Dhru Purohit Show - If Your Body Feels Different After 40, Look At Your Gut: How Gut Health Is Driving Weight Gain, Brain Fog & Inflammation with Cynthia Thurlow

Episode Date: April 29, 2026

This episode is brought to you by Bon Charge, Momentous, Rho, and Fatty15. Gut conversations around the changes happening in menopause aren’t discussed enough, and yet, they may explain why so many women suddenly feel like their body is working against them. Today on The Dhru Purohit Show, Dhru sits down with Cynthia Thurlow to unpack the seven big ideas around the gut transition during perimenopause and menopause. This conversation reveals how the gut becomes a central driver of aging, brain health, metabolism, and inflammation in midlife. Cynthia breaks down why so many women experience symptoms like brain fog, weight gain, and fatigue, how shifts in the microbiome and hormones are connected, and the overlooked role of compounds like butyrate, fiber, and circadian habits. She also shares her own wake-up call, the hidden signs of leaky gut, and the simple, high-impact strategies women can use to restore balance, protect their brain, and take back control of how they age. Cynthia Thurlow is a nurse practitioner, author, and host of the Everyday Wellness podcast. With over 25 years of experience, she’s a leading voice in intermittent fasting and women’s health, especially during perimenopause and menopause. Her TEDx talk on intermittent fasting has over 15 million views. Her mission is to help women thrive through midlife and beyond. Her new book, The Menopause Gut: Balance Your Microbiome to Reclaim Your Health in Midlife and Beyond, releases on April 28, 2026. In this episode, Dhru and Cynthia dive into: (0:00) Introduction (0:58) The hidden driver of aging that most people ignore (4:08) Why menopause is a turning point for your gut (6:42) What actually happens when you neglect your gut (12:07) The two biggest disruptors wrecking your microbiome (20:35) How to rebuild your gut without overcomplicating it (24:53) The “microgenderome” and why it changes everything for women (27:59) The gut crisis Cynthia didn’t see coming (35:51) The signs you might have leaky gut (and what to do) (39:59) What’s really setting your pace of aging (43:46) Why pre-menopause is a brain shift, not just hormonal (48:47) Why your fiber might be backfiring (55:07) The surprising place bone loss actually begins (1:04:45) Why body composition feels out of your control (1:09:37) The simplest habit that impacts everything (1:16:47) Important advice for navigating menopause (1:22:08) The non-negotiable habits to double down on in midlife Also mentioned in this episode: The Menopause Gut: Balance Your Microbiome to Reclaim Your Health in Midlife and Beyond The Step By Step Longevity Protocol this 72 Year Old Followed to Reverse Her Osteopenia, Build Muscle and Become the Oldest American Ninja Warrior DEXA Scans  For more on Cynthia, follow her on Facebook, Instagram, X/Twitter, YouTube, TikTok, LinkedIn, Apple Podcasts, and her Website. This episode is brought to you by Bon Charge, Momentous, and Fatty15. Right now, Bon Charge is offering my community 15% off their Red Light Cap. Just go to boncharge.com/dhru and use code DHRU to save 15%. Right now, Momentous is offering our listeners up to 35% off their first order with promo code DHRU. Head to livemomentous.com and use code DHRU for 35% off your first subscription. Try Rho Nutrition today and experience the difference of Liposomal Technology. Use code DHRU for 20% OFF everything at rhonutrition.com/discount/dhru. Fatty15 is offering an additional 15% off its 90-day subscription Starter Kit. Go to fatty15.com/dhru and use code DHRU to replenish your C15 levels for long-term health. Sign up for Dhru’s Try This Newsletter Learn more about your ad choices. Visit megaphone.fm/adchoices

Cynthia, welcome back to the podcast. Today, we're talking about the intersection of some important ideas. First and foremost, we're talking about aging. We're talking about the gut and we're talking about menopause. And there's been so much on this conversation of menopause. I'm proud to say that I was very early in this conversation for being a guy and hosting a podcast. I was talking about this years ago, eight, ten years ago. And there's more to the story than hormones. And what we've done today for today's interview, which is all about your new book, The Menopause Gut, balance your microbiome to reclaim your health in midlife and beyond, is we've broken down the key themes, seven of them, and we're going to go through them one by one. And a lot of these ideas

are going to shock our audience. I'm going to jump right into the first one. Are you game with that? I'm totally open to it. Awesome. Well, I'm excited because this is, I think, you're like fourth appearance on the podcast, and you always deliver for our audience. You're an incredible communicator. Let's dive right in with the first big idea that sets up this conversation. So something super important that I learned from reading your book and following your work, after estrogen declines, the gut, not hormones, becomes the main driver of aging. Talk about this idea. What do you mean? As a clinician and also as a woman who's now fully into menopause, I was observed.

patterns with patients that kind of stumped me. I didn't fully understand or appreciate what was going on. So when we look at this very important hormone of estradiol, which is our predominant form of estrogen that our bodies make prior to going into menopause, when I started looking at the literature and I started looking at lab work, I started to understand that estrogen is not just about bikini medicine. It is so important for immune modulation. It is so important for the health of the, uh, the small intestinal lining, which is one cell layer thick. It is so important for bone health. It helps drive, you know, when we actually go into menopause. It's one contributory factor. And so the topics that center around estradiol signaling and the microbiome is really a discussion on this intersection between hormones, the gut microbiome, which many people are unaware of what that actually is. It's our own ecosystem within the large intestine and helping people understand that if we are going to ensure that we kind of navigate the trajectory of our lifetime as women, it isn't just about replacing hormones. There's a whole lot more to it. And I'll actually make the argument that

the gut microbiome vis-a-vis estrogen is this key longevity organ and actually will mitigate and impact the axis between bone, the immune system, the ovaries, the brain. I mean, there is no intersection that does not involve the gut and can be magnified with the loss of estrogen. Let me give you an example. So estrogen has some important immune modulating properties. And so when I think about the interplay with estrogen and the immune system, it's helpful to understand that estrogen in its decline, you know, we start.

with perimenopause, it can be 20 to 30 percent higher, then we're navigating the end of perimenopause and menopause. We'll see this decline in estrogen. Well, with these shifts in estrogen, we get shifts in our immune system. So why do women suddenly become four to five times more likely to develop autoimmune conditions in this perimenopause to menopause transition? Why do we see more rampant inflammation or inflamaging, as many people like to refer to it? Why are we seeing more issues related to digestive fire. Why are we seeing more issues that impact, you know, bone health, leaky gut. I mean, there's a lot that goes on, but estrogen is one of these key signaling molecules slash hormones that is driving a lot of the changes that we'll see, not just in the

microbiome, but we will see throughout the body diffusely. One of the things you talk about in the book is that if midlife suddenly feels harder, that's women going through fatigue. Brain fog, weight gain. It's not because you're doing something wrong. Your body's command center has shifted and supporting the gut becomes non-negotiable. Do you think that that's something that has been missing from this menopause conversation? I think in many ways. And I'm so grateful that there are people that came before me, people now that are really using this as an opportunity to educate, not just other clinicians, but educate the lay public and the community at large. But I think in many instances, we haven't talked enough about the role of the gut microbiome.

