https://linktr.ee/saragottfriedmd

Sara Gottfried, MD, Moraga, CA (2025)

12/23/2025

Women have higher Alzheimer’s risk and the story doesn’t start at 60 or 70. It starts quietly, decades earlier.

Here’s the reframe: Alzheimer’s is a long disease with a long runway. Brain changes can begin 20+ years before symptoms, which means prevention often starts in your 40s.

So in midlife, we need to start thinking leverage: protect blood vessels, insulin sensitivity, sleep architecture, inflammation, hearing, and connection — because your brain is not a solo sport.

👇 Comment “LABS1” and I’ll send my list of the optimal brain labs.

12/19/2025

Medicine I practice is integrative, functional, evidence-based, and precise.

Not “tell you what to do.” Not “here’s a pill, good luck.”

It’s root-cause + whole-human medicine, where your labs are a story, not a verdict.

Where symptoms aren’t “in your head,”they’re data.

Where we stop gaslighting women and start listening.

We measure what matters (sleep, stress, hormones, metabolism).

We treat the why (inflammation, insulin, trauma load, nutrient gaps, thyroid, mitochondria).

And we build a plan you can actually live inside.

Because you’re not a malfunctioning.

You’re brilliantly adaptive.

And your body has been doing its best with what it’s been handed.

If you want healthcare that feels like strategy + sanctuary, you’re in the right place.

12/18/2025

Medicine 1.0 was built around the physician. Doctors decided treatments and fees, with little to no accountability.

If your OB had a golf tee time at 3 p.m., your odds of a C-section magically rose. Women’s bodies bent around the doctor’s schedule, not the other way around. That era is over. Finally.

We’re stepping into Medicine 3.0, a world where the patient is the North Star, and care becomes:
➡️Personalized: your biology, your hormones, your risk, not the default of the average male in clinical trials.
➡️Participatory: you’re no longer a passive passenger waiting for a cesarean section, you co-pilot decisions with real data and agency.
➡️Preventive: we don’t wait for disease to roar; we measure early, intervene early, and protect function.
➡️Predictive: multi-omics, wearables, and continuous data streams that let us forecast trouble before symptoms start to rise.

Because the old approach to women’s health, where pain was normalized, where cardiovascular risk was missed, where perimenopause was overlooked, where autonomy was secondary, was never acceptable.

Medicine 3.0 says: women are not smaller men, and their care should never again hinge on a doctor’s schedule.

The future is female, data-driven, and deeply humane. And it’s about time 🙌

12/18/2025

Medicine 1.0 was built around the physician. Doctors decided treatments and fees, with little to no accountability.

If your OB had a golf tee time at 3 p.m., your odds of a C-section magically rose. Women’s bodies bent around the doctor’s schedule, not the other way around. That era is over. Finally.

We’re stepping into Medicine 3.0, a world where the patient is the North Star, and care becomes:
⏩Personalized: your biology, your hormones, your risk, not the default of the average male in clinical trials.
⏩Participatory: you’re no longer a passive passenger waiting for a cesarean section, you co-pilot decisions with real data and agency.
⏩Preventive: we don’t wait for disease to roar; we measure early, intervene early, and protect function.
⏩Predictive: multi-omics, wearables, and continuous data streams that let us forecast trouble before symptoms start to rise.

Because the old approach to women’s health, where pain was normalized, where cardiovascular risk was missed, where perimenopause was overlooked, where autonomy was secondary and women underwent surgery unnecessarily, was never acceptable.

Medicine 3.0 says: women are not smaller men, and their care should never again hinge on a doctor’s schedule.

The future is female, data-driven, and deeply humane. And it’s about time.

12/17/2025

Four days. Four lectures. 4.5 hours of telling the longevity bros that female biology isn’t biohacking as achievement, it’s an entirely different operating system.

LongevityFest by was ready for the Medicine 4.0 conversation (see my slide)!

Here we are: Female longevity leverages all the benefits of personalized medicine while actually applying a female-specific lens. N-of-1 experiments. Time series data. Mitochondria as the central story of ovarian aging and brain slow down after 40. Closing the healthspan gap that’s been ignored since Medicine 1.0.

We talked reprogramming microglia (because your brain’s immune cells hold more power than your morning supplement stack) with 🤍 We loved schooling us on muscle (preorder her new book please: Forever Strong Playbook). 💪We discussed MUSE stem cells, psilocybin protocols that refuse to quit with — and digital twins that might finally understand what “hormonal” actually means in medical terms.

