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Scientist separating blood to test hormone balance in woman

Dr. Sara Gottfried: How To Feel Younger, And Live Stronger And Longer

Dr. Sara Gottfried uses evidence-based medical data, functional medicine and natural hormone balancing strategies in her practice to help women lose weight, detoxify, and slow down aging.

Scientifically reviewed by Dr. Gary Gonzalez, MD, in August 2023. Written by: Kyle Roderick.

Sara Gottfried, MD
Sara Gottfried, MD

Sara Gottfried, MD, is a board-certified gynecologist and a graduate of Harvard Medical School and MIT.

Based in Berkeley, Calif., Dr. Gottfried uses evidence-based medical data, functional medicine and natural hormone balancing strategies in her practice to help women lose weight, detoxify, and slow down aging.

The author of the New York Times bestsellers The Hormone Cure and The Hormone Reset Diet, Dr. Gottfried published her latest book, Younger: A Breakthrough Program to Reset Your Genes, Reverse Aging & Turn Back the Clock 10 Years in March 2017.

The following is a recent interview with Dr. Gottfried at her medical office.

genetic testing  

LE: The relatively affordable price of genetic testing is opening up new opportunities for the way women think about their health and how they care for their bodies. Many are getting their genes mapped. How do women find doctors who can understand this information and work with them to devise strategies that will help them feel optimally healthy and younger?

SG: I agree that finding a collaborative functional medicine doctor—who can perform root-cause analysis and look at the whole picture, from DNA to the entire body—is important, but I also believe we need to start with the basics of what are the most important seven genes to know and what can be changed with health strategies that address them (i.e., epigenetics). My new book, Younger, cites these genes and provides a foundation for women to learn evidence-based and specific directions to counter the aging process that begins in the muscles and skin, as well as to reduce stress at a molecular level, sleep better, and feel younger.

Functional medicine is an increasingly popular and holistic system of medicine that engages the whole person, not just an isolated set of symptoms, and works from the inside out to address the root cause of disease and accelerated aging. Most of the root causes for health problems stem from a lack of nutrients, movement, sleep, and mindset. Each of these impacts the body’s natural aging process. By looking at both genetics and lifestyle, I gain insights about changes that will reduce or eliminate chronic or recurring symptoms. Only 10% of a given disease is caused by your genes, while 90% is caused by environmental factors, including the environment you create with your lifestyle choices. I call this the 90/10 rule: Genetics loads the gun, and the environment pulls the trigger.

LE: What are some common health problems that you see in your practice?

SG: Fast aging is the biggest health problem that I see in my practice and with the people I work with online. It’s the elephant in the room that no one is talking about, yet most of it is modifiable with small lifestyle tweaks. For starters, I created the Healthspan Quiz to help determine the rate at which you are aging and set your baseline for calculating improvement. This quiz is online at

The Healthspan Score gives you a baseline measurement of the most important factors determining your rate of aging: demographics, lifestyle, stress, exposures, medical and family history, antioxidant status, connectedness, and brain function. These measurements indicate how your genes are performing. Every one of them affects your genetic expression and helps highlight, even prioritize, the functional medicine solution. Each measurement reflects a key aspect of aging, from disease risk to oxidative stress, and therein suggests where you need the most help.

Since mapping the human genome, scientists developed an important complementary concept called the exposome—the sum of all exposures in an individual over a lifetime from diet, lifestyle, and behaviors, how the body responds to them, and, finally, how these exposures relate to health. These factors have the power to work for or against you, and these can also adjust how your genes are expressed in your DNA sequence.

If you decide to pursue genetic testing, the good news is that it is increasingly more affordable. As of March 2017, it costs about $200 to map important genes. I predict that in the near future, many of us will carry our own genomes printed out on smart cards kept in our wallets. This will allow for a more personalized approach to preventing disease and unnecessary aging. Until that day arrives, though, you can still improve your health span and reduce the rate of your body’s aging, even without genetic testing.

gene-related rejuvenating  

LE: Please provide a few telling examples of gene-related rejuvenating strategies that are in Younger and how these can help women.

SG: At age 44, I got a research opportunity few people would want. I performed a simple blood test of how fast I was aging, and I failed. I was aging 20 years faster than my chronological years according to my telomeres, which are the protective caps on chromosomes that deal with aging. Looking in the mirror, I could see the telltale signs: wrinkles, puffy skin, bags under my eyes, a lack of sparkle. My telomeres specifically, and my body generally, needed rescuing, so I rolled up my sleeves, dove into the science, and created a breakthrough protocol to fix them and slow down my aging process.

My book zeroes in on the top seven genes that can be working for or against you as you age, and for example, these include the vitamin D receptor (VDR) gene. When this gene is turned on in your body, it codes for the nuclear hormone receptor for vitamin D3, which enables your cells to absorb vitamin D. When it’s turned off, you are more likely to suffer from osteoporosis. If you have a bad variant of VDR, as I do, you need to open the vitamin D receptor by keeping your blood levels higher than recommended by conventional doctors, with a target range of 60 to 90 ng/mL. My vitamin D receptor functions at half the level of a normal VDR, so I keep the amount of vitamin D in my blood at about double the recommended level in order to work around my bad variant. If you have a bad variant of VDR, your task may be to raise your intake of vitamin D beyond the standard recommendation of 1,000 to 2,000 IU per day.

