Change Your Body Weight Set-Point

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Five Tips For Women Over 35 To Breakthrough a Weight Loss Plateau

Have you ever wondered if models and movie stars know weight loss secrets they aren’t sharing?

Studies show that the ability to lose weight is hard for most of us, especially as we age. Most women over 35 have experienced the frustration of a sluggish metabolism.

Plus, dieting can be exhausting. The need for constant discipline, restricting food options, and feeling deprived can kill motivation.  It’s understandable to want a quick fix with a pill or diet plan that promises overnight results. In reality, the challenge with long term weight loss is much deeper.

One thing missing from the weight loss conversation is the connection between the brain to the body.  When we fail to address how our brain impacts our body, it’s a setup for failure because the brain affects not only our weight set point, but our mood, energy, and motivation to succeed.

The research into the brain and body brings hope for women who’ve hit a weight plateau.

 Let’s face it, losing weight is usually a dreadful experience.  After making progress, seeing positive body changes and loving how jeans fit, your body slams on the brakes.

Why does this happen? And what does it take to break through a weight loss plateau?

In this article, you’ll learn how the secret inner workings of the female brain directly influence weight loss. You’ll see how the brain regulates body fat and what you can do when the inevitable plateau comes along.

Key Insights You’ll Discover In This Article:

  1. The brain and body need to communicate with each other for long term weight loss to occur.
  1. Everyone has a weight their brain tries to maintain their body at called your “set-point.”
  1. Comparable to a house thermostat, your brain regulates body weight by a mechanism called the ‘adipostat.’

If you’ve tried to lose weight in the past, only to have it creep back over time, it’s not your fault. Rather, it might be your brain/body set point that is holding you back.

Here’s the good news, Dr. Sara Gottfried has cracked the code on how to reset that “set-point” in the brain. This matters because it can help you lose the extra weight, and keep it off.  Her protocol restores balance to the brain/body and helps you achieve your body weight goals.

Here are five insights based on her scientific protocol you can use to lower your body weight set point:


#1. Insulin is the Gatekeeper of Your Metabolism


No one enjoys feeling hungry, tired, or out of energy.  Typically, these symptoms occur when insulin in our body isn’t functioning well.  Our system becomes imbalanced from stress, improper diet, and a busy lifestyle.

Insulin is a hormone that controls blood sugar.  It affects our mood, thoughts, performance, and storage of fat.  Weight loss is much easier when you balance insulin. It is the gatekeeper of our metabolism. When you get your insulin balanced and functioning properly your well on the way to breaking through a plateau.


# 2.  Regenerate Your Thyroid Gland


A tiny gland in our throat area plays a huge role in many hormone functions throughout the brain and body.  One thyroid hormone in particular; T3 needs to be present as it is one of the keys to helping us lose or gain weight.   T3 has to go through a conversion process from the hormone T4 to do its’ job. The body needs the right nutrients to do this, or the thyroid slows down.

If we eat sugar, junk food, or have a virus affecting the thyroid, etc. our hormone production slows.  The solution? Give the thyroid the right nutrients; two of these are Inositol and Selenium. These are key for the thyroid to release hormones that positively affect our metabolism.  This is a crucial part of lowering the set point for your body.


# 3.  Regulate Cortisol by Controlling Stress


It’s no secret that stress causes inflammation, which causes an array of health problems.  Has your face ever looked a little puffy, joints ever felt stiff or brain felt foggy? That’s inflammation. It creates havoc in our brain and body.  We can’t see the tightening of our arteries, bad bacteria in our gut, or hormones that are imbalanced but after 35 we begin to feel it.

We have found two key nutrients that can help lower stress.  They work around the clock to improve the situation – Omega-3 Fatty Acids and Rhodiola.   They have the power to reduce stress both mentally and in the body. There isn’t a prescription medication available that can do that without adding a long list of side effects.

Omega-3 Fatty Acids reduce inflammation and improves our cardiovascular health.  This lowers rates of heart disease, dementia, arthritis, and depression. The body cannot make Omega-3 by itself, so we need it in food or a supplement.  It aids weight loss and improves brain function as it goes straight to the source.

Rhodiola regulates cortisol, mental stress, and relieves burnout.  It’s demonstrated an ability to reduce both anxiety and fatigue in as little as three days.  Plus, it’s an adaptogenic herb that will work with your body to aid whatever hormone is lacking.  Both nutrients are excellent options for anyone who has stress in their lives!