I think it's really been maybe the last five to ten years. It certainly wasn't anything that I learned about during my own medical training. And so the more that I understand about the gut terrain that is changing, the more it helps me understand and appreciate, you know, those vaso motor symptoms, the hot flashes that women experience, the brain fog is not just a shift in hormones. It is so much more than that. I think in many ways, when I reflect on the value of the gut,

gut microbiome and better understanding a lot of these topics and educating people on it, it's allowed me to have an opportunity to, like, really start putting some of these connections together and to say, yes, you know, we know that as women are navigating this perimenopausal transition, the gut microbiome shifts dramatically. You know, we have less microbial diversity. We get more inflammatory bacteria. So shifts in things like lactobacillicillai and bifidobacter, and those are those very beneficial bacteria. suddenly we start having more inflammatory bacteria. So those shifts are happening vis-a-vis these changes in estrogen and predominantly progesterone.

But it also has this downturnorative fact. It's impacting neurotransmitter production. So when women say I'm feeling more anxious and depressed, yes, there is a component related to progesterone, but it's also less estrogen, which makes it even more challenging for us to make appropriate amounts of serotonin and dopamine. And so, you know, the bulk of our immune systems in the gut and then also the bulk of the neurotransmitters that our body produces are also there. So there's this intersection on almost every level in our bodies that really is a reflection of these shifts that are going across the gut microbiome. Think of it as a processing plant. It really is that important.

It's vitally important for all these communication pathways between different organ systems as well as the microbiome itself. You know, I think about these new classification of drugs, GLPs, which we talked about on the last time you were here on the podcast. And there's more evidence and awareness now that people understand that if you just take GLPs and you're not doing all the things that you talk about and other people talk about strength training, eating adequate amount of protein, you may lose weight, but you could also be unhealthy in other ways. in that same sense, are there examples or anecdotes or people that you've seen in your own world or people that write into you that are like, hey, I finally got the memo on hormones and hormone replacement therapy? And I'm doing that. But then they're not paying attention to the gut.

What do they see or what do they go through or what symptoms are you noticing that they're navigating with even though they've gotten the memo on hormone replacement therapy if they so choose to do that. Yeah, number one is bloating. So bloating seems to be this kind of consistent theme with women in middle age that, you know, sometimes it's dependent on the type of food they eat. Sometimes it's stress dependent. But bloating is number one. I would say the other things that I hear often enough are constipation. So alterations in bowel habits, whether it's suddenly they have more diarrhea, maybe they have more constipation. You know, something as simple as we use a term vasomotor symptoms, which is just a fancy way of saying hot flashes, skin manifestation.

So women will develop new rashes. They may suddenly start developing hives. And these can all be attributable to alterations in the microbiome. And so I think that HRT is a very important part of the conversation. But as I always say, it always starts with lifestyle. Then we're laying around this HRT piece. And then there's more to it than that. There's a lot of nuanced discussions that impact the microbiome

that I think many people may be. are just starting to kind of discuss and have conversations around. But bloating is number one, without question. And that can be multifactorial, as we say. There can be many reasons that women are experiencing bloating in middle age. It can be as simple as you suddenly have, you know, you were on a course of antibiotics. Maybe it was appropriately dosed antibiotics. And then suddenly you find, you know, a month later, you're having a lot of bloating. You suddenly have, you know, maybe it's a food that you've never had problems with before. Like maybe I'll use dairy as an example.

A lot of women will say, I did fine with dairy up until perimenopause, and then all of a sudden I start having a lot of symptoms. And in fact, I jokingly call it the five-pound dairy, because for so many of us, dairy is suddenly this incredibly inflammatory food. And so the bloating piece can be underlying food sensitivities. You know, if you think about what happens when we take antibiotics in general, we know that it can alter the microbiome quite significantly, one dose of antibiotics can alter the microbiome quite significantly can also lead to some degree of a transient leaky gut.

And if you understand that that one cell layer thick of the small intestine, if those small intestinal lining opens up to leak food particles out, your immune systems right alongside that. So it'll provoke an immune response. You can develop some degree of food sensitivity. And so for a lot of people, that bloating piece can be as simple as new underlying food sensitivities. And so that seems to be one of the most common things that I see. In addition to bloating, in the book you talk about how the gut microbiome is also having this interplay with our brain health. And it's also impacting how these hormones behave in the first place. Can you touch on those two things?

There's this wonderful communication pathway between the brain and the gut. It's the vagus nerve. So it's a cranial nerve. And I think about it is a superhighway that goes between the gut and the brain. And so that means if the bulk of the neurotransmitters in our body are made, in the gut, what happens if someone gets a dose of antibiotics and all of a sudden they feel anxious or depressed? And their neurotransmitter production has actually been depleted by virtue of taking the appropriately dosed antibiotic therapy. I've seen this happen personally and professionally.

And so it's helpful for people to understand that, you know, the brain and the enteric nervous system are intricately interrelated with the gut itself. And so as we're kind of navigating these conversations, it's helpful for people to understand that, yes, you can intrinsically be taking, let's say you're taking oral progesterone or you're still making adequate amounts of progesterone. Progesterone is really important for upregulating a calming neurotransmitter called GABA. But if someone has been on antibiotics and maybe their GABA production is down or they're in the transient stages of early perimenopause, that can magnify some of these symptoms that people experience. And I always say what goes on in the gut doesn't stay in the gut. So if you have a leaky gut, you very likely are also going to experience this leaky brain. The blood brain barrier should be an impermeable layer, but it can become leaky just like that small

intestinal lining can become leaky, which can exacerbate brain inflammation. A lot of these symptoms that we talk about are really speaking to underlying inflammatory processes in the body. So when that communication pathway is disrupted, either because of stress, you know, those hormonal fluctuations, antibiotic therapy, standard American diet, alcohol, all of these things can disrupt that communication pathway and can magnify, perceive things like brain fog, anxiety, depression, or even, you know, just kind of a basic underlying feeling of brain fog. Can we give a little bit of a preview of hope for our audience?

Yes, absolutely. And let them know what are like the top one or two things that people are doing that are most damaging to the gut, but then also on the hope side of things. one or two things, and we'll go deeper into a lot of the action items you cover in the book towards the end of the conversation, but one or two things that are so key for the gut to restore its function and balance. When I say the word recovery, what do you think of? Probably muscle health and metabolism, but one area people forget about is skin recovery. Your skin is constantly repairing itself, but factors like stress, poor sleep, travel, winter light, and even dry air can slow down

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And if you've been thinking about trying red light therapy, now is the perfect time. Right now, Bon Charge is offering my community 15% off. Just go to bond charge.com slash Drew and use the code Drew, D-H-R-U to get that 15% off. Again, that's Bon, B-O-N-Chage, C-A-R-G-E- dot com. slash Drew, D-H-R-U, to give your skin the recovery support it's been missing. Fiber is having a huge moment right now, and it's for a really good reason. For years, I was on a higher fat and high-protein diet, and pretty much, without even realizing it, started to ignore my fiber needs, and my gut paid the price.

