Biodentical Hormones & Botanicals

Thyroid: Minimize Goitrogens for Optimal Metabolism + Weight

Here is a great list of foods that slow down your thyroid, from Wikipedia. They are also known as goitrogens. Isn’t that a weird word?

It’s best to avoid these foods in their raw form – lightly cooked is a better option.


Frequently, my clients say to me: “Dr. Sara, what gives? You are the Queen of Greens. Aren’t they good for my estrogen metabolism?!”

Yes, dark leafy greens and members of the Brassica family (such as cabbage, kale, spinach, chard, and Brussel sprouts) are good for making more of the good estrogens and less of the bad estrogens, but the effect is that of a sea-saw. When you help estrogen metabolism, you slow down the thyroid. If you are a fast metabolizer, you may not even notice. But if you’re like me and tend toward an unforgiving metabolism, you may just notice that your metabolism has slowed down a notch. Your weight has creeped up a bit. You may be a little more bloated or constipated. You might be slightly more fatigued…all signs of a slower thyroid.

Get a More Forgiving Metabolism

Minimize or avoid these foods if you have a thyroid issue. If you have some of these symptoms, ask your doctor for thyroid blood test, such as a TSH (Thyroid Stimulating Hormone) and a free T3 (active thyroid hormone). Extra credit for a reverse T3.

Get your thyroid on your side, working for you, not against you.

As always, let me know if you have questions or comments with your experience with goitrogens and your lovely thyroid.


Have You Seen My Sex Drive?

10,000 women in my private practice so far. Guess what every one of them wants to know?

Single, divorced, pregnant, married, retired, gay – seriously, everyone.

They can hardly wait for the door to close.

“My sex drive! Where did it go? I want it back.”

Inside my office, this question feels safe. Outside my office, you’re on your own. It’s too personal. No one wants to risk opening up to friends who don’t get it.

“No orgasm in months? How terrible for you!”

Trust me, they get it. (And if you forwarded this post to them, they just might smile with relief.)

Now that we’re all on the same page, I have a crazy idea.

I want you to pretend your fairy-sexy-godmother has just appeared.

Yes, the one with the magic wand. 

She has the power to wave this wand and to bring your sexy back.

In return, you must complete one of these under-the-covers missions.

Which mission can she put you down for?

___ Mission 22. Travel back in time to when you were 22 & hot. Seduce everyone using your current levels of smarts and witty banter, combined with your old levels of hormones.

___ Mission Pink Diamond. Immerse yourself in a world of mystery and intrigue, wherein you catch jewel thieves by day, and enjoy dining and salsa dancing with your partner by night, who is also secretly in love with you.

___ Mission Love Letter. Begin a passionate love-letter relationship with your favorite TV actor, _____. Exude so much confidence from this exchange that everyone who sees you in real life feels compelled to buy you dinner.

___ Mission Paris. Go undercover to a hotel in Paris, where you are disguised as the elegant benefactress to a young poet, who happens to be your sweetheart, also in disguise.

___ Mission Ball Crasher. Crash a real prince’s ball wearing a Cinderella-inspired ball gown. You’ve never had a fairy-sexy-godmother before, but you like it!

___ Mission Surf. Travel to Hawaii for an all-inclusive vacation on a private island, with surfing lessons followed by yoga on the beach.

___ Mission Naptime. Really, I just want a long, long nap in a luxury suite in an exotic city where no one even knows my name. Can you make that happen, FSG?

Can’t wait to see your answers—and to reveal how that magic wand may be closer than you think! Let us know your vote in the by leaving a comment, and next we will reveal the most popular choices!

If you want to be added to our mailing list to get more juicy propositions on Mission Ignition, click here.

It’s Not Me: It’s My Adrenals! How Your Adrenals Govern Your Vitality

Here's where your adrenals live, in the back body, above the kidneys

Do you wilt in the face of stress? Feel more anxious when you have to step up your game? Think you might be burned out?

It may not be you – it may be your hormones. Sprecifically, your stress hormones. Figure this out now, before you hit menopause, and your forties will be so very much easier. And, believe me, I speak from personal andprofessional experience.

Do you know if you have a problem with your adrenal function? Our adrenals sit like hats on top of our kidneys, and while they are small in stature, they are enormously influential in terms of your capacity to cope with stress.

What surprises me constantly is the number of empowered women I meet daily – entrepreneurs, lawyers, overeducated women with exciting lives who know their metrics inside and out from 401K to current home value – yet they have no idea what their adrenal numbers are.

Some of us, myself included, spend too much time in fight/flight/collapse in response to daily stressors. Over time, this ongoing state of hypervigiliance takes a toll – the cells of your adrenals can’t keep up with the overtime and burn out. How do you know if this has happened to you? Two options: take a questionnaire or test your levels of the hormones your adrenals make, namely cortisol and DHEAS.

Cortisol is like a General, in command of the army that is your body. Cortisol has its hands in many things – it controls how you use fuel, how much energy you have at your disposal, how you respond to a crisis, how you digest food, and whether to store the bread you just ate around your mid-section.

