Fresh Take: Gillian Goddard on How Hormones Affect Our Health At All Ages

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0:36Heidi Raykeil:Potential savings will vary. Hello, everyone, and welcome to Fresh Take. From what fresh hell laughing in the face of motherhood, this is Margaret. And this is Amy. Today, we're talking to Dr. Jillian Goddard. She is an endocrinologist and an adjunct assistant professor of medicine at NYU Grossman School of Medicine. Jillian lives in Westchester, New York with her husband and their four children. And she has a new book, which we'll be talking about today. The Hormone Loop, an empowering guide to restoring hormonal harmony from puberty to menopause. Welcome, Jillian. Thank you so much for having me.

1:11Heidi Raykeil:I'm delighted to be here. We're delighted to have you. As they say, we're soaking in it. So we can't wait to find out what's going on. That's right. Let's start by having you tell us, Jillian, about exactly what an endocrinologist is and the work that you do. Yeah, absolutely. So an endocrinologist is a doctor who specializes in all the hormones in the body and the glands that make those hormones. In my day-to-day practice, I see patients for a whole host of different things. But one of the things I see people for most often is I see women in midlife who are struggling with perimenopause and menopause and with weight gain.

1:51You don't say. Doesn't ring any bells around here. Don't worry. Nor for anyone listening, I'm sure. I feel like hormones, like so many things we talk about on the podcast, there's a medical version and a sort of anecdotal version. Oh, my hormones. My husband's so annoying. It must be my hormones. Oh, my teen is slamming the door. His hormones are out of control. So tell us the difference between our anecdotal understanding of hormones and the more medical definition of hormones. Yeah, I think our anecdotal definition of hormones is actually much more limited than the medical definition of hormones.

2:33And what I mean by that is usually when we're talking about hormones anecdotally, we're talking about a handful, half a dozen maybe of reproductive hormones, primarily estrogen, progesterone, testosterone. We actually have dozens of hormones and they control all kinds of things, not just reproduction. And so when I think about hormones, what I'm thinking of is a chemical that is sending a message from one part of the body to another.

3:07Heidi Raykeil:And those hormones control things. I was shocked reading this book. Their hormones control how quickly our heart beats, how quickly our bones release calcium or muscles grow new muscle fibers. I guess I understand when somebody's going through puberty and their growth goes into fast forward that the hormones need to be in control of that starting and I guess stopping at some point. So we're not 10 feet tall. But why do hormones control how quickly our heart beats and how quickly we digest food all the time? Why is that something good for our body to have? A part of our brain that sits sort of at the crossroads of our brain is an area called the hypothalamus.

3:45And the hypothalamus is actually part of the endocrine system. And the job of the hypothalamus is to take in all kinds of information, both internal in our bodies and external information from our environment and help our bodies respond to all of that information. And the reason that's important is so that our bodies can adapt to our situation, to our environment, so that we can respond to threats, so that we can respond to famine, so that we can respond to all the things that our ancient ancestors were exposed to and needed to respond to in order to survive. Obviously, some of those things are less critical now, but they were really critical historically to our survival.

4:38I had an experience when my husband and I were engaged where I was away on a trip, came home and found him in a, what I would say, manic state. I'd never seen anything like it. He had lost probably 20 pounds in the two weeks I was away. He had, there were rippers all over, like he'd been eating all this fast food. It turns out he was diagnosed with something called Graves disease, which is you can explain it better than I can. Some one some hormone goes crazy, basically. And it was a real revelation to me. I always think of hormones. It's like they're doing their thing in the background. Don't worry about them.

5:13And then clearly I saw that when things get off with hormones, this was a person who was having wild physical symptoms, wild mental symptoms. it was like a Dr. Jekyll, Mr. Hyde situation. And it was very frightening. Yeah. I will say he had been diagnosed before. I never mentioned it because he'd been in remission for 13 years. I said, something's terribly wrong. I was freaking out. And he's like, hmm, I think I might be having a Graves disease episode. So talk about the way that hormones can play this outsized role that those of us who haven't interacted or had not interacted with hormonal dysregulation get very suppressed by if you're me.