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Head over to live-Momenus.com and use the promo code Drew to save 35% off today. That's live, L-I-V-E, Momentus, M-O-N-E-N-T-O-U-S dot com with the code Drew, D-H-R-U to save 35% off today. If you care about performance, don't skip the fundamentals. Don't skip your fiber. I would say the two things that I think about that I think are most damaging to the gut. Number one is unresolved trauma plus or minus stress. So women become less stress resilient as they are navigating this transitional period in their lives. And so maybe the type of stress we dealt with in our 20s and 30s,

and I always use myself as an example of a former adrenaline junkie working in very high acuity areas of the hospital, that doesn't serve me well anymore. So underlying stress, not adapting to stress or to healthy boundaries, or there's a lot of ongoing research that suggests adverse childhood events can sometimes rear their ugly head in middle age, meaning things that you did not address or maybe weren't even cognizant of when you were a child, young adult, suddenly will become problematic and can show up in very different ways. In terms of nutritional choices, because I think that's always really important, I would kind of say that alcohol is certainly a contributory factor for impacting the gut microabom in really negative

ways. We know it leads to a transient leaky gut. It can be very volume dependent. So if someone's having a glass of wine once a week, it's very different than someone who drinks heavily throughout the week or throughout the month or binge drinks. But those are two kind of things that I think when looking at the research certainly suggest these are incredibly impactful. And as we better understand the stress, trauma, unresolved trauma. et cetera, I think that we will be getting a better sense of things that we can be doing in a much earlier age to help women. Two comments on that.

Number one, we just did an episode where we talked about this idea of surprise diagnoses, that you're healthy, you're doing everything right, and then all of a sudden something comes out of nowhere, especially when you don't have a family history around it. We had Ron Sinai on the podcast, and we were chatting with him, incredible physician up in the Bay Area, and he was saying that he would see this thing that would regularly happen in his patient you know, group. And these are people that have resources, great health care, no family history of breast cancer, autoimmune diseases, and then out of nowhere something comes up. And he said, you know, one of the most important questions that, you know, no physician really asked them was,

what do you think happen? What do you think happen that contributed to this disease? And he said, when I started asking that question, I saw something really powerful. And what I saw is almost all of them have some idea of how their emotional combination with some trauma, life events, some past stuff that's not been dealt with. He has this term called shamaly, where everything looks good on the outside, but your family situation is a mess.

Yeah. That all these things, again, he's largely talking about, he's not saying that metabolic health and toxins, these other things don't play a role, but that these years of accumulated stress, background stress, type A personalities, high achievers, that finally catching up and expressing itself in these crazy ways on the body. And I think that it's, you know, not enough people are talking about this. I'm so glad you are and you've been talking about it for a while. We talked a little bit about

unresolved trauma on the last episode. And I hope it continues to get more attention because it's one of those things that doesn't always have a simple answer, like take this supplement. Correct. But resolving it can have a massive impact towards your health for the better. Well, I mean, as the saying goes, the body keeps a score. I mean, it's like whether or not you are cognizant of it, your body is taking an information constantly. And I have consummate examples of people personally and professionally that prior to a scary diagnosis or something frightening, they had some type. of emotional, you know, transitory event, or, you know, they had a super stressful event. Like, they'll be able to say, you know, some of my friends who have breast cancer diagnoses,

they'll say, you know what? It was five years ago when XYZ happened. I think that really kind of started this root cause of later developing. And I'm not in any way suggesting that this is the case for everyone. But I think for many people who've had, whether it was a, you know, a traumatizing hospitalization or end up having a big surgery or big diagnosis, I think there's a lot more to it that we perhaps as clinicians don't fully understand or appreciate yet. Then we ask the patients in such a targeted way, and I watched that podcast that was incredible,

I think many people do have a sense. Like even I would say I had a hospitalization now almost eight years ago, and there was definitely an antecedent event the year before that I believe intrinsically absolutely contributed to being hospitalized and getting really sick. You open up your book with a little bit of a story that shows how all this is connected. I want to go into that in a second. But if I don't ask you the follow-up question number two, my audience is going to call me out. So we talked about two things that can play a major role for the worse, unaddressed, unresolved trauma,

and also things like alcohol and, you know, some of those aspects. What about two surprising things that can be a part of the healing process? when it comes to restoring microbiome health. Yeah, I would say probably the things that are a little more nuanced are things like supporting your body in a parasympathetic state. So, you know, we talk about the autonomic nervous system, rest and repose is what I'm really talking about as a culture. We're very sympathetic dominant.

We're on a rush, on the go all the time. We're constantly distracted. We're not fully present. And I think that the most successful patient outcomes, I have seen have been with women that are integrate, truly integrating some degree of meditation practice, grounding work, healthier boundaries, because we know that that stress response is so dysregulated in middle age. We're just not as stressed resilient.

That does not mean that we are not capable. But what it really speaks to is we become less stress resilient, so we have to do more to calm our nervous system down. And so that takes effort. And for a lot of women, they're like it's easier to run the mile or run five miles than it is to sit down and meditate for 15 minutes. Because you feel guilty. Correct. And I don't say you as in women, I mean the individual. And I think, you know, human beings feel guilty sometimes, especially if they're type A people. They feel like I cannot do this right now. Even like sitting outside and getting some sun. When you haven't gotten sun in such a long time, it feels like, oh, am I doing something wrong? Yeah, it feels indulgent. then I want to encourage women that's not an indulgent.

It's absolutely necessary. Through all the research that I did for the book and certainly combing through copious amounts of research on fiber, and I jokingly call fiber the new F word because it is so polarizing in different dogmatic niches, especially with the carnivore community. But the more that I have read about the benefits of fiber vis-a-vis changes in things like short-chain fatty acid production

in middle age, the more I realize it doesn't mean that every person needs the same amount. Let me be very clear. It's a very bio-individual. But every person should be aiming to have a little bit more than probably what they're already consuming because there are so many benefits. And I would say those are the two things that in terms of levers, I think, are most beneficial beyond, you know, the big things like hormones and, you know, specific key supplements. I think these are things that are accessible to everyone, truly.

and are also things that people can fine-tune. It doesn't mean you have to meditate for an hour every day. Maybe you meditate for five minutes, but most of us can be eating a little bit more fiber in our diet. Is there one hack like, you know, my friends are in the space like yourself, we're always like experimenting and figuring out a new way to hit our fiber goals or a type of fiber that's there to make sure we have the insoluble, soluble, the diversity of fibers.