Another example of a gene that many people in my practice have, and I do, too, is the fat mass and obesity associated (FTO) gene. I call this the FATSO gene because this gene is strongly associated with your body mass index and thus your risk for obesity and diabetes. When you have the variant of the FTO gene, your body has limited control over leptin, a hormone in charge of satiety. In other words, you feel hungry all the time. You can turn off the variant of the FTO gene with a regular exercise program and a low-carbohydrate food plan that’s high in fiber.

Another of your genes that’s vital to understand is the Detox Gene, also known as MTHFR. This provides instructions for making an enzyme that plays an important role in the processing of folic acid and amino acids, the building blocks of proteins. MTHFR is also important as it also helps you detoxify alcohol and homocysteine.

Science proves that degenerative diseases, like Alzheimer’s and cancer, begin in the body decades before symptoms. The good news is that you can now interpret your health through the lens of your genetic history and tendencies, particularly when it comes to aging, so that you can expand both your lifespan and your healthspan. Should you decide against genetic testing, you can consult the seven-week protocol outlined in Younger for food, sleep, exercise, stress-busting, and brain-boosting action plans that may help you slow down your aging process.

LE: How and why is the protocol outlined in your book authoritative?

SG: The 7-week protocol I write about in Younger was shown to be efficacious in a beta test of 1,000 people (99% women). On average, they added 10 years to their healthspan, the period of time where you feel vital and are relatively disease free. I’m happy to report that I’ve closed the gap: instead of being 20 years older than my chronological years as measured by my telomeres, now I’m only 3 years older biologically, and trust that the gap will continue to improve as I continue to follow the Younger protocol further. I’m a physician scientist who understands evidential hierarchy, which means that I only recommend medical strategies that have substantial scientific proof behind them.

LE: How is Younger especially relevant and potentially helpful to women in their 40s? Women in their 50s?

SG: The female body is magnificent, but it doesn’t come with a lifetime warranty or an owner’s manual. While each woman is the result of millions of years of evolution, many of the adaptations that helped her ancestors survive are now making her fat and wrinkly and are no longer needed. A woman’s genetic code—the DNA sequence that is the biochemical basis of heredity in all living organisms—is only a small part of the story. As I tell my patients, “Your DNA is a unique, one-of-a-kind blueprint that is specific to you. Even if you haven’t been dealt platinum genes, you can still look great and age more slowly.”

Let’s consider what’s actually happening in your body in your 40s. By the time you reach middle age, there has been an unseen, predetermined, 25-year process of cellular decline. Cellular decline progresses insidiously, unobserved by most people, perhaps including you and your well-intentioned doctor. You may notice it as muscle tightness, an emerging paunch, lingering hangovers, or difficulty reading labels, or you may recognize it by the fact that staying in shape seems to require ten times the effort. Your endocrine glands, from your ovaries to your thyroid, start to sputter and gasp in their hormone production. Then muscle mass declines and gets replaced by fat, and suddenly you realize—like I did on a recent fitness spree—that the activity of jumping is no longer an option. Nevertheless, thanks to recent scientific breakthroughs, middle age now offers all of us profound opportunities to reprogram our genes and bodies.

We can do this before decay, or what we can refer to as accelerated aging, sets in. One of the most intriguing recent findings regarding life extension comes from the Centers for Disease Control and Prevention, which reported in 2015, for the first time in several years, that longevity had declined due to an uptick in heart disease, diabetes, stroke, and Alzheimer’s.

If those diagnoses seem abstract and irrelevant to you, consider how by the year 2030, 20% of the population will be 65 or older (compared with 13% in 2010). New cases of Alzheimer’s will rise by 35%, while new cases of breast cancer are expected to rise by 50%. You don’t want to be included in those statistics—and there are many steps you can take now to reduce your chances of becoming one of those cases in the future.

Using my medical education and practice as well as my own very personal struggle as a woman in a middle-aged body, I crafted the Younger protocol to change the course of your aging body and grow your healthspan. The goal of the Younger protocol is to lengthen healthspan—the time in which you can thrive free from disease—by leveraging epigenetics, the turning on and off of certain genes that age you prematurely. You have the power to increase your healthspan and get your body to work for you instead of against you. It’s about the daily choices that defy your genetic tendencies and fight diseases of aging by turning on the right genes at the right time and in the right sequence.

For women in their 40s, I would hone the focus on FOOD, SLEEP, MOVE, and EXPOSE. For women in their 50s, I would hone the focus on the postmenopausal aspects of SLEEP (keep bedroom 64 degrees or cooler to prevent hot flashes), MOVE (exercise to prevent osteoporosis and injury), EXPOSE, SOOTHE, and THINK (particularly the ways to silence the APOE4 gene for women. This gene is responsible for approximately 20% of Alzheimer’s cases; women who carry the APOE4 gene are more likely to get Alzheimer’s than men.)


