transcript

Speaker 1:
[00:02] On this episode of The Resetter Podcast, I am bringing you back once again, Cynthia Thurlow. Now, I got to tell you, Cynthia has been one of our most requested guests. She and I have done two episodes on fasting. She wrote a book called Intermittent Fasting Transformation for Women. So we've united on the metabolic health of women over the years. And those of you who've been listening to The Resetter Podcast for a while may have remembered those conversations. Well, I am bringing her back today to talk about an extremely important piece of hormonal health that does not get enough attention. And that is our gut microbiome. Cynthia has a new book out called The Menopause Gut. It is a much needed conversation in the menopause space right now. On this particular episode, you're going to learn about a set of bacteria that we call the astroblome, which are bacteria that break and detoxify estrogen. And it is this set of bacteria that is critical for your hormonal experience. If this set of bacteria is off, your menopause journey may be incredibly turbulent. So, in this podcast episode, we talk about what do these specific bacteria do, what parts of our health do they control, what lifestyle habits that we have destroy them, and most importantly, what do we do to bring these microbes back. As you're going to learn in this podcast, these microbes not only break down estrogen, but they have a massive impact on insulin sensitivity as you go through menopause. They have a massive impact on your moods as you go through menopause, and there is a lot in this discussion about how these microbes affect sleep. If you're looking for a deeper conversation about how do you take your power back as you're going through menopause, how do you have more control through this experience, whether you're 45 or 75, this is a missing piece of the conversation. So I am so excited to bring it to you. Cynthia Thurlow, The Menopause Gut, it's ready for order now, and I really hope you get the depth of which Cynthia and I are bringing forward in this conversation a critical part of female health. As always, let me know, report back. I hope this one helps. So my first reaction when I heard this book title was, yes, yes, we need a book on the microbiome, with everything that goes on in the gut and menopause, because slapping a patch on you and hoping that all your problems will go away is not the solution. We've had a lot of great menopause books come out, but nobody has given us the manual for the gut. So let me first off say thank you for taking that task on. I can't wait for my audience to get your book.

Speaker 2:
[03:23] Thank you. It's interesting how there were things that happened in my personal life in 2018 that set the stage for this book, not realizing at that time, even though I'd like to think I'm a very evolved clinician, I stay on top of research, and yet no one has really talked a lot about the unique changes that are happening in our microbiome, vis-a-vis declining hormones and changes in neurotransmitters. So the story that I start the book with about being in Morocco and getting horrific food poisoning, even though my husband and I ate the same food, really got me thinking that there's more to the gut than we actually give it credit for, and the irony being, and I'm sure you've got a great podcast too, you bring on these clinicians or these researchers, and you take a little bit away from the conversation, you're like, oh, oh my gosh, there's so much more to this conversation.

Speaker 1:
[04:19] So much more.

Speaker 2:
[04:20] And to your point, HRT is an important discussion for women to have, whether they choose to take it or not take it. But I remind everyone that there is this foundational element that if we are not addressing it, we are not going to have the same success as someone who has an optimized or healthier microbiome. And it's almost like the saying, it doesn't get enough respect, but because we cannot see it, it's not tangible like the heart, the lungs, the brain. It's like the gut microbiome. What is that? Where is it? What does it do? And so the more that I understand humbly about the gut microbiome, the more I realize that there's a lot that we don't yet understand, but there's just as much that we can do to optimize our gut health as we're navigating these hormonal changes.

Speaker 1:
[05:07] Yeah. I was on that journey of understanding for 10 or 15 years in my practice, and it started very much like you're talking about where I was like, well, we have these microbes in our gut. They help us break down food. I was very familiar with candida because I had it when I was 20 years old. Then I started to understand heavy metals and I saw, oh, wait, some of that bad bacteria really flourishes when you have a lot of heavy metals in the system. Then I started detoxing heavy metals in my patients. That eventually led me to understanding what you have centered this book around, which is I call it the estrobalome. I know there's a lot of different ways we can call it. How do you call it?

Speaker 2:
[05:51] I call it the estrobalome. I always say I did not name it. It's an awkward name and it is what it is. But if you think about it as the estrogen processing plant of the microbiome, and you understand how critically important it is to nurture it, it's like, oh, my gosh, there's so much to it. But yeah, unfortunately, it's a weird aspect.

Speaker 1:
[06:11] Yeah. But what I realized when I ended up going from microbes to how toxins create an environment where microbes get off to, wait a second, we have a set of bacteria that break down estrogen? Then I started to question, well, what happens if we lather our body with cream? What happens if we put a patch on? Does it still have to be reformatted and metabolized? So I want to start this conversation at the astroblome. Why do we have a set of bacteria specifically designed to break down estrogen?

Speaker 2:
[06:45] Yeah, it's such an important conversation. So number one, whether we are producing estrogen in our bodies, we use the term endogenous, versus exogenous exposure to estrogens in our personal care products, our environment, our food, our body has a way of hopefully breaking these things down. And really we're talking about detoxification. And so we've got two phases in the liver. That third phase is supposed to be in the gut if it's optimized. And ideally what we're doing is we're breaking things down into water soluble metabolites. We are packaging up the excess estrogen and hopefully pooping it out. Now, that's an oversimplification. But what happens for a lot of people, whether or not it's genetic snips like MTHFR, as an example, or CompT, some of these snips or these genetic mutations can make it harder for us to break down metabolites. It can be recirculated. And for a lot of women, they'll say, it doesn't make sense. You're telling me that I'm in mid to late perimenopause or menopause and my estrogen levels are low. How could I possibly be recirculating estrogen? And it has a great deal to do with what we are exposed to in our environment. That's the best example I can provide, because some of these estrogen mimicking chemicals, or endocrine disrupting chemicals, can actually offset the receptor site for estrogen and can magnify a thousand fold. Now, that may not be every single chemical, but the things that we are exposed to over our lifetime, I always say it's this toxin bucket is getting filled up as we're going through our lives. And I feel like middle age is this opportunity to get tremendous clarity about how these toxins can impact our hormones. And I feel like perimenopause in a lot of ways is a litmus test for so many things. And so, yes, you can have trouble breaking down your estrogens, recirculate it, and then it magnifies all these estrogen symptoms, breast tenderness, brain fog, joint pain, skin issues, weight loss resistance, which I think most people are experiencing in middle age, which is an endless source of frustration. But the good thing is, there's lots of things we can do to optimize our estroblom with nutrition and lifestyle. And we have to have the conversation around pooping.

Speaker 1:
[08:56] Yeah. Oh, my God. Yeah, for sure.

Speaker 2:
[08:58] I was teased by a gastroenterologist, and he was like, Cynthia, you can't say bowel movement and don't say defecation. It's too clinical. Just say poop. And so on every podcast, I made this effort to say pooping. But how many women thinks it's normal to poop two or three times a week? And if we know that one of the main ways, and also when we consume fiber, kind of binds everything up and helps us poop it out. But for a lot of women, they think it's totally normal to have gas bloating, constipation, and that becomes their norm, and sometimes gets worsened through this menopausal transition. And so helping them understand constipation is different than what I was taught 25 years ago. We say if you're not having a bowel movement once or twice a day, you're constipated. Well, I think I'm a little more nuanced now, and I would actually say if you are pooping most days of the week, you're pretty good. If you're traveling or you get stressed and it becomes problematic, what is not normal is to have to strain to go to the bathroom or to have loose stools constantly. That is not normal. It's not optimal. And therefore, definitely worth part of that conversation. But I think for a lot of women, this is normalized. Like bowel issues are just normalized. Oh, you just have IBS or you're just stressed.

