EFR 543: Daily Biomarkers You Need to Know, Elite Athlete Secrets, and How to Properly Interpret Wearable Data with Dr. Sara Gottfried, MD

Dr. Gottfried: And what we mean by precision medicine is that we're taking data flows. So that includes wearables, for my patients, I see both men and women. I see executives, professional athletes, as well as mothers stay at home mothers. And we take these data streams. So biomarker testing, genomic testing, which is such an important piece when it comes to performance, recovery, risk of injury, we take biomarker testing such as blood work, urine testing, looking at hormones looking at micronutrients inside the cell. And then we also take these wearable datasets. So I'm a fan. 

Chase: the whoop and the Apple Watch. 

Dr. Gottfried: Yeah, with the apple, watch the Garmin, the aura, you know, these datasets that are really comprehensive. And I think a lot of physicians are not looking at dashboards with all of these data together to help our patients with performance to help them with capacity like VO2 Max to help them with gut health. So precision medicine is really pulling together all those data streams so that we can personalize what is true for you. And then one of our biggest tools is called the end of one experiment, where we take someone like you chase and say, Okay, we're going to try this nutritional tweak, we're going to do it for six weeks, we're going to measure your performance before and after, VO2 Max or lactate threshold, and see if that tweak made a difference. So that's in a nutshell, what precision medicine is. It was first developed in cancer. But now we're starting to use it this more personalized approach much more broadly than just oncology.

Chase: I think this is so unique and fascinating because I for one have been using wearables and getting a baseline blood work done for years through my physical, even through some cool new technologies and companies over the last couple of years that provide biomarker measurements at home. So I get a lot of data points over the years. And I have just loved looking at them and understanding them and researching them. Personally, it gives me great joy. But also it's my professional career, you know, being in the health and wellness world and health coach for so long. But for the everyday person who maybe is just grabbing a wearable who is getting a biomarker done, I think this is very, very important. Because there needs to be that next step. There needs to be education there needs to be unique application. So can you please kind of drive home what can the everyday athlete hear the everyday person? How can they really leverage having a professional like yourself or just having someone who is in the know, really interpret their data? And then what are the next steps that you see people needing to take and what success are they getting with it?

Dr. Gottfried: Yeah, it's such an important point. You know, what we know is that if you, if you take your health, and you just outsource it to your physician, and you wait for maybe your annual visit, maybe that's spaced out even longer because of the pandemic. If you take all of those measures of health, and you just let someone else deal with it, you're missing this tremendous opportunity to really get the gains that you want to get the performance that you might be after. So I think it's so essential whether you're a weekend warrior, or you're an NBA player, or say an executive who's looking at career longevity, to really take on this information. So understanding the data streams is one piece and maybe we could go a little bit deeper with some of them such as VO2 Max because that's where the revolution is really happening right now. What we know is that when we design these experiments that's actually the best quality of evidence that you can get to see if an intervention is valuable to you. So one of the problems chases that, in mainstream medicine, which I trained in, you know, starting 30 years ago, what we know is that we've been doing medicine for the average for really the past century. So all of the data that we've collected, looking at things like randomized trials, which are considered the gold standard in medicine, mostly looking at the intervention of a pharmaceutical, those are looking at average responses over, you know, a big population. But whether an intervention such as taking Metformin for longevity, actually works for you is not something that you get from population based studies. So when I was at Harvard Medical School, I was taught that the best evidence you can have is the end of one experiment. So I do and have one experiment with every single patient that I see. So for instance, I've got a professional athlete right now, who's got Hashimotos thyroiditis. So he's got this autoimmune attack of his thyroid. And this is affecting the way that he plays. So we are doing these f1 experiments looking at different interventions, some of them culinary spices, such as black cumin, which has been shown to help with thyroid function, and help with Hashimotos. Small interventions, like making sure that he's got enough micronutrients that support the thyroid, things like copper, zinc, selenium, that his cortisol is where it should be one of those really important hormones for performance. It's these what NF1 experiments that really, I think sets you apart as an athlete or as an executive, or just, you know, trying to be the best possible person that she can be. So that's why I think it's so important. I think you also asked, you know, how do you then take this a step forward? What we know is that there aren't a lot of physicians who do this kind of work, there's a few of us. And I think, especially those that are interested in working with professional athletes, that's where I see this moving more rapidly. But this is a really collaborative process, you know, you were just talking about some of the biomarker testing that you've been doing over the years, putting that together with your wearable data set, I imagine you make some changes along the way. That's what we want to be creating. But we want to do it as a team approach. So it's not just you on your own, you know, you're able to work with some other experts who maybe have a focus that's different than yours. So that could be nutrition micronutrients, it could be looking at your genomics. And so it's really this collaborative process, rather than I would say, the more old school disempowered process of just outsourcing this to your doctor,

