--:-- Mel Robbins: Hey, it's your friend Mel, and welcome to the Mel Robbins Podcast. So recently, I posted this video and it featured Dr. Gabor Maté, a world-renowned expert in trauma, and he was talking about how 80% of autoimmune diseases happen to women. Holy cow, this topic exploded online, nearly crashed our inbox. The only thing that I have ever seen resonate that immediately and all over the globe was the first time I shared the "let them" theory. And you know what that tells me? That tells me that you want to learn more about the topic of autoimmune disease, why they are impacting you or impacting the women in your life at alarming rates.
--:-- So here's what I did. I called in a world-renowned expert who wrote the book called *The Autoimmune Cure*. And she is going to give you and me a master class and a private consultation on all things autoimmune disease. What is an autoimmune disease? What are the three causes of autoimmune diseases? Why exactly are rates of MS, Hashimoto's, and all kinds of other autoimmune diseases rising at alarming rates, especially for women over the past 20 years? She's also going to ask you 17 questions. This is a tool that she uses in her medical practice, and every time you answer yes, it increases your risk for an autoimmune disease by 20%. But don't be nervous because there is also extraordinarily good news. There are things you can do starting today, and most of the things that you're going to learn and that she's going to recommend cost you nothing.
--:-- Mel Robbins: Hey, it's your friend Mel. And I just want to take a moment and welcome you to the Mel Robbins Podcast. First of all, I am so excited that you're here. I'm excited for our topic today. It is always such an honor to be able to spend time with you, to be together. And if you're brand new, welcome to the Mel Robbins Podcast family. Because you hit play on this episode and you made the time to listen, when I know you don't have a lot of time, but you found the time and you made the time to listen to this episode, here's what I know about you. First of all, you value your time and you're spending it because you want to learn more about your health and improving the quality of your life. And today's conversation, it's going to blow your mind and it will improve the quality of your life.
--:-- See, I recently posted a very short video clip that was just a short moment from this podcast. And the video featured the renowned trauma expert and medical doctor, Dr. Gabor Maté. And in the video clip, he was explaining the four reasons why 80% of autoimmune diseases impact women. Now, this video exploded online. The only other topic I've ever seen resonate that immediately and globally was when I first shared the "let them" theory. Based on my inbox crashing, the DMs and your comments, I'm like, we have got to go deep on the topic of autoimmune disease. And in particular, why is it impacting women at higher rates than men? What do you need to know? What are the symptoms that you may have that indicate that you have an autoimmune issue, but you don't even know about it? And most importantly, what can you do about it if you're concerned about your health or the health of someone you love?
--:-- Well, today, we're going to talk about all of that, and we're going to leave you feeling informed and empowered. I cannot wait to introduce you to Dr. Sara Szal. Now, Dr. Szal is a physician, a researcher, a renowned speaker on all things health. She graduated from Harvard Medical School as part of their joint medical program with MIT. She completed her residency at UCSF, one of the top hospitals in the world. Dr. Szal is the *New York Times* bestselling author of nine books about health. She's also a clinical assistant professor in the Department of Integrative Medicine and Nutritional Sciences at Thomas Jefferson University, and the director of precision medicine at the Marcus Institute of Integrative Health at Jefferson. Dr. Szal has over 25 years of clinical experience seeing patients, and she hopped on a plane. She flew across country for one reason. She did it for you. She's here to provide you with the information, resources, and the step-by-step treatment plan for anyone in your life who may be struggling with an autoimmune issue or just with some symptoms and can't quite get to the bottom of what's going on.
--:-- Well, today, we're going to do our best to do that for you. And I want to thank you in advance for taking a moment right now to share this episode with someone you care about, because there's no doubt in my mind, everything that we are about to learn is going to improve your health and your life. Dr. Szal, thank you so much for being here. I am so looking forward to our conversation today.
--:-- Dr. Sara Szal: Mel, I'm so happy to be with you.
--:-- Mel Robbins: Oh my gosh. We've got so much to talk about. And where I want to start is: could you tell the person who's listening what they might experience or how their life might change if they take everything to heart that you're about to share with us today?
--:-- Dr. Sara Szal: A few things. First, energy. Right now, we know that 30% of Americans have antibodies against the nucleus of their cells, anti-nuclear antibodies. That is causing a civil war in the body, and it is keeping you from having the energy that you need to live your best life. Number two is regulation, that sense of safety that I think women especially desperately need right now. And then number three is empowerment, so having the tools and the insights that you need to make the changes and to make them stick.
--:-- Mel Robbins: That's a lot. That's the promise of lifestyle medicine and a different approach to taking care of the body. I've never heard the term lifestyle medicine. What does that mean?
--:-- Dr. Sara Szal: It means that rather than deciding that you've got a diagnosis and giving you a pill, we want to think about, okay, how did you get to this place with this diagnosis? What are the lifestyle factors—your sleep, the way that you eat, move, think, and feel and love? How do we address those? How do we address those first? Because that provides about 80% of the prevention and reversal of chronic disease.
--:-- Mel Robbins: And that's what we're going to talk about, is chronic disease and in particular autoimmune diseases. So I want to start at the very top, most basic level. What exactly is an autoimmune disease?
--:-- Dr. Sara Szal: Autoimmune disease is when you've got a problem with your immune system. It becomes imbalanced and it starts to attack your normal tissues. You can think of it like a case of mistaken identity. So your immune system is kind of like your private security. It's supposed to identify what's healthy and normal in your body and then also find the invaders like a pathogen, like a virus, and attack it. But if your immune system becomes confused and it can't separate those two, you can have this problem where your immune system is attacking normal tissue. So that's what happens with autoimmune disease. And in that situation, your immune system is making a weapon called an antibody. You're making autoantibodies, antibodies against your own normal tissues, and you can measure it. So with autoimmune disease, you've got this imbalanced immune system, you've got autoantibodies, and then you've got symptoms that fit with a particular diagnosis.
--:-- Mel Robbins: I love the word that you use, confused, that your body is just confused as to what is the enemy versus what it's supposed to be protecting. As we kind of dig in deeper and deeper around what an autoimmune disease is, I have a couple just basic questions. Is there a difference between autoimmune disease and an autoimmune disorder? Because I've heard people refer to both.
--:-- Dr. Sara Szal: The way I think of it, Mel, is that there's a continuum.
--:-- Dr. Sara Szal: So there's a state of health. Your immune system is working perfectly. It can separate the invaders from your normal tissue. And then at the other extreme is autoimmune disease. And that can be well-established. And we'll talk about some of those conditions: type 1 diabetes, rheumatoid arthritis, Hashimoto's thyroiditis.
--:-- Mel Robbins: Wait a minute. Diabetes is an autoimmune disease?
--:-- Dr. Sara Szal: Type 1 diabetes is. Yeah, you attack the pancreas. Your immune system attacks the pancreas.
--:-- Mel Robbins: I mean, I probably sound like an idiot that I didn't know that, but I'd never even thought that there is probably a long list of things that we talk about that people struggle with that a lot of us don't even know it's an autoimmune disease.
--:-- Dr. Sara Szal: That's true. It tends to fly below the radar. And what troubles me so much about this is that these are the people who are often failed by the medical system. They struggle for 7 to 14 years before they get a diagnosis. So they could be somewhere along that spectrum from normal healthy to autoimmune disease. There's a pretty broad middle section where you've got antibodies that you can measure in the blood. When you've got early signs and symptoms—the fatigue, the joint pain, the other problems—and yet doctors often aren't putting it together until you cross that threshold into a disease.
--:-- Mel Robbins: Can you just list what some common ailments or diseases or things that people have that actually are autoimmune disease?
--:-- Dr. Sara Szal: There's two different categories. There's classic autoimmune disease. There's more than 100 of them.
--:-- Dr. Sara Szal: 100.