DHEAS is a hormone of vitality – it is a pre-hormone to testosterone, and contributes significantly to sex drive.

You can have either too much of these two hormones (stage 1) or not enough (stage 2) or adrenal failure (stage 3), a life-threatening emergency.

I’m an organic gynecologist in the San Francisco Bay Area, and adrenal dysregulation is the most common hormone problem I see. Typically, my patients report poor stress resilience, difficulty functioning well under stress or even to react to them, sometimes even bordering on paralysis, which is totally new (and often has an onset in perimenopause, that time in your forties when your periods start to get closer together and PMS reaches new heights). Adrenal dysregulation manifests differently in different people – sometimes it feels more like excessive sensitivity to human suffering, or excessive compassion for the pain of other people, or even excessive irritation at the suffering of others.

Both cortisol and DHEA influence other hormones too, and some you may know about. Excess cortisol inhibits thyroid, estrogen, melatonin, and growth hormone. Excess DHEA inhibits cortisol and stimulates testosterone.

Clearly, one has to juggle many hormones to feel most vital.

What do you do if you think you might have a problem with adrenal function, either too much or too little? I advise going to your doctor and asking for a blood test. See where you are right now, as a baseline. Know your adrenals at least as well as your 401K. Get as empowered about your health as you are in other realms of your life.

There are numerous therapies for wonky adrenals, and many of them have been tested with the tincture of time in ancient wisdom traditions such as Ayurveda and Traditional Chinese Medicine. Examples include botanicals such as Ashwagandha and Ginseng.


I like to start with nutrition, Whole Foods Nutrition. And boundaries.

Folks with high cortisol tend to crave carbohydrates, the refined type. Sugar, chocolate, pastries, any flour-sugar combination, really.

We must change that. Pronto.

I’m a fan of several food plans, depending on your particular circumstances. Generally, I find the Paleolithic diet, based on fruits, vegetables, meat, poultry and fish, is best at optimizing adrenal function. Limited, sprouted grains. I also recommend removing refined or processed carbohydrates, particularly breads, cereals, pasta, and baked goods. Particularly good for your best adrenal function are lean proteins, and healthy fats such as coconut oil and olive oil.

Want to take your adrenals to the next level? Reset the mother ship toward True North and vitality? Sign up right here to learn more about my Adrenal Reset e-course, coming to you this October.

You’ve got questions? I’ve got answers. Proven, safe answers (finally, whew!). Let me know your questions in the comments section. Tell me where you are with your adrenal function, and what outcome you desire. How do you want to respond to stress?


The Holy Trinity – Or Charlie’s Angels – of Vitality: Estrogen, Cortisol + Thyroid (and why they’ve got your back + your rack, baby)

Step into my time machine. We’re nine years old. It’s 1976. We’re fledgling feminists (already!) and we’re mad-passionately-crazy in awe of a trio of crime-fighting, bad-guy-busting women with brains, brawn and physical agility. And they are just like the hormonal system, when it’s working FOR YOU not against you.

They’re amazing. They’re Angels. (They even have winged… hair.) They’re Charlie’s Angels: Sabrina, Jill and Kelly.

The Angels, played by Kate Jackson, Jaclyn Smith, and Farrah Fawcett, fought crime as ably as men – and they were the first to do that on 70s prime-time TV, where detectives usually packed guns, not ovaries. Sure, it was a bit weird that the Angels did the dirty work of a disembodied boss named Charlie, but whatevah – seeing the three of them working in sync was poetry. It was empowerment. It was teamwork.

And it worked.

And so it is with your hormonal system.

Sabrina is Cortisol. Jill is Thyroid. Kelly is Estrogen.


Sabrina (Kate Jackson) has brassy charm and a quirky wit. Her voice is clear and well-honed. She stands up to Charlie more than the other angels and she’s less inclined to manipulate men with her feminine wiles. Her considerable intellect was more effective.

And so Sabrina is the “Smart Angel”. She’s no-nonsense, smart and strategic-thinking – not unlike Cortisol, the main hormone of your stress-response system. Cortisol amps you up to deal with danger.

Sabrina and Cortisol are a pair of Generals. They get the damn work done. No time for niceties…they’re too busy coming to the rescue. Just as Sabrina rescues the “Angel in Danger,” Cortisol rescues you from tight spots, such as a car accident or racing after a toddler heading toward danger. Cortisol is your stress-protector, intelligently and skillfully mediating the scary effects of your everyday adventures.


Kelly (Jaclyn Smith) is Sensitive Angel: softer, voluptuous, like Estrogen. Queenly, but also street-wise and tough. Like Estrogen, Kelly could be powerful and in control one minute, and a seductress the next. Estrogen serves all these purposes. Estrogen keeps you flush with serotonin, the feel-good neurotransmitter that makes your mood, sleep and appetite right-for-you.

Stable mood? Check. Toe-curling orgasms? Checkety check. Lubricated joints and vagina? Checkety check check. All estrogen. All good. All systems go. Perky boobs rather than pancakes. Pretty skin sans wrinkles. Estrogen keeps the other angels, cortisol and thyroid, in balance.