Chase: what are some of the key biomarkers we should really be paying attention to in terms of understanding this means I'm performing at just a good baseline and I'm air quote here, a good human being, I don't have maybe a medical need, but also what are some of the other ones that you would recommend us maybe playing around with first, what are some of these biomarkers we should consider or want to consider for peak performance to integrate into this next six week protocol even talking about as our own N equals one?

Dr. Gottfried: Well, what I suggest first is to start with genome x, because genomics provides a blueprint for pretty much all the rest of the f1 testing.

Chase: could you kind of define this for us, please? 

Dr. Gottfried: Yeah, of course. So by genomics, what I mean is looking at specific genetic pathways. So you know, in some ways, I feel like when the Human Genome Project was published, and we had the first genome in 2003, we were also excited about it, we thought this would transform medicine, and frankly, Chase, the party never happened. Like I mean, it's, and it’s been a disappointment. What happened was, we had a lot of why's that? Well, we had a lot of direct to consumer testing that started to get pushed on consumers and what, what we saw was that, unfortunately, they would say, Okay, you have this genetic variation. So you should take this supplement. And that's not really the way that work with genetics. We want to be working with pathways. So that includes cellular pathways, like what's going on with inflammation, what's going on with oxidative stress or rust in the body. What's going on with methylation, which is a way that we inactivate things like estrogens important for both men and women, as well as detoxification. So one of the things that I see with a lot of athletes is that their detox pathways are not open they're not, they're sluggish, they're not working the way that they could be. So with genomic testing, I've got a particular test that I like to do that looks at these different pathways. It also looks at systems pathways, such as the vascular system, the glucose insulin pathway, the what's going on with cholesterol and so we want to be mindful of all of these different pathways, you asked, okay, where do we start? Because this can be overwhelming I usually start with glucose and insulin. So I think that's such an important metric. I know you've talked in the past about glucose and insulin, what I love is the continuous glucose monitoring data, because that gives us such a fuller picture of what's happening to an individual in response to food.

Chase: Yeah, our metabolic health I think is one of the most underrated kind of sleeper biomarkers that the average person isn't quite paying enough attention to because correct me if I'm wrong here, please Dr. we typically don't until we have a need to until you know maybe we're feeling out of sorts or a doctor tells us hey, you're A1 C is elevated, hey, you're pre diabetic or diabetic or maybe you know somebody in family actually gets it. And there's that genetic predisposition as well. So I love how you're bringing up metabolic health for all of us. This is such an important concept.

Dr. Gottfried: It's a key concept. I mean, metabolic health is your engine. You know, a lot of people I think have a more narrow view of what metabolism is they think it's how fast or slow they burn calories. But whether you're an athlete or you know, a weekend warrior, whatever it is, what we know is that your engine, like what really powers you forward is all of the biochemical processes in your body. That's metabolism. So it includes the metabolic hormones, things like insulin that drives glucose inside cells, things like the Hunger hormones like ghrelin and leptin but what we know is that for a lot of athletes, they don't understand that, for instance, they're eating too much fruit and fruit is spiking their glucose so severely that they're crashing afterwards and their energy drops. So getting the accountability and the data from something like continuous glucose monitoring, I think is so helpful for athletes, because it really tells us the state of metabolic health. And really a key part of metabolic health, whether you're an athlete or not, is metabolic flexibility. So that ability to toggle the switch back and forth between burning carbohydrates and burning fat, because so many of us get stuck in that burning carb situation and the sugar burner, and so we're, we're not that good, depending on the fuel that's available at burning fat. And it's essential to have that flexibility.

Chase: Is there a big difference in what you've experienced personally, in your, your, your lab here, so to speak, between male and females in terms of maybe should one of us be considered at higher risk for poor metabolic health than the other? Would you recommend male or female just out of the gate to pay attention more to their metabolic health than the other?

Dr. Gottfried: Yeah, it's a great question. I would say. Well, I think it's important for both men and women; women are more vulnerable. 

Chase: Why is that?

Dr. Gottfried: When you look at the data, you know, a lot of the data on metabolic health unfortunately comes from people with pre diabetes and people with diabetes. Diabetes is defined as a fasting glucose that's greater than one 126 or greater. Pre diabetes is kind of this intermediate state of problems with metabolic health where your fasting glucose for instance, is 100 to 125. Normal so called normal we can talk about normal versus optimal, is where your fasting glucose is less than 100. So ideally, 65 to 99, what I like optimally is 65 to about 85, you start to see some insulin resistance above a fasting glucose of 85 milligrams per deciliter. So what we know is that for women, at lower fasting glucose, so say 115 milligrams per deciliter, they start to have vascular dysfunction. So their blood vessels start to have problems, the lining of their blood vessel, their endothelial starts to have more oxidative damage and so women start to have consequences of problems with metabolic health, at lower levels of fasting glucose, really so for that reason, I think, you know, both men and women need to pay attention to it, but women especially.

Chase: so the impact, you're saying, this internal damage is felt sooner and at lower levels for women than men.

Dr. Gottfried: Exactly. Right. And if we take it one step further, what we know is that, you know, you don't want to wait for a scary diagnosis. You don't want to wait for the diagnosis of type two diabetes, what we know is that if you look at type two diabetics, and you look at some of those deeper, what I call phenotyping, kind of looking at all these biomarkers in genomics we know that people start to have a problem with their biomarkers 13 years before a diagnosis of type two diabetes. But most mainstream physicians are not looking for this. So the thing that changes early on, there's a lot of them is the insulin level after you have a meal. So like an hour after a meal, postprandial insulin, as it's called, starts to rise, sometimes way more than it should. So, you know, my caution to people is to realize that we can start to see these changes in metabolic health more than a decade before some diagnosis that we want to prevent. So that's where I think the promise of precision medicine comes in because it can prevent that scary diagnosis.

Chase: It's funny you bring this up, I had an episode go live as we're recording now just last week with Dr. Jonathan Leary. He's the founder owner of this amazing Integrative Nutrition, integrative medicine Wellness Center here in LA called Remedy Place. And he brought up this concept in his own practice and what he seen out remedy that the damage being done in terms of your metabolic health, inflammation, hormones and even external items such as skin disease, cute chronic inflammation, things like that happens about 10 years beforehand, and so it's wild to hear you say this now again, says this kind of 10 to 13 Mark, so must be some proof in the pudding here over on the clinical side, I guess. Which brings me to my question of, let's say, we want to take pause right now myself, the listener, and I will where I am today, what was I doing 10 years ago that I can maybe see some markers of less desired effects, maybe some poor nutrition habits back then or just things maybe we were even doing that we thought were in the right direction. But what can we do right now to scan ourselves that we can take a look back 10 years ago, maybe this cause this kind of thing? What are some, you know, internal external kind of manifestations that we might be able to take inventory of and then navigate?

Dr. Gottfried: Good point. So I listened to your podcast with Jonathan, by the way, and I thought it was outstanding.

Chase: Thank you. Thank you. Yeah, he's an intelligent man. I love what he's doing over there.

Dr. Gottfried: I love it, too. Yeah, you know, so 10 years, I think is a good a good frame of reference. When it comes to things like, even scarier diagnoses to me like Alzheimer's disease, it even goes back further, like 30 years. But let's start with 10. So 10, you know, what I think about is, how many vegetables was I eating? So 10 years ago, I was not eating a pound of vegetables a day like I am now. If you look at metabolic health, and you look first at say, glucose, and what's happening with glucose, and then you look upstream at insulin, because that controls glucose levels, what we know is that a 100% plant based diet is probably the most proven to help you with glucose. Now that said,

Chase: in terms of regulation, staying even keel

Dr. Gottfried: staying even keeled, okay, then even the risk of type two diabetes, we know that one 100% plant based is the most effective,

Chase: so not even in just day to day management. But you're saying even in disease prevention, that's amazing.

Dr. Gottfried: Well, at least for type two diabetes but here's the problem, you know, I, I don't have any professional athletes that are 100% plant based. And I don't, when I eat 100%, plant based, no processed food, I don't do that well. So my hormone starts to decline. You know, fat is one of the backbones of the hormones that you make, my testosterone goes down, my estrogen goes down, I these changes that I don't think are so good for me. And we also know that there's some other ways to get the benefits like to still get the vegetables, but to add, for instance, animal based protein in a way that can still stabilize glucose and insulin. So one example of that, in terms of improving metabolic health is a ketogenic diet you have to be somewhat careful about that with, of course, athletes, because especially for the more anaerobic activity like my NBA players, they need to be explosive they need carbs for that.