5:58Yeah, absolutely. So what you're talking about, Graves' disease, is actually an autoimmune process in which our immune system tells our thyroid to pour out thyroid hormone in huge quantities. I like to think of thyroid hormone as sort of the gas pedal in a car. If you have too little thyroid hormone. It's like taking your foot off the gas, everything slows down. But in Graves' disease, you have too much thyroid hormone. So the opposite happens. It's like you've slammed the gas pedal down to the floor of the car and you're hurling forward at huge speeds. And everything speeds up. Your heart rate speeds up, but your alertness speeds up.

6:47People can't sleep when they have Graves' disease. Your metabolism speeds up. People drop weight. They can feel very jittery and anxious. And so you're right. When things are humming along and working normally, when we've got our foot just resting on that gas pedal and we're moving forward at a steady speed, we don't think about these things at all. But when that foot slams down to the floor of the car, I think all of a sudden things can get very out of control very quickly. Our bodies exist in this balance. One of my mentors always talked about endocrinology as being a Goldilocks problem. You don't want too much hormone and you don't want too little.

7:32You want it to be just right. That makes sense.

7:35Heidi Raykeil:I think that brings us to the reason that you wrote this book. I'm going to quote you to you. You say, in my practice, I often see patients who have put off their own debilitating symptoms. And I also see patients who have had their concerns dismissed, probably familiar to a lot of people listening. And it makes me think of this about Margaret's husband and his Graves disease. You can get the treatment you need if somebody believes you that there's something wrong in the first place. But what you were seeing in your practice was too many people, particularly women, being sort of dismissed. Yeah.

8:04I mean, I find that when people have something flagrantly wrong, it does get addressed. So if you are Margaret's husband and you go to the doctor, they are immediately going to jump to and pay attention. But a lot of the hormonal challenges that women face, particularly in midlife, but at lots of different times during women's lives, a lot of those symptoms are much more subtle and they are much less likely to be addressed very proactively. We know that women who have polycystic ovary syndrome or what we now call polyendocrine metabolic ovarian syndrome, it just got renamed in the last few weeks.

8:50We know that those women often spend upwards of two or more years and see three, four, sometimes more doctors before they get a diagnosis. And it's because the symptoms are not always so obvious and there's not an easy blood test to make a diagnosis. I think that some of the reason for this is because historically we've talked about hormones making women hysterical and we've normalized some of the things that women experience throughout their reproductive lives. And we obviously we should not be doing that. That goes back a little to the anecdotal version. Women are too hormonal to be president.

9:32Women are too hormonal. And the idea of being too hormonal is seen as definitive and negative about women. And I do think we internalize this to some degree that I'm like, as I am currently in menopause, being like, everyone back off. I'm a crazy harpy. And that's just to be accepted and there's nothing to be done about it. So how do we start to break out of that mindset? I think the first thing is to arm ourselves with some information about what's happening to us, both from a scientific point of view, by educating ourselves about our hormones and what's really going on, but also from a personal point of view, getting curious about our symptoms and collecting some data on ourselves.

10:25And I think that when we can go in with very objective information about our symptoms, things that we've noticed that we've, I make writing motions because I always think of writing things down, but obviously most of us are texting these things. Information that we've jotted down about ourselves, it's much harder for a physician to look at, I had this many hot flushes. I've been waking up this many times a night. My mood has changed in these specific ways at these specific times. I think it's much harder to ignore cold, hard facts.

11:10Heidi Raykeil:We're talking to Dr. Jillian Goddard. Her new book is called The Hormone Loop. When we come back, we're going to find out what the hormone loop is. So I just did the closet swap, right? I got out all my summer clothes and I immediately thought, huh, a lot of this I didn't really like last summer either. So you know what I did? I headed straight to Quince. Quince offers a wide range of high quality essentials, but without the luxury markup. I just got the linen pajamas from Quince. They are super cute and they look just enough not like pajamas so you can walk the dog in them in the morning, which is amazing.