#4. Vitamin D Actually “Does a Body Good”


Vitamin D plays a vital role in hormonal regulation.  Low levels contribute to slow thyroid function and other hormone disruptions.  It aids the absorption of calcium and minerals that boost our immune system and supports bone and teeth health.

Vitamin D is also key to maintaining a harmonious body and brain connection.  Most vitamins and nutrients can’t absorb in the body without another to help out.  Everything interconnects between our brain and body; no cell operates in isolation.

An example is Calcium and Vitamin D, too much calcium without Vitamin D hinders absorption.  The end result is that we get calcium clogging our arteries!

Vitamin D also helps with correcting set point weight, allowing the thyroid to release hormones.  This will happen when you ingest the nutrients that Dr. Sara recommends and follow the 40 day protocol she outlines in Brain Body Diet.


#5. Green Tea Polyphenols – The Best in the West (and East)




Green tea polyphenols are well known for their history of fat burning properties. They also get our system up to speed in other beneficial ways too.  Green tea has very unique health benefits by improving your microbiome (intestinal bacteria balance).

Make no mistake, the right combination of nutrients can reset your brain and body.  

Unfortunately, even with a diet rich in whole foods, it’s almost impossible to get all the nutrients your brain/body needs.  It’s why Dr. Sara created SET POINT, a daily supplement pack containing the essential brain/body vitamins to help improve brain function and lower body weight set point.

Your medical doctor can prescribe a variety of medications, but you don’t need a prescription to take SET POINT. For the first time, you can get all the brain/body balancing supplements you need in one daily packet.

It’s clear you need a balanced brain/body system or you’ll continue to struggle. A solution to your stalled progress is closer than ever before. You don’t have to wait any longer to reset your brain/body, try SET POINT for thirty days and experience the effects yourself.

Not sure you’re ready for SET POINT – take the quiz to find out your Brain Body Score and discover if you might have brain related weight issues:

Try the new SET POINT system risk-free. For a limited time, when you buy SET POINT, you can get Dr. Sara’s newest book Brain Body Diet free (saving $29).

Connect With Dr. Sara Gottfried MD

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Follow Along With The Transcript


[KATHY SMITH]: Sara, welcome to the show. 

[SARA GOTTFRIED]: Thanks, Kathy. I’m happy to be here. 

[KATHY SMITH]: Yeah, it’s always great. So, let me ask you. As I was researching for the show and finding about the brain-body connection, you talk about how when women come to your office, they usually come for some kind of symptom they’re having. But typically, it goes back to this body set point, which you talk a lot about and I want to get into. Because I don’t think I fully understand it. So, can you just delve into that?

[SARA GOTTFRIED]: Sure. There are a lot of reasons women come to see me. One is weight loss. Another is anxiety, depression, “My hormones are a mess. Can you help me with that?” When it comes to body weight set point, the technical term for it is adipostat. But really it works, Kathy, like a temperature gauge, like a thermostat. But instead of regulating the temperature, it’s regulating how much fat mass you have in your body. And the way that it kind of dials it up and down is with your behaviors and with your hormones, that control your behaviors.

[KATHY SMITH]: So, your behaviors– we’ve talked about this so much on the show already, but I’m assuming it has to do with exercise, what you’re eating. But do genetics and do aging play a role in it?

[SARA GOTTFRIED]: Well, aging plays a role in the sense that your adipostat can become dysfunctional. So, it cannot work as well as it did maybe in your 20s or when you were younger. So, in that sense, yes, aging definitely plays a role. 

The other issue is – we know less about this – but some toxins can make it less functional. Another consideration is that the amount that you’ve pushed your adipostat with chronic dieting, especially yo-yo dieting, that can also cause it to be dysfunctional. 


So, there are a few different threads here that are involved with the control of the adipostat. And then, in terms of your behaviors, the main behavior that it controls is– well, two main behaviors. The first is your hormones that are involved with your appetite. So, that includes ghrelin, which is the hormone that tells you to pick up a fork, because you’re hungry. And also, the hormone, leptin, which is involved in telling you to put the fork down. 

The other piece that it’s involved in is how fast or slow you burn calories. So, that’s involved in your metabolism as well as whether you are burning fat or storing fat.

[KATHY SMITH]: So, then, is it possible to change our body weight set point?

