part, you know, just really making sure that you don't kind of continue the householder way of working, and you get very deliberate about how you want your forest dweller years to be. Yeah. And for me, you know, part of that was going through a divorce, which was really painful and messy and difficult, but I stepped into authenticity in a way that I hadn't before. And I was taught as a kid that you stay connected. You don't get divorced.
Dr. Sara Gottfried Szal:You hang in there, especially if you have children. You've got a responsibility to your children. And I sacrificed authenticity for connection Mhmm. And what I perceived to be attachment, and that doesn't work. That doesn't work.
Dr. Sara Gottfried Szal:Really, you need both. You need secure attachment and authenticity. So that was a huge shift. And then I think all of this relates to boundaries. So those are the things that really made a difference for me.
Kate Northrup:So good. I'm curious. I was at a conference recently, and a bunch of people talked about the nervous system, which I was really excited about. Except nearly pretty much a 100% of those conversations were still essentially, they were talking about mindset work. Mhmm.
Kate Northrup:And I was like, Interesting how we're talking about the nervous system and yet keeping things on the level of the cognitive
Dr. Sara Gottfried Szal:Right.
Kate Northrup:And the mind. And I was like, what about the body? And so I'm so glad you talked about the full body yes as being the compass because that is not a head down approach. That is not like, let me check-in with my mind. Let me be you know, it's like there's so much information available to us if we go beyond the verbal, if we go beyond what we can even articulate as a thought, you know, that just deeper knowing.
Kate Northrup:And so I'm curious. When people refer to the body as a meat suit, How do you feel as a women's health doctor, and what do you think about when you hear that?
Dr. Sara Gottfried Szal:Oh my gosh. Well, it makes me think of Lady Gaga. Right? Oh, yes. She rocked
Kate Northrup:the meets it. Forgot about
Dr. Sara Gottfried Szal:that. I
Kate Northrup:must say.
Dr. Sara Gottfried Szal:Yeah. Rebranded the meets
Kate Northrup:so weird and fabulous. It's so weird. Yeah.
Dr. Sara Gottfried Szal:Yeah. I really appreciate this question, Kate. And I know you've been doing some certifications related to nervous system regulation and trauma, and I so appreciate hearing about that on your podcast. And I feel like that's that's part of what we're talking about here in terms of reclaiming authenticity and reclaiming a path that is less about what your mind thinks needs to happen versus getting your whole body on board. Yeah.
Dr. Sara Gottfried Szal:And nervous system regulation is something that I knew about going through my medical training. And when I was in medical school, I used to go to Kripalu as often as possible just to practice yoga. I became a yoga teacher. I teach meditation. Love your meditation that you have on your podcast.
Dr. Sara Gottfried Szal:Thank you. Beautiful. And I I feel like nervous system regulation is so critical. Mhmm. And a lot of women, men too, understand cognitively what that is, but they don't feel it.
Dr. Sara Gottfried Szal:Right. They don't feel regulated, and they don't know. And I I feel like a lot of it is I had this experience when I started doing psychedelic assisted therapy of realizing how dissociated I was. Mhmm. So that I was I spent most of my time upstairs Mhmm.
Dr. Sara Gottfried Szal:And with the cognitive approach and kind of dealing with my meat suit. And it wasn't until I started to heal that and started to learn how to do nervous system regulation that it allowed me to just open up all these drains of body wisdom, of, spiritual wisdom. So I feel like that is a really critical part. Yeah. And this functional dissociation that so many of us have, you wanna ask yourself if you have that.
Dr. Sara Gottfried Szal:I mean, I know you don't. But
Kate Northrup:I mean, all listeners. Right?
Dr. Sara Gottfried Szal:Well, it's an old pattern.
Kate Northrup:It's an old pattern. And and when you come through the world in families that really are focused on academic achievement, and then, you know, you're in New England in school, and it's like all about being celebrated for being smart. Right. You know, and figuring it out everything with your mind. It you know, when I got pregnant with Penelope my first and then gave birth to her in that first year of her life, none of my old tricks worked.