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14:33Heidi Raykeil:For a limited time, Nutrafol is offering our listeners$10 off your first month's subscription and free shipping when you visit Nutrafol.com and enter promo code LAUGHING. That's Nutrafol.com, spelled N-U-T-R-A-F-O-L.com, promo code LAUGHING. so dr goddard you said that we have four hormone loops that keep us in balance or not so much in balance throughout our lives so explain what a hormone loop is and what these four hormone loops are sure i think the easiest way to conceptualize the hormone loop is to think about two people playing ping pong and i always say i am not one of those people because i'm terrible at playing two good people we just got a ping pong table and i gotta say i'm awesome really i'm doing it all day So Margaret is playing ping pong with someone else who is equally fantastic.

15:25Yes, that would be my son, my 16-year-old. And what you're doing is you're hitting the ball back and forth. But with each stroke, both players are adjusting. They're moving slightly. They're hitting the ball a little bit differently. They're hitting the ball with different force and in different direction in an attempt to keep the ball in play. So I like to think about the players as being the glands. and the ping pong ball as being the hormones in that the glands are adjusting and readjusting based on how much hormone we have circulating at any given time and the inputs through the hypothalamus.

16:05We're adjusting to keep the hormonal system running smoothly in a smooth loop. And our glands respond to all of these things in a very smooth feedback loop, just like you and your son playing ping pong, keeping the ball going stroke after stroke after stroke. We love a good metaphor. That makes a lot of sense to me. Well, and I think what's helpful about it is this idea that our hormone levels are fluctuating and they're supposed to fluctuate within a certain degree in order to appropriately respond to what's going on in our body. A lot of times people think about, you know, or ask about balancing their hormones.

16:51In fact, in the vast majority of situations, our hormones are self-balancing. They are doing what they are supposed to be doing to keep the entire system running smoothly. The four main loops are the reproductive loop, which is the one everyone thinks of when they are thinking of hormones in general. So in women, this is the loop that helps us to ovulate and prepare for pregnancy during our reproductive years. That includes menstruation. Like that's part of that loop. Exactly. Menstruation. It's not just if you have a baby. It's the loop that is happening in your body to say baby could come. Exactly.

17:33And in fact, pregnancy has profound effects on the reproductive loop. It actually shuts down and kind of hijacks the reproductive loop to support the pregnancy. So when we're talking about the reproductive loop, we're actually talking about a woman who is not pregnant. And then we have the thyroid loop. We talked about the thyroid as being the gas pedal for the body. Yes. We have the growth hormone loop, which is actually more important pre-pubertally. So before kids go through puberty, because it stimulates growth in children, adults are not growing, but growth hormone does help maintain blood sugar levels and body composition.

18:13And then we have the adrenal loop and the adrenal loop is our stress loop. This is these are the hormones that we produce in response to, you know, the saber tooth tiger that we need to run away from. The PTA mom coming at us with a clipboard in modern times. Exactly. You don't have to have a saber-toothed tiger. No, you don't. You don't. It's just that we evolved in the setting of the saber-toothed tiger and our body responds to the PTA mom with the clipboard in the same way. Got it. But what's interesting about the adrenal loop is we hear about cortisol colloquially all the time, but we all need cortisol.

18:53And cortisol also maintains our circadian rhythms. It rises and falls throughout the day to make sure that we are awake and sleeping when we're meant to be.

19:03Heidi Raykeil:And then there's also four stages of our reproductive function as women. Puberty, the reproductive years, perimenopause. Menopause. Menopause. And each of them, in turn, they can trigger, this is what I think of when I think of hormones, Those stages, starting menstruation, ending menstruation, can disrupt the adrenal loop, can disrupt the thyroid loop, not just the reproductive loop. So explain to us how that can happen. Yeah, absolutely. So there are times in our lives where our reproductive loop is changing rapidly. So those times are puberty, pregnancy, and then perimenopause, so the years leading up to our last menstrual period.