[SARA GOTTFRIED]: It is. I remember the last time I saw you in person was probably– I think it was February 2018 – something like that. And when I saw you, I was probably about 20 pounds heavier than I am now. And so, when you’re able to lose weight, when you’re able to lose fat and maintain it for some period of time – that’s defined arbitrarily as about a year or longer – that’s a change in your set point. 

So, it’s definitely possible. I think there are a lot of women over the age of 40 who believe that it’s just not possible. They just kind of give up and say, “Okay. I’m just going to buy fat clothes. I’m going to just surrender myself to this process.” 

And I want to encourage those people to say, “Hey, you can still change your set point.”

So, even me, at age 50, was able to change my set point. And if I can do it, you can do it. 


[KATHY SMITH]: Well, it’s interesting that you say that, because I remember the talk you were giving here at the hospital. And I remember you talk about your grandmother; you talk about your genetics. And as we were talking, walking before the event, we talked about the differences in what you can eat. Can I eat oatmeal? Can you eat oatmeal? Can I have sugar in my diet if I’m exercising a lot or not? 

A lot of these variables, you were already noticing, you were already looking at. So, what changed in that? What was the difference in your life that got you to drop those 20 pounds? And by the way, you looked great then, but you look fabulous now. 

[SARA GOTTFRIED]: Thank you. You look consistently amazing. I think you’ve had the same body set point for the entire time I’m known you, including I used to watch your videos a while ago. 

Well, there are a few things that have changed. And you spoke to it a bit there. Because I remember you and I were at a chocolate shop that you took me to. And we were talking about how much sugar can you have in your dark chocolate? And I was saying, “I need 100% cacao. I need 95% cacao. I just can’t tolerate the sugar.” Because when I saw you in 2018, I had pre-diabetes. And one thing that’s important to know about pre-diabetes is that somewhere around 80% of people with pre-diabetes don’t know they have it. 

I knew it because I’m a physician and I like to track these things. But the hints, the sort of things that told me that I had an issue included my fasting blood sugar, which was elevated. I had a hemoglobin A1C that was not in the pre-diabetes range but just below it. And I also did a two-hour glucose challenge test that was not ideal. I had a high fasting insulin. 


So, all of those things were happening behind the scenes when I saw you in 2018. And what I decided to do was to develop a well formulated ketogenic diet so that I could really change the insulin and glucose response in my body. So, we could definitely talk about that. This is the topic of my next book. But I think it’s important to realize that about 60% of your cognitive function, as you get older, is related to your insulin and how well it’s working. So, this is an incredibly important hormone, not just for vanity’s sake in terms of how we look in our clothes. But also, for sanity.

[KATHY SMITH]: Yeah, to keep the memory and the mind sharp and not just memory, but the cognitive function, what I noticed, of just being able to multitask, get projects done, stay on task. Those sorts of things, I’m noticing with different people in my age range, those are shifting. And the other thing I notice is that women that are lean are telling me that they are pre-diabetic. They’re proud of the fact that they’ve been vegan or vegetarian or all plants or lots of plants, and now, they’re having some issues. So, I saw one of your blog posts. I want to talk about this, because I want to decide whether I should be doing this or our listeners should be doing this. 

You have a glucose monitor; you have different brands that you like. But you use it throughout the day to monitor glucose. And I think you also– the other thing, I want to join these two topics – cortisol. Because what I notice for myself is cortisol hits with speaking, with traveling, with being stressed out – how cortisol impacts glucose– if we should be monitoring this. And tell us, is it easy to do now? I know in the old days, it was hard to do. But it sounds like there are monitors now where you can just buy yourself a Christmas present and start monitoring your glucose in 2021.


[SARA GOTTFRIED]: That’s right. It costs about $20 to buy a standard glucose meter. It’s the type of small meter that a diabetic uses. But we’re not using it for that purpose. We’re using it to really define our own health and to have a target in terms of improving health over time. So, I use, every morning, my glucose meter. And I also use a keto meter. So, I can talk a little bit about brands if you want that, but I’ve found those to be very helpful. 

Now, I’ve been using those for a long time, and I especially noticed that point that you just made – that when I’m stressed, when I’m traveling, when I don’t sleep well, it does a couple of things. I know that my cortisol is high, because I’ve tracked that pattern in my blood and urine and saliva for a long time. But it also raises my glucose. And it makes me hungrier. So, that’s a pattern that we see very commonly. And it becomes more of an issue especially as we age. 

