With Sara Szal (Gottfried) MD
Pedram is joined by his ex “work wife” Sara Szal (Gottfried) in a super fun conversation and catch up where they vear into the world of toxic bro biohacking culture and how it’s dangerous for females trying to get healthy. They talk about safety, allostatic stress, and much more.
Check out Dr Sara’s work at – https://www.saragottfriedmd.com
Listen to the episode on Spotify here or on your favorite podcast platform and check out the Urban Monk Academy here.
Podcast transcript:
Dr Pedram Shojai: [00:00:00] Welcome back to the urban monk podcast. Dr. Pedram, Shojai here with a special treat. For those of you who’ve been with me for awhile. You’ll know that I started podcasting over a dozen years ago with a doctor named Dr. Sara Gottfried. Uh, it was called the health bridge. It was me Eastern trained monk. Meets doctor kind of, you know, raw personality with her.
Harvard trained OB GYN. So it was an east meets west and everything in between. Uh, conversation. We interviewed everybody. We were the number one health podcast for a very, very long time. And we had a lot of fun. We had a lot of fun. Um, and you know, just, it went for a long time. I don’t know, probably 200 episodes and it kind of ran its course. I have for reasons other than, you know, the suspicions that people are like, oh, you guys got into a fight.
Oh, you guys some weird things happen? No, no. It just kind of ran its course. A lot of love for Sarah. Um, she had a lot going on. I had a lot going on [00:01:00] and, um, we moved on. Um, and it was really, really good to see her. Recently in person. And I was like, can you please come onto my podcast and catch up? Uh, you know, on the urban monk podcast and she’s like, absolutely.
So you’re going to get a, an update from Dr. Sarah, uh, Including her name, Szar. And she’s no longer got freed. And, uh, you’re going to get a sense of some of the chemistry and the banter and some of the fun we had over all those years. So it was just delight to get back together with Sarah. Um, I miss her.
You’ll see why. Enjoy the podcast.
Sarah, I am so happy to have you on my podcast. I
Dr Sara Szal: so happy to be back with you.
Dr Pedram Shojai: it’s like a reunion. I had, um, we, we just did a talk folks. Um, we did something in Florida and, um, I was just like, this is my ex work wife. Like you don’t understand. I spent a lot of time with Sarah.
Um, we [00:02:00] spent hundreds of hours interviewing folks together.
Dr Sara Szal: We sure did. And those were good years. Those were really good years. I miss them. I miss you.
Dr Pedram Shojai: I miss you too. I miss you too. It was really good to see you in person. It was good to get like a human hug, not a COVID hug, right? Like it was just, it was nice to share space. I know we talked about this a little bit, just the fundamentals of like the dynamics of being in a room with humans. Online is cute, right?
I love, I love seeing people. So it’s great to see you.
Dr Sara Szal: Yeah, same. And we were on a panel talking about trauma, which is a topic you and I haven’t really explored before. So that was, it was fun to unnerve some new material.
Dr Pedram Shojai: It was, it was, you were up there with a couple other, you and a bunch of dudes, which is usually the case for female doctors, right? Um, and, uh, my, my man crush, um, Rabin, he’s great, I love that guy, I’ve really spent a lot of [00:03:00] time, digging into his work, and so, he and I have had some miles since you and I have last talked.
And so I was trying to manage, um, and moderate. Um, and it just got to the point where I was like, man, I I just want to hang out with these people. Like, there’s not enough time here.
Like, you can’t do anything on a panel other than give people turns. So, um, you have been up to a lot. Let’s just start with the obvious. You’re not Sarah Gottfried anymore.
Dr Sara Szal: Yeah, I like how you asked before you hit the record button. Is there anything that’s off limits? And my answer is no. We can go wherever you want, Bedroom. So yes, I am back to my maiden name. Feels good.
Dr Pedram Shojai: Listen, it’s, it’s been a few years. Um, I, I get it. I get it. It’s New Beginnings. Cool, cool last name. It took me a second where I was like, who the, I’m like, Oh my God, she went for it. She changed it all. A lot of people don’t just cause they build [00:04:00] their brand. They do all this shit around the other name and there they feel like they’re stuck with it.
Right. Um, so hats
Dr Sara Szal: It’s an analogy for authenticity in some ways, you know, I made this choice in 2003 when I got married to take my ex husband’s name and, uh, it worked long as the marriage lasted and then we completed our divorce last year. And yeah, I mean, my publisher would much prefer that I keep Gottfried as my name, but I’m not a slave to my publisher.
Like I would prefer to feel like I’m utterly in alignment with my name, with the brand that I build. I feel like our people can handle it. Like they’re not simpletons. They can handle a name change. They can handle, you know, the narrative that goes with [00:05:00] it. And I think that’s a big part of being honest, um, with the people that you work with, with.
a platform, you know, really being honest about how life changes and, and how you adjust, how you adapt.
Dr Pedram Shojai: I appreciate that more than half of these things don’t end well. So statistically speaking. It was likely to happen. We, a lot of divorces happen. Um, and you now are living in the Bay Area still. Um, you were doing a bunch of stuff in Philly with the team. Just catch up my folks cause I don’t know if people even know where the hell you’ve been.
So I, I work
Dr Sara Szal: I, I work at Thomas Jefferson university. I’m in there. Um, they’ve got a department of integrative medicine and nutritional sciences. So I’m going to update, uh, our listeners, but I’m also going to update you, Pedram, because, um,
Dr Pedram Shojai: do research and teach.
Dr Sara Szal: I don’t know if you know this, but there is no department [00:06:00] of integrative medicine anywhere else.
There’s lots of centers
Dr Pedram Shojai: There’s
Dr Sara Szal: that are kind of on the periphery of an academic, uh, institution, but to actually have in the medical school, a department of integrative medicine and nutritional sciences, that’s on par with the department of medicine department of surgery. That’s a big deal. So I joined this department.