For women looking to age optimally and stay strong, the following supplements are some of those cited in Dr. Gottfried’s book Younger as potentially health-enhancing:

  • A multivitamin mineral supplement.
  • Vitamin D for sleep regulation, bone health, and osteoporosis prevention.
  • Activated charcoal tablets for detoxification or after eating a restaurant meal.
  • According to Dr. Gottfried, “Resveratrol, which has been shown to fight the effects of aging on a cellular level and to mimic the benefits of caloric restriction. The dose is 200 mg once per day.”
  • “Magnesium counters the stress response, helps your muscles release and may even enhance your sleep. Take 300 to 1,000 mg a day, unless you have kidney disease, in which case you should consult your healthcare practitioner.”
  • “Lipoic acid can be helpful because even with a whole-foods diet, it’s hard to get enough to keep your oxidant/antioxidant status in balance,” Dr. Gottfried notes. “Lipoic acid repairs damaged cells, and it’s one of the most crucial anti-aging, anti-inflammatory, and antioxidant agents you can ingest—or apply to your skin. Lipoic acid may also protect your bones as you age and keeps your cells sensitive to insulin so that your blood sugar doesn’t climb.”
  • “Take omega-3 fatty acids—1 to 2 grams a day. It lowers your cortisol levels, increases lean body mass, and improves vagal tone as measured via heartrate variability.”

LE: Please cite the essential vitamins, anti-inflammatory herbs and other nutritional supplements that women should take every day.

SG: One of the biggest levers when it comes to aging is problems with blood sugar, which may occur whether you are overweight or not. For that reason, I’m a fan of berberine, an herb proven to reset insulin and blood sugar.

For daily use, I suggest a high-potency multivitamin that covers the B vitamins (particularly folic acid, since the MTHFR gene is commonly flawed among people in the United States), and minerals. For detoxification, I recommend n-acetyl-cysteine (NAC) and activated charcoal.

LE: You maintain an innovative practice that involves your rigorous study of patients’ evidence-based medical testing, virtual consultations and online teaching programs for women who want to upgrade their health. Please describe a typical “virtual” patient in their 50s. How do you help them?

SG: My approach is the basic functional medicine process, which I’ve personalized over the past 20 years. I follow the GOTOIT heuristic, complete the functional medicine timeline, and complete the functional medicine matrix for every patient. Your readers can find this at:

After 25,000 patients, I’d say my average is like the woman I had a session with today by Skype: a 59-year-old, healthy, active, and wise woman who eats well but feels more flat in terms of energy and cognition. Her libido is flagging and she wakes up at 4 am. Her joints are achier than 10 years ago, and she recently was diagnosed with frozen shoulder. Her main question is whether she should consider bioidentical hormone therapy.

I help a woman like this by going through the functional medicine tool kit for intake, as a means to identify the root causes of her symptoms, and then apply the Gottfried Protocol:

Step 1: What are the micronutrient deficiencies and perhaps nutritional excesses that we could address to reduce “inflammaging”—the unfortunate hybrid of increasing inflammation, stiffness, and accelerated aging. For instance, this woman appears to have symptoms of inflammation and low estrogen, and we are performing confirmatory laboratory tests. She may have leaky gut and an overactive immune system. She could have a food intolerance. She drinks coffee and eats dairy and gluten, which may or may not be increasing inflammation. We will look at her DNA for specific SNPs that may guide us with her micronutrients and targeted lifestyle therapies, and ultimately with the question about hormone therapy.

Step 2: Are there herbal therapies that may address her root cause? For instance, the supplement called maca, derived from a root vegetable indigenous to the Andes Mountains, raises estrogen levels and has been shown in randomized trials to improve sex drive. If she has blood sugar issues, I may also add a supplement to help regulate blood sugar.

Step 3: If steps 1 and 2 do not resolve her symptoms, would a small-to-moderate dose of bioidentical hormone therapy be helpful? We will continue to have a very thorough conversation about the risks, benefits, and alternatives of hormone therapy in the context of her values, philosophy, and quality of life.

Regarding hormones and the aging process, both men and women make less testosterone as they age, leading to more fat deposits at the breasts, hips, and buttocks. Women produce less estrogen, which normally protects the hair follicles and skin. Lower levels of estrogen and testosterone may weaken your bones and your sex drive, and furthermore, lower estrogen-to-testosterone ratios may trigger hair loss and heart disease.

Unfortunately, your thyroid gland slows down and, along with it, your metabolism, so the bathroom scale climbs a few pounds per year (or even per month). You get cold more easily. Your cells become increasingly insensitive to the hormone insulin, which leads to rising blood sugar in the morning. As a result of higher blood sugar, you may feel foggier and experience stronger cravings for carbs, then notice more skin wrinkling along with an older-looking facial appearance. The key point is that the right food, sleep, exercise, and support for detoxification can reverse many hormone problems associated with aging.

If you have any questions on the scientific content of this article, please call a Life Extension® Wellness Specialist at 1-866-864-3027.

For more information, check out Dr. Sara Gottfried’s website at: