You are now listening to The Model Health Show with Shawn Stevenson.
For more, visit themodelhealthshow.com.
Our hormones are the chemical messengers that connect all of our cells, our organs and our bodily systems, to keep all of our trillions of cells on the same page.
Our hormones are the signaling molecules that determine things like growth metabolism, reproduction and mood.
But what happens when these hormones change dramatically, erratically or seemingly plummet altogether?
This is one of the experiences that half of our population goes through when we're talking about the phenomenon of perimenopause and menopause.
And this information that you're going to learn today is critical for all of us to know, because this life cycle impacts each and every one of us.
It impacts our relationships, impacts our overall health and our connection, and we need to lift up women's voices and help to really understand how to support this process in the best ways, the most science-backed ways that we possibly can.
And today you're going to discover the profound connection between perimenopause and menopause and gut health.
Today, we're going to be exploring the menopause gut.
And our special guest is going to blow your mind with some of these incredible insights.
Without further ado, let's get to our special guest and topic of the day.
Cynthia Thurlow is a nurse practitioner, host of the Everyday Wellness podcast, best-selling author and international speaker with over 15 million views for her TED Talk.
Intermittent Fasting Transformational Technique.
With over 25 years of experience in health and wellness, Cynthia is a globally recognized expert in perimenopause and menopause and intermittent fasting.
And her work has been featured all over major media, including ABC Fox KTLA, Entrepreneur Magazine and much more.
Her mission is to help empower women to live their most optimal lives in perimenopause and beyond.
Let's dive into this conversation with the incredible Cynthia Thurlow.
Cynthia, I'm so happy to see you today.
So glad to be here.
We got so much good stuff to talk about.
First and foremost, the menopause gut.
What is the menopause gut?
It's really helping clinicians women men, the people that love the women in their lives better understand what's happening in the gut microbiome as women are navigating this perimenopause to menopause transition.
We talk about how our ovaries age.
We talk about how the immune system ages.
We talk about the gut.
We talk about bones, we talk about this brain, gut access.
We talk about hormones and supplements and all the lifestyle pieces that are so important and i think this is a left out conversation around this very important transition in a woman's life.
And to me, I think about it as the glue that makes everything else work.
I love this.
Now, just hearing the title, of course, it kind of resonates with like what about the gut itself, or body fat?
So is there a connection there as well?
I mean, the title is a double entendre without question.
But I do talk about how the gut microbiome shapes and shifts body composition, insulin sensitivity, all of these kind of key components that for many women they're really plagued with.
And I say plagued with in the most loving way possible.
I've experienced this myself, but I think for so many women they feel like their bodies.
Suddenly they don't understand what's going on with their bodies.
Everything that used to work no longer works.
And so we kind of weave into the conversation the things that building awareness around the changes that are happening and what they can do to offset those changes.
Yeah, this obviously can be very frustrating, you know, and Let alone, everybody wants to experience, just to have good health and to feel good about their bodies.
But this relationship changes, in particular when we're talking about this transition perimenopause, menopause.
And you know you are bringing to light so many incredible aspects that are simply not being talked about right now.
And one of those being the differences of the microbiome makeup of men and women and, in particular, with that transition into perimenopause and menopause.
So talk about that.
Yeah, there's something called the microgender room.
This was a new term to me when I was doing research for the book, but it talks about how young men and young women until they go into puberty.
Their microbiomes are very similar.
And not surprisingly, influence of testosterone, predominantly for men.
Estrogen progesterone for women and a little bit of testosterone.
We start to see differentiation in the gut microbiome.
And what I find fascinating is men stay pretty consistent throughout their lifetime.
Women however, have these dynamic shifts puberty pregnancy perimenopause, where we get dynamic shifts in microbial diversity inflammation, all these different changes.
And the irony is life comes full circle.
So if women live long enough after they go into menopause, their microbiome starts to resemble a men's again.
And so, again, it's these influences of these key hormones.
And inflammation.
It's fascinating to me how much changes in each one of those kind of significant.
I call them the three P's.
Not surprisingly, puberty, if a woman has a pregnancy, and then this perimenopausal transition.
And I think not enough individuals are talking about these subjects, but it explains a great deal about you mentioned body composition shifts.
It impacts sleep.
It impacts cognition.
It impacts the symptoms women experience.
It impacts why suddenly women develop odd symptoms like bloating, as they are having this transition, or they suddenly develop underlying food sensitivities that maybe they've never experienced before.
And so it really begs to have this conversation just to build awareness, so that people can be looking out for these things proactively.
And if they're already on the other side.
There's things you could do that can improve the health of your microbiome that don't necessarily have to be significant or expensive.
What is it about the gut that makes it such a powerful regulator for aging?
Yeah, it's such a great question.
So, when I think about the gut microbiome, it is, you know, 40 trillion bacteria fungi, viruses that influence every single part of our body, every single organ system.
You know I think about.
There's a gut bone access, there's a gut ovarian access, there's a gut lung access, there's a gut brain access, and it goes on and on and on.
And so, when I think about it from a longevity perspective, we know that our ovaries set the pacemaker of aging for our bodies full stop.
The most mitochondrial dense organs in our entire bodies, not surprisingly.
And as our ovaries are aging, you know, we are born with a finite amount of ovaries.
Unlike men that are making new sperm.
I think every 72 hours of memory serves me correctly.
We are born with a finite amount of eggs.
And so once we go into puberty, we go through atresia.
So where eggs are, maybe we have an egg that is, you know, potentially.