Speaker 1:
[10:11] But we don't talk about it so they don't even know.

Speaker 2:
[10:14] Right. Exactly.

Speaker 1:
[10:14] Two to three times a week isn't appropriate. So before we go into fixing that piece of it, I want to back up one step just so that everybody understands this. The astrobalome is a set of microbes in our gut that do two, what I heard you say, two very important things. They reformat estrogen so estrogen can be more usable to the cell, which I always think of that as like if you're going to send a big file on your computer, you actually have to condense it down and export it. So estrogen, you have to do that. Then what I also heard you say is that it detoxifies the synthetic estrogens and it helps us get rid of those carcinogenic estrogens. Did I hear you right and are there any other functionality of the astrobalome? No.

Speaker 2:
[11:04] I think about it as there's multiple functions. There's one key enzyme which I didn't mention, it's called beta-glucuronidase and that's the enzyme that's helping to cleave off the estrogen so that you can package it up and poop it out. But I think for a lot of people, it's understanding that things like stress, alcohol, processed foods, things we're exposed to our environment can make it harder for this system to be able to work properly. And with declining levels of endogenous, the estrogen that our body makes, it can make it a little bit glitchy. It can make it hard for bile. Estrogen and bile go hand in hand. So it's interesting that with the decline in estrogen, we're not breaking down and emulsifying our fats quite as well. So that can also contribute to the astroblome just not working quite as effectively. Because it's all about this enterohepatic circulation, which is a fancy way of saying, we've got multiple portals of entry that are contributing to the health of the astroblome. But to your point, I think a lot of people don't even think about these things that are going on in our bodies. And I think for a lot of individuals, we've had many years of women that have been, myself included, I took oral contraceptives for years and years.

Speaker 1:
[12:15] I was just going there, yeah.

Speaker 2:
[12:16] And we start to now understand the long-term net effect. Anyone that's listening, this is not shaming anyone taking oral contraceptives. It's just those synthetic estrogens that we have been exposed to for years and years and years to prevent pregnancy also have other net effects. I know Felice Gersh has talked very openly about the net impact of these synthetic hormones on not just the astroblome, but the entire microbiome and the composition of the diversity of bacteria and fungi that we have there.

Speaker 1:
[12:45] So if these bacteria are critical for how our body uses estrogen and how our body detoxes estrogen, if I spend 20 years on the birth control pill and I've had five rounds of antibiotics and I go roaring into my 40s with a decimated microbiome, what are some of the expressions of that, what are we going to see if we have this one set of bacteria not working at their best?

Speaker 2:
[13:18] Yeah, I would think, well, number one, you're at risk for leaky gut. We know that we're four to five times more likely in menopause to lead to leaky gut because we think about estrogen as being like, my new analogy is it's like brick and mortar. So in between the bricks is the mortar and that's the estrogen. So you start to get more leaky gut and when you are leaking food particles or inflammatory substances into your bloodstream, you provoke an immune response. So autoimmune conditions, this is when we'll see celiac, hoshimoto's, lupus, rheumatoid arthritis. There's over 100 diagnoses now, Mindy, and not the least of which, long haul COVID, chronic Lyme, all those kind of long-term tick-borne illnesses that we're seeing. For a lot of women, I see tremendous mood changes and we forget that the bulk of our neurotransmitters are produced in the gut itself and we have this wonderful re-license system that goes back and forth between the gut and the brain. So this gut-brain access. So I would say if your gut is inflamed because you're eating inflammatory foods or you've taken multiple rounds of antibiotics or you've had a lifetime of a lot of synthetic exposure to hormones, that can alter not only the neurotransmitter production but also this inflammatory pathway that goes back and forth between the gut and the brain. I think a great deal about just chronic inflammation, so joint pain, headaches, depending on whether or not you're still bleeding, this may impact the menstrual cycle itself. In a lot of instances, we see women that are not necessarily returning to, or they're not necessarily per se, returning to a normal cycle even after coming off of oral contraceptives. That certainly happened to me. That doesn't mean it's everyone's experience, but certainly was what I experienced myself. It just becomes this laundry list of symptoms that we'll see women dealing with. For me personally, it's weight loss, resistance, inflammation, leaky gut, inflammatory issues, mood changes, which in a lot of instances, when we think about the fact that when we have a leaky gut, we also have a leaky brain. If the gut is inflamed, the brain will be inflamed and many people aren't necessarily making that connection. They just assume, it's all related to low level of neurotransmitters, so this antidepressant is going to buffer that and that may in fact be the case. But in some instances, it's buffering changes in hormones, buffering and altering these degrees of neurotransmitters that make a larger impact.

Speaker 1:
[15:41] So if I'm 43 years old, 44 years old, and I've got brain fog, I've got fatigue, I'm not sleeping well, I'm having two to three bowel movements a week, not every day, my mood is low, my motivation is low, how would I know if that is a deficit of hormones or a challenge with the microbes that are supposed to reformat and detox those hormones? Is there a way for us through symptomatology to be able to tell? Because one of the things that has been killing me is the message that women are getting is these symptoms are because we read the HRT study wrong. When we go to that level of simplicity, I'm like, you don't understand hormones, it doesn't work like that. There's a complete ecosystem that needs to know how to break these hormones down. So is there a way for us to tell through symptoms if it's just low hormones or if it's low hormones mixed with poor microbiome health?

Speaker 2:
[16:42] Well, I would say it's probably multi-factorial, meaning it's multiple things. But number one, for a 43-year-old, where are the symptoms occurring within your menstrual cycle? Because if we can map out, is it every time you get past ovulation the week before your menstrual cycle that your symptoms worsen? Well, then I'm going to probably suggest that it could be a concomitant issue related to a drop in estrogen and also a drop in progesterone. If it's something that is not cyclical, then it might be something beyond that. There are absolutely women, Mindy, that need more than just giving them progesterone for a week before their menstrual cycle and thinking that's going to fix everything. Sometimes it's really getting granular about their gut health. Sometimes it's looking at stool testing. Sometimes it's looking beyond just an elimination diet and looking at food sensitivity testing. Sometimes it's getting really clear about what's going on in their personal life because we know that perimenopause and menopause are a litmus test for what's working in our lives and what is not. For so many super high functioning women, they do well in their teens, 20s, and 30s. Everything that got them to where they are at this point in their lives has been a byproduct of they just buckle down and do the work. Then all of a sudden, with these alterations in hormones and neurotransmitters, suddenly it's a whole lot harder to fake it. Or they suddenly realize they can't get by with not getting enough sleep. They can't get by with not managing their stress. They can't get by with eating the standard American diet and not moving their body. So these foundational elements become important, but that's where I would say a really good history, which is one of the things that I think is distinguishing about when we're doing intakes on patients is just getting really clear, how long has this been going on? Tell me more about your sleep. Tell me what we do for stress, because if you think that doing breath work one day a week is going to fix your inability to manage your stress levels like you did 15 years ago, that's really mistaken. So I always say it's multifactorial, but we peel back the layers of an onion looking to see, okay, we manage sleep first. Once we get diatiled, then we can address sleep. But sleep and stress are so intertwined, and a lot of people think that it's not important. And I'm the first person to say that, you know, for a lot of women that come to me, they'll say, well, I'm weight loss resistant, and that's their biggest pain point. But I can see five other things that are a greater priority to address. And I'm like, if I can't get you to sleep through the night, I can't get you to lose weight. And, you know, when I'm working with women, it's helping them understand sleep and gut health go hand in hand.

Speaker 1:
[19:17] I mean, you have... Our gut makes melatonin, correct?