--:-- Mel Robbins: What? What?
--:-- Dr. Sara Szal: Yeah. So exponential rise in the number of autoimmune diseases. But it's things like rheumatoid arthritis, where your immune system is attacking your joints. There's Hashimoto's thyroiditis, where your immune system is attacking the thyroid gland in your neck. There's multiple sclerosis. There's type 1 diabetes, as we talked about. Psoriasis.
--:-- Mel Robbins: Psoriasis? What? What? I'm sorry I'm reacting, but my husband and my daughter have really bad psoriasis all over their scalp. It's really gross. I mean, I don't mean to throw them under the bus, but it bothers them. That's an autoimmune disease?
--:-- Dr. Sara Szal: Yeah, your immune system is attacking your scalp in that situation. So a lot of people don't connect the dots. They don't realize that's an autoimmune disease.
--:-- Mel Robbins: Why is it important to identify that something is an autoimmune disease? Like, let's just take the psoriasis thing that a ton of people struggle with. Why is knowing that that's an autoimmune disease help you in terms of being empowered about what to do about it?
--:-- Dr. Sara Szal: It helps you address the root cause. And that's what's missing from most of mainstream medicine. What happens is you have psoriasis, you go to the doctor, you get a steroid cream. The steroid is like cortisol, it's like the stress hormone that you're sticking on your scalp. No one's thinking about your gut. No one's thinking about triggers that could be leading to your psoriasis acting up. So we want to do this root cause analysis. It's really critical.
--:-- Mel Robbins: So there's 100 different autoimmune diseases. The list is long. Graves' disease, celiac, psoriasis, as we talked about.
--:-- Dr. Sara Szal: Then there's other conditions that have commonalities with autoimmune diseases, and that includes things like endometriosis.
--:-- Mel Robbins: Really?
--:-- Dr. Sara Szal: When your body is attacking your own tissues, maybe you get endometriosis on your bowel or on your ovaries. It includes some forms of irritable bowel syndrome. You can even make autoantibodies with some forms. It includes chronic Lyme. It includes long COVID, post-COVID syndrome. So that's a more broad way of thinking about autoimmunity. But even if we just stick with the classic autoimmune disease, which every medical doctor would agree to—what are the classic ones? The classic ones, the most common ones are rheumatoid arthritis, type 1 diabetes, which we see in kids as well as adults, Graves' disease, Hashimoto's, celiac, which has been increasing phenomenally over the past few decades, multiple sclerosis.
--:-- Mel Robbins: So you used a word, I just want to make sure that I'm tracking with you because we're just at the surface and we're about to dive deeper. When you called it the autoantibody, is that the word that you used?
--:-- Dr. Sara Szal: Yes.
--:-- Mel Robbins: So autoantibody is what you would find in somebody's body when the person's immune system is attacking itself. Is that right?
--:-- Dr. Sara Szal: That's right. That's the kind of medical evidence that, oh, the immune system is confused because I see that these autoantibodies are present, which are the little soldiers in the Civil War that you are feeling inside your body.
--:-- Mel Robbins: You nailed it. Okay. So the thing that I think is important about these autoantibodies is that they're in the body for years, and you don't know it unless someone bothers to check it.
--:-- Dr. Sara Szal: So if you look at one of the most common autoantibodies, anti-nuclear antibodies, what we know is that over the past 25 years, the number of people that have positive antibodies has almost tripled.
--:-- Mel Robbins: Tripled? Over 25 years, yes. What does that tell you?
--:-- Dr. Sara Szal: It tells me there's something in the environment that's changed. Our food system has changed. Our stress levels have changed. The level of trauma that we're experiencing has changed. And we'll get to the root causes, but the genetics haven't changed. It's the triggers. It's the lifestyle. It's the environment that has.
--:-- Mel Robbins: Dr. Szal, what are the root causes of an autoimmune condition or disease?
--:-- Dr. Sara Szal: The root causes have been identified for years. There's a local pediatric gastroenterologist at Massachusetts General Hospital who found that there are three requirements. These are the root causes. Number one, genetic predisposition. Number two, leaky gut. So that's when you lose the barrier in your gut. You have increased intestinal permeability, and we can talk about what that is.
--:-- Dr. Sara Szal: And then number three, a trigger. So the trigger is where things get interesting. The trigger is often trauma or toxic stress, but it can also be big hormonal changes like pregnancy, postpartum, perimenopause, menopause. There's lots of different triggers that we want to consider.
--:-- Mel Robbins: So just again, to make sure that I'm tracking, because since this impacts so many of us, and now I'm realizing I need to share this episode immediately with my daughter and with my husband as soon as I'm done talking to you. Number one, genetic predisposition. Number two, you may have a leaky gut, which can contribute to, I guess, the balance in your body. And number three, there is something that happened, whether it's hormonal changes or some traumatic situation or unresolved trauma or stress in your life that then triggers confusion in your body and you start attacking yourself.
--:-- Dr. Sara Szal: That's right. It starts the civil war.
--:-- Mel Robbins: Wow. Okay. Well, let's take them one by one. How do you even know if you're genetically predisposed to this?
--:-- Dr. Sara Szal: You can do a genetic test. So the genetics are pretty well defined. They all sound like license plates, so I won't list them here, but a genetic test is a way to identify them.
--:-- Mel Robbins: And let's talk about leaky gut. Why does a leaky gut—first of all, what the heck is a leaky gut? And secondly, why does that contribute to your body starting to attack itself?
--:-- Dr. Sara Szal: Leaky gut is fascinating, physically, but also more poetically. It's a loss of a boundary in your body.
--:-- Mel Robbins: Oh, whoa, hold on. I want to make sure everybody—I want to make sure the person that's driving the car or taking you and I on a walk with them hears it. I've never heard anybody say that before. Leaky gut is a loss of a boundary in your body. What does that mean that it's a boundary, and what's the implication that leaky gut is now a loss of that boundary?
--:-- Dr. Sara Szal: When you think about the gut, at its simplest, it's a tube from your mouth to your anus. The part of the tube where your intestines are requires these things called tight junctions between the cells. So the cells are supposed to be lined up like an army. And what happens is that if you've got leaky gut, those tight junctions don't work. And so things that are supposed to be on the outside of you that you take in through your mouth—bacteria, viruses, maybe foods that you're reacting to like gluten or dairy—those can start to come through the tight junctions, through the boundary that you're supposed to have, and start to trigger the cells underneath. Now, here's where things get interesting, because 70 to 80% of your immune system is right there in the tube. And so, when you're passing these foreign particles through the tube, through the boundary, you're triggering the immune system in a way that it's not meant to be triggered.
--:-- Mel Robbins: The third thing that you talked about was triggers, that there are lifestyle triggers and there are all kinds of triggers, I would imagine, that can also cause this civil war in your body. What are some of the top triggers that you've seen in your research?
--:-- Dr. Sara Szal: The number one trigger is trauma. So I started to notice this. I didn't learn a lot about trauma when I went through medical school 30 years ago, but I had to teach myself because I saw this rise of autoimmune disease in my patients. And I kept noticing, oh, this woman had a traumatic birth. Oh, this woman has an adverse childhood experiences score. She had sexual abuse or physical abuse or neglect. And that seems to track with her autoimmunity. So trauma, toxic stress is a huge category. And then I would say hormones is a gigantic category. Think about pregnancy for a minute. What happens when you get pregnant is that you make this embryo and half the DNA is yours, half the DNA is your sperm donor. And so your immune system has to adapt to this foreign substance. And sometimes that works. We've got a lot of successful pregnancies, but sometimes it doesn't. And it leads to more miscarriages. It leads to autoimmune problems in the postpartum period. And complicated pregnancies.