Is there anything that you've been trying recently that you felt helps you get to that goal? I would say personally, chia and flax seeds in a smoothie, for whatever reason, that is what's worked really well for me. I can do it consistently. It's not a big deal. I'm not speaking to any specific fiber supplements because I really want the message to be, I want you to try to get it from food first. And then if you need to backfill, there are some great options that are out there, probably mutual friends of ours that have great supplements that are fiber dense. But I would say that, or just getting conscientious about building a salad bucket,

my husband and I call it that, where we're adding different types of fiber-dense vegetables and, you know, seeds and nuts and making sure that every day we're pulling something out of said fiber bucket because it's not only helpful in terms of plant species that we're supposed to be consuming more of. You're getting plenty of fiber as well. Just make it easy. Don't ever complicate it. In gearing up for your story and sharing a little bit about that as you kind of opened the book with it, just help us understand this term, which is our second big idea on the list today. microgenderome. Am I pronouncing that correctly?

You are. You are. What is it and why is it so central, not just to this conversation that we're having about why women age differently than men and how they need specific resources, potentially interventions and a plan that's unique for them, but also how it relates to your story. Microgendrom was a term that I kind of stumbled upon last year, and it really speaks to the fact that. that when boys and girls are born, their microbiomes, for the most part, up until puberty, are very similar. And then not surprisingly, the influence of key hormones like testosterone and estrogen change the terrain of the microbiome as young men and young women are navigating puberty. You know, for men, it stays pretty consistent for the rest of their lives.

And I say pretty consistent because that was what the research suggests. What's interesting, though, for women, there's the three peas. It's puberty, pregnancy, if women choose to become pregnant, and then perimenopause, where we see these alterations. Not surprisingly, obviously in pregnancy, it's transient. But in perimenopause, we again see this alterations in the terrain of the microbiome, again, which is a key reflection of alterations in estrogen and progester predominantly. And so when we speak to this, it just speaks that, you know, up until menopause, men and women kind of bisect. You know, men go one direction, women go another. but what's ironic is with menopause, our microbiome starts to resemble a male's microbiome.

And I say resembles, it's not identical, starts to resemble the male microbiome. And so life really comes full circle with these shifts and changes that occur throughout the trajectory of a young woman's life up until when fertility ends for us. And I found that fascinating because I was like, this makes so much sense. Although, you know, 100 years ago, 150 years ago, we didn't live as long as we do. now. And so we're just starting to get a sense of what is changing and how that ultimately impacts the aging process for women. One thing that's really important to kind of mention here, Drew, is the ovaries are the pacemaker of aging for women. They are the most mitochondrial dense organ in the entire body. And what I find really interesting is that pacemaker of aging is kind of

going alongside these alterations. There is, in fact, a microbiome that communicates with the ovaries. You know, it's the gut ovarian access. So there's this constant cross talk with every organ system in the body vis-a-vis the gut microbiome. And so when we talk about the microgenderome, it's understanding there's all this communication patterns that are ongoing with all these changes in a woman's life. Most women will go through at least two of the peas and the rest of the women will go through three. But for those of us, I find it utterly fascinating that, you know, we begin life with our microbiomes being fairly similar. and then in menopause, and men will go through andropause. It's just not nearly as dramatic.

Menopause and antipause, we get more similarities again. I think it would be helpful to hear a little bit about your story that is the context around setting this book up. Our audience has heard your story around fasting. They've heard your story around a few different topics that are there. But this one and some of the key details that you share around your gut microbiome and the journey that you went through I think are super crucial to this conversation.

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So my husband and I in 2018 went on this very romantic trip that we were going to take to Morocco and Spain. And my husband and I ate the same food while we were away. We tend to eat very similarly. And unlike my husband, I got the worst food poisoning of my life. And to the point where I told my husband, because he slept, me being sick, you know, for overnight for two days. I remember saying to him, I was like, if something serious happens to me, this is what I'm concerned about.

I thought I might tear my esophagus. It's called a Mallory Weiss tear. For anyone that works in surgery or emergency medicine, they know what it is. It's a significant tear in the esophagus because I was vomiting so violently. We ate the same foods. He didn't get sick and I got very sick. And I didn't feel right for months, truly. And we're not even sure what it was that I had eaten.

And the irony is it kind of set the stage for that hospitalization that I alluded to. And what I think is really interesting is beneath the surface, I was not aware of all the changes to my immune system that were happening vis-a-vis this perimenopausal transition. And so it made me more likely to get sick. It made it much more likely that I stayed, inflamed, and had this overt immune response to what turned out to be Giardia, which is the friend that I took home. home with me. And so we understand, or I understand now, that I was just primed for it. You know, I was more likely to have an exaggerated immune response. I was much more likely to get so violently sick. What I found really interesting about the entire circumstance, though, was it didn't stop. It wasn't like I felt better after, you know, one night of feeling ill. It was months of just not

feeling 100%. And I think that's a reflection of, you know, we talk about leaky gut. but for me it was this all out of salt that my body was trying to fight, but my immune system was not nearly as vibrant as it would have been probably five or 10 years before. And so it really sets the stage for, you know, this romantic vacation that turns out to be not so romantic, that then sets a stage for a 13-day hospitalization a few months later,

but really kind of primed everything. I just never felt right afterwards, but in the typical type A fashion, I was like, I'm fine, I'll be fine. And I really wasn't. it was really kind of setting this thing in motion that led to getting very, very sick. How long did it take you to feel like you got back to at least some level of normalcy or where you were before? And what were some of the big things that took you down that journey? After the hospitalization?

Yeah. Oh, 18 months easily. And when I say not right, for anyone that's hospitalized and as sick as I was, I was getting hit with very powerful antibiotics. I was on antifungals, which are really strong. I was too sick to take to surgery. That's how sick I was. And at some point, you know, my team actually was concerned and said, you know, if we don't figure out what's wrong, you're going to die,

which was a horrible thing to hear. But when I left the hospital, obviously I was weak and I had chronic loose stools for at least a year. I didn't feel better for probably 18 months. And when I say didn't feel better, I was appropriately treated with antibiotics and antifungals, given how sick I was. I waited another month to have my appendix out. But that disruption of my microbiome was so catastrophic that I didn't tolerate anything other than meat for six months, nine months. I couldn't tolerate any fiber. And if I ate anything with fiber,

I was, I started with the loose stools, I had lots of gas and bloating. So when I say I know what it's like to experience that, I genuinely do. And when someone says to me, I don't feel good when I consume fibrous foods, I'm like, it's because of what's going on in the gut at a very basic level. So 18 months to feel better. And I think it's probably taking me five years to recover my gut and be able to eat the way that I do now before I didn't feel poorly. So I think it's important for listeners to know, like, I have walked to that path.