19:47Those times are times of big shifts in estrogen. And estrogen certainly acts on our uterus, but it also acts on our brain, importantly. We have estrogen receptors all over the place. And so shifting estrogen levels that are dramatically shifting can trigger the thyroid loop to go off the rails. It can affect our immune system. And many, many hormone loop problems are actually because the immune system is attacking our glands. So a lot of thyroid disease comes about because of that. Type 1 diabetes, the type of diabetes that we associate with people getting in the peripubertal years is because of an immune problem.

20:39Lots of problems within the hormone loops come from a misdirection of the immune system because of fluctuating estrogen levels. It strikes me in thinking about these phases and in thinking about my husband and his disease experience that women have built in suffering that is normative in all of these stages in a way that men and boys really don't. I mean, I have sons who've had growing pains, and even that I had to explain to them. I'm like, you've never heard of this thing because it's not something that we really, it's a sitcom from years ago, but it's not really something that's understood, but that I think that one of the things that gets in the way, if my husband loses 20 pounds in two weeks and is suddenly eating 16 meals a day and can't think straight, that's a medical emergency.

21:37If my daughter is experiencing any of the symptoms of starting to menstruate or anything around puberty, it's like, yeah, that's how it goes. Women suffer through puberty, childbirth, perimenopause, and menopause. Sorry. Like that's just part of it for women. But for men, any symptom is considered very serious. And the problem is, is it really shouldn't be that way. Yes. We shouldn't be telling teenage girls that periods should be painful. And the challenge that comes in there, right? So we have, I have a teenager also, she has no frame of reference, right for what a period should feel like. She has no frame of reference for how much bleeding is normal in a period.

22:27As we get older, we develop a little bit of context around our own personal experiences. But one of the things that we do throughout these big changes in the reproductive loop is we normalize women's pain and suffering in a way that is actually quite detrimental to women. One of the things I always say is that no one should be suffering. If you can't go about your daily life, those are symptoms we should be talking about and addressing.

22:57Heidi Raykeil:You say that this book is something that we could bring to our daughters, because I was just thinking when you said that, I've been in the room when a medical provider has asked my daughter about her cycle, and I don't know. I obviously shouldn't have a clear sense of it, but I wouldn't even know if she were being symptomatic in some way. So I feel it's important to bring them this material to understand for themselves, because you might think it's normal to miss two, three days of work a month because that's how it goes. And you need to have somebody on the outside explain to you that no, it isn't.

23:26Heidi Raykeil:Yeah. So tell us a little bit about how this book is something that we can look at with our teenage daughters, maybe even give to them. Yeah. So the whole first section is about puberty. I think even if we've all been through puberty, there is value in understanding the entire reproductive shift over the course of a woman's life. And that does indeed start with puberty. So we do talk about puberty from the very beginning. And I think we give some normative information in that early chapter about what is normal and what types of things should we as mothers and should our pubertal daughters be concerned about?

24:12One of the things I love about pediatricians is that they are taught to give something called anticipatory guidance. And that is you take your child in and they say, these are the things that are coming next for your child over the next months or year, depending on the age of your kid. But adult doctors are not taught to do that. And I see the hormone loop as being that anticipatory guidance for women from puberty all the way through menopause. The other thing that the book does, though, is gives you a little bit of a rubric for how to think about your symptoms and how to talk to your doctor about those symptoms.

24:52And I think that that is as important as anything else. Unfortunately, doctors have 15-ish minutes, if they're lucky, to spend with you for a follow-up visit. And so you really want to, I mean, I want to teach my daughter how to make the most of those 15 minutes so that she can get her needs met. And some of that is around this idea of collecting data on ourselves and going in with some data to talk to the doctor about.

25:23Heidi Raykeil:We're talking to Jillian Goddard about her new book, The Hormone Loop, and we'll be right back.