The Wall Street Journal slide? That was me reminding everyone that longevity research has spent decades studying male mice while women quietly carried the metabolic syndrome burden with waist circumferences that medicine decided were unhealthy at 35 inches—and provided few other female-specific measurements and signals.

Shoutout to for being the ride-or-die through peptide deep dives and mushroom medicine rabbit holes. And to for creating space where we can actually have these conversations.

The female healthspan gap isn’t closing by accident. It’s closing because we’re done waiting for medicine to catch up.

Slides are mine but Medicine 4.0 is ours.

12/16/2025

Women are dying. And we’re pretending it’s not preventable.

Every 3.5 seconds, a woman dies from heart attack, stroke, or cardiovascular disease. Not other women, women like you. Women who said yes when their body said no. Women who wore exhaustion like a badge of honor until their heart literally couldn’t keep up. Women who didn’t get the testing and treatments they needed in their 30s-60s.

8.9 million women worldwide. Half are preventable.

Here’s what stings: If a woman died every 3.5 seconds from a shark attack, we would change the oceans. We’d hunt every shark, drain beaches, rewrite every warning sign.

But cardiovascular disease, T #1 killer of women globally? We treat it with GO RED campaigns, red dresses, and bubble baths. We scroll past it while our heart rate variability tanks, blood pressure climbs, and our bodies scream in a language we’ve forgotten how to hear.

Women 35+ struggle with excess “cognitive load” when it’s actually cardiac load. We call it “stress” when it’s literally causing or contributing to our #1 cause of death. We worry about dying of breast cancer, but 7-10X more of us die of cardiovascular disease or stroke.

I believe women’s higher cognitive burden, the invisible labor, the constant service and calibration of everyone else’s comfort is killing us. Not metaphorically, medically.

Your exhaustion isn’t devotion. It’s a medical emergency wearing business casual.

And the most dangerous lie you’ve been sold? That rest is something you earn after you’ve depleted yourself completely.

Your heart doesn’t care about your to-do list. Your nervous system doesn’t grade on a curve. Your body isn’t impressed by your productivity.

Please test yourself. Stop outsourcing your worthiness to your output. Your life literally depends on it.

This isn’t wellness content. This is a warning sign that women need to know.

Tag a woman you want to keep alive ❤️‍🩹

Global Burden of Disease Study 2019 & American Heart Association 2024 Statistical Update. And warm thanks to for hosting our webinar on Menopause 3.0!

12/15/2025

Vegas, you showed up. 🔥✨

This keynote at A4M was a love letter to women’s biology, especially the estrogen-mitochondrial-metabolism axis that keeps our lights on, our energy calibrated, and our cells resilient.

Here’s the truth I shared on stage: women live 5 years longer than men globally, but we spend far more of those years in poor health.

I was a prime example: insulin resistant in my 30s with prediabetes that no doctor was looking for, and I was surprised to find. My gestational diabetes tests were borderline and I ignored them. So did my doctors, but this is an example of the failure of our current medical system. Biological drift is right there in front of us if we just know what to look for and then measure it.

Women are winning at lifespan and losing at health span. Our gap widens at three inflection points unique to women: postpartum, perimenopause, and menopause.

When estrogen falls, mitochondria across the body dim. Metabolism shifts. Recovery slows. Sensitivity rises. Women are exquisitely designed and exquisitely vulnerable during these hormonal transitions.

Knowledge is power.

The organ at the center of it all? The o***y.

Our most misunderstood longevity organ, aging earlier than any other, setting off cascades that shape cardiovascular risk, brain energy, metabolic flexibility, and emotional resilience. When we protect ovarian aging, we protect the entire female system. It’s time to take this seriously.

Vegas was a reminder that this movement has momentum. The highlight? Meeting so many of you, including friends, colleagues, and longtime followers.

Our book signing at stretched into a long, joyful line, and we handed out 100+ books to patient, radiant humans I’m so grateful to know.

Thank you for hosting a superb conference and amplifying this work. Women’s health is no longer niche—it’s the blueprint for the future. 💛

12/12/2025

Women today are rewriting what midlife looks like.

We’re not slowing down — we’re starting over, leveling up, and living with more vitality than ever.

Stop accepting default aging as inevitable.

🎙️ Find my podcast TREATED on your favorite podcast platform and download the episode now🎙️

12/11/2025

Constipation is twice as common in women.

Yet how often is it discussed?

Or dismissed as normal?

Hormones, anatomy, stress, the microbiome, thyroid function, pregnancy, and even cultural conditioning all play a role.

The truth?

Constipation isn’t “just how your body works.”

It’s a signal. And it’s fixable.