So I can speak from experience. It's like now I can eat as much fiber as I want, but it took a very long time to be able to do that. I was oxalate sensitive. I was histamine sensitive. I mean, anything that you could be sensitive to, plant-based defenses, I was in that camp. But that has all improved as I have worked on, you know, my gut terrain. Yeah. One of the things you talk about is that, and you shared a little bit about in the beginning of the book, is that leaky gut, which a lot of people have heard of, intestinal permeability, when it is really full-blown and present and already going through the transition into menopause,

if your gut microbiome is not intact, if you're not paying attention to a few key things that we're talking about in the podcast, your likelihood of leaky gut is going to be higher. And then on top of that, you went through this unique thing where you got an infection and then you are throwing, you know,

antibiotics on it to save your life appropriately, and then there's even more leaky gut that's there. So now these things that normally a healthy person can tell really well and are an important part of maintaining a good gut microbiome, plant food, fiber, et cetera, your system is so sensitive as just reacting to everything. Correct. You know, that's an extreme example in your situation, but you've also talked about earlier in the interview that a lot of women do see that foods that work for them previously, all of a

sudden don't work. They have more bloating. They have more other things. Is there a way besides, you know, filling out a quiz for themselves? Like, is there a way that you've seen that somebody who's paying attention saying, well, I have a light version of that. I've not been to Morocco and had this situation, but I feel like things have changed now. What's the best way to figure out, are you dealing with intestinal permeability or are you not dealing with intestinal permeability? I think most people have leaky gut. I'll just be completely transparent based on years and years and years and years of working with patients, looking at stool testing and tracking symptoms. I think that the cautionary tale is, there's that. I think for a lot of people, they're so disconnected from their bodies.

That is the bigger issue. There are so many people that are just, frankly, disconnected with how they feel, if I ask them, you know, how do you feel when you eat X? Oh, I feel fine. You have to have a degree of connection with how you feel when you consume food. I think food diaries can be helpful. I think elimination diets can be helpful. Food sensitivity testing can be part of that. The irony is if you look at the research, food sensitivity testing is not as clinically validated as other types of testing, although I personally and in my practice have seen people that they remove foods that produce some degree of inflammation. They feel a whole lot better, which is why I'm a fan of track what you're eating, which is something everyone can do. You can eliminate foods and see how you feel, not forever,

but see, like, pull out, if you suspect dairy is the problem, try limiting dairy for four to six weeks and see how you feel. For a lot of women in middle age, Drew, the irony is dairy is, I call it the five-pound dairy for a lot of women, it suddenly becomes problematic. They can't tolerate the cheese. They can't tolerate the ice cream. It could very well be cow milk dairy. That's the problem as opposed to goat or sheep's milk products.

But for a lot of women, you know, we have a culture where there's a lot of substance. for dairy. And so we have dairy and everything. A lot of processed foods have dairy components to them. And so you can get cross exposure without even realizing it. And so dairy to me is probably number one in terms of what I've seen clinically women are most reactive to. And then beyond that, it can be very subtle things, meaning, you know, someone may have an intolerance to, you know, rice or grains temporarily. Other people, it might be something more subtle like, you know, we mentioned or I mentioned oxalids. Unfortunately, there are people out there that say everyone's reactive to oxalids and oxalids are terrible.

And I go back to saying, you know, if your microbiome is optimal, oxalids probably aren't going to be a long-term problem. I think it's people that are eating copious amounts of things or just have this breached leaky gut issue that can exacerbate some of these symptoms. It always speaks to me. There's work that we need to do. It doesn't mean a forever thing. It might just be, you know, you may just have to be conscientious. that you're not eating, drinking celery juice and eating buckets of raspberries and eating a kale salad every day. It might be that you have to, you know, kind of ratchet back and maybe

quantity dependent. Let's move on to the next big idea that you're covering inside of the book. You briefly touched on it, but I want to explain it a little bit more, especially this idea of setting the pace of aging. So you talked about how the ovaries are the most mitochondrial dense organ inside of the body for women. We had always learned, you know, from different people that come on the podcast, that the heart has a really strong center. That's what I thought for a long time. Right. And obviously the heart does have a lot of mitochondria, but here specifically, this organ that's all about creating life, you know, has this plethora of mitochondria because it's needed to actually 3D print another human being at some point in time, whether women, you know, get pregnant or not,

not get pregnant. But explain a little bit more about the pace of aging. I don't think our audience fully got that because we briefly touched on it, but we didn't go into it too deep. So it's fascinating to me that women, unlike men, we are born with a finite amount of eggs. So when we're born or even in utero, we're born with a finite amount of eggs. And depending on up until puberty, depending on whether or not a woman ovulates, there's a certain amount of, they call it atresia. But, you know, we're losing eggs die off. And it's, you know, one particular egg that's selected potentially to go on and to be fertilized. What's interesting to me is there are things we do in our personal lives that can impact the acceleration.

of the aging process in our ovaries, things like smoking, things like alcohol, stress and trauma. I mean, there's ongoing research that, and this is, you know, things that were done, you know, when we look at adverse childhood events. So it was a cohabited study between the CDC and Kaiser Permanente. Anyone that's listening can go online. You can get these questions and you can score whether or not you experience adverse childhood events. People that have higher adverse childhood event numbers are.

more likely to see kind of an acceleration of aging of the ovaries. And we think it has a lot to do with cortisol. Your autonomic nervous system, your parasympathetic nervous system kind of gets wired, sympathetic dominant, if you will, kind of gets wired where it can set this pace of aging where you're dealing with probably higher than normal cortisol levels throughout your childhood, young adulthood, that rewires the way we respond to stress. So there are those of us that just tend to be, even if we look really calm on the outside, the way that our nervous system is wired, it's kind of chronically activated.

And so there's certainly ongoing research that suggests significant childhood trauma, significant childhood adverse events. Those people will see an acceleration of this aging process. But when we're talking specifically about the ovaries and this longevity piece and the aging piece, there's certainly a lifestyle component. There's also other components like autoimmune diseases that can impact the aging events.

the ovaries. And so I find it really fascinating when I was writing the book, looking at the intersection between the health of the gut microbiome, the health of our ovaries. There is this cross talk that goes on. So to me, there's a lot of communication patterns that certainly suggest lifestyle can play a role with when we go into menopause. So if it's genetically encoded, like there are some people I interact with who just say, you know, my mom went through menopause at 48. and anywhere between 45 and 55 is considered to be normal. Average age is 51. But there are definitely women that go through earlier,

and that is considered to be normal, although it means they go longer without these specific hormones. So to your point about explaining the aging process of the ovaries, some of its lifestyle mediated, some of it's genetically mediated, some of it we have control over, some of it we do not. But there's definitely this communication pattern between the gut and the ovaries. So again, I go back and I humbly state, the health of that microbiome of the gut is really vitally important for the health of the ovaries and vice versa.