You know we ovulate as a potential to be a fertilized ovum, go on to be a baby, or you know you can ovulate a couple eggs per month and they just die off.
And so over the course of our lifetime, we have less and less eggs.
And what hearkens the beginning of the end of our fertility is this drop in progesterone.
And so for a lot of people understanding that know what's driving longevity is really the ovaries and helping people understand like what are the things that accelerate aging what accelerates our ovaries aging i think for some people it's surprising you know, some of our lifestyle choices, some of its genetics.
Like if your mom went into early menopause, you may be more likely to go into early menopause.
And maybe defining average age of menopause is 51.
It's considered to be premature menopause if you go in before the age of 40 and it's early if you go in before 45.
So normal is considered to be 45 to 55.
That's a huge range of time for people to fall within this normal distribution.
And so when I am having conversations with women and helping them understand, it's number one.
We want to preserve fertility for as long as we can.
Number two, what are the things that will accelerate aging of those ovaries?
Things like smoking alcohol use, toxins underlying chronic stress and trauma.
Adverse childhood events.
There's some genetic variants too as well.
But I think for a lot of people not realizing there's a lot we can do to preserve fertility or to kind of forego going into menopause earlier.
Some things we don't have control over, but I find it endlessly fascinating.
So thinking about our ovaries as a pacemaker of aging is unique and novel.
Let's talk about a specific connection because again, most people still today are not aware of the various connections with the gut right.
Gut brain connection, gut ovarian connection, list goes on and on.
But, with that being said, there are specific hormones that are being processed, interacted with, metabolized in relationship to the gut.
So let's talk about the estrobilone.
Oh, yeah.
It's an awkward name for a very important component of the microbiome.
This is where estrogen is broken down and metabolized.
And for a lot of people they don't realize there's this very specialized part of the microbiome that is designed to help them break down estrogen and get rid of it.
So there's two forms of detoxification in the liver.
And then you're supposed to package up this estrogen.
And effectively, I'm going to oversimplify it, poop it out.
Now, for a lot of people, they're like, this doesn't make any sense.
I'm in perimenopause, menopause, perimenopause.
You could have 20 to 30 percent higher levels of estradiol, which is the predominant form of estrogen our bodies make until menopause.
Or even in menopause, women can still have estrogen that gets recirculated.
So if it's not being properly broken down which can be for a variety of reasons a lot of it is related to poor gut health it can magnify symptoms.
Suddenly women are having more vasomotor symptoms, more hot flashes. more bloating, more breast tenderness, more weight loss resistance.
Weight loss resistance is kind of the bane of most women's existence at this stage of life, but helping them understand that being able to break down and detoxify estrogen is important.
Now, the word detoxification gets thrown around a lot.
And let me be clear, our bodies detoxify every day.
We breathe, we sweat, we urinate, we defecate.
Those things all help with that.
But over the course of a lifetime.
By the time women are in their 40s, I think of it as a toxin bucket.
The things you're exposed to in your personal care products, environment and food have a tremendous impact on how you are going to navigate this middle-age point of your life.
And so the estrobilum is very important.
And there's an important enzyme that's called beta-glucuronidase.
And that's important for helping to break down that estrogen piece, so that we can break it down, package it up and poop it out.
Now, how many women that are middle-aged think it's normal not to have a bowel movement once a day?
Like that becomes normal.
Whatever your normal is becomes normalized.
And so I oftentimes have to explain to women.
You know, if you're not having a bowel movement every day, that can be a sign that you may be potentially recirculating that estradiol which can magnify all these other symptoms.
In particular, it's the hot flashes piece.
Like women will say, I don't understand why my hot flashes are so bad.
It's not always just a blood sugar dysregulation.
It can also be that recirculating estrogen.
Also important to note that we can make our own estrogen.
So that's endogenous.
And we can also be exposed to it outside our bodies.
That's exogenous.
And those together can be quite powerful.
Wow.
I hope that everybody's really listening to this because again, understanding that our microbiome and in the case if we're talking about menopause, perimenopause has such a profound impact on estrogen like that is just a game changer in of itself.
And also again, what I love about your work is, like you even said it, just that you put a little blood sugar related.
It could be all these other things as well, but just for you to be able to have that investigation right.
Are you regular?
Because somebody might be.
Why I'm regular, but my, I'm having these hot flashes.
We're just checking off boxes here because there are a lot of people who are not regular.
Yeah, and all my years.
I've been in this field for 23 years now And I remember working at the university that I graduated from and I had a client who she owned a couple of restaurants that were pretty popular.
And you know I was doing her initial assessment and she you know which thankfully, at that point, about a decade in, I started asking people about their digestion.
And she shared that she uses the bathroom maybe every six or seven days.
Can you believe that?
Right, right?
I can't imagine what's backed up.
She was petite.
Okay, you would never know outside of all these other symptoms.
She did, of course, have some, but it wasn't always the case where she would have some bloating whatever.
But it was all these other symptoms of lethargy, of discomfort and headaches and things like that.
So it's not always just like you're just backed up and full of poop and it's just obvious to see.
Right.
But this is something that she didn't necessarily know was a problem.
Right.
That's where your normal becomes normalized.
And I think for a lot of people, there's a stigma around talking about bowel movements or poop.
Like, let's be really frank.
And I think for so many of us, we need to be able to have those conversations.
We need to be able to tell our provider.
We need to be able to say to ourselves, it's not normal.
I haven't had a bowel movement in four or five days.
Now for some people and this has been my experience clinically there are some people when they travel they get constipated.
That's different.