I’m the director of precision medicine at the Marcus Institute of Integrative Health. Um, it’s a pretty amazing gig. So I get to do research and teach and see patients. I mostly Take care of executives and also professional athletes. So I’ve been able to, um, I’ve been incredibly honored to take care of the Philadelphia 76ers for the past several years.
And that has been so much fun. I mean, these guys are all so much taller than I am, of course. Um, but wow. The physical [00:07:00] majesty, the, um, the way that these guys lead their community. The commitment they have to serve us, to leaving everything on the court. It’s profound. What a, what an absolute pleasure to be involved in their care.
Dr Pedram Shojai: The work ethic that they have, it’s almost like you take it for granted, it’s like, well they’re a pro athlete. Um, but if you have some sort of autoimmune disease, you have some shit going on, you gotta have a similar work ethic, right? And so these guys just find it everyday and they dig and they do it.
For chronic health conditions, folks that are suffering and are trying to get into functional medicine, Um, they come from a different, they come from a different world, right? Where work ethic wasn’t part of the health equation. These guys are working because they’re athletes and so it’s just part of what they do.
But getting healthy and staying healthy is also work. And so I’m curious as to how that’s translating, working [00:08:00] with, really high end athletes and kick ass, uh, performance folks. And then try to translate that back into the same type of direction you would give to folks that are just suffering a little.
Dr Sara Szal: You know, you would think that these guys don’t have much in the way of health challenges, but they actually do. So we know that about 70, well, when you look at the genetics. And the environment, you know, I, a lot of my work is at that interface of genes and the environment and about 40 percent of anyone’s risk of, uh, injury, the way that they recover from hard physical work, the, .
Their VO2 max, their capacity, their training, , function, all of those things, about 40 percent of it is determined genetically. So most of [00:09:00] these guys have won the genetic lottery, like they are extraordinary, but not all of them. There are a lot of players who have to work hard. To really be successful in the NBA.
And what I find with these players is that, you know, not all of them grew up with privilege. Not all of them were, um, you know, there’s, there are players on the team who grew up in projects. There are players on the team who had a single mom and lived in a food desert. So. Even though they’ve got for the most part, these great genetics, often their environment was not the best match to their genetics.
And so they’re still making up for, for that, uh, now that they’re professional athletes. And what I see pretty commonly is that there are a few NBA institutions that I personally have been working to overcome. Like for instance, Chick fil A, [00:10:00] I imagine they’re not one of your sponsors. So I think I can probably say this safely.
Um,
Dr Pedram Shojai: from Chick fil A.
Dr Sara Szal: I have a sense that you are still a man of integrity, Pedram. Yeah, so Chick fil A, I mean, it’s the rookie’s job to get the order of Chick fil A before they get on the plane to travel when they’re in season. And so I’ve had to replace the Chick fil A with customized functional smoothies. And you can imagine the, you know, the mouth tastes a little bit different.
So there’s a lot of training that goes along with that.
Dr Pedram Shojai: and
Dr Sara Szal: And then, uh, Cheesecake Factory is another NBA institution. So trying to get these players to understand fuel, to understand how they can improve their recovery with the way that they move, think, feel, connect. That’s been a big part of the work. So what I found somewhat surprisingly is that these guys [00:11:00] with an average age of 26, 27, 28.
A fair number of them have metabolic dysfunction. They’ve got prediabetes. And one of the things I see with regard to your question about work ethic is that many of them, they do not accept the word no. They do not accept the idea that they may have prediabetes and have to manage that for the rest of their lives.
What they see instead is opportunity. Like, okay, so I need to start wearing a continuous glucose monitor and really dial in the food that I eat and personalize it and stop eating
Dr Pedram Shojai: of
Dr Sara Szal: the toast and the fruit for breakfast every morning that they serve when they’re on the road. So there’s a way that they dig in when health challenges come up that I find incredibly inspiring.
So every single one of them sees. the [00:12:00] conditions that they face as malleable. There’s so much that they can do. They understand the power of lifestyle medicine to change the course of their health. And I wish that was understood more broadly, not just professional athletes, but everyone.
Dr Pedram Shojai: And you could have kind of a snarky retort of saying, well, these guys are well resourced and, you know, someone’s throwing smoothies at them and, you know, they don’t have to eat Chick fil a. That was cultural, but, they could afford better. But there’s a huge gradient, right? There’s a lot of choices in the decision making matrix between Chick fil a and slightly to much better.
That doesn’t have to be a, you know, 27 um, Erewhon smoothie, right? Um, and
Dr Sara Szal: All those, those are good. Those are delicious.
Dr Pedram Shojai: They
Dr Sara Szal: For the record.
Dr Pedram Shojai: I just, I, for me, I couldn’t believe it. I remember being in an Erewhon and saying, hey, can I get some [00:13:00] coconut milk? And he was like, oh, that’s 7. I was like, no, no, no, I just, not a coconut milk. I just want some coconut milk in my coffee.
He was like, yeah, that’s 7. I said, there’s no planet that that makes sense on. Like, I refuse to pay asshole tax. Like, I’m not going to do it. Right? Um, that’s L. A. right? Like, that’s the, the, the, the bougie, let them eat kale version of health. Right? Um, and it is delicious, but it’s not fair.
Dr Sara Szal: Right. That’s true.
Dr Pedram Shojai: Um, so this, this idea of giving access to this, I mean, obviously food systems are messed up and curious as to what opinions you have about what’s coming. RFK was just announced as the guy today. Um, are you hopeful about that? Are you hopeful about changes in the food system with the new administration and all stuff that’s kind of coming on us pretty fast?
.
Dr Sara Szal: we’re at a crisis. We’re at a crisis with big pharma, big food. Um, [00:14:00] I look at the FDA and the way they bungled the decision about, um, approving MDMA assisted therapy for people with post traumatic stress disorder. And in many ways, I feel like it certainly couldn’t get any worse. So, you know, I, I love living in a democracy.