All right. Let's go into the fourth big idea that we're highlighting here from the book, the menopause gut. We have the link in the show notes. People can pick up a copy or pre-ordered on Amazon. So periomentapause is as much a brain and neurotransmitter transition as it is a hormonal one. Let's talk about that. As I was writing the book and really kind of delving into the research thing, I was surprised by to find is that serotonin and estrogen are kissing cousins, if you will. They are

intricately interwoven. So I think so many people say, oh, well, you know, someone's anxiety and depression is just related to the changes in progesterone signaling. No, it's so much more than that. I mean, that contributes. But to me, serotonin, estrogen in a neurotransmitter kind of triangle, they interplay with one another. As estrogen is declining, estradiol, we see alterations and not just serotonin because serotonin is a precursor to melatonin. So this interplay with communication, it is never just one thing. The body is such a beautiful symphony. There's never one hormone or one neurotransmitter that has one identity. They have many identities. And so you start to understand if we're looking at serotonin production is that is declining because we're seeing less

estrogen. We have less melatonin production. Melatonin is thought of solely for sleep. It's a master antioxidant in the body. And so it's fascinating to me that there's this kind of complex interplay between all these hormones and neurotransmitters that is more than just what's obvious. But for a lot of women, helping them understand if someone is already at risk, for example, if someone's already at risk for anxiety and depression, or they have bad PMS or they have bad PMDD, which is the most significant form of PMS, they're probably going to have a rockier mental health experience in that perimenopause journey, likely because they're already very sensitive to alterations in these key hormones. And as they are being impacted by, you know, faltering ovaries or the aging

process in general, they will get much more magnified responses. The other thing that I think is so interesting is we've already talked about this interplay between the vagus nerve and the brain. When we think about the complex interplay between the microbiome and the super high weight, the vagus nerve, is it any surprise when we know at the basis of this aging process is some degree of inflammation? More brain fog, more issues with cognition, people feeling like they're brain fatigue. Women will say, I can't figure out the word. I can see it, but I can't remember it. And so a lot of these can all be impacted by just simple alterations in these biochemical processes. Let's take a pause for one moment and talk about something that I don't think people know a lot.

lot about in its role in this entire conversation. And that's buterate. You shared a little bit more about short chain fatty acids. We were talking about fiber. But why is a buterate in particular so crucial to this conversation? And then for our audience that's listening, I mean, there's thousands of supplements that people are pitching all the time and people are saying, hey, this is a good way to get beard rate up and that way. How do you actually get your butterate up in a way that it's central to helping you restore your gut microbiome, especially for women who are listening to. conversation. Yeah, so short chain fatty acids, their production declines in the setting of all of these gut microbiome changes. And short chain fatty acids, buterate is probably the most commonly

known. I would say it's probably one of the most important in terms of signaling molecules, because that's what these fatty acids are. They're signaling molecules in the presence of fiber that our body can produce. And buterate is interesting because it is not just signaling molecule in the gut. It can cross the blood-brain barrier. It's involved in redacted. it's involved in insulin sensitivity and so I think for a lot of people it's reemphasizing the fact that there's never just one thing that a signaling molecule like butyrate does in the body it's doing multiple things with this decline that we see in this transitional period in a woman's life this is why it's so important to talk about fiber we keep coming back to fiber fiber is one of

these things that helps with short chain fatty acid production because the colonocytes which are the cells in the colon are helping to produce these little metabolites that come off of them. And when we think about, you know, supplementation, and I'm always a fan, you know, if you can't get enough from your diet, supplements are great. But things like grass-fed butter, ghee, fermented foods, we can get buterate from these foods, which is why, again, I humbly say, this is why these foods are so important to be including in our diet. You know, sometimes people will say, well, I'm dairy sensitive. Well, then ghee might be a nice option because that's clarified butter, or these ferments. The work has already been done for.

it makes it much easier for our body to assimilate into our microbiome. And if I didn't already mention this, the gut microbiome is in the large intestine, the colon. A lot of people are like, where is it located? It's in the large intestine, which is a very important part of the digestive system. Once you start to go down that rabbit hole and really audit your fiber in a similar way that people were auditing their protein over the last couple years and have gotten aware that you think you're eating a lot of protein and you're not, same thing is kind of true. in our modern day world with fiber.

We've just have gotten away from a lot of these traditional foods that we all, maybe our ancestors grew up with, regardless of what region of the world, unless maybe you're in Eskimo. And then your gut microbiome has evolved for that, you know, that's there. But we've gotten away from a lot of these foods. Even a lot of healthy foods are overly processed, and so you don't have a lot of the fiber that's there. So when you actually start to audit your fiber and maybe track some of the calories

and the fiber intake that's there to see, many people are shocked how little fiber they're having in the day. I think the average standard American diet is five to 10 grams. So if that's where you are, there's no judgment. And that's why I always say, like, this is why I like people tracking their macros. Because it just builds awareness about, you know, what are the things I could be doing differently? Do I need a little more protein? Do I need to be more conscientious?

And the message is never that every single person needs the same amount of fiber. because very transparently, I have some patients that can tolerate 50 grams that kind of lower end of the bell curve. And then I have other patients that don't do well, you know, they get a lot of gas, a lot of bloating. So I always say if we're increasing our fiber intake, we want to be conscientious about portions and not going too fast. Like there are fiber bars that are out there. That's never what I recommend that people try to do. It's like just have a little another serving of vegetables or add some artichokes or add some fermented foods. I mean, there's so many different ways that you can look.

layer in fiber. I don't ever want the message to be that it's a, you know, if you look at the guidelines, they want you to have 25 to 30, not everyone can get there. You just want more than what you were eating before. Do you have anything that you want to say about the different classifications and soluble fiber and insoluble fiber and how much we should be shooting for any of those or just get as much as fiber as you can? I think it just to, you can helpfully tolerate. Yes. I think it's important to understand there are different types of fiber, but I think that what I've found is that it's so bio-individual that some patients do better with, you know, like cool-cooked rice or other people do better with like green banana flour or other people just do well eating the whole food

source as opposed to worrying about, oh, I've got, now I have to think about one more thing. It's like just keep it simple. If you track your macros over a week and you realize you're eating 12 grams, well, maybe we just shoot for 15. And really, you know, that is going to be better than where we were before. And so that's really. really the, I think that the conversation starts getting so nuanced and then people are like, I can't take action because now I have to worry about soluble versus insoluble. And really what we're speaking to is, you know, what happens in the gut? Does it just move through the gut without actually being broken down or is it broken down

and assimilated by the colonocytes? Yeah. I know it's a limited fiber, but I have seen and I think that the most studied fiber that's out there in terms of the literature is Sillium Husk. Yes. And that's, I talk about that in the book. Because I was like, this is at least something that's excessive. people can find.

Yes. Yeah. Just make sure you're having enough water with it. Me personally, I take cilium husk every day.

No affiliation with this company other than I actually visited their farm in India when I was there one time. It's called organic India. Okay.

They make a whole husk sillium husk. So it's kind of like the whole husk that's there. And I take a tablespoon of that and I put it in my morning shake

along with a few other fiber sources as well, as well too. Some berries and other things like that, some supplements that I've found that work for me. And I think that I want to just echo what you've said. Like, I do terribly on any kind of bean or lentil-based fiber sources.