I put together a practical constipation protocol with

▪ hydration targets
▪ fiber guidelines
▪ microbiome support
▪ magnesium dosing
▪ stress-gut tools
▪ and when to test deeper

✨ Download the my new guide - Women and Constipation: How to Find Relief
https://saraszalmd.com/constipation/

Your gut isn’t trying to frustrate you—it’s trying to communicate

12/05/2025

If you’re a woman in your 30s to 50s and your HRV is quietly tanking… your nervous system is telling you a story your annual physical is not.

Heart rate variability (HRV) is the tiny millisecond-to-millisecond variation between your heartbeats. Not a flaw, a feature. Higher HRV = a more flexible, resilient nervous system. Think of it as the shock absorbers on your stress response: more range, smoother ride.

In perimenopause and menopause, estrogen and progesterone are doing cartwheels. Your autonomic nervous system has to work harder to keep up. Studies using HRV show exactly that:
- Postmenopausal women have lower cardioprotective HRV compared with premenopausal women, especially under stress, reflecting a shift toward higher autonomic load and cardiovascular risk (Ramesh et al., 2022, PMID: 35608101)
- Women in the menopausal transition with more intense hot flashes and other symptoms have significantly lower HRV and reduced vagal brake, meaning more time with the stress “gas pedal” pushed down (Martinelli et al., 2020, PMID: 31940354).

This is why I want every midlife woman tracking HRV the way we track steps. You don’t need a perfect score; you need a baseline and a trend. If your HRV is drifting down, it’s your early-warning system for too much load: poor sleep, overtraining, alcohol, unresolved stress, blood sugar swings, the invisible labor of caring for everyone but yourself.

Measure it. Honor it. Use it to renegotiate how much you give away your energy.

Save this to revisit, and tag a midlife friend who needs to know her nervous system has a voice and it’s speaking in HRV 🤍

12/05/2025

If you’re a woman in your 30s to 50s and your HRV is quietly tanking… your nervous system is telling you a story your annual physical is not.

Heart rate variability (HRV) is the tiny millisecond-to-millisecond variation between your heartbeats. It’s not a flaw, but a feature. Higher HRV = a more flexible, resilient nervous system. Think of it as the shock absorbers on your stress response: more range, smoother ride. I gave a lecture this week on HRV in women.

In perimenopause and menopause, estrogen and progesterone are doing cartwheels. Your autonomic nervous system has to work harder to keep up. Studies using HRV show exactly that:
- Postmenopausal women have lower cardioprotective HRV compared with premenopausal women, especially under stress, reflecting a shift toward higher autonomic load and cardiovascular risk (Ramesh et al., 2022, PMID: 35608101)
- Women in the menopausal transition with more intense hot flashes and other symptoms have significantly lower HRV and reduced vagal brake, meaning more time with the stress “gas pedal” pushed down (Martinelli et al., 2020, PMID: 31940354).

This is why I want every midlife woman tracking HRV the way we track steps. You don’t need a perfect score; you need a baseline and a trend. If your HRV is drifting down, it’s your early-warning system for too much load: poor sleep, overtraining, alcohol, unresolved stress, blood sugar swings, the invisible labor of caring for everyone but yourself.

Measure it. Honor it. Use it to renegotiate how much you give away your energy.

Save this to revisit, and tag a midlife friend who needs to know her nervous system has a voice and it’s speaking in HRV. 💛

12/01/2025

One in three Americans has prediabetes. But here’s the lie we’ve been sold: calling it “pre” anything makes it sound like a warning instead of what it actually is... a disease that’s already damaging your body.

Let me be clear: prediabetes increases your risk of heart disease by 13-30%. Stroke by 6-20%. Dying earlier by 13-32%. It’s already causing retinopathy, neuropathy, chronic kidney disease, the same complications we associate with “full” diabetes. Once again, women are at higher excess risk for atherosclerotic cardiovascular disease with prediabetes.

We don’t call stage one cancer “pre-cancer.” We don’t call early heart disease “pre-heart attack.” But we slap “pre” on diabetes and tell people to come back when it gets worse.

This is your operating system failing, not a countdown clock to when your health “really” matters. The vessel you’re living in is already under siege—higher blood pressure, worse cholesterol, inflammation coursing through your cardiovascular system.

88 million of us are walking around with a diagnosis that sounds like a dress rehearsal but performs like opening night.

Stop waiting for permission to take this seriously. Your body isn’t practicing. Study from Stanford: “Glucotypes reveal new patterns of glucose dysregulation” PMID: 30040822

Share this with someone who needs to hear it. This is the medical truth we’re not being told.

resistance

Sara Gottfried, MD

12/23/2025

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