Kate Northrup:I couldn't get through that challenge by being smarter, being stronger, trying harder, doing more. Like, none of those things worked. And so it really was that invitation to say, well, I need a different skill set here. Like, one that I've has not been shown to me and has not been modeled, has is is really not many places in our culture, at least, you know, where I was living and in the in the part of the world that I was I was in. So I appreciate calling attention to that dissociation and really feeling the degree to which we over celebrate the mind.
Dr. Sara Gottfried Szal:We do. And you're right. I mean, that sort of mindset training and using that as a path forward never worked for me. Interesting. And I couldn't think of my way out of the problems that I had, especially with overfunctioning.
Kate Northrup:Yeah.
Dr. Sara Gottfried Szal:It had to be this bottom up. Mhmm. Like, I had to feel it inside, not up here, but downstairs, like, in my body Yeah. To really be able to make change.
Kate Northrup:And so you mentioned, you know, you mentioned yoga. You mentioned psychedelic assisted therapy. What are some of the other, like, downstairs practices that have been really useful for you in I don't know. Maybe you wouldn't say it this way, but, like, the reclamation of your embodied wisdom.
Dr. Sara Gottfried Szal:Oh, I would say it that way. I mean, definitely sex. Yeah. Orgasm. Yeah.
Dr. Sara Gottfried Szal:Female pleasure. Our bodies are made for pleasure. Mhmm. And if you're spending most of your time, including sexually upstairs, it just doesn't work. So I think that's a huge part.
Dr. Sara Gottfried Szal:I've always been someone who loves the outdoors. I spent a lot of years in Alaska. I went to high school up there, and my parents lived there for twenty years. So wilderness, like, it's a place that I connect to spirit and to divinity very easily. So spending time outside is really important.
Dr. Sara Gottfried Szal:Spiritual practice, relationship. It's so critical. And I I love how you talked about mothering Penelope and how your intellect didn't help you. And I I feel like that's that's really true. That was one of the first places that I hit the wall.
Dr. Sara Gottfried Szal:I felt like, yeah, there's a there's, like, a raw mammal quality to mothering that's so important, and that never goes away. Like, you don't you don't move past that. Like, there's still it's such a, touch point, and it's so critical for them. And then it also you know, this this is there's an unselfish quality to this. I'll just say it.
Dr. Sara Gottfried Szal:There's a way that my children hold me to a standard that is so much higher Yeah. Than the standard I hold myself to. So what I expect what I want for them, like, in terms of their relationships and the satisfaction that I want them to have in their careers, what they expect from their friendships, how they expect to be treated, how they develop secure attachment. I have to be modeling those things. Right.
Dr. Sara Gottfried Szal:Even now, even though they're out of the house. Oh, yeah. So it's I really appreciate, what you're saying about mothering.
Kate Northrup:Yeah. That is so true about and it's not even like for in my experience, it's not even like they're holding me to a higher standard in terms of any kind of, like, hierarchical structure that we would have externally. It's that higher standard of wholeness and full living. Yes. You know?
Dr. Sara Gottfried Szal:Authenticity. Yeah. Authenticity. Wholeness is exactly right.
Kate Northrup:Wholeness. Okay. So as we wrap up here, this show is really about abundance, and and and in and I talk a lot about people's relationships with money. You discussed HRV and our overfunctioning and, you know, the nadir, that dip of over you know, the u, whatever u was the study.
Dr. Sara Gottfried Szal:U The u Bend. Thank you.
Kate Northrup:Overworking, and so much of that is tied up for women in our relationship with money. And so it's kind of a big question, but answer however you'd like. What do you see are the impacts that our relationship with money has on women's bodies and our health and vibrancy?
Dr. Sara Gottfried Szal:Oh, it's such a good question, Kate. So let me let me feel into it Great. With a little bit at a time. I feel like I used to have the wrong idea about money. You know, I felt like especially going into medicine, I felt like I need to have a stable career and stable income, and I need to sock the money away and the four zero one k, and I need to have a house and pay off my mortgage and have equity.