I've tried so many different times. I've felt like, oh, I've healed my gut now. Let me try it again. Sometimes I can tolerate better my mom's sort of traditional Indian cooking because she uses a pressure cooker. So if she makes, like, lentils traditionally, she uses a pressure cooker. I do a little bit better, but I still feel kind of bloated afterwards. but I do great with like berries.

I do great with like cillium husk. I do great with, there's another fiber that's out there, a company called SunFiber, no affiliation again. I do great with like some sun fiber. And I found for myself, similarly to protein, if I can start off my day with fiber that works for me and my favorite sort of protein sources, and for me that's maybe a shake,

even if I decide to have some breakfast, I'm already starting off the day with, you know, 10, 15 grams of fiber, which makes it so much easier. And I have better bowel movements. I feel better. I'm not feeling, you know, bloated because I'm having the right types of fiber for me. So definitely trial and error. And definitely I've personally found front-loading it.

It can be helpful. Try it as an experiment. And, you know, everybody's got to personalize it for themselves. Well, and I think that's really what it comes down to. Because sometimes when someone listens to a podcast, what they hear is, I need more fiber and then they go out and they're like, I need to. They binge on fiber and they're correct. And then they're bloated and they're miserable and then I'll get probably an email in my inbox or you'll get a bunch of them saying, you know, I got a totally different message from that.

So go low and slow, whatever you decide to do. Yeah. And beware of, you know, there's so many marketing aspects with so many things. I think in particular right now there's a lot of fiber drinks. Yes. And they're largely using oligosaccharides as the fiber. source that's there. Not everyone tolerates. Which actually is one of the most intolerable fiber sources for a lot of people. It's high on FODMAP. I think it's the highest on FODMAP. So beware of a lot of the sodas that are

out there. You can have them maybe for pleasure here and there, but a lot of my friends drink them and they're like, man, I drink too. And why do I feel like crap and I'm super bloated? Well, that fiber is not really a fiber that's going to work well for you. Yeah. And I even talk about FodMaps in the book because I thought it was so important to kind of identify. There are people out there that they're trying to eat healthy food, but it just doesn't agree with them. Yeah. It's crazy. There's just so much going on in our modern world and we have so much access to so many different types of food sources, but you really have to do some investigation work for yourself to figure out what actually works for you. Okay, let's go into another big,

big idea, which is now bringing in a whole new category of things, which is so key for all people who care about aging, but especially women, who are uniquely more impacted with this category. And that category is bone loss. Again, the menopause gut. You can find the link in the show notes. You can look it up on Amazon. The menopause gut, a great and a fantastic book, even if you've already started a deep dive into this world.

I'm telling you, you're missing some crucial pieces in this conversation if you're not reading this book. So the fifth big idea, bone loss starts in the gut. long before it shows up on a scan. That was kind of mind-blowing. What do you mean by that? Yeah, I mean, we've talked a lot about leaky gut. Leaky gut is leaky bone.

And so there is a gut bone access and helping women understand that there are things we do when we're younger that can impact our bone health. So peak bone and muscle mass is usually in our 20s, maybe as late as 30. And what do most young women that are concerned about, you know, whether it's they have heavy menstrual cycles, they don't want to get pregnant, there's no judgment.

Things like oral contraceptives and Depo-Provera, as an example, impact laying down healthy bone because you're kept in a very low estrogen state. And certainly my generation, I want to plug my generation because I think this is important. My generation, everyone was on the pill, not necessarily for contraception, but we all had wonky periods. And so if you are on, if you are kept in a low estrogen state, and we'll circle this back to make it relevant to this perimenopon. to menopause transition, if you're kept in a low estrogen state, you're not able to build bone

effectively. And interestingly enough, Deppro-Povera, a very effective contraceptive aid, has a black box warning that if you are taking that drug, you are at risk for bone-related effects. It is reversible. Let me be very clear, so don't panic. If you or someone you love is taking this as a contraceptive agent. And it appears that the younger, so we're talking about teens and young adults are the ones that are most susceptible to the bone building effects.

But getting back to, you know, we go through our 20s or 30s, then we get into perimenopause. We know estrogen can be 20 to 30 percent higher during that perimenopause transition. What's interesting is as we are navigating less estradiol in our bodies, as our body's making less and less and less, it offsets this bone building and bone breakdown balance in our bodies that is controlled predominantly by progesterone and estrogen.

But as we have less and less progesterone, excuse me, less and less estrogen, we aren't building as quickly as we are breaking down. So we really get into this kind of bone building deficit, if you will, that again, if we have, if the microbiome is fortified, we are less likely to see an acceleration. And I actually would make the argument that if someone is dealing with osteoporosis, you need to be looking at the gut as well.

Because there are younger women that are dealing with osteoporosis for a variety of different reasons. But I think that the one thing that really stood out to me as I was writing this chapter was number one, early contraceptive use is important to have a fully informed consent conversation with that patient to say, hey, I just want to make clear that you understand, you know, maybe we utilize this option for a number of years. But I want to make sure you're not missing out on peak bone building efforts. Because if you're on like the oral contraceptive pill from 14 to 30, guess what you've missed out? on all those years of being able to build healthy bone, unless you're a gymnast. You know, gymnasts, I think, have some of the strongest skeletons based on the research of anyone else. But for most women, they're not doing enough physical activity to build healthy bone. And in that

setting, you're at a disadvantage if you're taking that as well. The other piece of it is, when I'm working with women and we're talking about gut health and I'm asking him, have you had an assessment in the United States, the way that the guidelines are currently written, women are not getting Dexas unless they request them before the age of 60. That is way too late. Every woman listening needs a baseline assessment and Dexas scans are inexpensive. I have no affiliation. It's not like I benefit from encouraging people, but getting a bone health assessment. I think about younger women. Like you, when you breastfeed, you are effectively breaking down some bone and that's transiently done. But I think young women, when they are breastfeeding

and after breastfeeding, they need a bone health assessment. They need that way before 60 when we can't intervene quite as effectively as we can at 35 or 40. By pure happenstance, I had a dexia in my 30s and I found out I was osteopenic. So there's a lot of things that you can be doing along the way. But I think many people aren't talking about that gut bone access as another interplay between the gut and bone health. Yeah, just to drive it home and what you say in the book, strong bones aren't built in your 60s. They're protected in your 40s and 50s often by fixing what's happening in the gut many of the things you talked about. Exactly.

That being said, it's never too late to start. Correct. Even if somebody's listening today and it's like, hey, I'm in that category. I think I'm in that category. I'm in the 60 plus category. We have an incredible episode with a woman. She's the oldest competing female ninja warrior, American female ninja warrior. Her name is Ginny McConnacle, Virginia.

Her friends call her Ginny. and she was a dancer in an entire life. She was a model when she was younger. And she always stayed very thin because she was focused on calorie control and things like that. And she thought she was blessed. And one day went into the doctor's office

and they told her that, hey, you have osteopena and you're on your way and there's not really much you can do about it other than just you should be aware you're going to probably have osteoporosis. And I think she was in her early 60s at the time when she found out this information. And she went to her daughter, who was a competitive cross-fit athlete.