Chase: yeah, you need some carbs in your system, for sure. 

Dr. Gottfried: you do and I think what happens with a lot of people on the ketogenic diet is they go too low on carbohydrates, they, you know, focus on butter and bacon and fat bombs, and not as much on net carbs, making sure that you're getting the prebiotic fiber that helps you with gut health. You know, you asked before Chase about what are some of those foundational tests that are so helpful, we talked about glucose and insulin and we can keep talking about it. But another one is gut health. Because so many of my professional athletes have something called increased intestinal permeability, just as a result of their training load.

Chase: talking about leaky gut syndrome?

Dr. Gottfried: Leaky Gut syndrome. So it's, it's where those tight junctions in the gut that are supposed to you know, keep the problems out and keep the good stuff in start to become leaky, and then your immune system can get over activated. So I see this and a lot of my professional athletes, they have no idea because this is flying below the radar until we do a stool test or a blood test look for this.

Chase: So am I hearing you correctly, and that I just want to drive home a point here that I believe you're making, perhaps a suppressed immune system, or an immune system not in homeostasis is triggered by this leaky gut syndrome, which is triggered by poor gut health, which is a key biomarker you're talking about, almost everybody should be paying attention to. So when we look at where we are right now, in the world, I think all of us would agree that we want to seek out a homeostasis and our immune system and it could be just boiled down to key foods we are eating or not eating.

Dr. Gottfried: That's right cue foods; I would say there's some key supplements as well. 

Chase: such as? 

Dr. Gottfried: such as l glutamine. So I have most of my professional athletes taking l glutamine after they you know train hard. Aloe is also shown to be helpful. We know that vitamin D levels are super important when it comes to the integrity of your gut lining. I really like how you described it as homeostasis of the immune system. I think that's absolutely correct. 

Chase: Because it can be too high or too low to not have it work in support of our wellness, for sure.

Dr. Gottfried: That's right. I mean, I see this less in professional athletes, but I certainly see it in more stressed out folks, that they've got a suppressed immune system. But the more likely thing I see in athletes is that they've got this overactive immune system. So I think homeostasis is really the right way to think about it.

Chase: Well, I mean, I would love for you to expand on that if you could, please because immunomodulators are things that I use in my day to day nutrition. And I have for many, many years. And once I learned that, oh, I can get sick if my immune system is running low, but I can also get and stay I different kind of sick of my immune system is running high. Can you maybe walk us through the differences of those two and why focusing on immunomodulators is so important?

Dr. Gottfried: Yeah, that's a really good topic. It's so juicy, I think after you know, we're trying to recover from this. So in terms of an underactive immune system, we see this sometimes in people who are overly stressed, we see it in people who have been burning the candle at both ends for a long period of time. It's kind of like the burnout phase of the control system for your hormones, which is the hypothalamic pituitary adrenal axis. We typically see lower cortisol levels in those people one of the tests that I do on pretty much every patient is to look at what's going on with cortisol throughout the day. So not just a diurnal cortisol, which is four points during the day. But a cortisol awakening response, which is where you measure cortisol first thing in the morning, 30 minutes later, 60 minutes later, that predicts things like your risk of anxiety, depression, this underactive immune system.

Chase: Wow, can you please say that, again, there are just some keywords right now that a lot of us are managing, at least trying to.

Dr. Gottfried: So what we want is for cortisol to be in the Goldilocks position, whether you're male or female. So you want cortisol to be not too high, and not too low. One of the biomarkers that I think is so important, or series of biomarkers that I want everyone to be measuring, is to look at your cortisol throughout the day. So there's two different ways to do this. You can do a four point cortisol test. So that's usually in the morning, around noon in the afternoon before you go to bed. And then there's something called a cortisol awakening response and this really tells you about the control system for your hormones, the hypothalamic pituitary adrenal axis.

Chase: okay, HPA access. Maybe people have heard that term before

Dr. Gottfried: HPA. It's a little bigger than that. If you want to get super nerdy with me, it's the gut. It also involves the thyroid. And it involves the gonads so testes in men, ovaries in women. So it's the full term for it is hypothalamic pituitary adrenal thyroid, good Natl gut axis

Chase: HPA is little bit cleaner there, that's for sure.