Dr. Sara Gottfried Szal:I thought all of those things would provide security and safety, and it turns out they don't. It turns out that safety and security is an inside job. And I know that's easy to say, but we are now finally at a stage scientifically where we can say, here's how you create safety in the body, and here's how you measure it. And we've talked about some of the measures, like heart rate variability and cortisol and even, you know, estrogen, progesterone, testosterone. We can actually we can define safety in the body.
Dr. Sara Gottfried Szal:And I think the experience over my lifetime of realizing how unsafe I felt as a kid and how foreign the idea of safety was until I really started to learn about nervous system regulation, that has been a gigantic game changer. And then it maps to money because I used to think, you know, I just need to charge as much as possible and, you know, sock away this money and be able to pay for my kids to go to college and maybe help them buy a house. And now I realize, no, the security and the safety, I could have that driving around in a van. Yeah. And it has the same physiological effect.
Dr. Sara Gottfried Szal:So I've really changed the way that I think about money as an exchange of energy. But you're asking a bigger question, which is, you know, what do I see in women? I see a lot of women who compromise their authenticity to provide what they perceive to be safety and security, and I think that's that's a huge question. They sacrifice their wholeness. They sacrifice their gifts because they think they need to stay in a marriage that maybe is dead, isn't working.
Dr. Sara Gottfried Szal:They feel like they need to stay for the kids. Mhmm. So I I see a lot of that. And then I also see various patterns of women who maybe because they grew up with a feeling of lack, chase money in a way that leads to, you know, kind of a basic level of overwhelm and overwork and overfunctioning. But, also, there's another pattern of women who are not appreciated and still hang in there in a relationship that's not working.
Dr. Sara Gottfried Szal:And it's more of a neglect situation. And then there's a more advanced version, which I probably had, which was this chronic state of overworking Yeah. And, and waiting until your body objects with the low heart rate variability, the repeated infections, the the cortisol that never seems to get better. So those are some of the patterns that I see in the women that I work with.
Kate Northrup:Thank you so much for saying that. I mean, I you know, for you listening, I did I did not ask Sarah to say those things about money and safety and the nervous system, but that, I mean, that is the core of what I what I'm here to share at this particular time that We need to educate. Yeah. Without the embedded embodied feeling, no amount of money is ever gonna make you feel safe if you can't feel safe already. And then once you do, great.
Kate Northrup:Add more money. Wonderful. Or not. And the cool
Dr. Sara Gottfried Szal:thing is once you feel safe, there's no going back. Like, there's no way you can tolerate Yes. That lack of safety again.
Kate Northrup:That's very cool. Yeah. That compounding impact of nervous system regulation.
Dr. Sara Gottfried Szal:Yes.
Kate Northrup:This has been just an absolute pleasure. I think you're the best. Thank you. Thank you for this conversation. I know you have you have so many beautiful books.
Kate Northrup:You have a new podcast out. So can you tell folks where to find you, where to connect if they wanna dive in deeper?
Dr. Sara Gottfried Szal:Well, I'm going through a name change, so I'll mention that first. I used to be known as Sarah Goughried, and, I'm going back to my maiden name, which is Sarah Zal, s as in Sam, z as in zebra, a l. So my website, sarahzalmd Right. We just rebranded, and the podcast is there. It's called treated with doctor Sarah.
Dr. Sara Gottfried Szal:Those are the main ways. Beautiful. I hang out on Instagram. That's a good place to interact.
Kate Northrup:Great. Okay. Amazing. So find doctor Sarah Zal, all the places. Thank you for being here.
Kate Northrup:I really appreciate you. Thank you, Kate. This episode is brought to you by Glossy, which is skin care you can drink. I have been using and loving Glossy for the past couple of months, and it combines a beautiful blend of clinically tested probiotics that actually survive in your digestive tract and hyaluronic acid, prickly pear, vitamin c, and so many other beautiful ingredients to help you glow and hydrate prickly from the inside out. It is also delicious and convenient and refreshing.
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