I love that the people have spoken and we are on this path toward reforming healthcare. Healthcare has been broken since the day I first set foot in medical school. And that was 35 years ago and people have been talking about the broken healthcare system for 35 plus years, and if anything, I’ve seen it get worse, not better. So, I’m at a point where I’m looking for hope in all of the surprising places. So, I don’t know [00:15:00] if. RFK Jr. is going to be the right person to lead this charge, but I like the conversations that are happening. I love the protests at Kellogg’s. I love hearing about, um, how so many of these therapies that are limited in this country, like use of stem cells or peptides, that the, that may be changing. So, you know, I’m also, uh, I’m careful about my political positions and I feel like, uh, politics is not my focus. It’s not where my expertise is. I am an advocate for women’s health. That’s really important to me. Um, and I also really believe in the constitution and I believe in democracy. So I, I hope that things are going to [00:16:00] change and I’m dying to hear your response to that question, bedroom.
Dr Pedram Shojai: I’ve been very guarded in answering. I have friends on all sides of this, right? Um, I have opinions about, Donald Trump as a person, I have opinions about being, I’m kind of a middle of the road libertarian when it comes to all of it, right? You know, I like the rights, I like the freedom. Constitution and all of it.
And I think healthcare is broken. And I think that anyone with any conviction saying it’s this way or this way is very confused because it’s fucking gray. And there are a lot of positives and negatives on all sides of this. Um, and I agree. Democracy has done its thing. The people have spoken. Let’s give this chance, right?
And I would love to see positive systemic change. I would love to see the Death Star culture of the NIH and the FDA and all of it shift in a way where we allow for a lot of things that I [00:17:00] take for granted being in the Alt medicine world, right? Coming from a place of, of wellness and prevention and prediction.
And then suddenly, you know, being relegated to saying you all, you are alternative, um, we know the shit works, but it’s still not mainstream. Why? Right. You can’t throw patents on things you can’t, you know, there’s just no money to be made. So I think that there’s a lot of potential for this to be disruptive in a positive way.
Um, I do feel. The concern that I’ve always felt in people waiting for a savior, you’ve got to fix your own damn health, right? Like getting the right information, getting the right access, getting the right, you know, choices and legislation to allow you to do it is definitely there, but no one’s going to wave a wand and make you healthy.
And waiting for someone to do so is, I think part of the folly that got us here in the first place. And [00:18:00] so, you know, I’m still avidly in the corner of, you know, patient empowerment, right? Education. Here’s what we know. You know, make some better choices, right? And so, I don’t know, I don’t think any of that’s ever changed on my end.
Dr Sara Szal: Yeah. It’s a really good point. I feel like, uh, regardless of what happens over the next four years,
Dr Pedram Shojai: that
Dr Sara Szal: there’s a way that
Dr Pedram Shojai: I
Dr Sara Szal: we still have to
Dr Pedram Shojai: it go? That’s
Dr Sara Szal: it upon ourselves. To be fully in our power when it comes to claiming our health. And you know, that, that varies depending on what it is you’re up against, but no one is going to do that for you. And. And I, I still see people who give their power away, you know, whether that’s a perimenopausal woman who goes and sees her doctor and she’s told, Oh, yeah, you’re not sleeping and you can’t lose the weight and, [00:19:00] um, you’re more tired. You’re just getting older. Like, no, you don’t give your power away in that situation, and you also don’t give your power away in any other health related situation.
You want to, um, to understand that even if the healthcare system changes, if these systemic changes that you’re describing come our way, as we hope, no one is going to know your health as well as you, and that is still a fundamental aspect, regardless of who’s in power and who or precedent is.
Dr Pedram Shojai: look, the tools are layering, right? Like you’re doing personalized medicine, integrative medical, I mean, I love the seat that you’re sitting in, right? Because you are, in a position to be a change maker in a system that needs it, right? You gotta, you get to be a disruptor and you get to bring a lot of credibility and legitimacy.
I mean, I wear all the [00:20:00] gadgets, I use the data, but I don’t need this dumb ring to tell me how I slept last night. I wake up and pretty much know how I slept last night. I use it to cross correlate with other data and really learn longterm trends and look at my heart rate variability and look at all of it.
I think this era is turning into one of, of supreme excitement for folks that get how the tools work. And I also think that, and there was a, this conference we spoke at, there’s a lot of fricking hyperbole. There’s a lot of people drinking baby blood. You know, there’s like vampires drinking stem cells and doing stuff that are just crazy.
And then there’s some legitimate stuff somewhere in the middle. And so I think healthcare. Being all the way back here slow and stupid and corrupt and busted and all the things and then kind of wellness cowboys saying and doing stupid shit on the other end and somewhere in between is [00:21:00] is this reality where most of us can Can improve in a lot of ways in our lives?
and so I think there’s danger on both ends right the the stale stagnant and the Flashy object and somewhere in between I think reality is is getting really cool
Dr Sara Szal: True. So here it is. Uh, you and I are both on the middle path and, um, it’s a, I remember what we’re doing the health bridge. We used to talk about, okay, where do we disagree? Like, where can we actually have a little conflict and a fight? Because more often than not, you and I were very aligned on most topics.
So, um, as I search deep. For a few differences with you, maybe we could talk about wearables for a moment, because you just made a really wise observation that you don’t need an aura ring to tell you how you slept last night. I actually do. I do [00:22:00] because I think In my medical training, because I’m old enough that I was one of those hundred and twenty hours a week type of people for about eight years, um, I lost my ability to be a good historian to actually have the interoception.
The awareness of what’s happening inside of my body to, to have a sense in the morning of how restorative my sleep was. Now you’ve had a very different path. And I wonder with your martial arts and the interception that you’ve developed, that that’s less of a problem for you. So how do you respond?