Dr. Gottfried: Yeah. So what we want is the immune system to be in homeostasis, where cortisol levels are relatively normal, most of the day, we are not underactive, we're not in that burned out phase, where you're more prone to infection, you're more prone to viruses. DHEA, one of those really important hormones of vitality is not low testosterone, it's not low but you also want to prevent increased intestinal permeability, which is associated with, you know, this is simplified, but a more overzealous immune system, where you start to attack your own tissues. So for instance, I mentioned this professional athlete who's got Hashimotos thyroiditis and autoimmune disease is something we see more of in women versus men, but men still have it. So we want to just like we want good inflammatory tone, we don't want too little, we don't want too much, just like we want hormones to be not too little, not too much. We want the immune system to be the same way.

Chase: Now, how much actual work does it take to seek homeostasis in our hormones and all these things we're talking about because what I'm hearing you say is that it, it doesn't take a whole lot sometimes to tilt it one way or the other? And that could be through so many different things, something we ate or didn't eat that day, a stress response. I'm just thinking, a lot of this might sound overwhelming for some people. So what are what are some common approaches that you'd recommend us to do to get to this kind of homeostasis?

Dr. Gottfried: Well, if we're talking about the immune system, and homeostasis, there are a couple things that I think are important. One is to wrangle stress. You know, not, not just manage it, but you know, think of it as like another 401k. Think of it as your retirement account. Because cortisol in the hierarchy of hormones, cortisol is the most important. And for people who are endurance athletes as an example, we know that the load of cortisol is really high. So you want to think about ways to buffer the effect of high cortisol, especially if you're a big exerciser, vitamin C does it. So Vitamin C is an example of an immunomodulator. We just talked about vitamin D as an immunomodulator, and helps with leaky gut. It's, uh, you know, I like vitamin D during the pandemic, and generally to be about 70 to 90. So I push vitamin D pretty hard. 

Chase: a little bit on the higher range there. I would agree. But it's definitely what the typical range is what I think like 20 to 80 is like the acceptable range and most people, most Americans are way on the lower side.

Dr. Gottfried: So about 80% of Americans are too low, and are taking doses that are way too low. So I like to push it a little higher, we know that higher levels are associated in women with less breast cancer, it's got about 400 jobs in the body. And I would say immunomodulation is one of the most important. What I see in a lot of my patients is that they have low DHEA levels. So DHEA is one of those really important, you know, kind of like coordinator hormones in the body for both men and women. It's involved in vitality; it's a precursor to testosterone in both men and women. And I often see, especially in patients, you've got issues with immune homeostasis, that DHEA is too low. So supplementing with DHEA can be helpful. This is something that I generally recommend that you do with a clinician who's knowledgeable because you can overdo it and then produce too much. The other thing to keep in mind with DHEA is that in women, it tends to produce more testosterone. So we like that. But you don't want to do that in a woman with polycystic ovary syndrome who's already got high testosterone, right. In men, it tends to go down the estradiol pathway. So it tends to make more estrogen, more aromatization, which is, you know, increasing the breast tissue, the fatty tissue in the breast for men, most of us don't want that. So you want to be mindful of DHEA. If you get too much of it, you can also have acne, you can have more greasy hair. So we just want to be cautious. But that's an important immunomodulator as is testosterone, as is estrogen and progesterone, especially in women.

Chase: Kind of going back to how he started the conversation with talking to our athletes out there active community. What you just said earlier reminded me of something that I think goes overlooked in this community and I've definitely overlooked it in the past we're training, we're active, we're exercising, we're a go, go, go because it's good for us, right? Whether we're on a strict program or a competitive athlete, or we're just trying to maintain healthy weight, healthy body composition for the long haul but that in and of itself over even just a short period of time is a consistent stress load on the body. So when we're trying to do the right thing here, and being active and exercising is the right thing but we're also causing chronic stress on the body how can we be mindful of this all along the way so that we in fact, are doing the right thing, the best thing supporting our body for the long haul here? I guess what I'm asking is my question is, how can we integrate in almost even I'll say periodized stress management, while in pursuit of our exercise and physical activity?