There are some people who have to have a bowel movement in a public restaurant and like they're totally, I would say, the non-public poopers of the world.
For a lot of individuals it's like let's figure out how we can make your body feel safe, because part of that parasympathetic nervous system, in order to defecate, your body has to feel safe.
So if you're stressed or you're rushing around or you're not allowing yourself enough time, that might contribute to that.
Yeah, and some people are the opposite.
It's evacuation when they're nervous and stressed and all those things.
It's just, again, paying attention to your own temperament.
Thank you for bringing this up, because I don't think we've really talked about this before in all these years.
Is your body when it comes to digestion?
It's a circadian medicine as well.
It's looking for that consistency.
It's looking for routine, certain conditions.
And for many people, they want that home court advantage.
Yeah, when they use the bathroom.
But there are people everywhere you go.
You know, we just went to a basketball tournament who were, you know, taking a deuce.
You know, at a basketball tournament, like the audacity.
For me it's just like there are people I remember going to the club, you know, when I was like, you know 20, 21 or whatever.
And there are people, you know, taking a deuce at the club.
Like, it's just like, your level of comfort is remarkable.
Yeah.
I call it the non-public poopers.
Like I used to put it in charts NPP because they would disclose that they just couldn't do that.
So I think there's there's certainly extremes of comfort levels, but like the reality of the situation is, if you got to go, you got to go.
Yeah.
Yeah.
Better out than in.
Correct.
Correct.
Now, to move this a little bit more forward, I want to talk about the relationship with the microbiome and some of these markers including, you know, inflammation.
You know the things that are really the hallmarks of abnormalities with perimenopause and menopause.
Inflammation is such an underrepresented part of the discussion, but obviously inflammation can mess up so many aspects of our health and cause disruption.
But let's talk about the relationship between the health of your microbiome and inflammation in this context.
Oh, they go hand in hand.
In fact, I would say aging in general goes along with an uptick in inflammation.
So the inflammation?
There's Acute inflammation.
You trip, you fall, you skin your knee.
That's acute inflammation.
The chronic stuff is the achy joints, the brain fog, all the other constellation of symptoms that people experience.
But when I think about inflammation as a bigger bucket, it's thinking about changes in muscle mass that lead to a loss of insulin sensitivity.
That will stoke that inflammation.
I think about the loss of estradiol, predominant form of estrogen, that our body makes.
With that loss of estradiol, more inflammation in the body.
I think about how this inflammation piece intersects with our immune system and how there is a complete flip in the way that our immune system reacts in perimenopause and menopause.
It tends to be more inflammatory.
There are these T helper cells that are part of the acquired immune system.
And it's interesting we become.
They use the term TH1, so T helper, one dominant, which tends to mean we are more reactive.
We are more likely to develop autoimmune conditions and perimenopause and menopause.
We are going to be less reactive to vaccines, not as a political statement.
This is what the research says. we are more likely to not recover as easily from infection.
So we're more likely to get infected and stay infected.
Those opportunistic infections, a lot of the people that were impacted by the pandemic.
If we take the metabolic health piece out of it, we're generally older individuals and the immune system just becomes less vibrant.
And so I think this inflammation piece is really tied in with immune system, and i know the immune system is neither sexy nor uncomplicated, so i try to keep it simple, but it's helping people understand.
Why do we see four to five times more autoimmune conditions in perimenopause and menopause?
It's because the immune system is just not as robust, And so I think it's endlessly fascinating.
I think about you know.
We talked about how we have this loss of insulin sensitivity, more brain fog, more cognitive changes.
For a lot of people that can be a sign of inflammation.
I think people think about inflammation like, oh, my joint hurts. oh, I have tummy trouble.
And it's helping them understand that inflammation can show up very differently.
It can be as bio-individual as each woman is.
It can show up as uniquely.
For me personally, inflammation generally shows up in my gut.
Like I will have digestive system issues We think about we're more likely to experience leaky gut.
That small intestinal layer is one cell layer thick.
What's on the other side of that small intestine right outside of that cell is the immune system.
The immune system gets provoked.
It drives an inflammatory response.
If you're eating particular types of food, you leak food particles into your bloodstream.
That provokes an inflammatory response.
So I also think about that food piece.
Women will say.
I was never sensitive to gluten before.
I was never sensitive to dairy before.
I was never sensitive to insert nightshades oxalates, whatever it is, you know, the hot food of the month.
For a lot of individuals.
They suddenly find that their tell for the inflammation piece is they just react differently to otherwise healthy types of foods.
And that can be quite a quandary.
But I find it's multiple things that are overlapping.
So it can be challenging to figure out like, oh, it's definitely this.
It's multiple things that we use the term multifactorial.
It's multiple things contributing to those symptoms that are driving the inflammatory process.
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Now back to the show.
Oh my goodness.
Thank you so much for bringing this up because truly.
This is something that I didn't think about as well in relationship to perimenopause and menopause the role of the immune system.
This is so profound.
It's just like, why do we separate it?
And so, with that being said, to see the incidence of autoimmune conditions rise during perimenopause and menopause.
Now, Those rates have gone up in recent decades, even that manifestation.
Why is that?
Because, and I want to ask you in two different ways.
Historically, a few decades ago, a couple of generations ago, it was not as common to have the onset of these autoimmune conditions.
Just because, again, things are changing as far as the perimenopause and menopause.
But also there are still places on earth today where you don't see such a high increase in autoimmune conditions.
During perimenopause and menopause.
Why is that?
Why is the change happening today?
And also, why is it happening more in the quote Western world?