Dr Pedram Shojai: love this. I love you. Um, so I train interoception, right? I preach interoception. I think interoception, um, chemoception, extra all the sections, right? There are a lot of ways to analyze data from internal feeds. Um, I don’t, we haven’t even caught [00:23:00] up on this, but my last kind of like my big nerd out session in the last year has been looking at interceptive signals from endotoxemia, uh, Flaring safety signals, um, and, and basically signaling allostatic challenges that manifest in the form of low grade anxiety, insomnia, all these things.
I started digging into it because I came back from Portugal and I was all fucked up from eating their cheese. Like, what’s wrong with me? Oh, look at that. You gelato was good and you are now not sleeping. And being someone trained in introception, I’m like, this isn’t my monkey mind. What is this? What is my body telling me?
And so I had to renegotiate my relationship with introception by not playing whack a mole and saying, shut up, shut up to the noises at night. But I hear you and I respect that, right? There’s, I mean, it’s easy for me to make fun of Dave Asprey cause he’s like walking around, you know, [00:24:00] looking like this all the time.
Um, For those of you who are listening, I put on my red blockers, but the dude broke himself. So sometimes you just, you never put the crutch down if you broke yourself at that stage. And so if you lost your innate sense of being able to ascertain whether or not you slept well or not because you didn’t sleep for so long, you fucking broke it.
I love the ring for you, right? But I also love the The, the, the Jesus plan and the salvation of saying, can we bring your interception back through calming your nervous system, rehabilitating and building that, that capacity again. Um, I don’t think I haven’t met anyone that I feel is too far gone. It’s just a lot of work because the show must go on and Sarah’s seeing patients and Sarah’s probably drinking coffee to get through her day.
So it’s squishy. It’s hard. But, um, I agree. I also, I’m going to say one more thing about the devices, which I think I used to moan about this back in our [00:25:00] days, but I also have a strong aversion to a particular aspect around these devices, which is this concept of idolatry. love Dave Rabin, but my ability to calm down should not be tied to this device.
That is something from outside of me trying to fix me. I think that that is inherently taking away my agency. And so it’s a love hate with the devices. If you understand that this is part of my sensory array and my tools and all this, but it’s my agency, I’m much happier about it. If this is the thing I need to fix me and it runs out of batteries and I’m screwed, I don’t know how helpful that is.
It’s a long term.
Dr Sara Szal: Yeah. I love this conversation that we have ended up in because, um, you know, if you and I are at different places on the spectrum of interoception, I agree with you that really my job is to [00:26:00] develop my interoception and a lot of the ways that I learned in my 30s and 40s to develop my interoception kind of stopped working as effectively.
So I’ve got, you know, a long time meditation practice, a long time yoga practice, and what I found was that the thing that helped me more with interoception than anything else was psychedelic assisted therapy. And so, yeah, I think there’s a responsibility that we have to address interoception.
And I really like this point about not becoming dependent on external factors to create that sense of wholeness. They’re just tools. They’re just, you know, when I, when I got up this morning and I saw that my heart rate variability was in the seventies yesterday, I did a happy dance because that doesn’t happen so often for me. And it, [00:27:00] it gets me to, to think through, okay, what happened in the past 24 hours? Like how do I understand the metrics that led to that fluid balance between my parasympathetic nervous system, stay in play and my. Synthetic nervous system, fight, flight, freeze, fawn. So I think we need to use it as a tool. I think that’s really critical.
And then, um, and then I, I’m curious about after all the cheese in Portugal, what did you do to, to, to rehab those signals that you were getting?
Dr Pedram Shojai: So it started by me having, you know, and again, I’m not the brightest, right? Because it took me years to, you know, you read this stuff and then you don’t realize what it is that you’re reading. Right. Um, my body doesn’t speak English, but it will speak anxiety. It will speak insomnia. It will speak racing thoughts.
It will speak elevated heart rate. It would, it will speak, um, [00:28:00] A pulse that you can feel in your abdominal aorta, right? You’re like, Oh, what is this? And to turn that introceptive array inward and be like, okay, perhaps this isn’t me needing to anesthetize whatever this is, but to just listen, what the hell can this be?
And then the worldwide web opens up, then all of the, the, the tools and the resources and the podcasts. And so I’m like, Oh my God. Mangoes are high in FODMAPs. Huh. Right? And goji berries, it’s part of Chinese medical pharmacopoeia. They, you know, somehow, somehow they snuck in under the radar because they were good for you in a different kind.
I can’t have high FODMAPs goji berries by the fistful. And so it started to, the, the anchor, The act of listening and the act of not averting away from the problem and saying, well, I obviously need to find some magnesium or some be better melatonin, or [00:29:00] whatever the re remedial path would be, right? And saying, okay, body, what are you telling me?
Why is the baby crying? led me down this path of saying, Oh shit, well, you tore your gut lining and your gram negative bacteria drop an LPS into your bloodstream. This is a subtle form of, you know, immune system activation and arousal and that arousal will trigger your childhood trauma and trigger all the other stuff.
But it’s just like a baseline amplification of volume. So then how would we bring down this volume? First of all, stop eating like an idiot. Check. Secondly, let’s start healing the gut lining. Okay, slower check, but you start doing that and you start re inoculating. You do all that stuff. Within two to three weeks, I was sleeping through the night again.
I’m like, huh, got it. And you know, I, you, you know, my history, I used to own a sleep lab. There’s not a sleep lab in the country that’s having this conversation, right? And that’s the problem. Oh, look, you have an [00:30:00] apnea or not. And so there’s just the primitive degree of kind of understanding of the body signals, I think is also a problem, right?
It’s just plain whack a mole on things that are making noise instead of saying, why is the body throwing this alarm? And that
Dr Sara Szal: It’s,
Dr Pedram Shojai: has been a big thing in my, in my last few months.