Dr. Gottfried: Love this question, too. You know, I think what you're talking about is really load management, and also recovery and risk of injury. So the way the way I think about it is genomics are really helpful, because we know that genomics predict about 40% of performance recovery, risk of injury capacity, that's a really key. And what we see is that, you know, for instance, with my NBA players, I've got some players who recover super fast, they recover 20, you know, they're in the first to 25th percentile in terms of recovery. Those the guys who don't need rest days, they don't need the, you know, to be on the bench, the way that kind of the old way that we used to manage the NBA. And then I have other players who need more recovery, they need 24 hours, they need 48 hours. So playing back to back games night after night is not going to get the peak performance out of these players. So I think genomics is one really important piece, but then you want to put it together with real time data. So for instance, your whoop, your I would say the Garmin is also another great way to track recovery, to look at things like heart rate variability, to look at the balance in your autonomic nervous system between fight flight freeze the sympathetic nervous system, the on button versus the rest and digest parasympathetic nervous system, what's the fluid balance between those two? So I think it comes down to looking at cortisol load, as we just talked about with measuring cortisol, looking at genomics and then also looking at wearables, I think that's the best way to assess. And in terms of injury risk, you know, what I see is that, when it's not managed, is that you get more stress fractures, you get more ACL tears, you get more Achilles tendinopathy, you get more shoulder injuries. So all of that is predicted by genomics and I think, you know, these wearables can really help us understand better where you are, in terms of recovery. What have you noticed in terms of recovery?

Chase: Well, I've definitely noticed the more that I track it, the more I actually recover well and I've got two years now over two years now of whoop, data. 3.0 can't wait to get the 4.0 and what I've noticed is that just by simply having a tool, simply having something that gives me feedback, makes me pay more attention overall. I think you could use a lot of different things there. Whether you get a wearable, whether you have you know, an accountability friend, or you know, a coach, just having someone or something to mirror back some kind of assessment of your performance of what you've been doing for how long the peaks in the valleys, so to speak, it just gives you a snapshot, it gives you some kind of just awareness of me, I've been really going hard, or I've been slacking kind of thing. Beyond that, I will say, my HRV has leaps and bounds giving me the most Chase, let's amp it up a little bit, or really let your foot off the gas when I have a really high HRV day and in particular for me personally, I've noticed when I have multiple in a row, like 2-3-4 days in a row, that will just fuel me up, I'm like alright, cool, maybe I'll add an extra day in the gym. Or maybe I'll shoot for that PR. And then when I see it begin to dip, I kind of just it helps me kind of auto regulate, I guess I'll let off the gas a little bit because I want to keep that as high as possible and I want to perform and train and recover as optimally for as long as possible. And I know now that 90% maybe even more than a majority of that is like the balls in my court kind of thing.

Dr. Gottfried: It is the ball is in your court. And I love what you're describing, because that's the ideal, I think to get that feedback every morning and to let it guide you for how hard you go that day. I think you were asking me before, okay, this sounds complicated. It's overwhelming where do we start? I think heart rate variability is really the place to start, you know, just measuring that getting into a habit of measuring each morning, you can do it with a chest strap with, you know, an app, or you can use one of these wearables that we've been talking about. Just starting with heart rate variability, kind of tuning in for yourself, to see where you are with your autonomic nervous system is so helpful in terms of performance and you said a couple things that I want to emphasize. One is, we know that some people athletes especially are not great at discerning their own heart rate variability. So I see this a lot especially in people who train hard and they've got that kind of type A personality they have a hard time with something called interoception you know, kind of that self awareness of what's true. I my interoception is broken, probably because of all the medical training that I did. And so having wearables that give me objective data, like heart rate variability, or on my Garmin body battery, that really helps me understand where I am like in terms of the longitudinal data set, here's where I am, here's how hard I can go. Now another layer that I just want to put in for the women who are listening, is that if you're cycling, it brings in another piece that I think we want to be aware of with personal bests with gains with when to really go for it and hit the gas pedal so we know for women that if you're cycling, it's right around day nine of your cycle, hypothetical 28 days cycle, day nine to day 14 is when you're most suited to go for personal best to go for muscle gains, because that's when estrogen and testosterone hit a peak and progesterone is relatively lower.

Chase: So all your hormones are basically working in your favor for more exertion is that I'm hearing you say?

Dr. Gottfried: exactly right. So whether that's running sprinting, or weightlifting, that's really the time where you want to go for it. So round a nine to day 14, whereas the week before your period, as an example, when progesterone is higher, that's where you want to maintain, that's where you want to just really focus on not so much hitting the gas pedal, but just maintaining what you have.