So, we know overall, somewhere around 34% of people have pre-diabetes. It rises to about 45% or higher once you get over the age of 65. The other advance that I think is really important to know about is the continuous glucose monitor. I think that’s, maybe, what you’re speaking to. I wear a continuous glucose monitor most of the time because I’m doing constant experiments. And I have a lot of patients that wear them too. Not for the purpose of diabetes (which is why it was developed) but for the purpose of really understanding what it is that food is doing to your glucose. 


I can give you some examples here, because at the time that I saw you, I remember we went out and had a meal together. And I can’t remember exactly what was in the salad that we ate, but I remember talking to you about sweet potatoes and beans and some other things like that. And what I learned once I started wearing a continuous glucose monitor, which was about two years ago, is that beans, garbanzo beans, all types of legumes, oatmeal, sweet potatoes, all of these things cause a spike in my blood sugar. And so, they increase inflammation. They make me store fat. And I just don’t have a normal response to them. 

So, I had to cut some of those things out of my diet. And when I did, when I went on this well-formulated ketogenic diet, it just made my glucose very steady. And it helped me with mental clarity, with focus. But it also made me burn fat, which was a lovely side effect.

[KATHY SMITH]: I t’s so interesting – the personalized medicine here – because I have the exact opposite of you. I went on a more of a time-restricted approach. And I still am. I want to talk about that. But I went to kind of extremes – not intentionally. I remember you saying maybe a 13-hour window. I want to go into windows again. But I was extending it to, like, 16 hours just out of, “Oh, my gosh. I have an interview, and I haven’t eaten yet, and it’s now two hours later.” And now, it’s 1:00 in the afternoon. I haven’t eaten, and now, I go and eat. And then, I eat, eat, eat, eat. And I eat in that other window, but I eat a lot. And then, it’s like, “Fat’s good. I’ve got my window, and I can eat whatever I want, because I’m in my window.”


Now, guess what? I am starting to put on– yeah, Kathy Smith’s starting to put on some weight around my belly. And I started noticing– I told Paige, who works for me, I said, “If I haven’t eaten by 11:00, you hang up the phone and tell me to eat something,” because I noticed I was getting like – not cranky, not like hangry. It was just decision-making wasn’t quite as great by noon, let’s say.

So, my thing is I went back, then, to my oatmeal to everything you just said: oatmeal, the garbanzo beans, things like that. All of a sudden, weight drops off. I feel like I’m in my zone. But I also feel, for me, it’s a balance. I also know if I’m exercising more, if I’m doing a hard cardio, if I’m going for a long hike, some of those complex carbs are good. If I’m going to be sitting all day, maybe not. But isn’t it interesting the different responses?

[SARA GOTTFRIED]: Yeah. You’ve put your finger on something so important, which is we’ve had, the past 50 to 100 years, medicine of this one-size-fits-all approach where we try to find the diet that is the best for everyone. And the best we could come up with is the Mediterranean diet. I still think that’s the architype of a low inflammatory, anti-inflammatory diet. But the truth is, for someone like me and patients who are like me, the Mediterranean diet makes me gain weight. 

Now, with your experience with trying time-restricted feeding, I don’t know exactly what was going on. It would be interesting to look at a continuous glucose monitor while you’re going through time-restricted feeding versus your usual way of eating to see if there’s a difference in your average glucose and the standard deviation of your average glucose. But for some people, time-restricted feeding can cause more of a stress response. And I think about stress response not just in terms of its effect on raising blood sugar, but it also can make you deposit belly fat. 


So, we’re in the era of personalization. We’re in the era of better predictability. Knowing, based on not just your genetics, but how your genetics interact with the environment such as the oatmeal that you eat so that we understand what your individual response is. And then, we can make kind of a tailored protocol so that we can achieve whatever health goals you have. 

So, I think that era of precision and precise medicine is really important. And, here, we’re talking mostly about precision nutrition. But I think this is a much more effective strategy than saying, “Okay, everyone should have oatmeal for breakfast.” Because we know that that doesn’t work across the board. 

[KATHY SMITH]: It doesn’t work at all. We’ve touched on a few subjects that I want to loop back around. Because that’s kind of my personality. I bounce around a little too much. So, some things I want to make sure we talk about is you’ve said, “A healthy ketogenic approach.” That’s kind of the basis of your new book. I want to touch on that. I really want to touch on – because we get so many questions on time-restricted eating and your thoughts and the plusses of time-restricted eating and, for women, what is the window? 