Dr Sara Szal: I love hearing about it. Thank you for sharing it, Pedram. It also reminds me of the conversation that we had. In West Palm Beach with Dave Rabin, where we were talking about how psychiatry historically relies on history, behavior projections, and not really biomarkers and how. The, the ship is turning, you know, Dave Rabin is, is part of this new generation of psychiatrists, MD, PhD, who, um, is developing [00:31:00] a way of understanding the metrics of health and understanding the metrics of pre disease and disease.
So, you’re describing, you know, that, that shift that can occur when you go, you probably went healthy when you went to Portugal and then you came out in some sort of pre disease state. And most people don’t recognize those symptoms, the anxiety, the difficulty with sleeping. They often treat them with a pharmaceutical instead of getting to the root cause, which is what you did.
So I really appreciate this, uh, tableau of how our metrics are changing and how we can now develop a set of metrics of what health looks like in Pedram, what health looks like in Sarah, what health looks like in an NBA player. And to really then understand when you [00:32:00] start to shift out of that point of allostasis, that other word, that’s part of my love language that you used earlier, you know, what happens when you start to shift out of that place of homeostasis or allostasis?
Dr Pedram Shojai: Hope you’re enjoying this podcast as much as I am. I love these conversations with folks who’ve been in the trenches and understand how squishy some of the stuff can be and just how difficult it could be to get good advice from folks want to introduce you to the newest course inside the urban monk academy. Uh, it is releasing today.
So, um, this is, uh, Getting on the end of November. And I am just releasing a brand new course called sanctuary. Turning your home into a Zen healing Oasis.
It’s this powerful powwow around how we need to heal. And how we [00:33:00] need to feel safe in this place called home so that we can heal. Um, as you know, I’ve done so much in medicine so much in my body, so much in personal development. And this last project I did called homesick homes all about the environmental toxins that make us sick and make us unwell at home. And it really got me thinking. About. The sanctuary that we need to create. At home in order to feel safe so that we can sleep, we could recover it.
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We create. A place of safety at home. And then we allow healing to happen. So many of my patients over the years, it’s like, oh, you should do this, this, this, and this, [00:34:00] and take these supplements. And. You’re going to be all better. Why is it not working? Oh, they don’t feel safe. Their alostatic load is high.
Their perceived stressors are high. And they’re in an environment that does not allow them to relax and heal. So, this is how we fix that. Just go to my website. The urban monk.com. Uh, joined the academy. It is part of that. You could always get my courses, all a cart, but being part of the academy allows you to also be on the live calls and with the community.
All of it. So do do whatever you gotta do to get yourself into that course. It’s a good one.
conversation, um, what we started offline just catching up and she’s like, are you going to sit up straight? And I’m like, yeah, yeah, yeah. I’m all beat up because I was working out with all these like super elite athlete types yesterday and , talk about allostasis.
It’s like you get in the cold dip, you do all this stuff that’s aggressive and you, you know, you put on hormetic stressors. Um, And you push growth. But this is something that I wanted to bring up [00:35:00] because you and I were both at this conference, right? And so you’re, you’re on the doctor side of the spectrum, less, less so, but definitely not, not in the biohacking side, right?
But then there’s this, this tendency where I noticed this in the last several years where folks end up going to all these wellness conferences because their doctors have failed them, their medical system has failed them, but then they start doing a bunch of. Stuff that is good for a Ben Greenfield that is good for a Max Lugavere but might not be good for a 55 year old woman who has had enough allostatic load that cannot bear the same type of remediation yet she is trying anything.
And there’s a straw that can break a camel’s back in that. And I just, I want to get your perspective on that because I think a lot of people are lost in wellness land. There are some dangers to not knowing where your line [00:36:00] is.
Dr Sara Szal: It’s such a good point. Yeah, there’s a, as you were talking, I was remembering some of our old episodes at the health bridge and I think we had been Greenfield on once after he had done a weekend of SEAL training. And do you remember this and he, I mean, Ben Greenfield usually is standing when he films a podcast and he was like lying flat on a sofa as he did the interview with us, he was like, dude, I can’t, I can’t stand.
And yeah, so even his allostatic load was tested by SEAL training as is, you know, for most people, even elite athletes. Um, So 55 year old Linda, who is listening to the bros. And we’ve got so many bros now, so not just Max and Ben and Dave [00:37:00] Asprey, but we’ve got Andrew Huberman and Peter Atiyah and all the guys who are, you know, when you look at kind of their gene environment interface and you look at, okay, how much did you rock today?
You know, Oh, I did 90 pounds and I did it for two hours. You know, like there’s a, there’s a one. upmanship that I think, um, can be egoic and is part of kind of this performative quality to, okay, what’s the latest hack that you’ve got when it comes to increasing your performance or improving your VO2 max or, uh, changing your lactate threshold or, uh, making your calculation of biological age even less.
So there’s this broization process that often does not translate So 55 year old Linda is one example, but I would say it’s also [00:38:00] 35 year old Linda. It’s 45 year old Linda. And, um, that this is where interoception is so important and kind of understanding what your metrics are. You know, if you’re someone who was like me at 35, where I had cortisol, that was about three times what it should be.
I had this. You know, I had a normal amount of stress, but I was working in mcmedicine and I was highly sensitive. I didn’t know as much about it then. And I had a high degree of perceived stress. So even though my allostatic load wasn’t that high, it was high for me. And so I think a lot of women will get into that situation.
They’ll hear, Oh, okay. This biohacker is recommending a fasted workout. Four days a week. I’m going to try that and what works for men what works in the literature in [00:39:00] men’s health Often doesn’t apply to women.
Dr Pedram Shojai: Not only do I want to double click and highlight that, I almost want you to say that again loudly. Like this, I think is one of the biggest challenges. 70 percent of my followers, right? And I’m not like a bro guy, right? My success metrics are like, you know, how good of a dad was I, right? But they’re women.