Chase: Now, you've been mentioning how you work with professional athletes, and so I have to pick your brain on this what are some of these secret sauces of high performance athletes and professional athletes that showing up on time, day in day out and at your best your peak? Almost, you know, six, seven days a week is a part of the job? What is some of this feedback you can share with us here? What are some of the recovery secrets, the go, go, go secrets, the secrets in general for optimal performance that we can apply to our everyday lives?

Dr. Gottfried: Yeah, there's, there are a number of them and, you know, I'm an academic physician. So I was go to the literature first to answer a question like this. Number one is the coach relationship. So, you know, we know that that's key in terms of the most elite performers. The second is actually self awareness. And I think this is a place to dwell a little bit Chase, because I think we could always do better with self awareness. So wearables certainly help with that. But it's also about, you know, what are those decisions you're making about nutrition throughout the day, that's where a third point comes in, which is accountability. What I love about wearables is that it really reinforces accountability. So if we just look at a continuous glucose monitor, as an example, to have that accountability of what happens when you eat a banana, versus what happens when you eat, you know, a salad with a hunk of salmon and some extra virgin olive oil, understanding what happens immediately, in real time with your glucose is a great way to provide that kind of accountability. Wearing some of these other trackers also provided some of my highest performing NBA players they have a team built around this, right? Right. I mean, they've got a team nutritionist, they've got me, they've got, you know, a whole group of people behind them that are working on their fascia and, you know, help coaching them with defense and coaching them with offense, etc. But what really makes a difference is when a player understands that they need to invest in their health, you know, for the NBA, most of these players will go for 20 years, sometimes less LeBron James, maybe it's gonna change that particular duration but LeBron James sleeps about 12 hours a night, right, and he's got a private chef, he's got a private nutritionist, he is making those really careful decisions about nutrition, and what he personally needs all day long. He is not my patient, let me just say that.

Chase: I was gonna say, I heard he spent something like, over a million dollars, or in the millions a year just on nutrition, training, recovery, you know, human performance kind of stuff, which I believe.

Dr. Gottfried: yeah, I've seen that too and it makes sense to me with what I've seen with his performance. And you know, the cool thing is you don't have to spend a million dollars a year you can do good things

Chase: good because I am a little short.

Dr. Gottfried: Right. Yeah, don't have a spare million but you can start with, you know, a simple genetic test, where you're looking at some of these things that are involved with your recovery pathway or looking at your performance pathway. You can start with looking at your nutritional program, are you getting five colors a day? That's one of the key ways that you can prevent micronutrient deficiency. So there are simple things that you can do that cost a lot less than a million dollars to get that peak performance.

Chase: And I'll share just a couple in earlier I apologize. I've looked like I was on my phone I was trying to pull up I but I just got a new phone in my account wasn't there. This at home biomarker test kit that I've used now for about a year is called vessel. Have you heard of them vessel health? It's an at home stick you pee on it. It's like a pregnancy test but for men and women first thing in the morning, and it measures a lot of key biomarkers such as cortisol, vitamin B, vitamin C, they're, I think the seven or nine right now and they're upping it to 12 very soon and I was as you were talking about cortisol is trying to bring up my most recent cortisol test. Something like vessel health and I'll link all this stuff that we've talked about in the show notes for you guys but vessel health is amazing for at home biomarker testing, I literally just yesterday, I think you can still see the sticky right here on my arm, I took off my levels, continuous glucose monitor. Yeah, there we go, I use that two to three times a year and now here's why. All the reasons we've been talking about today just to get a snapshot of my health and get that feedback, but knowing my genomics, my genetics, my pre disposition, I've got diabetics in my family. It's this, what are the tools and ways that we can get a snapshot of our health and why? Because we are constantly I think we should constantly be an n equals one and you don't have to be a walking, talking, you know, plugged up to wires and cables all the time but just little things here and there, such as a continuous glucose monitor a wearable whoop. You know, for me, it's vessel and you know, and urinating on a stick, you know, once a month, or whenever I'm changing something in my diet, these are just little things that I do that we all can do, that provide just a little information on where we need to maintain and where we have room for improvement. And it doesn't take a whole lot to improve. That's my big point here as well, if we just first empower ourselves with information, and then act accordingly, the body wants to get to this homeostasis in all systems and if we just understand where and how first and then apply accordingly, like we can get there. And we can even to our conversation earlier, reverse a lot of the stuff maybe we've been doing incorrectly or not in support of our wellness for the past 10-13 years and what we're understanding now about genetics and genomics moving forward is we can set our 10 year self up in the future way better our 20 years, self 30 yourself, and just be so much better in all in all ways. And so I'm just so grateful for people like you're here to kind of help us understand where and how to look first and how to then act accordingly.