Jill (Farrah Fawcett-Majors) is Sporty Angel – lithe and athletic. On the show, she plays tennis, basketball, swims, bowls, skateboards and rollerskates. Her metabolism is working for her, like Thyroid. She drives a speedy car with blue racing stripes, and even retires from the show to become a race car driver. Thyroid drives your race car. Without enough thyroid juice, you feel fatigued, gain weight, and your mood sinks. Libido? Fah getta bout it….

To Bust the Bad Guys – Depression, Lack of Energy, Slow Metabolism – Get Your Hormonal Angels Working Together

How do these three hormonal angels work together to protect your vitality?

All three, together, are absolutely pivotal to you feeling that all is right with the world. Cortisol, Estrogen and Thyroid are three legs to a three-legged stool. Get each in right proportion and you sit straight. No tipping or careening off to one side or another.

What I commonly see in my practice is that a woman has one wonky angel.

Let’s say it’s her thyroid. She has been taking the same damn dose of levo-thyroxine for 20 years, yet her thyroid is still not doing its job. She’s tired, particularly in the morning. She’s gaining weight and finds it hard to keep the pounds from piling on. Her joints are achey and her cholesterol is climbing with her weight – and it’s all attributable to thyroid. Angel Jill needs to get racy – and she needs her angel partners.

Because if your thyroid symptoms and numbers are missing the mark, you can bet that’s affecting the balance of the other hormonal angels: Estrogen and Cortisol.

Sometimes I’ll see a client with two wonky angels, thyroid and estrogen.

Let’s imagine this client is 45 years old. An enterprising gynecologist has started her on an estradiol patch (a form of bioidentical estrogen) for night sweats and low libido. Because this gynecologist knows that night sweats and low libido relate to thyroid function as well as estrogen function, she measured her client’s TSH and free T3 – and, sure enough, both numbers indicate a sluggish thyroid.

Our client gets started on thyroid medication and has a delicious honeymoon…of two weeks.  For fourteen days, she has more energy and vitality. More sex drive. She’s chasing her husband around the bedroom.


Where’s Sabrina? Her two angels need their third. Wonky thyroid and estrogen are working better, together, but cortisol steps in and demands to be noticed.

Most conventional doctors will take a look at your thyroid and estrogen but will not consider your cortisol levels. Yet, like the third leg in that three-legged stool, or  the Sabrina to your Jill and Kelly, cortisol is vital to your most robust, sustained vitality.  Cortisol is crucial to hormonal balance.

And what’s also crucial is to have all three angel hormones functioning in sync.

Each Hormonal Charlie’s Angel – Sabrina, Jill, Kelly or Cortisol, Estrogen and Thyroid – is important, essential and useful on her own, but it’s when all three of them are at the height of their individual powers and working together that the magic happens.

Health. Happiness. Vitality. Libidic lusciousness. And all the bad guys – depression, weight gain, sluggishness – busted and behind bars.

Ah, those angels. They were my girls when I was a girl and they’re my girls now that I’m a grown-up doctor-lady.

They can be your yours, too.

Let’s get the Charlie’s Angels of your hormonal system – Cortisol, Estrogen and Thyroid – fighting for you.


Thyroid Questionnaire

I love this questionnaire from Dr. Hotze, another integrative physician. It gets to the heart of whether you should be tested for thyroid dysregulation, even if your conventional doc has dismissed your concerns. I also like to use these questions to build a tracker for how you improve with different therapies, as trial-and-error continues to be the best route for choosing the best thyroid optimization.

If the question addresses a concern that applies to you, record the number. When done, total the numbers.

1. Do you experience fatigue (4)?
2. Is your cholesterol elevated (4)?
3. Do you have difficulty losing weight (2)?
4. Do you have cold hands and feet (2)?
5. Are you sensitive to cold (2)?
6. Do you have difficulty thinking (2)?
7. Do you find it hard to concentrate (2)?
8. Do you have poor short-term memory (2)?
9. Are your moods depressed (2)?
10. Are you experiencing hair loss (2)?
11. Do you have fewer that one BM per day (2)?
12. Do you have dry skin (2)?
13. Do you have itchy skin in winter (1)?
14. Do you have fluid retention (2)?
15. Do you have recurrent headaches (1)?
16. Do you sleep restlessly (1)?
17. Do you experience afternoon fatigue (2)?
18. Are you tired when you awaken (2)?
19. Do you experience tingling in hands or feet (2)?
20. Have you had infertility or miscarriages (2)?
21. Do you have decreased sweating (2)?
22. Do you have muscle aches (2)?
23. Have you had recurrent infections (2)?
24. Do you have joint pain (2)?
25. Do you have thinning of your eyebrows or eyelashes (2)?

Score < 11? You are unlikely to have a thyroid problem.
Score 11-30? Low thyroid function is a possibility.
Score >30? Low thyroid function is probable.
Get tested if your score is > 11, including a free T3 and TSH.