--:-- Mel Robbins: I never even thought about that. There's this meme that's going around of a woman standing in a kitchen and she's got like three kids running around and, you know, her partner's standing there and the thing on the meme says, "That moment when you realize all these people have been inside of you." And you know, I...
--:-- Mel Robbins: Yeah. And how are your boundaries?
--:-- Dr. Sara Szal: Yes.
--:-- Mel Robbins: And it never even occurred to me that even the mystical and magical experience of carrying a child is a foreign body inside of you that you have to adapt to. And so when you think about the three things—genetics, the loss of a boundary in your digestive tract because of leaky gut, and then these triggers that are all around us, whether it's past trauma, current trauma, the amount of stress that you're under at this moment in your life, or hormone changes, or there's probably a list of a hundred other things that can trigger this—it makes sense that at times in your life or all throughout your life that your immune system would get confused and attack itself.
--:-- You know, one question I keep wondering is if autoimmune disease is on the rise, why is this not taught in medical school to the extent that it probably should be?
--:-- Dr. Sara Szal: It's a good question. What I believe is that much of medical training is influenced by the pharmaceutical industry. So this is a big topic and I don't want to disparage the kind of training that I've had because I'm incredibly grateful for it. But I would also say I was taught to make a diagnosis and then to offer a pharmaceutical. When it comes to things like autoimmune disease, what we know is that lifestyle medicine is probably the most effective approach, at least the beginning, depending on when you catch it. There are some conditions that are too far gone. Type 1 diabetes. If you have your immune system attack your pancreas to the point where you don't have any islet cells left to make insulin, then you need insulin. Lifestyle medicine isn't going to cut it. But that very approach of lifestyle medicine that's so effective at addressing root causes is not taught in medical school. So the solution is not part of this, you know, seven-year training that I went through.
--:-- Mel Robbins: So Dr. Szal, how did you learn this?
--:-- Dr. Sara Szal: I had to teach myself. So a lot of it was being in my 30s and, you know, feeling way more exhausted than I should have. And going to my doctor and saying, "I'm so tired, I've got PMS, I can't lose this baby weight." And he offered me an antidepressant and a birth control pill. And he told me to eat less and exercise more. And so that was one of those moments, Mel, where I was like, wait, this isn't right. Like there's something deeper here that's not gonna be fixed with a pharmaceutical, because pharmaceuticals, if you think about them for a moment, they block biochemical pathways in the body. That's the way they work. That's how you can patent them and make billions of dollars from them. Whereas lifestyle medicine is working with the intelligence of the body. It's not blocking pathways, it's making them better. That's what happens with exercise, with eating the right foods, with having the kind of love and connection that we most need.
--:-- Mel Robbins: And if I extrapolate as to where you're going, if the body can attack itself, it's your opinion, Dr. Szal, that it can also heal itself.
--:-- Dr. Sara Szal: Oh, absolutely. I mean, the beautiful thing about these three root causes is that you can do something about two of them. You can't change your genetics, at least not yet, but you can address the leaky gut and you can address the triggers.
--:-- Mel Robbins: Dr. Szal, I would love to hit the pause button for a second so we can hear a short word from our amazing sponsors. And while you listen to our sponsors, a couple things. Number one, make sure to share this with anyone in your life that is tired, is struggling with an autoimmune disease, that might have something going on but they can't get to the bottom of it. I know everything that we're going to continue to dig into is going to truly help them. Second, don't go anywhere because coming up a little bit later, Dr. Szal is going to ask you and I 17 questions that she uses in her medical practice. And anytime you answer yes to any one of these 17 questions, it increases your risk for autoimmune disease by 20%. That's coming up and so much more. So stay with us. We'll be right back after a short break.
--:-- [Music plays, then fades out]
--:-- Mel Robbins: Welcome back. It's your friend Mel Robbins. And today you and I are getting to spend time together with the amazing Dr. Sara Szal, who is teaching us everything that we need to know about autoimmune disease. So Dr. Szal, what is the difference between alleviating the symptoms that somebody feels when they're struggling with an autoimmune disease versus treating the root cause?
--:-- Dr. Sara Szal: The difference is that alleviating symptoms works temporarily. It's like a band-aid. It's a way of masking the symptoms so that the person stops complaining. Whereas if you address the root cause, if you start to turn the physiology back toward a healing state, that's where you get lasting change. That's where you start to reverse these conditions or maybe prevent them to begin with.
--:-- Mel Robbins: Well, I think it's really exciting that there are things that you can do that actually trigger your body to go into a healing state versus a civil war.
--:-- Dr. Sara Szal: That's right. To put yourself at peace.
--:-- Mel Robbins: As a medical doctor, what's the worst thing that you could eat or drink when it comes to a leaky gut?
--:-- Dr. Sara Szal: The worst is alcohol.
--:-- Mel Robbins: Oh, really? How come?
--:-- Dr. Sara Szal: Because it attacks the tight junctions. So it leads to leaky gut. And if you look at animal models of leaky gut, the way that they most consistently create leaky gut in an animal, in a mouse or a monkey, is to give them alcohol.
--:-- Mel Robbins: Really?
--:-- Dr. Sara Szal: Yes. That's how you set up the experiment so that you can see what works. There's other things too. So stress can do it. Having too much stress—there's a certain amount of stress that's normal and healthy. Too little stress, you're not very productive. Too much stress, it pokes holes in your gut.
--:-- Mel Robbins: How does stress poke holes in your gut?
--:-- Dr. Sara Szal: So it gets the brain to release something called CRH, corticotropin-releasing hormone.
--:-- Dr. Sara Szal: And that directly pokes holes in the gut, leads to the loss of this boundary.
--:-- Mel Robbins: Wow. Why would something that is stress in your brain poke holes at the soldiers holding the boundary in your gut?
--:-- Dr. Sara Szal: Well, that's more of a philosophical question. And I appreciate that.
--:-- Mel Robbins: I appreciate that.
--:-- Dr. Sara Szal: But I think it's, you know, we are marvels of adaptation. And so there are ways that boundaries come together and come apart, come together and come apart. And they're meant to be pretty fluid. And there's some purpose behind them. They're not meant to come apart and stay apart. But even the stress of being an athlete, of working out really hard, that raises cortisol levels and it can cause leaky gut. It doesn't cause a permanent state of leaky gut, but it leads to more leaky gut. I see it in the professional athletes I work with.
--:-- Mel Robbins: And I bet the same is true at work. If you see a massive increase in burnout or you're somebody that's working as a first responder or an overnight shift, just something that's just constantly stressing you out, I would imagine you see a direct connection with that too.
--:-- Dr. Sara Szal: I was just looking at the data on this last night and how night shifts are associated with more autoimmunity.
--:-- Mel Robbins: Really?
--:-- Dr. Sara Szal: Yes. Because you don't get that same circadian rhythm. Your mitochondria, the powerhouses inside of your cells, don't work to the same degree.
--:-- Mel Robbins: Dr. Szal, do autoimmune diseases impact women more than men?
--:-- Dr. Sara Szal: Absolutely. Four times more women than men.
--:-- Dr. Sara Szal: There's a number of reasons. There's sex differences, which are biology, things like X chromosome versus Y chromosome. But then more concerning are the gender differences. And those are socially constructed. That's the fact, for instance, that women experience more stress than men. They experience more trauma than men. They experience trauma earlier. When men and women are exposed to the same trauma, women have higher rates of post-traumatic stress disorder. We've got huge hormonal differences. We go through pregnancy and postpartum, perimenopause and menopause. So this idea that a lot of people have, that it's just a biological difference, it's just an X chromosome, that's an oversimplification. It's necessary, but it's not sufficient for this dramatic rise that we're seeing in autoimmune disease, especially among women.
--:-- Mel Robbins: Well, I think it's shocking that in the last 25 years, based on the research, MS, for example, women are experiencing it four times more than men. And when I think about the number of female friends of mine that are the primary caregivers, or they are the breadwinner in the household and the caregiver, or the chronic levels of stress that women feel, the rise in anxiety, the rise in depression, are these all factors too?
--:-- Dr. Sara Szal: They're all factors. What's important to realize is we can measure these things. We can measure the cost of not being able to say no. We can measure the cost of caregiving and over-functioning and giving until you're depleted. We know that women are at greater risk of burnout. I think it's important to take it out of the purview of women to start measuring up in some way and to say that there's something wrong with our environment. It's a health hazard to be female in our culture. It makes me sad to say that because I was here in Boston in 1989 learning about how it was a health hazard to be a woman in our culture. And if anything, it's gotten worse, Mel. So we've got double the rates of depression, double the rates of insomnia, four times the rate of autoimmune disease, twice the rate of Alzheimer's disease, more regional and chronic pain. We've got so many differences, gender differences, research gaps. Most of the research is done in men and assumed to apply to women. There's a knowledge gap. There's a gender bias in the way that doctors take care of patients, females versus males. There's a treatment gap. If you have perimenopause or menopause and you go to your doctor for some help, 73% of women don't get the treatment they need. So that's the situation in which autoimmune disease is increasing.
--:-- Mel Robbins: I think it's important to say it because it validates the experience of a person listening, or as you're listening, you're thinking about somebody in your life who's struggling, and you're going to share all of Dr. Szal's wisdom and research with that person in your life to go, oh, it's not that you're damaged. There are things that have happened to you that are creating this confusion and this civil war in your body. And one of the encouraging things about all the depressing news is that if it's environmental and if there are things that were done to you, it means that there are corresponding things that you can do once you understand all this to help your body go back into a state of healing itself and getting the boundaries back up and removing the confusion so that your body is not at war with itself.
--:-- Dr. Sara Szal: Perfectly stated. What happens for a lot of women is that they go to their doctor and they're trained to turn over their power. They're trained to just go along with what the doctor says, whether that's being dismissed or being told, okay, you've got rheumatoid arthritis, we're going to start this pharmaceutical. And so what's hopeful here is that you can step into action. You can start to make these changes about leaky gut, about the triggers that you've experienced, and you can take back the wheel of your health.
--:-- Mel Robbins: I love that. I love that. And your book, *The Autoimmune Cure*, is basically a roadmap for doing that. You know, when I posted this clip, Dr. Gabor Maté was on the show, and he had this moment where he talked about autoimmune diseases in women. And it's one of the single most viral things that I've ever posted online. And it was all about what you're talking about, these environmental factors that contribute to the documented rise in autoimmune diseases in women. I want you to hear this clip, and I want to play it in particular in case the person that's with us right now hasn't had a chance to hear it. And then I would love to hear your reaction to it.
--:-- [Audio clip begins]
--:-- Dr. Gabor Maté: 80% of autoimmune disease, which are diseases where the immune system attacks the body that it's supposed to protect, 80% of them happen to women. Why?
--:-- Dr. Gabor Maté: I knew people before they got sick. And I knew them in the context of their families of origin. And these people had four significant characteristics. One is they tended to put other people's emotional needs ahead of their own. Number two, they tended to identify with duty, role, and responsibility rather than the needs of the self. Number three, they tended to be very nice, which means they repressed healthy anger. And number four, these people tended to believe that they're responsible for what other people feel, which is a point that you address in your book, *Let Them*, and that they had this belief that there was never disappointing anybody.
--:-- Now, those beliefs lead you into not saying no to the demands of the world. And you're constantly taking on stuff and stress and other people's stress. You get stressed. That stress undermines the immune system, which then turns against you. Why is it women? Because who in this culture is programmed to always look after everybody's emotional needs, taking everybody's stresses, identify with their duties and their role, be nice all the time, not be angry in a healthy way, and to take responsibility for other people's feelings? It's women. It's not a gender issue. It's a cultural issue.
--:-- Mel Robbins: Why do you think this topic triggers so many people, positive or negative? Because people had very strong reactions to what he was saying—when he was saying chronic stress, they're the caregivers, there's a lot of sexism. Why do you think this topic triggers so many people?
--:-- Dr. Sara Szal: I think that clip nailed the experience of women. And as I listened to it, I felt like I was nailed to the wall, not in a good way. I was nailed to the wall because there are cultural norms that make us sick and keep us sick. And Dr. Maté talked about how we over-function, we prioritize other people's needs over our own, we get caught up in over-providing, over-caring, and there's a cost to it. And the cost is our health.
--:-- Mel Robbins: Yes. And you also talked about trauma as a big trigger. And in the book, actually, if I turn to page 48 and 49 in your book, you go through a bunch of questions that are part of something called ACE, which is your Adverse Childhood Experiences Score. And this helps us understand experiences from the past that may have created stored trauma in your body. Is that what this is?
--:-- Dr. Sara Szal: That's right. This questionnaire was developed in the 1990s with the Centers for Disease Control and also Kaiser Permanente. And they did this really interesting thing where they took midlife people, people like you and me, and they looked at how many childhood experiences they had that were adverse. Things like abuse, neglect, having a mother that was beaten, physical violence in the home, having a parent with an alcohol or other substance use disorder. And they found that women and men, if they had an elevated adverse childhood experience score, they had a greater risk in midlife of 45 different chronic diseases.
--:-- Mel Robbins: Really? Including autoimmune disease.
--:-- Dr. Sara Szal: Including autoimmune disease.
--:-- Mel Robbins: Wow. Could you read through some of these questions just so that the person that's with us right now can just be really thinking about what this adverse childhood experiences score is? And I think when you start to hear these questions, it makes sense that it would connect to something in terms of your health.
--:-- Dr. Sara Szal: Before your 18th birthday, did a parent or other adult in the household often or very often swear at you, insult you, put you down, or humiliate you? Did a parent or other adult in the household often or very often act in a way that made you feel afraid that you might be physically hurt? What about push, grab, slap, or throw something at you? Did a parent or other adult in the household often or very often hit you so hard that you had marks or were injured? Did an adult or person at least five years older than you ever touch or fondle you or have you touch their body in a sexual way? Did an adult or person at least five years older than you ever attempt or actually have oral, anal, or vaginal intercourse with you? Did you often or very often feel that no one in your family loved you or thought you were important or special? Did you often or very often feel that your family didn't look out for one another, feel close to one another, or support one another? Did you often or very often feel that you didn't have enough to eat, had to wear dirty clothes, or had no one to protect you? Did you often or very often feel that your parents were too drunk or high to take care of you or take you to the doctor if you needed it? Were your parents ever separated or divorced? Was your mother or stepmother sometimes, often, or very often pushed, grabbed, or slapped, or had something thrown at her? Was your mother or stepmother, sometimes, often, or very often, kicked, bitten, hit with a fist, or hit with something hard? Was your mother or stepmother, sometimes, often, or very often, repeatedly hit over at least a few minutes, or threatened with a gun or knife? Did you live with anyone who was a problem drinker, or alcoholic, or who used street drugs? Was a household member depressed or mentally ill? Or did a household member attempt suicide? Did a household member go to prison?
--:-- Mel Robbins: Yeah, you hear those questions and it's a wonder anybody makes it to adulthood.
--:-- Dr. Sara Szal: It's true. It's very true. And what was so fascinating about this particular questionnaire is that we never connected the dots before between these kinds of adverse experiences and physical problems later in life.
--:-- Mel Robbins: Dr. Szal, can you connect the dots for us? So let's take something that I think most of us could probably answer yes to, which is, did you often feel that no one in your family loved you or thought you were important or special? Like that feeling of not being seen. So something that feels not as "serious" as being punched with a fist or sexually abused—how does even that type of traumatic experience of not feeling seen or important to the adults and caregivers around you connect to physical issues with your health later in life?
--:-- Dr. Sara Szal: This is where things get interesting. So if you imagine being a child, and I certainly had experiences when I was a kid where I didn't feel special or loved, that then changes the stress response in the body. And the way I think of it at its simplest is the PINE network.
--:-- Mel Robbins: What's a PINE network?
--:-- Dr. Sara Szal: PINE network stands for your Psychology. I is your Immune system, N is your Neurological system, and E is your Endocrine system. So the PINE network, when you're that kid with an adverse childhood experience, it becomes dysregulated. And for some people, it's the immune system that becomes most dysregulated, and those are the people who have a greater risk of autoimmunity. For some people, it's the endocrine system. They produce a lot of cortisol when they're experiencing that ACE, that adverse childhood experience. And then they have problems with cortisol for the rest of their life unless they address it. Other people have nervous system dysregulation, and they don't understand why their heart rate variability—with maybe a wearable—why they're so stressed all the time and their HRV is so low. Or why they have chronic anxiety.
--:-- Mel Robbins: Hi, Mel Robbins. Right? No, seriously. Yeah. That makes a lot of sense. I've never heard anybody talk about the PINE Network, but it makes a lot of sense because when you're little, that entire network is developing.
--:-- Dr. Sara Szal: That's right. And it's developing and learning and changing in real time based on what you're exposed to. And if you don't feel safe or you feel under threat, then your entire system—from hormones to immune to nervous system to your psychology—adapts because of these adverse childhood experiences.
--:-- Mel Robbins: That's right. And you just used the word safety, which is so critical. Safety is the fundamental part of childhood that we want our kids to experience, and too many of them don't.
--:-- [Let's take a quick pause right here and hear a word from our amazing sponsors. Thank you in advance for taking the time to share this with the people in your life that you deeply care about, especially the women in your life. And don't go anywhere because we have so much more to dig into, including more things that you can do if you are struggling with an autoimmune disease. Stay with us.]
--:-- [Welcome back. It's your friend Mel Robbins. And today you and I are getting to spend time learning from the amazing Dr. Sara Szal. We're talking about autoimmune diseases.]
--:-- Mel Robbins: Dr. Szal, how does trauma and adverse childhood experiences relate to autoimmune disease?
--:-- Dr. Sara Szal: For people who have a dysregulated immune system, so their immune system is imbalanced, it starts to get confused about what is normal healthy tissue and what's foreign. That then sets them up for a greater risk of autoimmune disease.
--:-- Mel Robbins: How does someone who says, "Okay, that happened in the past, it's the past, I've talked about it, I've dealt with it. I've moved on from it." How can it still be influencing your health right now?
--:-- Dr. Sara Szal: This is one of those places of connecting the dots that I think is critical. So a lot of people say that they've got this cognitive approach to the trauma they experienced, and they don't realize that their high blood sugar or their multiple divorces or the conflict they experience at work is actually related to adverse childhood experiences. So there's a way that ACEs live on in the body. Even if you think you've already cognitively processed it, we know that it can disrupt you mentally, emotionally, and also physically.
--:-- Mel Robbins: And that makes sense. And if you have these stored adverse experiences in your nervous system and in your body, of course it would interrupt your body's ability to function because you're always bracing and you're always still feeling like there's some level of threat, which means the healthy boundaries that your body has internally slowly get worn down.
--:-- Dr. Sara Szal: That's right.
--:-- Mel Robbins: How would you know if you're dealing with an autoimmune disease or condition if nobody's ever told you? Like, what are the symptoms that you may be dealing with an autoimmune disease?
--:-- Dr. Sara Szal: There's a long list of symptoms. And part of what makes people search for a diagnosis and a doctor who will take them seriously for years is that the symptoms are what we call nonspecific.
--:-- Mel Robbins: That's a medical term?
--:-- Dr. Sara Szal: That's a medical term.
--:-- Mel Robbins: Non-specific? If my doctor said, "Well, those are non-specific symptoms," I'd be like, "Well, let me put some berries on that. It really hurts." Very specific, doc.
--:-- Dr. Sara Szal: So it depends on which part of the body is being attacked by the immune system. So the most common things that we see across all 100 autoimmune diseases are things like fatigue, exhaustion, swelling, signs of inflammation, joint pain, and aches. The other symptoms depend on what's being attacked. So with Hashimoto's thyroiditis, we know right now 13% of relatively healthy people have positive antibodies against their thyroid.
--:-- Dr. Sara Szal: 13%. So with Hashimoto's thyroiditis, it's the fatigue, it's the joint aches, but it's also that you just can't put your foot on the gas like you once did. You find that you're gaining weight seemingly out of nowhere. Intermittent low-grade fevers or night sweats, and that's where perimenopause and menopause can make things confusing. Neuropathy, so an autoimmune attack of the nerves in the legs and the arms that can cause tingling or even difficulty with your gut function like diarrhea or constipation, difficulty swallowing. Loss of appetite, gut issues like acid reflux, bloating, cramping. Skin reactions, we talked about psoriasis, rashes, swollen glands, anxiety and depression. Visual changes, especially important with people with multiple sclerosis. Weight gain or loss. Irregular or rapid heartbeat.
--:-- Mel Robbins: And you write in the book, and I think this is important for everyone to hear, that given that there's usually clustering of symptoms, you recommend going to your primary care practitioner if you have three or more. And if you've got additional symptoms, you definitely want to see a specialist—whether it's a rheumatologist or a gastroenterologist or somebody that is really a specialist in that part of the body that has the most acute symptoms.
--:-- What's interesting about you connecting the dots between the symptoms of autoimmune disease and menopause is that if I go back to the original words that you used, which is your body is confused and your boundaries that were there to protect you are now no longer there. If you look at the drop of estrogen production in a woman's body, of course your body's confused if it runs on it. So if you take the exact same approach of "my body is designed to function properly, my body is designed to heal itself," if I look at this condition, whether it's menopause or an autoimmune disease, as me needing to recognize that I'm at war with myself, and if I really embrace that, I can also activate the healing properties in my body and reestablish the boundaries internally—whether it's nervous system or my hormones or it is my psychology or it is my gut—and that that's going to make a huge difference.
--:-- Dr. Sara Szal: Amen. Wow. So I would say I love the point that you're making because I think a lot of women don't understand this. I didn't until we're having this discussion and you use the word confused and civil war. Yes. And there is a way that we take the experience after age 40 of perimenopause and menopause, and we think it's mostly hormones. We think it's estrogen going down, progesterone going down, maybe a little testosterone goes down. There is a much more complex backstory where your immune system is changing. Your metabolism is changing. The way that you make energy inside of your cells. It's not just hormonal.
--:-- Mel Robbins: Well, and plus, if I take everything that you're teaching us today and sharing with us, Dr. Szal, what I'm also embracing is that around that age, the caregiving load actually starts to grow up as your parents are aging. A lot of people go through a change in their relationship and might find themselves single again. And you now have the burden of being the primary breadwinner. And there's a lot of changes that happen in people's lives where they move and friend groups change and that causes stress. And so there are a tremendous number of lifestyle factors too that come crashing down, which makes me wonder, is there a particular age range where you see autoimmune diseases spike?
--:-- Dr. Sara Szal: Yes. So the most common spike that I see is perimenopause and menopause.
--:-- Mel Robbins: And what age is that for most women?
--:-- Dr. Sara Szal: 40 to 55.
--:-- Mel Robbins: So 40 to 55 is when you also see the spike in autoimmune symptoms and diseases.
--:-- Dr. Sara Szal: Yes. And it's because it seems that there is this just crashing of factors outside of us and inside of us that cause a huge change in our immune system and the way that our body functions.
--:-- Mel Robbins: I have a feeling it's going to be one of those conversations that not only is shared all over, because I know as you're listening to Dr. Szal and you're nodding your head, you're thinking of about 10 people that you're going to share this to. But now I'm like, okay, I am tracking with everything that you're saying. I feel both scared and empowered. What are the three things that I need to do or that the person that I love needs to do immediately, regardless of if I have a diagnosis or if I'm just tired and achy and just feeling like something's off and I'm in that age range of 40 and up?
--:-- Dr. Sara Szal: Number one, get tested. Number two, elimination diet. Number three, track those triggers. Address them. Hunt them. Stress, adverse childhood experiences. And adult trauma too.
--:-- Mel Robbins: And adult trauma.
--:-- Dr. Sara Szal: And adult trauma.
--:-- Mel Robbins: When you say test, give me the list. What is the succinct thing as I'm walking into my doctor's office or I'm doing one of the tests online that you can now do to measure all this stuff? What exactly am I testing for?
--:-- Dr. Sara Szal: You want to test your immune system. So complete blood count with the differential. You want to test your level of inflammation—high sensitivity C-reactive protein, erythrocyte sedimentation rate, something called the neutrophil to lymphocyte ratio.
--:-- Mel Robbins: Neutrophil to lymphocyte—what? What was that?
--:-- Dr. Sara Szal: NLR. So it's the neutrophil—
--:-- Mel Robbins: These are white blood cells.
--:-- Dr. Sara Szal: Neutrophil to lymphocyte ratio. Then you want to look at your metabolism. And a lot of people don't connect these dots with autoimmunity. But what we know is that when you look at your white blood cell count, when you look at your T cells, which are part of the army in your immune system, the T cells, the mitochondria that are working inside your T cells, they start to become impaired. And it seems to lead to this confusion, or at least it's associated with the immune system confusion that occurs. So you want to look at things like your glucose and your insulin levels. How are you turning your food into fuel? Is that working properly? And then you want to look at your hormones. Estrogen, progesterone, testosterone. Vitamin D, which is really important for leaky gut.
--:-- Mel Robbins: If you're someone who's listening and you're halfway around the world and you don't have access or the money to be able to pay for these tests, without getting a test, is there something that you should be doing right now in order to activate the healing properties in your body and to start to heal the leaky gut for sure?
--:-- Dr. Sara Szal: The thing you can do right away if you can't test is an elimination diet. It's free. So what we know is that gluten, dairy, alcohol, sugar—all of these tend to trigger problems with leaky gut. So you've got to give those up. An elimination diet itself helps to reverse leaky gut. We think that addressing your stress, addressing your cortisol levels, if that's driving the leaky gut, that also helps. So give up gluten, dairy, sugar, and alcohol. Do it for three weeks.
--:-- Mel Robbins: Three weeks.
--:-- Dr. Sara Szal: Three weeks. See what happens to your symptoms. Does your psoriasis clear up? Do your joints feel a little bit more loose? Are you less tired? That's what we want to track. There are some people who have had lifestyle factors working against them for so long. They've had leaky gut for so long that three weeks may not be sufficient, but usually in three weeks, you can tell if you're going to feel better. You can tell if there's a partial response, in which case, keep going.
--:-- Mel Robbins: And how important is diet in improving or worsening your autoimmune disease?
--:-- Dr. Sara Szal: It's critical. I think of diet as the way that you bring the outside world inside your body.
--:-- Dr. Sara Szal: So we want those boundaries. You know, here's what I just saw as a vision. Let's take Person A and her name is Mel and she has all these symptoms and she starts her day with a big cup of black coffee and six sugars. And then she does the drive-through at a fast food joint. And then she's munching on chips at her desk. And then when she gets home because she's stressed out and exhausted and has little kids to take care of and parents that need her too, she is downing a bottle of Chardonnay as she's cooking dinner. And dinner is something I'm heating up in a microwave after wrapping the plastic off. And then I take two Advil PM to help me knock out and get a better night's sleep. And if I take that person Mel versus the person named Sarah who wakes up in the morning and maybe makes a couple scrambled eggs with some kimchi and is breathing and listening to a good podcast on the way to work and has a salad and a little bit of chicken and then goes home at night and has water and has a wonderful bone broth and some homemade meatloaf or something with some leafy green vegetables. And then you meditate before bed with a nice cup of chamomile tea. I don't think you need a medical degree or a PhD to understand that Mel is not doing herself any favors and that Sarah's internal system and boundaries are probably a little bit better.
--:-- Mel Robbins: I feel like you just described so perfectly why we are facing the exponential rise in autoimmunity. It's these lifestyle factors that are harming our health. I also feel like you've been a fly on the wall at my house. Is that what you eat?
--:-- Dr. Sara Szal: Yes. Well, you know.
--:-- Mel Robbins: I'm a little more protein because I'm trying to build muscle.
--:-- Dr. Sara Szal: Yeah, me too.
--:-- Mel Robbins: But so the reason why I say this is because those two choices, the choices that Mel made that are not doing my body any favors, they don't remove the fact that I have aging parents and kids to take care of or financial stress or a dickhead for a boss who's constantly causing me stress or an ex that's blowing up my phone. It doesn't remove those environmental and lifestyle things outside of my control. But I can see how the choices that the other person, Sarah, makes actually empowers you to feel a little bit better and to get a better night's sleep and to feel more grounded in your body, which of course makes you feel more equipped to meet the demands of this moment in your life. And it'd be easy to kind of roll your eyes and say, those two differences in the choices about what you put in your body, whether you hydrate with water or you're hydrating with soda, that that's not going to make a difference. But you could see over time, it actually does make a difference because it changes how you feel from the inside out. And it gives your body a fighting chance to stop the civil war that's contributing to the chronic fatigue and ache and just like, "What the hell? Why do I feel like this?" And that's not to blame anybody. I'm trying to highlight in a way that makes us all go, "Oh yeah, when I slow down a minute and really absorb what Dr. Szal is teaching me and I really consider what's in my control, that would make a difference over time."
--:-- Dr. Sara Szal: Yes, you're talking about the locus of control, which I think is critical here.
--:-- Mel Robbins: What does that mean, locus of control?
--:-- Dr. Sara Szal: It means that these decisions you make all day long about the cup of coffee with the six sugars versus the green tea—
--:-- Mel Robbins: It tastes so good, Dr. Szal.
--:-- Dr. Sara Szal: I get that, Mel. And I made those choices through my teenage years, my 20s and my 30s. I had disordered eating. I loved carbs. I ate a lot of sugar. But the truth is, the state of dysregulation, the state of pain that I was in, and the way that it was causing the civil war in my body, because I had positive anti-nuclear antibodies, it was more miserable than any of these lifestyle changes that we're talking about. And once you feel regulated in your body, once you're feeding yourself the right fuel and you get your stress level just right, there's no going back.
--:-- Mel Robbins: You know, one of the things that I've come to believe, especially after starting this podcast and speaking to so many world-renowned experts like you, is that the single barrier that's the biggest thing that stands in most of our way around getting better or being happier or improving our health is this despair and discouragement that it's not going to matter. And so I would love for you to speak to the person listening and to the person that they love who they're going to share this with who feels like they've lived for so long feeling tired and inflamed and achy and they've been disregarded and told to take some medication and just stop complaining about it. I'd love to have you speak to the hope, the very real hope, that this can get better with some small changes over time.
--:-- Dr. Sara Szal: I feel for the person you're talking about, because I used to be that person. I was in a marriage that was unhappy. I didn't like my work. I felt stressed all the time. I had teenagers and there was a lot of challenges there. I really struggled with stress especially. I have an adverse childhood experience score of six, which is really high. Every elevated score—one or higher—increases your risk of autoimmunity by about 20%. And what I want people to understand is that you can just make small changes and bit by bit, those small changes add up to major transformation. And what you notice in your body as you go along, as you give up the gluten, the dairy, and the sugar, and the alcohol, and then maybe you start addressing the trauma in your body—every day you feel a little better. The brain fog starts to clear. Your joints don't hurt as much, and so you're able to walk or go rucking or build your muscles. These small changes add up. They make a difference. They signal to your body, "Darling, it's safe now." You start to feel better, and it's little by little, but it adds up to something major.
--:-- Mel Robbins: What other changes can you make to help your body heal, especially if you have a lot of adverse childhood experiences?
--:-- Dr. Sara Szal: Your breath.
--:-- Mel Robbins: Say more about that.
--:-- Dr. Sara Szal: Your breath is the most underutilized health tool in the world.
--:-- Mel Robbins: You said breath and I immediately was like... [Mel takes a deep breath]
--:-- Dr. Sara Szal: Right? Now I'm meditating.
--:-- Mel Robbins: As you say breath, I wasn't even thinking about the fact that I was breathing. I think I've been holding my breath the entire time I'm talking to you.
--:-- Dr. Sara Szal: That's what we do. So we develop this pattern often as a child of shallow chest breathing. And it signals to the brain and the rest of the body, the immune system, that you are not safe. Deep, slow abdominal breathing is the best medicine you can offer your nervous system, the cells of your body.
--:-- Mel Robbins: So what's your favorite way to do that? There's so many different ways.
--:-- Dr. Sara Szal: I mean, I'm a yoga and meditation teacher. What we know is the rule of fives are very important.
--:-- Mel Robbins: What's that mean?
--:-- Dr. Sara Szal: So we know that if you breathe for about five and a half seconds in and five and a half seconds out, and you do that for several minutes, or just do it for three breaths, that starts to change your physiology.
--:-- Mel Robbins: Will you just take us through three breaths right now?
--:-- Dr. Sara Szal: Sure. So let's inhale together. [Breathes in] Hold at the top. [Pause] And then exhale for 5.5 seconds. [Exhales] We're going to do that two more times. [Breathes in] Exhale. [Exhales] Once more. [Breathes in] Get your belly in there. And exhale. [Exhales]
--:-- Mel Robbins: So three breaths can change your physiology. I feel my shoulders dropping.
--:-- Dr. Sara Szal: Yeah, I saw that. That's pretty cool.
--:-- Mel Robbins: Wow. Dr. Szal, could you speak directly to the person listening who may be dealing with an autoimmune disease and taking medication for it? And explain what changes they might experience if they were to add in the lifestyle shifts that you're talking about.
--:-- Dr. Sara Szal: That's the best way to do it. So I work at the Department of Integrative Medicine and Nutritional Sciences at Thomas Jefferson University. We don't use integrative lifestyle medicine as a substitute for mainstream medicine. We use it as added value. So if you're someone who has, say, rheumatoid arthritis and you're taking a medication like methotrexate, what you can do is start to layer in an elimination diet, which has been well-proven in a randomized trial to be beneficial for people with rheumatoid arthritis. You can start to address the boundary issues. You can look at your triggers and start to unearth them, resolve the trauma that's in your system. And what you might find is that you're able to reduce the dose of your medication. You're going to do that under the care of a collaborative clinician. You might be able to get off of your medication.
--:-- Mel Robbins: Wow. If the person listening is like, "Wow, I feel like I'm at risk for developing an autoimmune disease," what's the single biggest change that you could make today that would reduce your risk?
--:-- Dr. Sara Szal: If you're going to make one change, focus on your diet. Give up gluten, dairy, alcohol, sugar. Look at why you're attached to those. If it's difficult for you to give them up, just give them up for three weeks and notice what happens in your body. Because your body is this magnificent network that is meant to support you. And we throw all these obstacles at it. And sometimes they can overcome the obstacles, but sometimes they can't. And I would say autoimmunity is one of the consequences of not being able to adapt.
--:-- Mel Robbins: Dr. Szal, I want to ask you about some specific autoimmune diseases that I've been seeing a lot online. You know, I've seen Hashimoto's a lot, whether it's in the news or on social media or friends talking about it. What is Hashimoto's?
--:-- Dr. Sara Szal: Hashimoto's is when your immune system is attacking the enzymes in the thyroid, the gland in your neck.
--:-- Mel Robbins: And what is the thyroid's purpose?
--:-- Dr. Sara Szal: So the thyroid has a lot of different jobs. I think of it like the gas pedal in the body. So it controls metabolism, like how fast or slow you're making energy, you're burning calories. You have thyroid receptors that interact with thyroid hormone, almost like molecular sex. You have thyroid receptors on almost every cell in your body.
--:-- Mel Robbins: Did you just say molecular sex?
--:-- Dr. Sara Szal: Yes, molecular sex. And so what happens if you're attacking your thyroid is that you might have hair loss, fatigue, constipation, transit time changes in your gut. You might notice that your cholesterol is coming up. It's rising. You might have joint aches, some of those other common symptoms that we see with autoimmunity. Hashimoto's thyroiditis is nine times more common in women than men, and it is the most common cause of what we call hypothyroidism.
--:-- Mel Robbins: That's the word I had heard in the past, but now I'm hearing Hashimoto's. So is it the same thing?
--:-- Dr. Sara Szal: It's not the same thing. It's about the cause of 95% of hypothyroidism. So it doesn't cause all of it, but it causes most of it.
--:-- Mel Robbins: And how do you know if you have Hashimoto's? What's the most common symptoms that people experience?
--:-- Dr. Sara Szal: The most common symptoms are fatigue, maybe weight gain, joint aches, your cholesterol goes up, you might have dry skin, dry hair, hair loss, especially the outer third of your eyebrows, eyelashes.
--:-- Mel Robbins: Really? Now I'm sitting here going, do I have Hashimoto's? Wait a minute, because I've been buying the brow growing serum because I'm losing my eyebrows. How do you confirm that you have it? Do you just get a blood test?
--:-- Dr. Sara Szal: Yeah, we check your thyroid.
--:-- Mel Robbins: No kidding.
--:-- Dr. Sara Szal: So we look at thyroid stimulating hormone and we look at the autoantibodies.
--:-- Mel Robbins: You know what I'm doing over lunch?
--:-- Dr. Sara Szal: Yes, please.
--:-- Mel Robbins: Let's check. Can we talk about POTS? What is it and why is there a rise in it?
--:-- Dr. Sara Szal: POTS is postural orthostatic tachycardia syndrome.
--:-- Mel Robbins: Also a mouthful. Does that mean like I'm slouching? What does that mean?
--:-- Dr. Sara Szal: It means that you stand up and your body can't adjust to the change.
--:-- Mel Robbins: Meaning you get lightheaded?
--:-- Dr. Sara Szal: You get lightheaded, you might faint.
--:-- Mel Robbins: Really?
--:-- Dr. Sara Szal: So the body is designed to be able to adjust. You know, for instance, when you get out of bed in the morning, you go from lying down to sitting or standing. And you've got this part of your nervous system, the autonomic nervous system, which is mostly automatic, that is meant to adjust the valves and the blood pressure and the pulse so that you can stand up and not fall over, not faint.
And that system, the autonomic nervous system, can become dysregulated. It can be an autoimmune attack, which is what we think much of POTS is. It can also be something that we saw a lot during the pandemic and post-pandemic. So we've seen a dramatic increase as part of long COVID.
--:-- Mel Robbins: And is there a test that you can take in order to determine if you have POTS?
--:-- Dr. Sara Szal: The test is pretty simple. So you go to your doctor, you get your pulse and your blood pressure checked. When you're lying down, you then sit up, we take it again, and then you stand up and we take it again. And so there are criteria for how much your pulse should change or not change and how much your blood pressure should change or not change.