Speaker 2:
[19:20] Yes, and so we have these circadian clocks throughout the digestive system. And it's helping people understand, no, it is not just the penile gland in the brain that secretes melatonin. We have melatonin clocks and little circadian clocks throughout the digestive system, which is why when people eat an hour before bed, they wonder why their sleep is terrible. And it's because melatonin can't do its job because now we're increasing cortisol to process this bolus of foods. But I think for a lot of people, they don't understand the interrelationship of chronic stress and what that does to our body. And show me any woman that's not sleeping well in middle age, they're not managing their stress. That is absolutely how it shows up. And I think it's oftentimes not part of the conversation because it's not sexy. It's not a bright, shiny object. It's not a device. It's not something that we can necessarily track with sexy metrics. But the reality that for so many of us, there are multiple things that contribute to the symptoms we're experiencing. Unfortunately, it's never just one thing.

Speaker 1:
[20:20] For the listeners that may have never heard that the birth control pill was damaging to the microbiome, can you help women understand that? Because I find that to be a real shockeroo. A lot of women have not completely grasped.

Speaker 2:
[20:35] Yeah. And I always give Dr. Felice Gersh credit because she was the one that initiated the conversation around this. They're endocrine mimicking chemicals. And so what that does is they're damaging the delicate microbiome. So I think for a lot of people, it seems very intangible because we can't see the microbiome. But understanding that when we're taking these synthetic hormones, which again, not shaming anyone, I was on oral contraceptives for a long time until I got married for a variety of reasons, not just for contraception. But I think for a lot of people to understand these synthetic chemicals are actually damaging the delicate layers, not just to the microbiome itself, but throughout the digestive system. I think that the biggest thing is that it's cumulative dosing over time. It's not like one month of taking an oral contraceptive, it's 12 months times 16 years over time, what that's doing when we're in a low estrogen state to begin with, because that's how the pill works. It's keeping hormones at a certain level so that you will not ovulate, if you're taking the pill as directed, you're not going to become pregnant, but we're kept in essentially a very low hormone state for a long period of time. Then the only hormones we're exposed to are in fact not bioidentical hormones, they're a synthetic version of that. As I tell everyone, I think that we have to make the best decision with what we know. At the time when I started taking the pill when I was a late teen because I had irregular cycles, no one was talking about fully informed consent, no one was talking about what's the net impact of young women being put on Depo-Provera or contraceptives. What does that do to bone health? What does that do to long-term muscle health? What are the things that we're thinking about beyond just, let's not let this young woman get pregnant or let's fix her period symptoms? From what I understand from what Felice has shared with me, the exposure long-term of those synthetic hormones is what actually damages the microbiome. Do I know definitively how long it takes to improve upon that? I don't. I mean, no one's done that study. But I think it certainly makes sense that the degree of endocrine mimicking chemicals we are exposed to over a lifetime is where we start getting concerned because we live in an environment, and I hate to say that the environment itself is toxic, but we've never lived in an environment that has this many chemicals for as long as we have. And so when I start thinking and looking at statistics for increasing prevalence of colorectal cancer in younger patients and other, you know, even these neurocognitive issues, like I think about Eric Dane, who just passed away from ALS, it's like I was listening to a physician, and I know this is tangential, I was listening to his own physician talking about what she believes are some of the reasons why they're seeing more and more ALS patients. And this is, you know, Lou Gehring's disease. And she said, I think it's the toxic environment. This is a scientist, a physician scientist saying that. So I think that it's important for us to just be aware that these exposures can be cumulative over time and can become problematic. I'm not suggesting that is what's driving ALS. But I think especially as women when we are trying to have agency over our fertility and whether or not we choose to become parents, that should be part of fully informed consent. That should be part of the conversation. And in many instances, it's not. In the book, I talk about Depra-Provera as just an example, that has significant bone effects. And so we know it has a black box warning. And apparently, if you look at the research, like two years after being off of Depra-Provera, those bone effects are reduced. But enough that contraception can impact bone health, as well as the microbiome, to me, is fascinating.

Speaker 1:
[24:31] Well, maybe they'd listen to us if they understood. Have you seen the study where if you're on birth control and you pick your partner, your life partner, that you might actually be attracted to them very differently. And when you go off of that birth control, your attraction to your spouse may be very different because of the immune suppression.

Speaker 2:
[24:51] Isn't that amazing?

Speaker 1:
[24:53] Of that, of birth control, which is mind-blowing.

Speaker 2:
[24:56] Yeah, that little estrogen state. I mean, that's, you know, senescence. It's amazing. And in fact, who was I talking to about that on the podcast? But I was saying, there's so much about the immune system that we don't fully appreciate or understand. Another intangible part of our bodies that people are like, it's too complicated. I don't want to know more.

Speaker 1:
[25:14] Yeah.

Speaker 2:
[25:15] Yeah. I'm like, oh no.

Speaker 1:
[25:16] Are you seeing clinically that if somebody has a very depleted microbiome, they may not respond as well to exogenous hormone therapy, whether it is a synthroid or a levothyroxine that they're taking. When we're talking about hormones, we're not just talking about HRT, but thyroid is a big one. Do we see a correlation, whether it's scientifically or clinically, between the worst microbiomes and the inability of these exogenous hormone replacement therapies to do their job?

Speaker 2:
[25:51] It's a great question. I mean, I definitely see, when people have more depleted microbiomes, when we're looking at stool testing, I certainly see worse sleep, more mood disorders, more autoimmune conditions, more immune system issues. And we know that our immune system takes a massive hit. Do I necessarily see that there's a correlation with worsened microbiome testing and also concurrent thyroid issues? Yes, because that immune leaky gut piece is just such a huge part of middle age. It's like I think I had said earlier, four to five times more likely. And if you've already had an autoimmune condition, as you kind of sail through middle age, you're more likely to pick more of them up. And so that's another piece of that puzzle. So if someone's already got Hashimoto's, are they going to be as responsive? I still think it always goes back, Mindy, to like this chronic stress piece. Like so many women, they just don't even register in their bodies. They're not even paying attention to the fact that they're chronically stressed because their nervous system has been wired that way since they were children. And so they get into middle age and they're like, I feel fine. And it's just they're so pervasively disconnected from their bodies. Do you see that with your own patients?

Speaker 1:
[27:07] Oh, I see that with, I saw that with my patients when I had my clinic. We see it in our Reset Academy. I've experienced it with myself. I mean, you know, where I sit at 56, I have decided the most important thing I do is heal my trauma now. And that's I've been going deep into psychedelic work, EMDR, like everything I can to go back and heal parts of my life that I swept under the carpet. And with each healing comes a new level of ability to sleep, a new level of happiness, a new level of brain clarity. And I'm like, not even, this isn't supplement dependent. This is actually the roll up your sleeves and let's heal this. And it's been so liberating for me.

Speaker 2:
[27:51] Well, kudos to you because it's so much easier to continue at 30,000 feet than it is to do the work. Like I always say that I feel like the blessing in middle age is that you get clarity about what is important and what isn't. And for those of us that are doing that internal work, like I jokingly say this, but I mean this, I will be in some form of therapy for the rest of my life. Because every time I think I've gotten around the corner, something else veils itself. And thankfully, I'm married to a very patient husband. But I think for a lot of women, it's the invitation to think about our lives differently.

Speaker 1:
[28:29] And that's the point of this moment, I think, is pause, right? I've seen you talk about, it's menopause. Like, let's pause and decide what we're carrying forward and what we need to heal from the past. And I find, I'll say that, I find it, this is gonna sound silly, but I find it a little trigger-y when people are like, we need to learn how to manage our stress better. Because, what does that mean? How do I do that?