And women taking male advice that doesn’t necessarily apply to them. And fuck that one upsmanship, right? That is idiot stuff to begin with. If you’re lucky now, if you’re using that to better yourself and to improve your ability to, you know, be around planet earth and do good things, great, whatever power to you, but you comparing yourself to any other guy just because I think is incredibly unhealthy.
And I think that kind of brings us back to the work that you’re doing at the university, [00:40:00] which is the personalized bit of this medicine. Devices, what data can feed in to an array that also has introceptive data that you can also weigh in a meaningful, respectful way? Like, I have a feeling about this.
Well, he just mansplained over me and I’m, you know, I’m just going to listen to that guy. No, I, what, what is this feeling I have? And how do all of these data streams get weighed in, in, uh, In a matrix of information that serves you better. But I think the question that a lot of people don’t ask is why, right?
Why do you want to be healthy? What is the why? It’s not the bikini bod, right? The bikini bod is such a low order reason to be healthy. And I think a lot of people come in and never really get the bigger why. Um, and therefore they fall for all the shiny objects and listen to disparate advice and all of it.
[00:41:00] So, Linda’s listening, Sarah. What would you say to her?
Dr Sara Szal: There’s so many things. I want to say to Linda.
Dr Pedram Shojai: She’s listening.
Dr Sara Szal: I agree with your point about the why I want to circle back to that but the the place I want to start is with dysregulation so what I’ve seen Taking care of people mostly women for the past 30 plus years. Is that when you’re in a dysregulated state? You And chances are Linda at 55 is dysregulated because she’s probably in perimenopause or just went through menopause.
She’s got one of one or more of 100 plus symptoms that are signs of nervous system and endocrine system and immune system [00:42:00] dysregulation. Maybe there’s also some emotional dysregulation that is. uh, bidirectionally involved with how her systems are dysregulated. When you take someone like that, you know, someone who’s got maybe a, if you run a, a functional medicine panel, you find that their cortisol is off.
Maybe their DHEA is low. They have, you know, Antinuclear antibodies that are positive, and we know that about 30 percent of the population has that right now, even healthy people, maybe, um, she’s on hormone therapy, or maybe she’s not. And so she’s got low estrogen, low progesterone, maybe low testosterone.
She knows she should work out, but she’s too tired to go work out. You take someone like that, and you then give her her bro advice? You know, start wrecking, Linda!
Dr Pedram Shojai: In this ice bath.
Dr Sara Szal: Ice bath, [00:43:00] wrecking! And, uh, then sauna for an hour, you know, make sure you’re sweating. Um, that’s where I think you get into trouble because there are phases to this process. And I would say the, the first phase is looking at your emotional dysregulation, your physical dysregulation. And those systems that we talked about are the ones that are most important.
susceptible to dysregulation, your immune system, your psychology, your pine system, your psychology, eye is immune and as nervous system dysregulation, and then the endocrine system dysregulation. So your pine system is where you’re most vulnerable to dysregulation. Look at those systems and see where you are.
Address those first, like get into a place where you have a feeling of balance and homeostasis, and then you can start doing more of those hormetic Stressless. [00:44:00]
Dr Pedram Shojai: So you bring up a point that, um, took me back to last week. And, um, I didn’t get a chance to get a word in, thanks to somebody. Um, but
Dr Sara Szal: Are we talking about the panel again?
Dr Pedram Shojai: Uh, yeah. Um, it’s, there, there’s, there’s just different cadence, right, in how people emanate. Um, and I’m not, and I’m not a like jump out in front of people guy, but there was a point that you all were making and you brought it up. Uh, Dave doubled down on it. It’s this concept of safety, psychologically, physiologically, emotionally, spiritually, so on all levels, safety, you cannot heal.
You cannot. Be well, if you’re not, I mean, just all of the body’s signaling says, shut down. We are not safe. We, you know what, power down the mitochondria. I don’t know what’s going on, but this animal may or may not make it right. It’s like these switches that get hit. And so you had mentioned, you know, so all of these [00:45:00] auto immune slash challenges with a chaotic, dysregulated system.
And then trying to, go into a scary movie, or go into a war theater. It’s just not going to work out well. So, this idea of Linda getting her body to feel safe again, so she can rest, restore, recover, and heal. And not hear this bro advice, but do the thing that she actually needs. It’s like How does she start, like how do you, how do you go in and do that after years of marching and marching and avoiding because the show must go on?
Yeah. Yeah.
Dr Sara Szal: I miss you so much Pedram. And I feel like you, um, you have a way of cutting through the noise and getting to the crux of a [00:46:00] problem and what you just did now with shining the light on safety.
Dr Pedram Shojai: slide.
Dr Sara Szal: I sort of vaguely knew that I knew it on a, in a theoretical way, you know, when I was going through my medical training, but now I actually feel it for the first time in my life.
And it took, it took getting to my fifties to really feel it for people who grew up with a family of origin that understand safety and knows how to create it and knows how to, you know, it’s inevitable that in human relationships we have ruptures, but they create safety by knowing how to repair well. Um, That kind of environment allows people to have a [00:47:00] sense, this inward sense of safety that is such a critical touchstone for all of their physiology, not just their mental health, not just their autonomic nervous system, but every aspect of their physiology. And then there’s the rest of us, 70 percent of women, 60 percent of men, according to the studies on adverse childhood experiences. Who had trouble with safety growing up and then that becomes this inside job that’s part of adulting to really understand how do you break that cycle if you’re someone like me who has an A score of six.
A big part of the work is to understand what safety feels like inside your system and then to be able to co regulate, if you decide to have children, be able to co regulate your children and [00:48:00] to co regulate others that you love and work with and live with. I, I really appreciate you bringing it back to safety because I think that’s the foundation of all of this.