Dr. Gottfried: Well, thank you Chase, I feel like you are an honorary precision medicine physician, because we know that what you measure improves, you know, when you shine a light on things like the analytes that you're getting from your vessel health test, once you measure it, and you know what your baseline is, that then allows you to make these changes so that you don't, for instance, have food stress that can raise your cortisol, you don't have issues with low vitamin C that might be causing a problem with your immune system or how you respond to endurance exercise. So I think you're absolutely right, we got to measure it to make improvements.

Chase: I want to ask you one other question before we get to the final question here. Dr. Gottfried. I'm sure. 

Dr. Gottfried: Sara, please.

Chase: Thank you, Sara. I'm sure there's someone listening who is hesitant to learn anything about their internal health, external health because I've been there on a few things. I don't want to know the truth sometimes, because maybe I have a feeling, I'm going to find out something that I don't like, or I'll be totally transparent here I remember when I went in just a couple months after my father passed away, he passed away from a terminal illness, ALS and I knew it wasn't genetic but I was so scared for months, I put this off, but I knew I needed to do it to go and just to have this neurological test done because sometimes we do find something, sometimes we find a biomarker, or we get something back from our doctor or an at home test, that is cause for concern. Now, I never want that to be a reason why nobody why somebody doesn't, you know, put health back into their power. So for someone listening right now that is maybe hesitant, or is concerned about finding something because of what that might mean, how would you guide them to do so?

Dr. Gottfried: I would say first that the way that I practice precision medicine, there's nothing that I measure that you can't do something about. I think what is the scariest for people is that they think of genetic testing and they think they're going to find out something that is, you know, a death sentence, Alzheimer's disease, whatever and that scares them into inaction meaning that they don't want to know. What I found in my practice is that it's actually the minority of the folks that I see probably less than point 1%, who are feeling like they don't want to proceed, they don't want to know. But 100% of what I do is something that you can do something about. And I think that's the empowering vision that pulls people forward because when you learn about your metabolic health, and you draw a line in the sand, and you know exactly where you are today, that sets you up, to be able to make different decisions all day long, all month long, all year long, so that you can prevent, you know, perhaps a genetic predisposition towards type two diabetes So I think the most encouraging thing I can say is that what to measure improves, getting baseline measurements is really the key to moving forward. Don't wait for your doctor to do it, I think this is the way that we're going to transform our broken healthcare system is by consumer saying, okay, I'm gonna do this at home testing, because I'm just not satisfied with what's on offer from my family doctor. So I think that's really the piece that can move people forward to realize that all of the things that we've talked about today are things that you can change, you can change the arc of your life, just by starting with measurement.

Chase: Truly, truly, love that answer. Thank you so much. And speaking of pulling ourselves forward, that's the whole premise here is we're trying to learn things to live a life ever for to bring awareness into key areas of our life that we can measure and then manage and then optimize. So I'm curious Sara what does that mean to you, you hear those two words ever forward? How does that fall into here today? What does it mean to you to live a life ever forward?

Dr. Gottfried: Ever Forward for me is about legacy. So I am, I'm at an age where, you know, I've got two daughters, I'm really happily married. I've had a career that I really love and I think a big part of me going forward ever forward is to be thinking about how I can most deeply serve the world and the way that I can really act on my mission and serve the world, is to have the best possible metabolism. So it comes back to me to metabolic health, to metabolic flexibility to having that engine to pull me forward, and allow me to deliver on my mission.

Chase: There's never a right or wrong answers, but I always say so much for your interpretation and please, I'm gonna have all of your information on the show notes, of course, but if somebody wants to go somewhere, right now, they want to click down on the show notes. Where can they go to connect with you more, learn more about your work?

Dr. Gottfried: The best place to go is SaraGottfriedmd.com. That's my website. You can also find me on Instagram, Sara Gottfried.

Chase: Amazing. Well, this was great. Thank you so much. I love hearing how a lot of things that I've been doing over the years are on the right path for me and my personal wellness goals. And you've definitely given me some insight on some new things to go check out and no doubt for the audience as well. So thank you.

Dr. Gottfried: You're welcome. Happy to be here.

Chase: For more information on everything you just heard, make sure to check this episode show notes or head to everforwardradio.com