Speaker 2:
[28:57] Right, too simplistic. And I also think, like I jokingly say this, but I don't jokingly say this. I am like the black sheep in my family because I'm the truth-teller.

Speaker 1:
[29:08] Yeah, there's one, and I'm that in my family, too.

Speaker 2:
[29:10] Yeah, I mean, I'm the one that picks at that scab. I'm the one that talks about stuff that people don't want to talk about because it's not nice. And so I've come to find that part of my healing journey and being in middle age is that I'm comfortable with that. Like before, I felt shame about it. And it was interesting. In 2024, my dad got sick and rapidly declined and passed away. And it was like, I got so much clarity in that two week period of time. My brother and I are very close. My parents had been divorced for 45 years and it triggered my mother. My father dying triggered my mother, who did not have a good relationship with him, but I was able to see her in a unique lens with compassion, but it forever changed my relationship with her.

Speaker 1:
[29:59] That's really cool.

Speaker 2:
[30:00] Yeah.

Speaker 1:
[30:00] That's really sweet.

Speaker 2:
[30:02] But it's one of these things, I think for so many of us, that the patterns could be different, our experiences can be different, but that's the invitation of middle age is giving us that opportunity to recalibrate or decide for ourselves, this is no longer working like we were talking in the pre-chad about different ways that we look at things through our business now than we did 10 years ago, and how freeing it is to have that clarity because a lot of people are still in that kind of people-pleasing mode where they're subjugating their needs over and over and over again, and yet I would argue that the women that are able to acknowledge what they've gone through, move through the feelings and not try to pretend, that's a lot less stress. I feel like I'm at greater peace now than I was two years ago, five years ago, 10 years ago.

Speaker 1:
[30:48] Totally.

Speaker 2:
[30:49] Because I'm fully looking at things in the mirror and not pretending that they're not there.

Speaker 1:
[30:55] If I'm entering my perimenopausal years, we need a checklist of if you have been on birth control, if you've had four rounds of antibiotics, if your stress levels are through the roof, if you're eating ultra-processed foods, if you check eight out of these 10 things, you're in for one hell of a menopausal ride. Do you have a checklist like that or have you put that in the book at all?

Speaker 2:
[31:24] I have some free bonuses that kind of walk through different types of gut types, meaning based on symptoms, based on experiences, to kind of give them a sense. I mean, I think that there are people that go through multiple rounds of antibiotics. There are people who have been on birth control for years. There are people who've had a lot of trauma that are still scooting along at 30,000 feet because they're not seeing anything below where they are. But I think that there are definitely women that are like, hey, this isn't working for me anyway. What can I do? So that is what I think is important. The gut is incredibly malleable. That is like A number one. There's always things we can do. But I do think that there are people who set themselves up for a bumpier ride. Like if you're not happy with where you are in time and space, if you're in an unhappy relationship, you don't love your job, maybe you're in a position where you're not eating nutrient dense whole food. Then that can look different for everyone, right? You're not moving your body, you're not connecting to nature. I know that on social media, you're talking a lot about surfing and how much you love that physicality of it and connecting with nature. But I think for a lot of people, they spend so many years downplaying what they really want to be doing. That the band-aid comes off in middle age and you get to decide for yourself, am I going to truly step into the person I'm meant to be? Or am I going to stay, I don't want to use the term play small because that sounds pejorative, but am I just going to continue as I am not fulfilled and just subjugate what I want? That will be worked out in other ways. How many patients have I taken care of who are incredibly deeply unhappy in a relationship and a job where they are who end up being emotionally corrosive or are people that are deeply angry? I'm sure we've all seen women like this, not well emotionally regulated. So I think that it's that opportunity to acknowledge what is working for you and what is not.

Speaker 1:
[33:20] Yes.

Speaker 2:
[33:22] It doesn't have to look the same for everyone. It doesn't have to be extreme. It could just be one thing that you do differently that allows you to feel like you're letting a little bit of steam off.

Speaker 1:
[33:30] Right.

Speaker 2:
[33:31] Then as you move through it, doing more. Because I know even since our last conversation, you've been doing more and more things that you feel like are liberating and allowing you to fully step into who you are at the stage of your life. Yeah.

Speaker 1:
[33:43] For me and my audience knows this, because I've been doing a lot of podcasts on it. Honestly, the Epstein files were a huge wake up call. Peter Atiyah and Deepak being in there, and I allowed myself for two weeks to go into every piece of information I could find. I told myself to be as horrified as I needed to be horrified. After two weeks of that, I came out and I was like, are you freaking kidding me? How we think about ourselves from a beauty standpoint, how the health care system that has been run by science, that was manipulated by Epstein. You start to see that every single industry has infiltrated the way that women think about themselves and the way that we operate. I just hit a point of no more, no more. I will not partake in that energy anymore. Then I had to flip it and ask myself, well, what does it mean to partake in a different energy? It was like, I need simple, I need slow, I need surrender, I need connection. I just started doing words that this is the energy I want to marinate in. I think what's ironic to this conversation is that's what your microbes need too. They don't want toxic thought, they don't want toxic food. If you give them toxic food and toxic thought, they die, and if they die, they don't break estrogen down, they don't detox estrogen, they won't make you neurotransmitters that I want to talk about here in a moment. I do think there's a real parallel between the ecosystem that we are living in day-to-day and the ecosystem of the terrain inside our gut. That is why I'm so excited about this book, because I'm like, let's bring that conversation forward. This isn't about taking a probiotic. This is about changing the ecosystem in which you live in.

Speaker 2:
[35:43] Well, that's such a beautiful analogy, because you think about the outside should mirror the inside. That's really what you're speaking like. Being attuned to who you are as an individual, but acknowledging that if you're not managing your sleep or your stress or the people you spend time with, or the influences and imagery, I've noticed as I've gotten probably the last couple of years, it's like I just, there's certain things if I'm having mindless time, which I'm trying to have some mindless time so my brain can turn off, but it's like certain things on a streaming service. I'm like, I don't want to watch things that are dark and depressing. I'm like, I want happy, happy, happy, happy, because that is what's good for my soul and that is what rejuvenates me, or connecting with people that fill my cup. People that you feel like it's effortless to be friends with them.

Speaker 1:
[36:31] Yeah.

Speaker 2:
[36:32] So to your point about the Epstein files, it's interesting how the health and wellness space, for the most part, really, I mean, I feel like everyone did a 360-degree shift. At least the people I follow were like, wow, we need to start getting really granular about who we emulate in this space, because we're starting to see some consistent patterns that we do not want to be. We don't want to be idolizing these individuals who, arguably, are narcissistic, sociopathic, dishonest, deceitful. Those are all values that we don't embrace. I think that it's going to give us opportunities to have other individuals that are going to be able to emulate this positivity in different levels of energy. I think energy is everything.

Speaker 1:
[37:23] Yeah. I also think that we have to hold ourselves accountable for our desire to follow gurus and celebrities. What we're doing in that, we are actually giving our power away. We're saying, Peter Attia knows better than me. If Peter Attia says it's this way, then I must do it this way. I think one of the things that has launched out of the menopause space with all the menopause books that are out there in the menopause conversations, is I think we're going to start here really clearly to see the difference between a book that tells you how to do something, and a book that invites you into your own healing experience as you move through menopause. This is why I will continue to tell you that I think this menopause gut idea is so powerful because nobody's talking about this. We have to start to realize dopamine, serotonin, melatonin, oxytocin, all these hormones that make us feel so good come from the microbes, and how have you been treating the microbes? Can you talk a little bit about that correlation? Let's keep on the ecosystem idea. If I am having a wake-up moment of like, wait a second, happiness begins in my gut, okay, then what do I need to do to get these microbes back, is where I really want to go to.

Speaker 2:
[38:46] I so love this conversation. So when I'm thinking about from a science perspective, because that's usually where I start from, just to give women some perspective. So these hormones that we're talking about, progesterone, estradiol, testosterone, they have multiple effects. But one of the most important effects I think is their effects on neurotransmitter production. And so most women, when they hit the wall of perimenopause, it is very likely because as progesterone is faltering, it's impacting GABA, which is this main inhibitory neurotransmitter. And I think for a lot of individuals, they don't even think about these hormones until they're depleting. And so think about when you were in perimenopause in the week or two before your cycle, you're like, why am I having trouble sleeping? Why am I feeling more anxious and depressed? I've never had mood disorders. So that's number one. Then you have estradiol on the other hand, that we can have loop cycles throughout perimenopause where our estrogen is 20 to 30 percent higher. That can impact serotonin, which impacts and begets melatonin. But that can make us irritable. When there's less circulating estrogen, I think it's irritable, can make us grumpy, can make us feel like we don't want to bond. This is this major bonding hormone. This is the one around ovulation that makes us want to have sex, want to couple and have sexual intercourse because that's what propagates the species. But I think for a lot of individuals, they're not even making that connection that the health of the microbiome has a tremendous amount to do with whether or not we are making these neurotransmitters. So imagine you have the perfect storm of declining hormones, declining neurotransmitters, unhealthy microbiome. Why do we see a lot of women that are, and I say this respectfully because I acknowledge all of us come from different backgrounds. So some of us have control, we don't have any control over how we are born and how we are initially raised. But if we don't learn emotional regulation, it is going to really show up. These are the women that go from 0 to 60, they're very emotional, they're having trouble, they have labile moods. Some of that is because they never learned from their family how to regulate their nervous system. You then throw in there changes in hormones and neurotransmitters, and then you add in just being unhappy. I think that it's a mind-body connection. We talked about the vagus nerve, but what your brain perceives, your gut will also correspondingly adjust to. And so I think when you're telling your brain, or if you're feeling unhappy, it's transmitting that information to the gut, and it goes back and forth through this relay system. So I think it becomes profoundly important that we acknowledge how we choose to sleep, how we manage our stress, what food we choose to eat, whether or not we exercise has an enormous imprint on the microbiome through middle age. And for a lot of women, they do a really good job managing their emotions, and managing their relationships, until they get into perimenopause. And then all of a sudden, it's the great awakening. I can't tell you how many of my girlfriends that have gotten, I mean, thankfully, it hasn't been many, but changing their relationships or getting out of unhappy marriages, or changing their jobs, or doing a 360-degree shift where all of a sudden, all of us are like, whoa, what's going on? And of course, as their friend, we're like, you know, with guardrails on, just helping them kind of process what's happening. But it's the great awakening. And I agree with you, Mindy, that the crosstalk between the microbiome, these microbes, are really important for determining how we navigate middle age and beyond. And I think a lot of people kind of keep it down to like a boilerplate, like, oh, the microbes are important. You know, you eat fiber and the microbes fermented, and then the colonocytes help create short-chain fatty acid production. That's true. But it's not this reductionistic perspective. I think we're just seeing this burgeoning field of neuro gastroenterology. We're really getting a sense between the gut-brain connection and all these powerful processes that are ongoing that maybe haven't even been fully elucidated at this point. So I think from my perspective, the gut is malleable, perimenopause is your litmus test. If you're not doing a lot of the things to have a healthy microbiome, it is going to make that perimenopause and menopause transition harder, not impossible, but make it even more challenging. I always use the example of, I was someone that was on rounds and rounds of antibiotics as a teen, and probably had a couple doses in my 20s because I had Lyme appropriately treated. Wow. Then I was on oral contraceptives for a long time, like a lot of our generation. So I think about, I probably sailed into perimenopause with a not optimal microbiome. On the outside, I looked healthy, right?

Speaker 1:
[43:33] Right.

Speaker 2:
[43:33] Then I hit the wall going 1,000 miles a minute. I think that many reasons why I left traditional allopathic medicine 10 years ago was when I hit that wall, I was like, something needs to change full stop. My parents were beside themselves. They're like, what are you doing? You have a good job. You went to a great university. What is your husband? Your husband thinks you're having a mental, your husband, what do you think? He says, when I think about what my husband said, he's like, are you having a midlife crisis? I said, no, I just have tremendous clarity.

Speaker 1:
[44:03] Yeah. Amazing. I love that. I love that. How do you know? If I'm listening to this and I'm like, okay, maybe my depression isn't my husband. Maybe my depression is because my microbes aren't making enough serotonin. How do we tell the difference? Is there a three-day fiber test we can do or something we can like, okay, well, let's start to bring these microbes back and see if your moods change? Or is there another way of knowing?

Speaker 2:
[44:33] Yeah. I think it's so nuanced, Mindy. I think that it's so many different things. I would say if a woman's, let's say 10 years ago, I was 44. I would have been like, Cynthia, you need to adjust your diet a bit because I was so low carb, and that was the time I was fasting really long and so low carb. Actually, I do better with more carbs and less fat. That's just me personally. I would have adjusted my fiber intake. I would have probably given myself 50 or 100 milligrams of progesterone the week before my menstrual cycle. I would have worked diligently at stress management because I came into perimenopause like so many of us do. I mean, super type A, really struck the job. My husband traveled a ton, my kids were young. I mean, it's like I came in at 1,000 miles a minute. I think for so many of us, it's part of that reawakening of looking at what's working for us and what is not. More sleep. The things I think about from a foundational perspective, more sleep, try to manage your stress a little better, or have a less stressful lifestyle, changing up your food and fiber is one of these things. It's very much become the new F word. When I go on podcasts, I have to be careful who I'm talking to because I will take a lot of heat from people that are like, oh, you don't need fiber. You don't need fiber. I was like, but if you understand what's happening in the microbiome, you actually do need fiber. It might be different. Mindy, maybe you tolerate 40 grams and I tolerate 30 grams, but it's eating more than where you are. But I think if I had done things differently 10 years ago, I suspect my perimenopause would not have been quite as abrupt and jarring as it was. To the point, I think I would have most definitely felt a whole lot better. I had never experienced anxiety and depression before, and it was before every cycle, I was like, what is happening? I just realized now, I was probably, not even at the beginning of perimenopause, I was probably in the middle of perimenopause. Really everything was just so much more magnified. If someone's listening and they're trying to figure out what's my litmus test, you have to make a couple changes. It's never just one thing and it's not just doing stool testing. Anyone that tells you that it is just doing stool testing, is going to figure out you still have to do the lifestyle changes, unfortunately, or fortunately, depending on how you look at it.

Speaker 1:
[46:54] Is there a checklist we can create for women, and you may have created it deep in the book, but just like here, whether you're in perimenopause, postmenopause, here are 10 really important habits that you need to implement to make sure that you keep your microbiome healthy.

Speaker 2:
[47:13] Yeah, so at the end of each chapter, we had little one or two sentence top things that take away. So it's like if someone's skimming the book, and you need the biggest takeaways, that's generally what we were doing. Looking at as an example, what's your fiber intake? Track it, and then improve it.

Speaker 1:
[47:32] What should it be? Do we know?