And that’s often what. It separates the 55 year old Linda, who takes up bro advice, doesn’t have a sense of safety in her body, and it just feels like yet another thing where she misses the mark, and she can’t get the outcome that she’s looking for. But there’s also, you know, 55 year old Alice, let’s say, who teaches herself how to take Sense safety in her body.
She builds her interoception. She does the inner work, maybe through reading your books and, um, doing Qigong with you and other practices. She builds that sense of safety and it adjusts her [00:49:00] physiology. Her cortisol is now in the normal range after being elevated for, uh, decades. You know, maybe her insulin also is now in the normal range.
So safety, the safety signal is far reaching and we can talk about some of the individual metrics of it. But I would say, you know, that we were talking about heart rate variability, HRV is a measure of safety. Being able to sleep well, having adequate deep sleep and REM sleep and not too many interruptions. Having a low resting heart rate. Those are all indicators of safety. So thank you for raising this point about safety. It’s the first place where Linda should focus.
Dr Pedram Shojai: And it gets a little squishy here, and this is where I’d love to indulge if you would, you know, because Linda could then say, okay, so what I’m hearing [00:50:00] now is I should go do some ketamine therapy or some psychedelic assisted therapy and really get after my childhood trauma and my sense of safety and deal with my ACE score and then everything else downstream.
Or there’s a school of thought saying, well, I also have a safety signal saying I don’t have enough progesterone in my DHEA is running out. So I’m stealing pregnenolone right now. And internally I am starving to make shit work because you’re robbing Peter to pay Paul. Can you make me feel safe on a hormonal level?
Or my gut lining is torn and all these stupid bacteria are attacking in my immune system is saying well How did these guys jump the TSA line and I have a three bell alarm going on inside my body and oh shit And so there’s safety signals that are coming from this EMF and the Wi Fi So it’s like do you do all of it at once?
Do you start with some sort of hierarchy? I’m just curious and again folks. This is squishy. But this is just me and Sarah having fun now
Dr Sara Szal: So [00:51:00] there’s so many ways to answer this. I mean, I think the, when you’re trying to prioritize where to put your attention and there’s You know, a hundred places where you could put it, I would say, start with your food. It’s such a basic place to start. And you talked about that with endotoxemia, with, um, having increased intestinal permeability or leaky gut, uh, after this trip to Portugal.
So I would say food is such a beautiful place to start. And just as, just as food can take us off track. You know, ultra processed food, processed food, living in food deserts, eating, um, excess carbohydrates, eating food that has micronutrient depletions, all the things related to food that’s not healthy, just as those can take you off track, I would say healthy food [00:52:00] can bring you back into safety, into a state of balance.
And really what we’re talking about here is all these different ways of creating homeostasis in the body. And every time I use homeostasis in one of my books, my editor always says. Oh, I think that’s too complicated. Like you need to find some other way to describe homeostasis. And I, I’m just like, no, I think people can handle it just like you want.
It’s a word. And you know, when it comes to your gut, homeostasis is incredibly important. You’ve got homeostasis with the tight junctions in your gut. And when they don’t work, when you’re out of homeostasis, you’ve got leaky gut. You have homeostasis with your microbiome and the microbiota. You have, , with your hormones, there’s a state of homeostasis and women who go through perimenopause and menopause get pulled out of that homeostasis and for people who are good candidates, [00:53:00] you can restore homeostasis.
with hormone therapy. There’s also a lot you can do with your food and with your lifestyle to adjust those things. So I would say first food, second hormones, third metabolism, insulin, cortisol. And I would say through all of that is also your stress response. That’s the horizontal, what do you think?
That’s my priority as of today.
Dr Pedram Shojai: Yeah, I’m very much of the same line of thinking. For me, I think it’s fuse length and how you need to get it. And so all of the places where your signal pushes you over into arousal. If I have worse issues with my gut, I gotta deal with that. For the more I could bring down the alarm bells, the more I can sit on my perch and make better [00:54:00] decisions, which will help me be a better me tomorrow.
And so looking at all of the areas, one of the areas we didn’t even cover. And this just happened. My son gets in the car and I’m like, what? What am I smelling? He’s like, Oh yeah, Jacob had cologne. And he like, you know, I’m like, why is a 10 year old boy have cologne? And why do you think it was a good idea to like, try his Italian?
It like sets me off. Cause I’m chemically sensitive. And for me in that moment, you know, the food didn’t matter at all because I had an aggressive Italian cologne punching me in my nerves. Right. I’m like, yeah. Right. Okay. And so what is that to you? What is the exotoxin, the environmental toxin, the endotoxin, the guy snoring in the pillow next to you?
I mean, there’s a lot of things that can trigger us to go over the line and not feel safe. And to me, I think it’s a yes and. Right? It’s like we’re always [00:55:00] looking for the one vector. It’s like, is it ice baths or saunas? Maybe it’s both. Maybe it’s neither. Right? And so I think that the the Um, the operating system and the wellness deal has been corrupted by the, the shiny object marketing ploys.
And I think it is as complicated and I think homeostasis is a word and it should be used and people are smart enough to hear it, right? And so I, I think that there are many answers depending on the many ears that are hearing this. And you have to kind of. As you’re listening, see, okay, what is the thing that I feel is setting me off the worst?
And you can get the help of doctors, you can get the help of devices, you can get data to help inform that decision. But there are things that are poking at you. What are they? Which ones do you remove first? And once you start doing so, the next five steps get easier, I think. [00:56:00] Is
Dr Sara Szal: a really good chance that that is affecting your sleep, maybe increasing anxiety, maybe, um, making it harder to soothe yourself.
And so that’s a good place to start. And it can be with things like vitamin C, 750 to a thousand milligrams raises. Your blood level of progesterone. It can be something as simple as Vitex to help raise your progesterone. And then 45 to 55, getting up to Linda’s age. There’s a good chance that estrogen is causing dysregulation and a big part of what women also experience is, uh, [00:57:00] this thing called cerebral hypometabolism.
