Dr. Sara Szal — Harvard- and MIT-trained physician, bioengineer, and hormone expert who has tested and treated roughly 40,000 patients. A pioneer of precision and lifestyle medicine, former director of precision medicine at the Marcus Institute, and author of several books on hormones and autoimmunity.
The gist
Dr. Sara Szal argues that conventional medicine is 'broken' because it treats the average patient with pharmaceuticals rather than personalizing care, even though lifestyle changes prevent about 70% of disease. She frames cortisol as the dominant 'dictator' hormone, linking chronic stress and childhood trauma (measured via the ACE score) to belly fat, brain shrinkage, pre-diabetes, and hormonal imbalance. The conversation covers practical tools like continuous glucose monitors, fiber, the ketogenic diet's differing effects on men versus women, and supplements for cortisol. It then opens up into perimenopause and the women's health gap, where 73-75% of women don't get the menopause treatment they deserve. Szal also shares deeply personal material about her own trauma, divorce, psychedelic-assisted therapy, and sex life.
Big reveals
- Szal reveals her own ACE childhood-trauma score is 6 out of 10.
- Recounts that her doctor pushed Prozac and birth control, so she ordered her own labs and found cortisol three times normal and pre-diabetes in her 30s.
- Claims high cortisol shrinks the brain in women but not men, starting in midlife.
- Discloses she had anorexia as a teen and bulimia through her 20s and 30s.
- Argues birth control pills can shrink the clitoris by up to 20% and that women rarely get full informed consent.
- Shares that she divorced two years ago after 20 years of marriage and started psychedelic-assisted therapy hoping to save it.
- Says in her 50s she is having the best sex of her life and talks candidly about polarity and domination.
- Bartlett highly recommends her newest book, The Autoimmune Cure.
Things worth remembering
- Around 90% of the 40,000 patients she has tested have a cortisol problem.
- About 70% of the diseases we face are preventable with lifestyle medicine.
- There are more than 700 known endocrine disruptors, including BPA, parabens, and flame retardants.
- Roughly 70-80% of people are deficient in vitamin D, which has about 400 jobs in the body.
- Testosterone is the most abundant hormone in the female body, higher than estrogen or progesterone.
- Liverpool University research suggests barefoot-style shoes can increase foot strength by up to 60% over six months.
- The average American gets about 14g of fiber a day versus a recommended 30-40g; paleolithic ancestors got 50-100g.
- Perimenopause has more than 100 symptoms and typically begins between ages 35 and 45.
- Women are about 14 times more likely to be raped and have four times the rate of autoimmune disease compared to men.
- Only about 2% of the population carries the 'short sleep gene'; everyone else needs to optimize sleep.
Recommended in this episode
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Cortisol Manager
Integrative Therapeutics (inferred)
“one of the things I often do is to give them cortisol manager, which is a supplement that includes ashwagandha and phosphatidal serereine. And it's been shown to lower cortisol levels” — Dr. Sara Szal 00:39:09Find it on Amazon
Rhodiola
various (herbal supplement)
“Rodeiola is an adaptogen. So, it's a it's an herbal therapy that's been shown to help with cortisol. Lowers cortisol. Yes... Do you prescribe that to athletes? I do.” — Dr. Sara Szal 00:39:40Find it on Amazon
Eight Sleep
Eight Sleep
“one of the things I really like is they eat sleep. Have you used that at all? Yeah, I have. Um, the mattress... I was sleeping really really good on it.” — Dr. Sara Szal 01:51:28Find it on Amazon
The Autoimmune Cure
Dr. Sara Szal
“The autoimmune cure, healing the traumas and other triggers that have turned your body against you is the book that I'm going to um highly recommend. I think this is the new one” — Steven Bartlett 01:55:05Find it on Amazon
The Hormone Cure
Dr. Sara Szal
“I've also got another book here called The Hormone Cure which is all about reclaiming balance, sleep and sex drive, maintaining a healthy weight, feeling focused, vital and energized naturally” — Steven Bartlett 01:55:35Find it on Amazon
Women, Food, and Hormones
Dr. Sara Szal
“one of the books that I was referencing as we were going which is Women Food and Hormones a four-week plan to achieve hormonal balance lose weight and feel like yourself again” — Steven Bartlett 01:55:35Find it on Amazon