Speaker 2:
[47:34] Based on research, 25 to 30 grams, but I can tell you it's so bioindividual. I have patients that tolerate 50 grams. I probably tolerate 40, but when I was on six weeks of antibiotics and antifungals, I couldn't have tolerated any fiber for probably 18 to 24 months, and even then, a little bit at a time. So when someone tells me they don't tolerate fiber, the first thing I'm thinking is what's going on with your microbiome? Is it quality?

Speaker 1:
[48:00] Is it quantity?

Speaker 2:
[48:01] Right. Because the microbes need to be able to adjust, and if you've decimated them like what happened with me, you have to build that back up. So I think that it's starting with simple things, like aim for better quality sleep. And I know that seems ambiguous, but doing one thing differently, go to bed 30 minutes earlier, life changing. When people say manage your stress better, what the hell does that mean?

Speaker 1:
[48:24] Right, right.

Speaker 2:
[48:25] It's like find a strategy that you like and do it often. Yep. Ooh, I love that. Yeah, and then thinking like protein and fiber, I think, are the two big things. It's not that you have to be eating dinosaur size protein portions, but you need more than what you're probably eating. And then the fiber piece, track it and figure out where you are and adjust it from there. I can tell you quite honestly, I had a colonoscopy in 2020 and I had one in 2025. And my gastroenterologist said to me when I was done, he said, well, when he was done, he's like, what are you doing differently? And I said, I'm eating more fiber and he said, I can tell. So when people tell me the fibers are relevant, I tell them that's BS. And then, you know, move your body. I mean, we're designed to not be sedentary all day long, but what most of us do, we're just sitting. And that's also not good for those microbes. So all these things are certainly important. And I would say lastly, you know, stool testing is helpful. You know, looking at HRT as an option, because we know that it's helpful for our immune system, our bone health, heart health, brain health. I mean, even though the brain health is still, brain piece is still evolving. I'll continue taking my estrogen because I do believe it will be helpful. But I would also make the argument there's evolving research that estradiol in particular and progesterone are very beneficial for the microbiome. In different ways, you know, there's like the contractility piece, there's the leaky gut piece, there's, you know, the bone health piece. There's so much about the gut that interfaces with all these different systems that I think can be benefited from adjunctive using HRT. But I think for a lot of us, we're just conditioned, Mindy, to take a supplement instead of actually doing the work. And I would actually say the way to optimize in middle age is to actually do the work, figure out what works for you, and then layer in the rest of these pieces, which are equally important, but you have to lay the foundation first.

Speaker 1:
[50:19] And what do you say about the sleep piece? Because I find that one interesting, because if the gut makes melatonin to help you sleep, and you need to go to sleep and prioritize sleep so that you can repair the microbes that make melatonin, but if you don't have enough melatonin, and we're talking about, there's a lot of interesting new research on the chronic use of melatonin for adverse effects on the cardiovascular system, like where do we go in on that? You know what I mean? Do you sense what I'm saying? If I have a really bad microbes, and they're not making enough melatonin, it's really hard to prioritize sleep.

Speaker 2:
[50:59] Well, I think it's multiple layers. I think about this inflammation piece. A lot of people have an inflammation piece going on in the gut, which sends that information to the brain. So you've got leaky gut, leaky brain. You have non-optimized neurotransmitters. Melatonin, as I'm sure your community knows, is not just a hormone. It's also a master antioxidant. And so just like other hormones get replenished in middle age, I am a believer of low dose. Let me be really clear. I'm not talking about 10 milligrams or 50, one milligram, two milligram. I think that there are a lot of benefits to supplemental melatonin, provided that you're using it properly. Like, you know, obviously when I travel overseas, I'm using a scooch more, but I think that the benefits kind of outweigh the risks over time. And in the study that you're talking about, when I looked at it, I just felt like I think sometimes things get taken out of context.

Speaker 1:
[51:58] I did a video on that and I felt the same thing. Like, there's more to this story. It wasn't like people who just chronically took it, all of a sudden started having heart attacks.

Speaker 2:
[52:08] Yeah, I mean, I think we know one in three women will die of cardiovascular disease and that's well known. And we know that generally menopausal women are at greater risk. So it's like looking at all the other lifestyle-mediated pieces that are going to reduce your risk of cardiovascular events. I would actually make the argument there's more to that conversation. And when they say it's so reductionistic, oh, it's just supplemental melatonin is what's driving this. It's like, well, wait a minute, there's some other variable or variables that we're not looking more closely at. But when we think about sleep, I think about cortisol. I mean, cortisol is an important hormone, but when cortisol is excessively high over time, it degrades bone, it degrades muscle, it leads to leaky gut, it lowers our immune system. It can also inflame the brain. And so I think a lot of people don't think about how chronic stress is influencing their sleep support. Like they fall asleep and then they don't stay asleep. And so yes, it could be low blood sugar. Yes, it could be chronic stress. I mean, there's so many things. Yes, it could be your gut microbes are so inflammatory that it's sending signals to your brain to wake you up. But I think it's this like nuanced conversation around these topics to say, I wish I could say it's just one thing.

Speaker 1:
[53:23] Right.

Speaker 2:
[53:24] It's usually multiple things that are making it worse. But I think chronic stress is not given enough, enough, you know, homage. And the other piece that I would argue is trauma shows up in different ways, but trauma for many, many patients shows up as, you know, an inability to manage and regulate their emotions. They can't sleep. They're sympathetic dominant. They really struggle to get themselves into their parasympathetic. And you and I both know when you're chronically sympathetic dominant, you're not going to be able to digest and assimilate food. You're not going to detoxify. You're not going to help your strobilone.

Speaker 1:
[53:59] Right.

Speaker 2:
[54:00] You're not going to be able to relax. And so I think there's usually multiple things that are at bay that contribute to an inability to sleep. It's never just, I wish it was just one thing that would make it so much easier.

Speaker 1:
[54:11] I know. I mean, I laugh sometimes when I think of all the things I have to do to sleep. I'm like, I used to just be able to put my head down on the pillow. And now I'm like, where's my eye mask? Where's my weighted blanket? Wait, you brought me a difficult conversation on the way to the bedroom. Like, there's so much. I just have to wrap myself in bubble wrap before I actually go into my bedroom. And it works great as long as I protect the time right before going to sleep.

Speaker 2:
[54:36] So isn't it funny that so many of us took sleep for granted until middle age? I was telling someone the other night, like the extra things I have to do now in the midst of a book launch, like I sit at my kitchen Thailand and I have a vagal device that I use on my neck. It's not in the book. You're like stupid. Yeah, I would say it's not in the book. So I'm going to just put that out there. I just discovered it a few months ago. And that gets me like I have to do a couple rounds. And my kids think it's hilarious. And I'm like, listen, I will do anything at this point because I come in hot when I'm done with all the podcasts and all the things. And I go and sit in my kitchen island. I'm like, all right, I'm going to eat. I'm going to decompress. I'm going to get off my laptop because we could always be working. It's like hospital medicine all over again. The work will always be there. You don't need to work 24-7. But what do we do as entrepreneurs? We have the ability to work 24-7.

Speaker 1:
[55:29] Yeah, it's unfortunate. I agree. I absolutely agree. Let's take a little turn to insulin sensitivity because I think you and I have spent many years educating the public on this. I can tell you that in my YouTube videos, the most common video that everybody just wants me to keep talking about is menopausal belly weight. Talk a little bit about how our metabolism changes and how the microbes are involved in that.