And then, what was the last thing? The last thing that we kind of talked about was this idea that how all of these things we’re talking about impact your brain. And I’d love for you to comment on this questionnaire you have in your book – the 18 questions – to see if your lifestyle is impacting your brain. So, a healthy ketogenic diet as well as a time-restricted eating and the 18 questions. Now, it’s your show.


[SARA GOTTFRIED]: In some ways, I feel like a ketogenic diet is– we have to define what I mean by that. Because a lot of people think keto is you go to In-N-Out Burger, and you get a burger wrapped in lettuce. And that’s not what I’m talking about. So, the ketogenic diet was initially developed for epilepsy. There are a lot of other clinical reasons to do it now. There’s a trial, for instance, looking at Alzheimer’s disease. I think you’ve had Dale Bredesen on your show. There are a lot of different reasons to go on a ketogenic diet. 

The problem is the classic ketogenic diet, which is 70% fat, 20% protein, and 10% carbs, that may not be enough carbohydrates, especially for women. So, the 10% carbs, which translates typically as 20 – 50 grams of carbs per day. I know you know that’s just not very many carbs. The problem with that is it’s probably not sufficient to feed the good microbes in your gut. And we know that health rests on healthy diversity, a healthy number of microbes. And if you start to limit them by not feeding them prebiotic fiber, which usually comes from your vegetables as well as some fruits, then you may starve off some of those protective benevolent microbes. 

So, we don’t want to do that. I really believe that you have to have a well-formulated ketogenic diet. And here, I’ll just be super transparent with you, Kathy. I tried a ketogenic diet twice before I was able to succeed. I tried it for the first time in 2016. I did it with my husband. He lost, like, 20 pounds in a short amount of time – two months or something like that. I gained a couple of pounds. 


And I think part of the problem then was that I wasn’t tracking the macronutrients. And so, I did it again, tracking better. But then, I restricted carbs too much. And I found that even with kind of that initial boost in energy that a lot of people get because ketones are feeding the brain, what happened for me was that I just kind of crashed after a few weeks. I just didn’t have the energy that I needed for a big life. 

And I think part of the problem there– I also didn’t lose weight– was that I was eating too much fat – too much fat for me. So, this is where we want to personalize. We want to dial it in and get it right. So, I developed a protocol for using net carbs that I could really get my patients to eat the carbs that they need to feed those benevolent bacteria. And that, I found to be very effective. 

So, we’re tracking fasting glucose. We’re looking at ketones to make sure that you’re in ketosis – blood ketones. And in some of these patients, I also have a continuous glucose monitor.

[KATHY SMITH]: Before we jump off that topic– because you mentioned brands. I think everybody listening, including myself, if you feel comfortable, can you give us a– if I want to go on tonight and order these things, which brands would you suggest? Or do you not feel comfortable?

[SARA GOTTFRIED]: No, that’s fine. I use a Keto-Mojo. And I have no affiliation with any of these brands. Keto-Mojo is great because you can get both glucose and you can also get ketones. So, one device, you can get both of those measures. Some of the Keto-Mojo also gives you hemoglobin and hematocrit, and I like that if someone is still menstruating. One Touch also does both ketones and fasting glucose. That’s what I used back in 2016. I like the Keto-Mojo now. 


For continuous glucose monitoring, there are a couple of ways to get them without prescription. We can talk about that if you’d like. But the devices that I have the most experience with– well it’s one brand, and that’s Abbott Freestyle Libre. Some of my friends really like the DexCom, but I don’t have experience with DexCom. And then, the third company is Medtronic’s. 

[KATHY SMITH]: Okay. So, we’ll have all of that in the liner notes so that everybody can pick them up if they want to. I really am going to make this my 2021 vision – new lifestyle approach. Because I do think with aging, brain function, the glucose factor here is so important. So, let’s jump into time-restricted eating and then, let’s get to your questionnaire. Because I want to hear about this questionnaire. But time-restricted eating, where do you stand right now on the length of time you think that people should be doing their fasting and their feeding?

[SARA GOTTFRIED]: That’s a great question, and I would say that window has changed over time. When I first started doing time-restricted feeding, I did a 16/8 protocol. So, a 16-hour overnight fast, eight-hour eating window. And I think the conversation that you and I had was that there is some data to suggest that may be too stressful for some people, especially women. Whenever we compare men and women, when it comes to diets or time-restricted feeding, we know that men tend to have an advantage. I hate to admit that, but it’s true. It’s probably related to testosterone. 

So, testosterone just builds muscle. It helps you lose weight a little more rapidly. It helps you burn fat. And men have about 10 times as much as women do. Women still have it, and it’s incredibly important for us. I would also say we’re exquisitely sensitive to it. 


But back to intermittent fasting, what I love about intermittent fasting is that it’s so doable. Back in the days when caloric restriction was popular before it got disproven as an approach – back in the 90s and the early 2000s – what I found was that very few of my patients were successful. They just couldn’t sustain it. And the reason they couldn’t sustain caloric restriction, where you cut down to, say, 1,200 calories a day is that after a few– 10 days or a few weeks– the adipostat would kick in. And the brain would say– the adipostat is in the hypothalamus of the brain– it would say to the rest of the body, “Listen, she’s restricting calories. Let’s make her super hungry. Let’s increase those hunger hormones, and let’s conserve energy and slow down metabolism. So, that’s another example of how the adipostat works. 

So, very few of my patients were successful with caloric restriction. Somewhere in the range of, like, 5% to 10% long term. But 90% to 95% of my patients can do intermittent fasting. So, it’s very doable. There are some people who have reactive hypoglycemia and have to be very careful about doing intermittent fasting. Some of my patients with more severe – it’s called adrenal fatigue; I don’t like that term – Hypothalamic–Pituitary–Adrenal Axis issues, those are the people I like to put a continuous glucose monitor in. But otherwise, a lot of people can do it. 

So, what do you do if 16/8 is too stressful? And it sounds like it may have been for you. I don’t know for sure. I’d have to look at the rest of your biomarkers. But what we know from the work of Valter Longo and also Barbara Patterson at the University of California in San Diego is that shorter windows are still very effective to achieve our goals, to improve health span – that period of time that you feel fantastic – to help with weight loss, to help reset insulin, which is so important in terms of fat burning, with a lot of other goals – turning white fat beige, with increasing thermogenesis, etc.


What Barbara Patterson found, for instance, in a study of women with breast cancer (early-stage breast cancer), she found that a 13-hour overnight fast was effective at reducing the risk of recurrence. So, this did not get a lot of media attention. I mention it in the book. But it’s a really important study to know about, because a lot of people who are breast cancer survivors– and I happen to have a lot of them in my family– they look to the drugs to help them with decreasing recurrence. And here’s this tool of intermittent fasting that could be very effective for them. 

You also have to pay attention to what to eat in that eating window. But what she asked her participants to do was to have an overnight fast of 14 hours. And she defined if very strictly, meaning that if you have black coffee in the morning, that breaks the fast. So, not everyone looks at intermittent fasting from a research perspective that way. But that’s how she defined it. And that’s what I use with my patients.

[KATHY SMITH]: So, for you, it’s water only?

[SARA GOTTFRIED]: Water only, because–

[KATHY SMITH]: What I’m saying is no water with lemon, green tea, none of that? Just water, correct?

[SARA GOTTFRIED]: That’s right. It could be warm water. It could be cold water. What we know is that even non-caloric phytonutrients like the squeeze of lemon that my great-grandmother used to put in her water every morning, those have effects on the body. So, I think even if it doesn’t have calories, it can change the metabolism. It can change the biochemistry. So, I like to define it very strictly.


[KATHY SMITH]: Okay. But, Sara, here’s one thing that I’ve wondered about. You talk about tests and research on men and then, on women – the differences. Then, it’s the differences between young and old. And what I was wondering is that I see so many– as we know keto got very popularized recently by the biohackers and typically young males that were trying to get cut for their looking good and for health reasons, all of that. But what I notice, and I don’t know if there’s very much research on this, if I want to maintain every shred of muscle that I can on this body– so every year that I get older, I notice that maintaining muscle, building and maintaining muscle gets harder and harder. I’m going to be turning 70 next year, and with that, I can say muscles are my best friend. And sometimes, that’s when I feel if I go too long, I probably am not feeding properly during the feeding time. But I just feel like I start to atrophy slightly. Not a lot but slightly. Is there any evidence one way or the other?

[SARA GOTTFRIED]: Yeah. Really important questions. The way that I would answer that is to look at your muscle mass while you’re intermittently fasting. We could track your muscle mass. I think some of the devices that you can get on Amazon are actually pretty good not for the absolute values but in terms of tracking your fat mass and your muscle mass and to look for trends over time. All of my patients that go on this new ketogenic protocol, they’re using a blue tooth device with bioimpedance to measure their body composition. 


