Why 80% of Autoimmune Diseases Happen to Women & Solutions From a Renowned MD

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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?

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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 Besting 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 they don't know what's going on.

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Today's conversation is a free life-changing resource for anyone in your life who is struggling with an autoimmune disease or is just chronically tired or has a lot of health 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 Gottfried (00:04:38):

Mel, I'm so happy to be with you.

Mel Robbins (00:04:40):

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 Gottfried (00:04:57):

A few things. First, energy right now, we know that 30% of Americans have antibodies against the nucleus of their cells, antinuclear 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, that's a lot. That's the promise of lifestyle medicine and a different approach to taking care of the body.

Mel Robbins (00:05:46):

I've never heard the term lifestyle medicine. What does that mean?

Dr. Sara Szal Gottfried (00:05:50):

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.

Dr. Sara Szal Gottfried (00:06:36):

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.

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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 (00:07:42):

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. And as we kind of dig in deeper and 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? I've heard people refer to both.

Dr. Sara Szal Gottfried (00:08:09):

The way I think of it, Mel, is that there's a continuum. 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 one diabetes, rheumatoid arthritis, Hashimoto's thyroiditis.

Mel Robbins (00:08:33):

Wait a minute, diabetes is an autoimmune disease.

Dr. Sara Szal Gottfried (00:08:36):

Type one diabetes is Yeah, you attack the pancreas, your immune system attacks pancreas.

Mel Robbins (00:08:42):

I mean, I probably sound like an idiot that I didn't know that, but I'd never even thought that. There are probably a long list of things that we talk about that people struggle with, that a lot of us don't even, it's an autoimmune disease.

Dr. Sara Szal Gottfried (00:08:56):

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 seven 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 (00:09:44):

Can you just list what some common ailments or diseases or things that people have that actually are autoimmune disease?

Dr. Sara Szal Gottfried (00:09:56):

There's two different categories. There's classic autoimmune disease, there's more than a hundred of them.

Mel Robbins (00:10:02):

A hundred.

Dr. Sara Szal Gottfried (00:10:02):

A hundred. And there's what? Yeah, so exponential rise and the number of autoimmune diseases, but it's things like rheumatoid arthritis where your immune system is attacking your joints, Hashimoto's thyroiditis where your immune system is attacking the thyroid gland in your neck. There's multiple sclerosis. There's type one diabetes as we talked about,

Mel Robbins (00:10:26):

Psoriasis, psoriasis,

Dr. Sara Szal Gottfried (00:10:27):

Psoriasis.

Mel Robbins (00:10:28):

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. Yeah, your immune system

Dr. Sara Szal Gottfried (00:10:46):

Is attacking your scalp in that situation. So a lot of people don't connect the dots. They don't realize that's not an immune disease.

Mel Robbins (00:10:55):

Why is it important to identify that something is an autoimmune disease? 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 Gottfried (00:11:12):

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.

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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. So there's a hundred different autoimmune diseases. The list is long graves disease, celiac, psoriasis, as we talked about. Then there's other conditions that have commonalities with autoimmune diseases, and that includes things like endometriosis. Really, 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,

Mel Robbins (00:12:40):

What are the classic ones?

Dr. Sara Szal Gottfried (00:12:41):

The classic ones, the most common ones are rheumatoid arthritis, type one 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 (00:13:01):

So you used a word, I just want to make sure that I'm tracking with you because we are just at the surface and we're about to dive deeper. When you call it the auto antibody, is that the word that you used?

Dr. Sara Szal Gottfried (00:13:12):

Yes.

Mel Robbins (00:13:13):

So auto antibody is what you would find in somebody's body when the person's immune system is attacking itself. Is that 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.

Dr. Sara Szal Gottfried (00:13:40):

That's right. You nailed it.

Mel Robbins (00:13:42):

Okay.

Dr. Sara Szal Gottfried (00:13:42):

So the thing that I think is important about these autoantibodies

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Is that they're in the body for years and you don't know it unless someone bothers to check it. 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. Tripled over 25 years. Yes. What does that tell you? 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

Dr. Sara Szal Gottfried (00:14:45):

The root causes have been identified for years. There's a local gastroenterologist at Massachusetts General Hospital who found that there are three requirements. These are the root causes.

Mel Robbins (00:14:58):

Okay.

Dr. Sara Szal Gottfried (00:14:59):

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.

Mel Robbins (00:15:13):

Okay.

Dr. Sara Szal Gottfried (00:15:13):

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 (00:15:35):

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 Gottfried (00:16:16):

That's right. It starts the Civil War.

Mel Robbins (00:16:18):

Wow. Okay. Well, let's take 'em one by one. How do you even know if you're genetically predisposed to this?

Dr. Sara Szal Gottfried (00:16:25):

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 (00:16:36):

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 Gottfried (00:16:50):

Leaky gut is fascinating physically, but also more poetically. It's a loss of a boundary in your body.

Mel Robbins (00:17:00):

Oh, whoa, hold on. I want to make sure the person that's driving the car or taking you and I on a walk with them, here's 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 implications that leaky gut is now a loss of that boundary?

Dr. Sara Szal Gottfried (00:17:29):

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 (00:18:42):

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 Gottfried (00:18:59):

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 a 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

Mel Robbins (00:20:16):

And complicated pregnancies, complicated. Never even thought about that, that there's this meme that's going around of a woman standing in a kitchen and she's got three kids running around and 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

Dr. Sara Szal Gottfried (00:20:40):

How are your boundaries,

Mel Robbins (00:20:42):

Yes. 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 track 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. 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 Gottfried (00:21:44):

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 one diabetes. If you have your immune system attack your pancreas to the point where you don't have any eyelet 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.

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So the solution is not part of this seven year training that I went through. So Dr. Szal, how did you learn this? I had to teach myself. So a lot of it was being in my thirties and 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. There's something deeper here that's not going to 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 (00:24:09):

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 Gottfried (00:24:18):

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 (00:24:34):

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 Gottfried (00:24:44):

The difference is that alleviating symptoms works temporarily. It's like a bandaid. 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 (00:25:14):

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. That's right. To put yourself at peace. As a medical doctor, what's the worst thing that you could eat or drink? When it comes to a leaky

Dr. Sara Szal Gottfried (00:25:31):

Gut, the worst is alcohol 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 get them alcohol.

Mel Robbins (00:25:51):

Really?

Dr. Sara Szal Gottfried (00:25:52):

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. So it gets the brain to release something called CRH corticotropin releasing hormone, and that directly pokes holes in the gut leads to the loss of this boundary.

Mel Robbins (00:26:23):

Wow. Why would something that is stress in your brain, poke holes at the soldiers, hold in the boundary in your gut?

Dr. Sara Szal Gottfried (00:26:31):

Well, that's more of a philosophical question and I appreciate that. I appreciate that. But I think 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 (00:27:15):

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 Gottfried (00:27:33):

I was just looking at the data on this last night and how night shifts are associated with more autoimmunity.

Mel Robbins (00:27:40):

Really?

Dr. Sara Szal Gottfried (00:27:40):

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

Dr. Sara Szal Gottfried (00:27:56):

Absolutely. Four times more women than men with autoimmune diseases. Why? 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 of 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 next 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 (00:28:59):

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 Gottfried (00:29:25):

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 burnout. I think it's important to take it out of the purview of women just aren't measuring up in some way

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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 smell. 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 (00:31:04):

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 Gottfried (00:31:59):

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 (00:32:36):

I love that. I love that. And your book, the Autoimmune Cure, is basically a roadmap for doing that. 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.

Dr. Gabor Maté (00:33:18):

80% of autoimmune disease, which are diseases where the immune system attacks the body that is supposed to protect, 80% of them happen to women.

Mel Robbins (00:33:25):

Why?

Dr. Gabor Maté (00:33:26):

I knew people before they got sick, and I knew them in their 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 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 disappoint 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 looking after everybody else'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 (00:34:39):

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 Gottfried (00:34:57):

I think that clip nailed the experience of women 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. Mate talked about how we over-function, we prioritize other people's needs over our own. We get caught up in providing over caring, and there's a cost to it,

Mel Robbins (00:35:43):

And the cost is our health.

Dr. Sara Szal Gottfried (00:35:45):

Yes.

Dr. Sara Szal Gottfried (00:36:15):

That's right. This questionnaire mill 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 really including autoimmune disease.

Mel Robbins (00:37:01):

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 Gottfried (00:37:24):

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 touched 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?

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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? 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 (00:39:47):

You hear those questions and it's a wonder anybody makes it to adulthood.

Dr. Sara Szal Gottfried (00:39:51):

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 kind of adverse experiences and physical problems later in life.

Mel Robbins (00:40:14):

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 Gottfried (00:40:56):

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 (00:41:19):

What's a pine network?

Dr. Sara Szal Gottfried (00:41:20):

Pine network stands for your psychology, GI 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

Mel Robbins (00:42:17):

Or why they have chronic anxiety. I Mel Robbins. Right? No serious. That makes a lot of, 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 Gottfried (00:42:31):

That's right.

Mel Robbins (00:42:32):

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.

Dr. Sara Szal Gottfried (00:42:51):

That's right. And you just use 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.

Mel Robbins (00:43:06):

Dr. Szal, how does trauma and adverse childhood experiences relate to autoimmune disease

Dr. Sara Szal Gottfried (00:43:12):

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 (00:43:32):

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 Gottfried (00:43:46):

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, and we know that it can disrupt you mentally, emotionally, and also physically.

Mel Robbins (00:44:29):

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.