Speaker 2:
[55:56] Yeah, it's funny when the topic of the book title came up, I was like, no, I don't want to name it The Menopause Gut. I started to realize it's a double entendre. We're speaking about something and then we're also speaking about this aspect to middle age that so many of us find frustrating. There's a lot of things that contribute to shifts in body composition with middle age. Number one is loss of muscle mass. So many people don't equate that physicality piece with this loss of muscle mass, but that is our glucose reservoir. The more muscle mass we have, the more insulin sensitive we are. So as we're losing muscle anywhere from 3-8% in a decade, over time, that's a lot as estradiol is declining. So we know it can be 20-30% higher depending on where we are in our cycles. As we get closer and closer to menopause, less circulating estradiol, less insulin sensitivity. So it is multiple things that are contributing. We tend to deposit more fat in our viscera, so across our major organ so that we go from a pear shape to an apple shape. The pesky fat we had on our butt and thighs isn't much of a problem, but any fat that's around the visceral organs is concerning because that is inflammatory. There's a lot of cytokines, a lot of inflammation. So that in and of itself is problematic and that can be get more insulin resistance, so it sends out inflammatory signals. So when I think about all these constellation of things that are occurring, and we could plus or minus testosterone shifting body composition. For a lot of women, helping them understand it's not just about estrogen, there's this testosterone component as well. Then you layer in this lack of less stress ability to manage our stress and regulate emotions. Cortisol being up, cortisol is not a bad hormone, but gets this bad rap and it degrades muscle. It impacts our immune system. It impacts leaky gut and it also impacts body composition because we have 40 times more cortisol receptors in our belly. Then we do it in other parts. So women will say, I went through this stressful period, and why do I feel like I have an accumulation of belly fat? I'm like, oh, that's cortisol. There's multiple reasons why body composition shifts. But I think for many people, they don't understand the interplay between the microbiome and insulin sensitivity. There's a couple of things that happen. We have a reduction in short chain fatty acids, which are these signaling molecules, but they are helpful for reducing inflammation. We know that there's this complex interplay. Different types of diets can impact how much calories we extract from our food. That's number one. Number two, we know that certain diets that are lower in carbohydrate, that doesn't mean no carbs, let me be clear, can sometimes improve that insulin sensitivity of those cells. There's multiple things at play, like metabolic health and the microbiome go hand in hand. Insulin sensitivity also has interplay with moving glucose into cells. Again, we go back to, there's multiple hormones at play, there's multiple things that are occurring, but the microbiome health has a lot to do with caloric extraction, has a great deal to do with, do we have inflammatory species with that decline in diversity? Instead of having predominantly beneficial bacteria, we can have dysbiotic organisms. These are non-beneficial, sometimes inflammatory organisms that can drive more inflammation. We've talked about this vagus nerve. A lot of information goes back and forth between the gut and the brain, so that can drive more inflammation, and so it becomes this vicious cycle. It's never just one thing. This is where meal frequency, whether or not you do 12 hours of digestive rest or you have a strategy of intermittent fasting, how much you're giving your digestion a break so that you're helping to bring your blood sugar back down, whether or not you can effectively utilize stored fat as a fuel source, whether you're creating ketones and that interplay between beta-hydroxy-biterate crossing the blood-brain barrier, just like iterate, which is one of the short-chain fatty acid molecules. So there's a lot of different things that are happening that are impacting metabolic health, but I always remind women, it's never just one thing. There's usually multiple things at play because obviously, I think the statistic now is 92-93 percent of Americans are not metabolically healthy. So we have to get clear about what are the things we know are effective to help with metabolic health. So we go back to the basics. It's the sleep, it's the stress management, it's not eating too much ultra-process or much ultra-process foods, it's moving our bodies after meals, it's getting clear about gut health. I think I would actually recognize that we're probably doing gut testing at least twice a year. Some patients need it more frequently if we find something that really doesn't belong. But I think in some instances, it's both helpful for them to have some understanding, because it's not like we can see the gut microbiome, but there's dual testing. They can then make this connection of like, okay, this is a proxy of what's going on in my microbiome. But that's like a little taste of what contributes to this loss of insulin sensitivity. It's never just one thing. It's usually a lot of things together.

Speaker 1:
[61:16] Basically, they need to give us like a decade-long sabbatical is what I'm hearing. Where we just check out and we're like, hey, y'all, I've been taking care of everybody else for 30 years. I'm now going to go on a little journey by myself is what I hear in all of that.

Speaker 2:
[61:32] Yeah. I mean, it would not be nice, but that's probably not reality. I mean, I think for most of us, we're teetering on the edge of the open door, the emptiness to wherever you coin it. So our youngest will go off to college in the fall. I was saying to my husband, I was like, Oh my God, what are we going to do with all this time?

Speaker 1:
[61:50] Oh, it's crazy. Call me when it happens. It's crazy. It's a whole interesting experience onto itself.

Speaker 2:
[61:57] No, it's definitely, it's a huge adjustment. So I think for so many of us, we're like, oh, I finally have made me enough time to devote to going to the gym regularly, or not having to be like rushing little kids out the door where I can barely brush my teeth, let alone I have to get dressed and drive them to school. And all of a sudden, there's new found opportunities to be able to focus on yourself, which is, it's interesting. I was telling my husband that when I think about my life before kids versus now, I'm like, you don't realize what you're missing before you have kids. And then, you know, the good slash bad thing is if you do your job well, you've created these strong, independent humans. But then you're like, oh, dang, now I know what I'm missing. So it's like this kind of duality of parenting that is both wonderful and also like you have this like wistfulness about reminiscing. Like I see photos like all of us get on Facebook of 10 years ago, 15 years ago, and I'm like, oh, my gosh, I go back there in a heartbeat.

Speaker 1:
[62:56] It's a tender one. The way I always explain it is it's like they like you've been asked to retire, gather your stuff, leave the building, and then we'd like you to come stand by the water cooler every once in a while because if we have a question, we'll know where to find you. That's the best way I can explain empty nest life, and I'm just standing by the water cooler, hoping that somebody is going to ask me my opinion about something, one of my two children that I birthed. It's very unique. I want to go back to one thing that I think will be really helpful for people because you said it a couple of times, and I think it's been greatly misunderstood in the health space, which is carbohydrates. So when you say, I like to eat carbohydrates to feed the microbes, so they can make the neurotransmitters, can you just help us understand which type of carbohydrates before somebody rushes off and grabs a bag of Doritos?

Speaker 2:
[63:54] Yeah, I know. I'm most definitely talking about nutrient-dense whole foods. So fruits and vegetables, like gooms and beans, and I know this is almost sacrilegious to say this in the fasting community. Everyone is a little carbohydrate different. And by that, I mean, I am metabolically healthy and I exercise so I can get away. But it's not like I'm eating a cup of beans, Mindy. I'm having like a quarter cup on top of a salad. It's just I'm constantly interjecting different types of carbohydrates. So like people will say, how much soluble, how much insoluble? I don't even care about that. Just eat more. Like for me, the flex is consistently with my patients, I tell them to have a tablespoon of flax and chia seeds every day, they tolerate that. If I tell a patient, use the inulin, horrifically bloating for some people and not for others. Like every once in a while, I want some of the least dark chocolate. It doesn't matter if it's one teeny tiny piece or a whole like little fake peanut butter cup, does the same thing to me. I don't tolerate inulin. So when we're talking about carbohydrates, there is a carbohydrate threshold. I think most women should not be consuming more than 30 carbs in a meal. Now that blows people's minds because they're like, wait a minute.

Speaker 1:
[65:06] Net carbs?

Speaker 2:
[65:08] No, total.

Speaker 1:
[65:09] Total, OK.

Speaker 2:
[65:09] Total.

Speaker 1:
[65:10] Which is why you want them from fiber because just to remind everybody, then you get to subtract the fiber and that gives you a net carb.