And I would say the same thing is true for you, because I agree, we want to hang on to every muscle fiber that we have. And if we could even build it as we get older, even after 70, then that’s one of the best things you can do for health span and for longevity. I know you know that.

It’s possible that you could have had some muscle loss related to intermittent fasting. And if you look at the research– you know I’m a total nerd. If you look at the research, and we have a nerd moment here just very briefly, some of the work that came out of the University of Illinois shows that alternate day fasting may be better for post-menopausal women in terms of that muscle mass issue. And so, that’s an interesting way to consider this. Maybe it’s not intermittent fasting each day. Maybe it’s alternate day fasting that works better. 

[KATHY SMITH]: Yeah, I think intuitively, I’ve come to that conclusion – that that’s probably what works best for me. So, I want to get– because I know I don’t have you for much more time. I can’t wait until your new book comes out. But can we talk about– just get back to everything we’ve talked about so far and pull it back up to the brain? Because the brain-body connection is all about all these things that we talk about: how it effects our belly fat, it effects our energy. But at the end of the day, it effects our brain but also our brain is affecting some of the things we’re talking about. So, can you, kind of, close the loop on that?

[SARA GOTTFRIED]: Sure. It’s a bidirectional conversation. And I think what’s important to realize with the brain and the through line of everything that we’ve discussed so far today is that the way that the body is behaving – is talking to the brain – and the way that the brain is behaving and functioning is talking to the rest of the body. So, I’ll give you a couple of examples.


We talked about insulin. And one of the things we know– and I’m going to go a little slower here because I think this is so important for women over the age of 40. One of the things we know from the work of Lisa Mosconi at the Weill Cornell Center– she runs the Women’s Brain Initiative at Cornell– what we know from her is that about 80% of women over the age of 40 have this slowdown that occurs in their brain. The technical term is cerebral hypometabolism. But when I talk about this to patients, when I talk about there’s this problem that starts to happen where the brain just doesn’t utilize glucose the way that it once did and it can show up as hot flashes, night sweats. It can show up as anomia, where you can’t find that word that’s on the tip of your tongue, and so, you pick the second-best word. It can show up as sleep difficulty. It can show up as brain fog. 

What I find in my practice is that 80% of women will say, “That’s me. I definitely have that.” So, I think this is a really important piece to understand. That there’s this cerebral hypometabolism that occurs in about 80% of women over the age of 40. And we don’t know the details of it, but we think it’s related to mitochondria – those organelles inside of cells that serve as kind of a power factory. And it’s also related to insulin and glucose.

So, the better that you can manage your glucose and your insulin, the better that your metabolism in your brain is going to work. And fortunately, the better the metabolism in the rest of your body is going to work. So, I think that’s a really important piece to know about. 


Another related piece is that the very same enzyme that breaks down insulin also breaks down amyloid beta, So, amyloid beta is that potentially toxic compound that can build up in the brain. It’s not sufficient for the development of Alzheimer’s disease, but it’s necessary for the development of Alzheimer’s disease. 

So, if you have the kind of body like I did two years ago where my poor insulin was getting broken down because I was so high – because I had insulin block or insulin resistance – because I was so high in my blood, this enzyme was working all the time at breaking down my insulin. And it probably didn’t have as much time or ability to break down amyloid beta. 

So, these kinds of connections, I think, are really important. They’re just starting to emerge. This is relatively new just in the past few years. But I think the important piece to take away is that if you can really pay attention to your insulin and glucose or just focus on your glucose like you suggested you might do in 2021, honestly, that is your retirement account. That is the most important investment you can make in your health. If there’s one take away today, I would say pay attention to your glucose. Aim for a fasting glucose between 70 and 85. Aim for a hemoglobin A1C that’s less than 5%. Maybe get a continuous glucose monitor if you don’t hit those numbers so that we can see what’s going on and how you respond to food and you can get that immediate feedback.

[KATHY SMITH]: That one change could completely turn around your health. I agree. And along with that, the other change is picking up the brain/body connection. And before I go – because I’ve already asked you a few times now – you have to tell me. There are 18 questions that you have people answer, and that tells them where they are on the spectrum of health. Give me some feedback on that.


[SARA GOTTFRIED]: Well, I have a number of questionnaires in this book. I’ve got a questionnaire related to toxins. Each chapter starts with a questionnaire just to guide people to see if this is an issue that they need to pay attention to. I think the questionnaire that you’re speaking to– I’ve got the book right here in front of me. 

[KATHY SMITH]: It really is the one where you have to answer– I’ve gone through the book, by the way, a couple of times. I love this book. And we haven’t even hit on the chapters, honestly, that I love the most. Because it’s a big thing in my world. You mention it. We don’t have time to go into it. But it’s toxins and the impact that they have, the impact that stress has, the impact of sleep. And this idea that when you have– we always talk about leaky gut but, then, this kind of leaky maybe brain type of syndrome. And it is fascinating. And each time I pick a book– I have your books around and I read them. Like, I’ll pick up a chapter. I don’t have to read them cover to cover necessarily. There will be something right now that interests me and I’ll go to the toxin chapter. But it is fascinating. So, I keep going back to them. 

Anyway, I do like the way the book is structured and laid out, so I recommend to everybody to pick it up as a gift to themselves for 2021. And then, give a quick plug for your book, please. Because I can’t wait to get that one.

[SARA GOTTFRIED]: The new book is called Women, Food, and Hormones. And it’s about the way that your food talks to your hormones, and then, your hormones talk to your food. It’s all about fat loss, and it’s about this protocol – a four-week protocol – with a well-formulated ketogenic diet. 

[KATHY SMITH]: I can’t wait. So, you’re saying fall of next year? Is that what we’re hoping for?

[SARA GOTTFRIED]: Fall of 2021, yeah.


[KATHY SMITH]: Okay, perfect. Well, I hope we can get you out here one of these days and we can all travel – skiing, hiking, whatever. Miss seeing you. And once again, you look fabulous. I think that you going through this journey has just given you such insights that people go through. But just the fact that you know everything you know, and obviously, I think you’re the smartest woman on the planet. I love you to death. And yet, this is the type of thing that knowing and doing are two different things, and then, you find that one piece of the puzzle that kind of helps connect it all, which just sounds like that’s what happened with you.

[SARA GOTTFRIED]: That’s very true. I joke sometimes that I’ve had almost every hormone imbalance that a woman can have. And I’m grateful for that. I feel like it’s guided me to have not only a level of empathy for my patients and what they’re going through and never dismiss any symptom that I hear about. But it also has helped me really understand what some of the gaps are in the science so that we can address them. 

It just breaks my heart when I hear of a woman who’s trying to lose weight and feels like she’s tried everything, and nothing seems to work. Because chances are, her hormones have not been addressed. And the way that the food is talking to the hormones have not been addressed. So, that’s what I hope to address with this new book.

[KATHY SMITH]: Okay. Well, from one yogi to another, namaste. Have a great holiday and 2021. I look forward to seeing you soon. 

[SARA GOTTFRIED]: Thank you so much, Kathy.

[KATHY SMITH]: Bye, Sara. It was such a pleasure having Sara on the show today. My big take away is that it’s important to reclaim your health now. Because unlike other of life’s challenges, it’s harder and harder to bounce back after going through diminishing health and vitality. So, if you’re curious about whether your weight issues are brain driven, you might want to take the 18-question test in Sara Gottfried’s Brain Body guide book. 


I love the way that the book is laid out and its structure. It not only informs you about why your body might be working against your best self, but it also helps you identify where you are on the spectrum of wellness. It gives you basic protocols for improvement and then, tops it all off with actual recipes that will help you get to where you want to go. 

You can find out more about Sara on her website, which is You can also just check out her Instagram, which I love following, because she’s got so many amazing posts. 

And by the way, remember you can join me for a workout anywhere in the world with Fit over 40. It’s a free program that includes 40 days of workouts from walking to HIIT training, from bar to ab routines and so much more. Plus, there’s a private Facebook group with over 50,000 encouraging members who are doing the challenge with you. And they give you inspiration and help you keep accountable if you want to reach your goal. So, just go to to join.

If you enjoyed this podcast, don’t forget there are dozens more you might want to check out in the archives. If you’re interested in learning how to reverse brain aging, then you’ll want to check out Dr. Amen’s show, which was episode 25. How about discovering why testosterone is so important? Well, you might enjoy Dr. Tami’s conversation in episode 24. Or if you want to find out how a woman unlocked her son from autism, then listen to Susan Levin’s interview in episode 26.

You can listen to them all at This podcast is available wherever you listen. So, search it on The Art of Living with Kathy Smith on Apple Podcast, Stitcher, or Spotify. You’re going to find all the other episodes. So, until next time, love you all. Here’s to your health.