I think number one.
I think we do a better job of being able to differentiate different types of autoimmune conditions.
Maybe before there were a couple big buckets.
There's clearly more higher incidence and prevalence without question.
I think there's over 100 diagnoses right now for autoimmune conditions, which is mind boggling.
I think our modern day lifestyles play a huge role.
I think it's our food.
It is our stress level.
It is that we're not sleeping.
I mean, if you really look at the research on sleep.
There was a meta-analysis that was done in 2019 looking at for every one hour you sleep less.
If you sleep four hours or more, it's for every one hour it's a 9 increase in obesity.
That's not even looking at all the other factors that come with that.
So I think it is our modern day lifestyles that are driving all of these issues.
We are eating foods.
They're frankenfoods.
A lot of us are eating foods that are food like substances.
And I'm not being I'm a realist.
So I get it.
Whether it's protein powder, protein bars, whatever it is that people are eating, we're just eating and not sleeping.
And we're constantly stimulated by.
We live in this hedonistic environment where you can stream anything you want, any time of the day or night.
Uber Eats will deliver you food any time of the day or night.
Then you add on top of it the complex role of trauma that I think for so many people maybe we're just hitting the tip of the iceberg, talking about what happened in someone's childhood and how that's influenced their immune system and their cortisol response and their autonomic nervous system.
So I think it's multiple things, Sean, not just one thing.
But I do think when you look at cultures that are maybe not as exposed to our hedonistic type lifestyle, I think they're just preserved.
I think it's a much more, and when I use the term simple, I just say it's a much less complicated situation.
People are eating predominantly nutrient-dense whole foods because that's all that's available and they are not tethered to technology 24-7.
And maybe their stress might be something that's brief and sporadic, which is what stress is designed to be, not unrelenting stress throughout the day, 24-7.
I think it has primed our bodies to be that much more susceptible.
And the more that I understand about the immune system and the role of cortisol and the catabolic effects, the more I think we are just primed to just be much more likely to develop not just one autoimmune condition but multiple.
And for people listening, I tell everyone, once you have had one, you're more likely to have others.
It's very much a domino effect.
Profound, profound.
So I mean to put it in a nutshell we are living in very different conditions.
Yes, the world is very, very different than what it was just, you know, a couple decades ago, and things are not slowing down anytime soon.
And so, getting this education and finding ways to not try to hide from the world.
But how do you adapt?
How do you increase your resilience and survivability in these conditions?
And if you're unaware, you're just going to be at the mercy of these changing conditions.
And that's the thing.
And this is why this education is so important.
Most people are unaware.
Yeah.
You know, but with this ignorance is not bliss.
No.
Well, and I think about you know, I had my 30th high school reunion a few years ago and I remember I went with my best friend and we had a great time and I was looking around the room and and.
You know, being a clinician, like I'm just always kind of observing.
I'm an empath and I just kind of take everything in.
And I was like.
You know, the people that are doing the best right now are the people that are not acting like they're 18 years old.
And I'll just simply put it that way.
If you are still thinking that you can get by as a middle aged person, or nearly middle aged person, with what you did at 18, it's not going to serve you well.
And so to your point.
I think that through knowledge builds awareness around things that we can be doing to ensure that we don't have a marginal decade.
I don't want a marginal decade.
I want to have, you know, a great decade, one after the other.
And I think for so many people, when I hear a woman say to me, This is just the way things are.
I'm X age, 54, 45, 62, 70.
This is just the way things are and the degree of acceptance.
And I would say, you know, fighting against that acceptance of things that you do have some control over.
I'm not talking about things we don't have control over.
The things we do have control over.
Giving people options to be able to make different choices to improve their quality of life is really that's why I'm here.
And we have so much power within that, you know.
And so thank you for saying that as well, and i know that some people spit their coffee out when they heard 30-year anniversary of your high school graduation.
That was a while ago so, but you know, i was just thinking recently Because you know, when I think about my high school class, you know there's certain songs.
I even have my senior book, you know, that I wrote, like, what are the hot songs right now?
And we've got things that are tied to that time.
And I think about the kids now, you know, like, what is their songs going to be?
I know.
You know, sexy red is, I don't know if that's going to stand the test of time, you know?
Probably not.
No disrespect.
No disrespect.
Sexy red is from my hometown, St.
Louis, and I know a lot of girls like her.
But, you know, anyways, with this being said, it's incredible to have access today, right?
We have access to education.
And so part of this is just making sure that people know that the bridge is already there.
Right.
And so this is why I'm so grateful to do this work.
But we also need to focus on strategies, which we're going to dig more into that.
But there's such an important part of this conversation that you are bringing forth that again.
Largely no one is talking about this.
And this is the influence of trauma in relationship to menopause.
So i want to talk a little bit more about that and just to dig in deep.
Can you help us to to make sense of why this is an influential factor?
Yeah, i think this is such an important conversation because how many of us experience significant child adverse childhood events?
I certainly did, and so there was a study done between kaiser and the cdc looking at the impact of specific traumas that younger people can experience.
And you can go online.
It's not gatekeeped.
You can go online and do the quiz.
And so I transparently have an ACE score of nine, which is quite high.
What that does is it completely undermines or rewires your autonomic nervous system.
So what I grew up in was physical and I share this just transparently to give people some perspective.
Physical and emotional abuse alcoholism, narcissism all those things were part of my childhood.
But i adapted, and the way that i adapted was i was the good kid, i was the kid who was perfect, i was the kid who got good grades, because then i was left alone and so my my nervous system was rewired to suppress a lot And also at a heightened stress response.
So, even though I always say I look like the duck paddling across the lake, like I look calm on the outside but like inside, my body is fighting fighting, fighting.
And the same is so similar for so many other women.
But what that chronic cortisol does to your body, that elevation is We know it can age your ovaries faster.
We know it contributes to autoimmune conditions.
We know it can lead to distorted relationships with food.
It can lead to poor metabolic health.
That doesn't mean that happens to everyone.
But when I was diving into the research, the understanding that trauma, whether it's sexual abuse, physical abuse, emotional abuse, all these things rewire our nervous system.
And so it can definitely make us more likely to or have the potential for an earlier menopause.
In fact, there was a study that was done looking at a woman who was sexually abused.
If she goes on to have children who are sexually abused, she will go into menopause eight years earlier.
That is substantial and significant.
What's interesting to me is I've been having conversations with physician friends of mine who are OBGYNs.
So a physician that is up all day and all night delivering babies obviously a kind of a stressful environment to be in.
How many of them went into early menopause?
And I think that there's a lot that we don't yet fully understand.
But stress can age our ovaries faster.
And so I find it interesting, and certainly this ovarian senescence so that's a fancy way of saying ovarian aging can definitely be impacted by the stress that we experience as young people.
And by young people, I mean children under the age of 18.
Obviously, if you experience stress and trauma when you're older, that can also influence it, but quite significant when young people are exposed to quite a bit of trauma.
Wow, yep, yep.
This boils down to just with that being highlighted when you said the nervous system wiring, and so we're talking about the brain, we're talking about the peripheral nervous system, everything downstream.
Why would that influence menopause?
When you just said that piece, it immediately clicked in for me that we again we separate that right.
What does that have to do with hormones?
They're integrated, right?
The hypothalamus, these are integrated with our nervous system and our endocrine system.
And so your perception of stress.
When you talk about wiring, we're talking about our perception of stress how our bodies process metabolize, interact with stress in our environment.
Perceived stress yes, and so that is instantly going to change what your hormones are doing 24 7 365 yeah, and so thank you so much for highlighting this, because this could be another place for women to investigate When they're wanting to like.
I want to make this process again.
I don't want to settle.
I want this process of perimenopause and menopause to number one, to not have to suffer unnecessarily, but also to come out the other side feeling healthier and stronger.
And even during the process, dare I say which?
Again, there are so many examples emerging of this being possible, but the education needs to be there.
Yeah.
And I think for a lot of people, if they're not doing that internal work, if they've experienced, they've had post-traumatic stress disorder, they had significant childhood trauma, young adult trauma.
When you go into perimenopause, if you are not dealing with your stuff, it will bring itself up.
I think 70% of divorces are initiated by women.
And I'm not suggesting that you go into perimenopause and you instantly want to get divorced.
I'm just saying that if you don't deal with your stuff and each one of us have stuff it will make it more challenging as you are navigating this transition, because it isn't just hormones that are fluctuating, it's neurotransmitters that are fluctuating.
So the way that we perceive the world shifts enormously.
Well, you've said this a couple of times, we've talked about the ovaries, we've touched on this.
In relationship to aging.
Can you share what is the most mitochondrial dense organ in a woman's body?
The ovaries.
And which is, it's not surprising.
I mean, they're there to help create life.
And I think if you were to ask most people, including healthcare providers, they probably would say the heart, the brain.
Yes, those are mitochondrial dense organs.
Our ovaries are the most mitochondrial dense organ in our bodies.
So this is why earlier when you were saying, you know, we want to sustain fertility, you know, as long as possible and that healthy fertility.
And I know that some women are like, I don't want to.
I don't want to have the possibility of having a kid.
It's not about that.
It is about that, but it's not all about that.
It's an expression of longevity as well.
Well, and it's like I didn't know.
10 years ago what I know now.
So obviously I went into menopause earlier than expected.
I think a lot of my 2019 hospitalization had a lot to do with that.
But I'm the first person to say do i talk to younger women about, like all this emerging research that's coming out, it's like this is really exciting that maybe women instead of going into menopause average age of 51 maybe they go in a little later.
I mean, the longer we go without hormones is significant.
You know, a hundred years ago people didn't live as long Now they do.
And I think in many instances, having a conversation about how long you go without hormones is critically important.
I want everyone listening to be able to have a fully informed conversation with their licensed medical provider so they can decide for themselves what makes the most sense.
Because maybe HRT isn't the right decision for everyone, but every woman deserves to have a fully informed conversation.
And I think nothing is more sad to me as a clinician if a woman says to me yeah, I had a Total abdominal hysterectomy.
They took out my ovaries, my uterus appropriately, and then they're 38, and they go from 38 to 50 with no hormones.
Understanding what is happening physiologically.
It's one of these things where I'm like you deserve to have.
That person that removed your ovaries and your uterus should have said to you let's get you started.
Because between 38 and 50 you should have been on higher levels of hormones, because that's a young age to go into menopause.
And I think there are some instances where There are people who are still fearful to have those conversations with their patients.
And I'm like, there's plenty of other people that aren't.
So make sure you're working with the right person.
Amazing.
Amazing.
Let's dive in and talk a little bit more about some of the things to consider, to test out and to utilize in this context.
One of those.
Obviously, diet plays a big part and you've mentioned that a little bit.
But my big question is you know, a lot of women experienced more struggles with weight management during perimenopause and menopause in particular.
And is it just like they just need to just need to get on a calorie reduced diet?
Oh, the bane of my existence.
Some of the and I'm going to say this lovingly, not all, but there are a few males out there personal trainers typically, that'll say.
What are you talking about?
It's just calories in, calories out.
And I'm like, if it were that simple, none of these women would be suffering like they are.
It really is so much more than caloric intake, and whether we are having a conversation about sleep disruption, which we know can be a disaster for metabolic health.
Not managing your stress, we become so much less stress resilient.
And we've already talked about how.
Cortisol is an important hormone, but if it's chronically elevated it's catabolic.
You're breaking down what muscle you do have, not to mention the fact you're driving your immune system to be dysregulated and you're leading to more leaky gut.
You know, the kind of ultra processed foods that the bulk of us are still eating.
We know you're going to consume an additional 500,000 calories a day.
That's significant over time, because your brain is tricked into believing you haven't eaten as much food as you have.
And then we can talk about meal frequency.
We could certainly talk about the lack of muscle mass.
Sarcopenia is a real issue, and it's not just lip service.
It's the understanding that yeah, muscles make us look healthy and strong and all of that, but it is absolutely critically important for metabolic health to maintain muscle mass.
It's a glucose reservoir.
And then you add in all the other things the gut health piece.
You know what's going on with your gut.
Are you dealing with your stuff?
Are you someone that has, you know, connections to others?
I think we underestimate the importance of, you know, connection to other people.
Something as simple as having friends, having loved ones, people that check in on us.
You know, loneliness is equivalent to cigarette smoking.
And that's another thing that we forget about a lot of times our elderly friends and family members that I mean they're incredibly sad, they feel, you know they're, they have no connection to other people and how that will also influence all this.
So we have to feel a sense of connection, we have to feel a sense of purpose.
And then, on top of that, we have all these other levers that we have to be considering when it comes to shifts in body composition, and it is so much more than calories.
It's something that I find endlessly fascinating that there are so many people that still want to die on that sword.
And I'm like, hang on a second.
I was like, let's think about the hormonal changes that a woman goes through.
So, as estrogen is depleted and follicular stimulating hormone talking about the hypothalamus, a very important hormone that tells the ovaries to release an egg as our FSH is going up and our estradiol is going down,
Protein becomes so much more important for satiety.
It's important because if we're not enough protein, We're standing in our pantry at nine o'clock at night wondering why we're hungry.
We're hungry, It's because of this appetite regulation.
Leptin and ghrelin if they get dysregulates, all these hormones and become very, very important for women as they're getting older.
You know, I think that GLP-1s absolutely have a place.
I feel like they become part of the conversation every time I talk about body composition.
And obviously there are clear-cut indications for insurance coverage versus things that can be compounded.
I see a lot of benefits for women being able to help with body composition.
There, foundational elements have to be addressed first.
I think in many instances it's having that conversation that yes, a glp-1 may be helpful for shifting body composition, but if you don't do all the other pieces, you're not going to be successful long term, and that's an important kind of distinction to make.
Not to mention the fact replacing the hormones you lost can be very helpful for shifting body composition, and that's estrogen and progesterone for most people and plus or minus some testosterone, depending on the woman.
Not every woman in menopause needs to have her testosterone replaced.
Got it, got it amazing.
Um, as you know, mental health challenges have skyrocketed in recent decades and without addressing the root cause of this emerging change in our society, we're going to continue to see poor outcomes.
We need to address, of course, nutrient deficiencies, our sedentary behavior, our lack of social connection, our poor sleep quality.
All of these things are proven to contribute to these epidemics of poor mental health.
Of course, medication can be helpful in some contexts, but most people are not educated about the science-backed natural supplement that has been shown to be as effective as many medications.
So making sure that we're being mindful of our lifestyle factors, but also utilizing science-backed supplementation.
An analysis published in the Journal of Effective Disorders found that the renowned spice called saffron was just as effective as conventional antidepressant drugs like Prozac, Tofranil and Celexa.
Additionally, and of the utmost importance, people who are utilizing saffron had none of the side effects that we're seeing rampant in those who are utilizing those conventional treatments.
So something that is far safer, but equally, if not even better, in effectiveness.
That's what we get when utilizing something like saffron.
And my favorite resource for saffron in therapeutic amounts, and actually in a tasty version, are the happy drops from Organifi.
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And now back to the show.
I want to say this as clearly as possible.
The issues are not the calories.
They've never been the calories.
We have estimations of what amount of calories are in a food.
But most people don't realize this.
It's not based off of somebody's actually testing that food to see and using a bomb calorimeter.
It's the at-water system.
It's just estimation.
And it's always been estimation.
It's not about the calories though, regardless, if we have estimation of the calories in that food.
There are no two people on planet earth whose bodies process calories the same way whose bodies metabolize interact with Even identical twins.
And this was part of one of my books.
I shared multiple studies on identical twins.
If their microbiome makeup was different, one twin was more inclined to gain weight than the other twin.
Firmicutes bacteroidetes, you know, just these certain two very general classifications of bacteria.
You know.
So our gut microbiome, our hormone function, our age, our genetics, you know, the list goes.
Our muscle mass, our nervous system.
Not to mention all of these kind of epicaloric controllers with the food itself.
You mentioned protein.
Like, I can go on and on and on.
And some people's bodies process protein.
You know not some people.
Everybody's bodies process protein slightly differently.
And there can be people at extremes, right?
And so...
It's not this cookie cutter thing.
And it's more so in what you're doing is providing areas of investigation instead of saying just do this thing and all your problems are going to be solved.
Wouldn't that be so much easier?