--:-- Mel Robbins: And is it something that once you know that you have it, that you can make it better based on the same lifestyle changes that you've been talking about with us today?
--:-- Dr. Sara Szal: There are a number of lifestyle changes that really make a difference. So we think that making sure that you get enough salt and electrolytes are really key. We also know that insulin resistance can contribute to POTS. We know that there are medications that you can give, but I always prefer to do the lifestyle things first.
--:-- Mel Robbins: If you could speak directly to the person that is with us right now. If they were to just take one action based on absolutely everything that you have so generously shared with us today, what is the most important thing for them to do?
--:-- Dr. Sara Szal: Deal with your trauma. Assess your trauma. Deal with it. Resolve it. A lot of people think they're stuck with their trauma, and I would say you're not. Make the choice to resolve it.
--:-- Mel Robbins: And how do you resolve it? Like if you're someone who always thought, "Oh, trauma is just something that happens to people that are at war," and you're starting to embrace the truth that I don't think anybody gets to adulthood without experiencing some level of trauma that is stored in your body and your nervous system, how do you begin to address it? Because it does feel very overwhelming when you embrace that this may be something from your past that is actually impacting your day-to-day life still today.
--:-- Dr. Sara Szal: It starts with creating safety in your body. And this is especially important for those of us who had adverse childhood experiences before age three. So creating safety in your body, using the breath that we practiced together, meditation, yoga, ways of being in your body, creating safety. That's where you start. There are lots of different ways that you can create regulation in your body. Nervous system regulation, immune system regulation. I would say it starts with being fully embodied.
--:-- Mel Robbins: That's a big word. I don't even know what the hell that means. You know what I mean? Like I know what it means kind of. But if I were to hear that, I'd be like, "But Dr. Szal, I don't know what the hell that means."
--:-- Dr. Sara Szal: If you are the kind of person that has ever gone to a yoga class or you've tried a guided meditation on YouTube or iTunes or Spotify, and at the end of it, you have this experience of feeling at peace and you almost never feel that way. To me, that's a sign that there are stored experiences in your body that are driving how you live your life as an adult. And there's a different way for you to be able to go through life, that that sort of moment of calmness in your body and that safety, the word that you just used, Dr. Szal, that that could be the majority of how you feel.
--:-- Mel Robbins: That's right.
--:-- Dr. Sara Szal: And it's entirely within reach. And yet you won't be told that by most doctors. What I was taught to do with people with trauma when I went through my medical training here in Boston was that you do talk therapy with or without a selective serotonin reuptake inhibitor. And there are three medications that are approved for post-traumatic stress disorder. The effectiveness of that approach, which is the gold standard right now, is about 30% because you can't think your way out of trauma. You had a beautiful quote about this.
--:-- Mel Robbins: Yeah, I don't remember whose quote this is, that if you didn't talk yourself into it, how are you going to talk yourself out of it?
And for me personally, talking about adverse childhood experiences or traumatic experiences or just periods of my life where I was so out of control and a walking red flag that I have a lot of shame and regret about who I was because I didn't know any better. And I didn't know that trauma and adverse childhood experiences were driving behaviors I couldn't get control of. But talking about it helps legitimize what you're feeling and validate what you're feeling. And it helps you kind of architect the story of what happened. But it didn't do anything to settle the programming from the neck down.
I had to take physical approaches of cold plunging, meditation, yoga, being outside in nature more, guided therapeutic psychedelic modalities that were all done with the intention of trying to settle my body to that point where I would go to a yoga class 20 years ago. I'd spend 90 minutes on the mat if I could find 90 minutes. The entire time I'd be in my brain thinking about the grocery list or how much better somebody else was at yoga or how hot it was or how I hated the song. And it wasn't until it was over and I laid down that my body just felt safe.
--:-- Dr. Sara Szal: Yes.
--:-- Mel Robbins: And I am here to tell you that if you first recognize that your childhood is impacting you in ways today that you may not realize, but you actually accept that is true. And then you realize that talking about it is going to help you validate what happened and some of the patterns that you can't get control of. But really, your body is designed to heal. Your body does want to be at rest. And if you truly take that on and you follow the recommendations that Dr. Szal just gave you and you also even just following the breath and doing the 5.5 breath whenever you feel yourself go up in your head or get triggered, that right there is you activating the healing response. And it's possible. It truly is.
--:-- Dr. Sara Szal: What I love so much is that the body is designed to do this.
--:-- Dr. Sara Szal: And we keep getting in the way.
--:-- Mel Robbins: Well, after today, we're not going to because you've taught us, Dr. Szal, how to get out of the way and how to validate what we're feeling and to grab the wheel and to turn our relationship to our own health in an entirely new and empowering direction. What are your parting words, Dr. Szal? I know we talked today about things that are scary and threatening and for some people shameful.
--:-- Dr. Sara Szal: What I want you to remember is that it is so much easier to live in a state of regulation, to live in that place of safety inside of your body. And it sends these cues everywhere in your body. It sends the cues to your immune system, to the sweet private security force that you have working on your behalf. It sends the cues to your nervous system. It sends the cues to your hormones and how they're produced in your body. It's so much easier to get into a state of regulation than it is to live with the misery of being dysregulated.
--:-- Mel Robbins: Dr. Szal, I know I speak not only for myself, but for the person who found the time and took the time to be with you and me and learn from you. And what's so exciting about everything that you shared is that, I think when you're really struggling with your health and you feel dismissed by your doctors or your family, that you feel disempowered. And everything that you talked about today puts the power back in our hands and our bodies and being reminded that your body is this magical, amazing thing that is designed to heal and you just taught us how to activate that within ourselves. So thank you, thank you, thank you for taking time out of your extraordinarily busy practice to get on a plane and fly here and spend this time and be so generous with us. I just loved being with you and cannot thank you enough. I cannot wait to see how many people's lives change because this is life altering what you just shared.
--:-- Dr. Sara Szal: Thank you so much, Mel. I mean, I love the service that you provide in the world. You're such a deep listener and a critical messenger in this time in our lives. Thank you.
--:-- Mel Robbins: Thank you. Thank you. And I also want to take a moment and thank you. Thank you for finding the time and making the time to listen to something that could truly change your life. It could improve your health. Thank you for sharing this with the people that you care about. There's no doubt in my mind that if you take everything to heart that Dr. Szal just shared with us, all the research, all the recommendations, all the wisdom, your life and the health of people that you care about, it will get better. And I think it's really cool that you're taking the time to learn this stuff and to invest in your health and in your life. That's absolutely why I'm here. And I just love that you're doing that too. And in case no one else tells you, I wanted to be sure to tell you that I love you. I believe in you. I believe in your ability to change your life. And there's no doubt that by taking the time that you took today, you will.
All righty. I'll see you in a few days. And I'll be waiting for you in the very next episode to welcome you in the moment you hit play. I'll see you there.
--:-- [Sound of a door opening and people moving]
--:-- Mel Robbins: You good? Cool. Are you guys good? Okay, great. Okay, great. You have your phone in here with you?
--:-- Unidentified Crew Member: It's in the closet.
--:-- Mel Robbins: Perfect. Okay. The best place for it. Good. Amazing. Okay. Oh, gotcha. Okay, great. Oh, I love this. Okay. Okay, great. Great. Okay, no problem. Boom. Okay, now. Okay, great. I think that's it. That was great, guys. Come on out. All right, everybody. Dr. Szal.
--:-- Mel Robbins: Oh, and one more thing. And no, this is not a blooper. This is the legal language, you know, what the lawyers write and what I need to read to you. This podcast is presented solely for educational and entertainment purposes. I'm just your friend. I am not a licensed therapist, and this podcast is not intended as a substitute for the advice of a physician, professional coach, psychotherapist, or other qualified professional. Got it? Good. I'll see you in the next episode.