Speaker 2:
[65:17] And so total. But it's interesting, you know, if someone is not metabolically healthy, if someone is insulin resistant, diabetic, PCOS, et cetera, you probably have to be more mindful about your carbohydrate intake. And so you may need less. Some of those patients do well with ketogenic diets. Some do not. And I wish I could tell you that the research tells me exactly who will and who will not. What the research does say is there are some women that do really well with a ketogenic diet and that is because their microbes do well with a ketogenic diet. And there are others that don't do well with a ketogenic diet and has a reflection of their microbes that are there. So I think when I talk about carbohydrates, it's number one, they should not be vilified. Number two, we're talking about unprocessed carbs. I'm not talking about pasta and I'm not talking about bread. I know it makes everyone so mad about bread crackers. I'm talking about glycemic berries. I'm talking about broccoli. I'm talking about cauliflower, lentils, beans, etc. Number three, depending on your degree of metabolic health, you can probably get away with more. Like I actually have been able to start eating rice again, which was shocking. I was out and had sashimi with my youngest and I was like, I'm going to actually try some rice. I didn't know a lot, but I did pretty well and I think it's because over time, my body is more tolerant of those. This is where I think if you suspect that you have an issue with specific types of unprocessed carbohydrates, this is where a glucometer or a continuous glucose monitor can be helpful. Not to perseverate over every single blip on your recording, but more to be aware like plantains, I can't eat plantains. They spike my blood sugar, it doesn't matter what I eat them with, it doesn't matter the quantity, they just don't work for me. So I focus on other nutrient dense, like other root vegetables and things like that. So I think the biggest thing is no macronutrient should be vilified. That's full stop. Number two, fiber, I think a fiber, even though I know that we can get it in fruits and vegetables, I think about it differently. I just think about the more that we understand about the research and the changes that are happening in the microbiome, B to B, changes in short-chain fatty acids, and I'm just going to riff for one second. People are like, why are these important? We think about butyrate, acetate, propionate, butyrate crosses the blood-brain barrier, but these are important for insulin sensitivity. They're important for reducing inflammation. They're important for the mucus lining of the digestive system. When we know the small intestinal lining is one cell layer thick, it's important to understand why they're important. I will make the argument that fiber is important. The dovetail caveat is this. Each one of us tolerate a little more and a little less. If you track your macros and you find over the course of a week that you're having about 10 grams a day, which is about the average for an American right now, just aim for a little more and work your way up to more than where you are. Don't do it too quickly because your microbes will not be happy with you. They'll produce a lot of fermentation and a lot of gas and can make people uncomfortable, maybe even constipate you. But that's where I think carbohydrates have gotten a really bad rap. I think for many people in the low carb, keto fasting space, if you say carbohydrates aren't bad or if you say carbohydrates are good, people get upset and I think what I have learned working with so many thousands of women is that there might be a time in your life where you don't tolerate something and then a couple years later you may.

Speaker 1:
[68:51] That's it. That is so important because microbes are constantly changing and if women apply what you're talking about, what might not work for you today may actually work for you six months from now.

Speaker 2:
[69:04] Yeah, that's why I mentioned the rice thing that I mean I've been avoiding grains for a long time and so I was like I'm gonna try it. I had a big piece of tuna steak and then I had my rice and I was like we're actually you know did pretty I probably had maybe half a cup of rice but it was like this is glorious because this isn't something I eat every day but I felt fine I didn't feel my blood sugar drop or spike and come back down and so I think the experimentation the end of one is important.

Speaker 1:
[69:30] It's so important. Fast forward ten years from now and let's just say every perimenopausal woman has read your book. What do you think, how do you think menopause would look different if women prioritized their estrobalome?

Speaker 2:
[69:49] I think women would have less symptoms. We certainly know from research that a lot of the health of the microbiome and the estrobalome drives a lot of vasomotor symptoms, hot flashes, et cetera. I think if women are coming into perimenopause or even younger women, 30, 35, if they're even aware, imagine how much less suffering women will go through. That's really what it comes down to is that there has been a prevailing theme. I think that we are working against the patriarchal establishment where we're saying it's no longer acceptable for women to suffer like I think about the boomer generation post-WHI, many of whom have suffered. This is not a new thing. This is a long-term thing. My hope would be that my work, your work would alleviate suffering in women because it doesn't have to be that way. There's so many ways that we can support our bodies that allows for us to be educated, inspired, empowered to make different choices, and to advocate for ourselves because isn't that really what it's all about is just bringing good information to women so that they can make better choices for themselves, or at least be aware that there's not a one-size-fits-all philosophy. I am sometimes stunned, as I'm sure you are. You get DMs on social media, your team gets emails. Some of the things that women share, I sit back and I'm just, I'm like, that's not even standard of care. Yeah. Some of the information that women are hearing from their providers. So my hope would be, and I say this genuinely, I would hope that there will be less women suffering through their perimenopause and menopause experience.

Speaker 1:
[71:35] Yeah. One thought I've really been deeply marinating on over the last month has been, if you want to take a woman's power away, the first thing you do is you make her distrust her body.

Speaker 2:
[71:49] Yep.

Speaker 1:
[71:51] You make her hate her body, which is what has exactly happened. You have to be this size, you need to look this way in order to be worthy. I fear that we are doing a little bit of the same in the menopause conversation, where we're saying, your symptoms shouldn't be happening. We need to slap a patch on you and then maybe give you an antidepressant and everything's going to be okay. If you're not okay, then it's your problem. I mean, that's what I hear from a lot of women, like I'm doing everything they told me to do and I'm not feeling any better. So I'm just going to keep reflecting back to you that I think this is a brilliant book topic and it is a wide open space in the menopause world that we need to be talking about the astrobalone. We need to bring back the importance of these microbes that we can bring our own power back and we can control our health destiny. So Cynthia, I'm just over the moon thrilled that you wrote this book and I think everybody should get a copy of it. So tell us where we get it and how do we dive into it? And I'm just really excited that you birthed this forward. So thank you.

Speaker 2:
[73:09] Thank you. No, I'm so touched and so grateful for your friendship and your support. As you know, writing a book is like birthing a child.

Speaker 1:
[73:17] It is.

Speaker 2:
[73:18] I mean, it really is. It really is, truly. For listeners, it truly is. So easiest to go to my website, www.cynthiathurlow.com. At the top, you can click a banner and it'll take you to any retailer of your choosing. It does not matter to me, although I always remind listeners to be mindful of the fact that our brick and mortar stores have really been hurting since the pandemic. So if you have an opportunity to pick it up at your local bookstore, I'm active across social media, usually as Cynthia Thurlow because I didn't quite catch it so that everything is the same across social media, but I'm loving Substack. I have an amazing podcast. It's probably one of my favorite things I do in my business, Everyday Wellness. I would love for you to take a listen. And if you purchase the book, we have a lot of genuinely heartfelt, well-needed accompaniments to The Menopause Gut. We spent a lot of time working on the book bonuses because we knew these would be things that would be helpful teetering around some of your questions. So it was delightful to know that validation, these are things that people will be looking for. But so appreciate our time today, Mindy. Thank you.

Speaker 1:
[74:22] Yeah. Thank you, Cynthia. I hope everybody grabbed the density of this conversation because there's so much more we can discover about ourselves. So again, thank you, Cynthia. I love this conversation and thank you for coming.

Speaker 2:
[74:35] Thanks for having me.

Speaker 1:
[74:37] Thank you so much for joining me in today's episode. I love bringing thoughtful discussions about all things health to you. If you enjoyed it, we'd love to know about it. So please leave us a review, share it with your friends, and let me know what your biggest takeaway is.