I mean, I think on a lot of levels, you know, women in middle age are marketing themselves. know they're a marketing draw you know we're a vulnerable population for a lot of women they're like i don't know what's going on with my bodies everything i used to do no longer works i know for so many women especially my super type a you know patients and clients that you know they have no problems with motivation to go to the gym they have no problems with eating pristinely they have no problems with plus or minus intermittent fasting And when their bodies betray them, I'm using their words, they become incredibly frustrated.
They're.
They struggle with being patient because I will say to them this is not a we're going to figure it out in two weeks problem.
Am I going to get you feeling better within a month?
Absolutely.
But if your sole focus right now is losing weight, and that's usually what it is.
I'm like there's so many other things we have to work on to help us understand why your body is struggling with relinquishing control over body composition, fat mass, muscle mass, etc.
And so I find it endlessly frustrating.
We put so much pressure on women.
You know, I grew up in the thin as in stage.
Thankfully, now we're starting to see strong is what we're focused on, a strong bodies for men and women, which I think is a blessing.
But that mentality that we've grown up with doesn't go away.
So my generation really still it's a it's a complete mind screw.
Because on the one hand, they're like, intellectually, I hear you.
On the other hand, they're like, yeah, but the devil's on my shoulder.
And it's telling me what I need to do is more fasting, more exercise, more caloric restriction, eat less carbs, insert whatever, whatever you know whatever.
Macronutrient is having a moment, good or bad, or indifferent.
And they really struggle with that.
So I share this because over the past 10 years, I've exclusively worked with women.
And it is so apparent to me that the way that things are marketed to women it's really designed to make that it's kind of fuel this degree of insecurity.
Like my body's betrayed me.
What's going on?
This pill, potion or powder is going to take it away.
That's not going to do it.
Well, what is the angel on the shoulder saying?
What are some of the principles that women can investigate when it comes to their diet?
Like what are some of the nutrition principles?
Again, not this is the thing that's going to save you, but what are some kind of consistencies that most women would get a lot of value from if we're talking about the menopause gut?
Yeah, I would say number one, slow and steady.
So this is not you know.
You're going to snap your fingers and you're instantly going to feel better.
So we talk about protein centric diets because protein is so important, not only for satiety but maintaining muscle mass.
And we need more protein with age, not less.
So I jokingly say my very athletic teen, well, one teen and one young adult children.
They can have 10 grams of protein and probably trigger muscle protein synthesis, whereas I need 40 or 50, as do most of my patients.
So being really conscientious about getting at least 30 to 50 grams of protein in each meal.
If you are intermittent fasting, please, please, please.
Do not compress your feeding window to such a short, narrow window of four hours and think you're gonna eat 100 grams of protein in four hours.
It's not gonna happen.
I don't know any woman that can do that.
And if you can, bravo, but you're part of the minority.
I would say the other thing is carbohydrates are not the enemy.
I think for far too long we've told men and women carbohydrates are bad, and so I have an entire group of women who are paranoid or fearful to eat carbohydrates.
It's the context that's important.
It's helping them understand fruits and vegetables are not the problem.
You are not going to get obese eating a an orange.
You are not going to get obese eating a piece of watermelon, like unfortunately we've.
We've kind of gone the wrong direction.
I'm usually talking about processed carbohydrates, but I really emphasize fiber.
I emphasize fiber for a number of reasons, but fiber is critically important because we have less.
One of the many things that happens in the perimenopause-menopause transition.
We have less short-chain fatty acids.
And why is this important?
Because short chain fatty acids are a fuel substrate and a signaling molecule that is critically important for insulin sensitivity.
It's important for reducing inflammation that can be involved in endogenous GLP-1 production, along with things like acromantia.
And so helping them understand that fiber is consumed, it's fermented in the colon and then these beautiful short chain fatty acids go out and do their work.
But we have less of them in this transitional period.
I would say the other thing that is a consistent theme is hydration.
Something so simple like hydration.
We start to lose our perception of thirst.
By the time we get thirsty, and this is that, again, it's that estrogen play.
As we're losing estrogen, we lose those kind of thirst responses.
It's not necessarily the baroreceptors in the neck.
It has nothing to do with that.
When I looked at the research, I was like, this makes so much sense.
Like my little old ladies that didn't want to pee and would tell me I'm on a diuretic.
I don't want to drink more water because I don't want to go to the bathroom.
I'm not talking about that.
It is general hydration, day to day, week to week, that makes an enormous difference in your cognition, your sleep quality, your digestion.
So hydration becomes a huge part of the conversation.
I would say those are the consistent pieces.
Now the question always becomes, what about healthy fats?
So bio-individual.
Some people do well with plant based plant based fats.
Some people do well with saturated fats.
I am more the former than the latter.
So I can do more carbohydrates, more protein and lower fat doesn't mean I eat no fat.
I just eat less of it.
And certainly more plant based varieties.
So there's a degree of experimentation.
But the nutritional piece is so important to get your head wrapped around.
And it's not designed to punish you.
I cannot eat the way I did at 18.
Heck, I can't eat the way I did at 35.
But I found a happy place where I can exist eating plenty of protein.
And for a lot of my patients, when they're eating enough protein, they just feel so much better.
They're like.
I'm not standing in the pantry at nine o'clock at night wondering why I'm staring at chips and thinking about the ice cream in the freezer.
All of a sudden I'm like I can go to bed and I feel satiated and I feel good about my choices I've made today.
Love it.
You've mentioned intermittent fasting a couple of times, and this is obviously a very popular framework for dieting today.
But.
This is grounded in very, very deep historical You know, human evolution.
We didn't have constant.
We're not eating all the time.
Right.
Today is the access thing.
And so having to be strategic is just something that we're doing in this new environment.
Now, with that being said, can intermittent fasting be something that's a helpful tool during perimenopause and menopause?
Yes, but.
So here's my caveat.
Obviously, this is something I'm known for.
So I always have to provide the caveat.
Can you get enough protein into your feeding window?
Because what I find is easily 80 percent of the women I work with can't.
And so I always say this is where I coined the term digestive rest, which gives people a 12 hour break.
You know times table during their day to get three boluses of protein in.
That is sustainable.
You're still getting benefits from a digestive rest, improved blood sugar regulation.
You're not eating constantly.
But for a lot of women that can't get that protein into an eight hour, six hour, four hour feeding window takes the pressure off of them.
Now, One thing that I do do and I ask women to consider is track your macros for a week.
Just track them.
No judgment, just track them.
Pretty consistently, there's not enough protein intake with those very narrow feeding windows.
Do I suggest intermittent fasting if people are traveling and they're in an airport and there's no decent things that you can eat?
I think that's absolutely fine.
But if the goal is to maintain and build muscle, You have to be careful with fasting.
It doesn't mean that I don't believe in it as a strategy.
And if someone's incredibly, if someone's not particularly metabolically healthy, we know this is someone that could benefit from losing, you know 40, 50 pounds.
I think that intermittent fasting can be of benefit, but it always has to be in the context.
Can you get your protein needs met?
And that's always the conversation that I think a lot of us are not having with ourselves.
Phenomenal.
The data that we do have is showing even 10 to 12 hours.
After finishing a meal and just having that time of not consuming food, we see some metabolic changes, benefits take place.
Insulin, obviously, sensitivity goes up.
It doesn't have to be so stringent to get some of those benefits, but more so we don't want to miss out on especially and I'm so glad you mentioned this it's one of the Not only but best protein related studies that we have.
In older age, we know that the ability to process and utilize protein goes down as people get older.
And so this is even more important, because we see the degradation increase when they're not getting an adequate protein.
And so this is such an important thing to be focused on and to be strategic about for your life as an individual, and finding out what works best for you.
And so, with that being said, we covered some of the – foundational pieces when it comes to diet and nutrition.
Are there any other things that you want to point people to and that they're going to learn about in the menopause guide?
I do talk about alcohol.
That's kind of like poking a bear because it is a very personal decision.
But if you look at the research and I'm not talking about a glass of wine once a month, I'm talking about the heavy drinking that is still part of the mommy drinking culture
And I know this because if I'm at events or I'm talking to people and I'm just listening, I'm sometimes surprised that even women in their 40s, 50s and 60s still drink fairly heavily.
We know that it is problematic for a number of reasons.
Puts you at greater risk for certain types of cancers.
Heavier drinking or consistent drinking can lead to leaky gut.
Can increase your estradiol levels within your body to points or estrogen levels.
That elevates them for several hours afterwards impacts your sleep quality.
You know, I would say a lot of people drink because they're trying to manage their stress levels.
It actually makes it worse.
So kind of looking at your relationship with alcohol and saying, you know, is it worth it?
Because I think that the you know, certainly the research that's out there is certainly starting to head in the direction that alcohol really has no health benefits.
And so being selective if you choose to drink.
Just being selective about using it sparingly and not habitually.
You said poke the bear.
I thought about cocaine bear.
I think they might even have a part two of that, by the way, but.
Alcohol bear movie would would would it's triggering.
It's it's interesting to me how triggering it is to talk about alcohol.
And I just say, listen, I'm just presenting objectively what I read and see.
And certainly, you know, I have my own personal preferences because of the way that I grew up.
But.
That's not what's clouding my perspective.
It's like really looking at the research.
And if we're talking about a healthy gut and knowing that we're at greater risk for leaky gut at this stage of life, it's like that would be one of the things I would use sparingly or not at all.
There actually was already an alcohol bear, which was Yogi the Bear.
If you think about it, he was always chasing the picnic baskets.
He called his little friend Boo Boo.
You know, he was tipsy all the time.
So, if you could, can you share just what people can expect when they pick up a copy of the menopause gut and also, of course, where they can pick up a copy?
Yeah, thank you so much.
So the menopause gut is really giving us a expose into the microbiome, the gut microbiome predominantly, but really looking at the influence on our immune system, on bone health, brain health, looking at hormones. hormone replacement therapy I unpack the WHI women's health initiative and explain how that's influenced prescribing privileges we talk about supplements we talk about sleep nutrition exercise and lots and lots of resources I don't touch on peptides in the book much because you know some of them are not FDA approved and that can be kind of a little bit of a landmine and so Menopause gut is available anywhere books are.
If you have a local bookstore, please go place a presale order and check it out, because we want to be supportive of our local bookstores or brick and mortar bookstores.
But anywhere you find books, Amazon, Barnes and Noble, Target, etc.
Awesome.
Thank you so much.
And you know, I know how much you care truly and how much you put into.
You know the work that you share.
And creating a book like this is very special and it's timely.
And you are addressing so many of the things that you know again, they're just kind of hiding in plain sight.
And so I'm so grateful to be able to support this project.
And I'm so grateful for you.
Thank you.
Thank you.
I'm grateful for you as well.
Thank you so much.
Amazing.
The one and only Cynthia.
Thank you so much for tuning into this episode today.
I hope that you got a lot of value out of this.
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