It happens in 80 percent of women over the age of 40, where they just don’t use glucose that way they once did in their brain. So their brain’s use of fuel starts to falter. It’s related to mitochondrial function. And that once again is regulated by estrogen. So there are some ways to kind of parse what sort of dysregulation, what sort of, uh, loss of homeostasis is happening by age, especially in women.
Dr Pedram Shojai: there a way back from that? Cause, you know, there’s so much narrative around saying, okay, well I broke it. So , These types of things where you’re like, Oh man, I think that’s me. I broke. Now I don’t metabolize glucose in my brain. You’ve been around the block with all this. You’ve seen some of these incredible recoveries from people who get their food right and fix the systems and things start to come [00:58:00] back online.
Right? And so people feel like they’ve broken themselves. Now they’re doomed to do something. Message of hope. Um, with all the stuff that you’ve seen in your days here, and I, oh God, I miss you so much. This is so fun. Um, there’s so much hope for Linda, right? And sometimes it could feel really despondent because she’s listening to the bros, giving bro advice that doesn’t work for her.
So how can we help her?
And
Dr Sara Szal: the next step is seeing if it’s right for her. And this is where I really, you know, what makes me hopeful [00:59:00] is the idea of experiments. And of one experiments, and I was taught when I went through my medical training, I was taught that when you look at that, the quality of evidence for different scientific studies, you know, the lowest is expert opinion.
Then you come up to, uh, observational studies and randomized trials, but that’s really medicine for the average. It tells you whether an intervention is safe and effective. It’s really end of one experiments that I think make the biggest difference. So for Linda at 55, you’re still in the window of time where it can be helpful to consider bioidentical hormone therapy.
So that would be something to consider. Um, not everyone is a candidate, but I think many more women are candidates than are being talked to and counseled about the possibility of hormone therapy, because we know right now that somewhere around 75 to 80 percent of women [01:00:00] don’t get the treatment they need.
So, for Linda, I would say, start with food. Step 1. Step 2 would be to see if you’re a candidate for hormone therapy, because that can be so regulating. It can help to reduce. So many chronic diseases that women experience at greater numbers if they don’t take hormone therapy. And I’m not saying that to create fear.
I’m saying it because it’s so empowering. And I want you, Linda, to have agency around it.
Dr Pedram Shojai: it’s a small hinge that’ll swing a big door for Linda versus the ice bath, right? It’s
Dr Sara Szal: That’s right.
Dr Pedram Shojai: It’s not necessarily what she likes, right? Sarah, what a pleasure to be back with you. Have fun. Um, hope to see you in person again soon. That was a rare treat. Uh, we are in the same state now, so it’s
Dr Sara Szal: We’re back. We’re back on the plan, Pedram. I’m so excited to hang [01:01:00] out with you. And I remember when your son was born 10 years ago. So it’s, it’s so funny to hear about the cologne, the assault of the cologne. It’s
Dr Pedram Shojai: explain to him He’s like, what? All these guys are wearing cologne in my class. And I’m like, so it means they’re morons. And he’s like, what do you mean? Just cause everyone’s doing it. I’m like next week, they’re all going to be smoking dope next week. They’re going to be, you know, jumping their bikes without their helmets.
Trust me, this isn’t good for you. Right. And so parenting in an age where toxins are everywhere and people are blind to all of the things that you and I know better about, man, that was, this is way harder than the monk days. Right, like be,
Dr Sara Szal: true. Yeah. You, you not only have to keep your children alive, you have to, um, help them with judgment and help them with, you know, this toxic environment that we live in and [01:02:00] how to navigate it.
Dr Pedram Shojai: It’s, you know, listen, no one said these are going to be easy times, but these are the times we live in and you do with that what you will. And I promise every one of our listeners that the version of you that isn’t reacting to endotoxins and to Italian cologne into hormonal issues and childhood trauma and all these things are kind of bubbling up and knocking you off your perch.
That version of you is what’s needed by the world, your family, your spouse, everything. And so, I hope you found something here. Sarah, love you so much. Love you
Dr Sara Szal: Love you too, Petra.
Dr Pedram Shojai: We’ll see, I’ll see you around soon. We’ll figure out when.
Dr Sara Szal: Yes, please.
Dr Pedram Shojai: Alright.
I hope you enjoyed that. And I hope you can tell how much fun I was having catching up with a dear, dear old friend. Uh, and you know, what’s funny is we got so into all the stuff. I didn’t even get into asking what she’s up to now, [01:03:00] other than the, you know, the, the job job that she has. I’m sure she’s up to all sorts of wonderful stuff.
Uh, go to her website, check it out. I’ll put it in the show notes. Obviously I’m a big fan of Sarah big fan of the work she’s doing. I’m a big fan of the integrity. She has always brought. To the conversations around health and. How we have to live in order to properly do this thing called health. Um, it is the journey, right?
It is how we live. And Sarah is one of the powerful voices in that. And so always, always got love for her. Always respect what she’s doing. So check out my new course, if you haven’t already, it’s called sanctuary. It’s in the urban monk academy. Uh, and I am very proud of what I have brought together in terms of research, in terms of practical application of how you could turn your home into a safe healing Oasis. A lot of leverage there, right?
Not just better sleep, not just faster recovery. But also [01:04:00] less mental clutter. Uh, higher asset value for your home. Less allergies, less auto-immunity so we cover the environmental toxins. We cover the cluttering. We cover all of the areas that get in your way. And stop the flow of your vital energy at home, whether it’s in health, whether it’s in goals, in perceived stress.
So it’s pretty comprehensive and like anything else it’s there to wrap around your life and your lifestyle. To help you get more leverage so that you can be a better version of you. Courses called sanctuary in the urban monk academy. I’ll see you in there.