And she said, mom, I think there's a lot that you can do about this. Let's start small. And we did a whole episode. So I might have mixed up some of the details, but I believe that her daughter, they didn't live in the same town, was like, let's get you a trainer. Let's start upping your protein a little bit. Amazing. Let's start getting you more active. And then just meeting a different community and people that are there.

She saw that there's this whole world of people, competing in these incredible competitions. If you're never seen American Ninja Warrior, there are these crazy obstacle courses. And when she first started, she couldn't even do one pull-up and just started small and, you know, stayed focused,

cleaned up her diet. I'm sure, you know, even though she wasn't focused on gut health, a lot of things that she was doing were supporting her gut health, getting more fiber, having better protein, getting rid of any kind of other processed foods that were there.

And I believe it was like a year and a half she went back to the doctor and the doctor said okay i don't know exactly what you're doing but keep it up you don't qualify for being in that category of osteopena anymore and that was like a year and a half two years and then she went on to then end up competing in different competitions and is now an inspiration to so many people you can look her up jeannie maconical will put the link in the show notes so it's never too late correct to do these things and regardless of what age you are right now take a snap of your bone density by getting a Dexas scan. Generally speaking, you could probably get them done for like 90 bucks, 100 bucks in most places.

And you can go on their website. We can link in the show notes and find somebody around you that can do that. At least now you have a snapshot and you can decide. I think a lot of people, they feel anxious like, I'm not sure. I don't know if I want to do these labs or this test or this scan because what if it says X, Y, or Z, well, that's a good thing because sometimes when you find out, that is a little bit of that fire under your ass to say, hey, there's actually a lot that we can do in this category. Have you seen through your lifestyle changes over the years that your dex scans have improved?

It's interesting. And I apologize. I am not an expert in this area, but there are bone health markers that you can do that give you a sense of, you know, what's actually going on, like how much bone build up, how much bone break down. This is why, you know, estradiol is a primary, has a primary indication for osteoporosis protection, but it needs to be started earlier rather than later. But yes, have I seen women that, you know, make the kinds of changes, maybe not to that extreme, but make lifestyle changes that have a positive net impact? I mean, the one thing that I think is important to kind of reinforce with listeners is it's not just the bone health piece. It is the loss of independence that many people are not thinking about when they're younger, that we don't want to

develop osteoporosis because, you know, the whole piece of, you know, muscle mass loss, which is sarcopenia leads to frailty, frailty leads to falls. Well, if you fall and you have, and you're osteoporitic, you're more likely to break that bone. In some instances, you may no longer be independent. And so we know that 25% of people that fall and break a hip will not go back to their previous level of independence. And so I think that that's the bigger picture that maybe some people aren't thinking of is that bone health is really important. It is very important.

But we don't want to get to a point where we become frail and then we lose our independence. On to the sixth big idea, which is something that a lot of people think about. There's a lot of layers to this conversation. But the way you talk about in the book, midlife weight gain isn't just about calories, isn't just about calories. It's about cellular signaling. Let's break this down. Hey, y'all. It's Kelly Clarkson with Wayfair.

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The scourge of every middle-aged woman is that this weight loss resistance piece comes up. And we are as individual as we could be. I can tell you from working with women over the past 25 years that there are some consistencies in terms of factors

that contribute to weight loss resistance at this stage. Things as basic as, you know, changes in metabolic health. You know, that loss of insulin sensitivity as we're losing estrogen, that becomes problematic. We have a loss of muscle mass

and muscle is this insulin, you know, it's this glucose reservoir in our bodies, helping people understand with loss of muscle mass, we lose insulin sensitivity. Changes in macronutrient intake. So if you're 50 years old and you're eating like you're 18, hey, guess what?

You need more protein and less of those processed carbohydrates because that becomes problematic. So there's multiple things that contribute to body composition shifts. That's at a very basic level. So metabolic shifts. There's also this piece of women in middle age suddenly start to struggle with something as foundational as sleep. and so sleep is foundational to our health, as I always talk about. If you're not sleeping through the night, you've got to fix that first.

But for a lot of women not understanding that when you're not getting, you know, seven to eight hours of high quality sleep, you're not getting that restorative opportunity. You're also going to deal with metabolic health issues because we know that if you're getting less than six hours a night to sleep, you're more likely to have insulin sensitivity issues and insulin resistance. And again, that contributes to that piece. But for many people, are so stressed about not sleeping that the stress, the chronic stress piece also contributes to

changes in metabolic health. And so I think about the people that, you know, ruminate, meaning they wake up in the middle of the night and their mind is going a million miles per minute. And they don't realize that that chronic stress that maybe they think they're dealing with during the day is rearing its ugly head in the middle of the night or someone that intermittent fast and doesn't eat enough calories during the day and they wake up in the middle of night because they become hypoglycemic, meaning that their blood sugar drop. those things contribute. Nutritional choices also contribute.

What I find is most women under-eat protein and overeat process carbohydrates, which that is a recipe for disaster. I think about what hormones contribute to shifts in body composition. And again, we go back to estradiol, testosterone, which is sometimes the forgotten bastard hormone that contributes to body composition changes

as we're navigating this perimenopause-to-menopause transition. I also think about gut health. You know, gut health. Again, we've talked about how the gut modulates a lot of these neurotransmitters and hormones, and the health of the gut is really a crux of how we age and what our body composition is like. And then you add in all the other things that come along with that, the chronic exposure to toxins in our environment, personal care products and food. You could also add in, you know, toxic thoughts, you know, a lot of people.

I always say what someone says to me outwardly is a minor reflection of, what they're saying inwardly. So if someone is depressed or really pessimistic or is feeling badly about their circumstances, those negative thoughts can absolutely influence the way that we age and the way that, you know, our body composition goes because I find for many of these people, they also do that rumination of thoughts. And then lastly, I would say that another contributory issue towards body composition shifts is also that trauma piece, which I don't want to continue to like, harmer on on this, but I think it's helpful for people to understand that, you know, the trauma piece, whether it's, you know, you had a bad boyfriend in college or you had untoward circumstances

growing up with parents or loved ones, those kind of unresolved things seem to find their way into our psyche, our stress management, our sleep quality as we get older. And the research also suggests that people that experience significant underlying trauma, and it doesn't, you know, our traumas are as unique as what we experience them as, they also can contribute to not only chronic autoimmune conditions, eating disorders, body composition changes can increase and influence when we go into menopause, which I think is also really significant. But many things impact those body composition changes. And I think about, you know, that signaling piece, it's really speaking to hormones, neurotransmitters,

influencing when we eat, how we eat, how we interact with our environment, etc. One thing we didn't touch on, but I know you're a huge fan of as well too, is, you know, also people getting outside and getting appropriate amount of sun. Morning light. Connection to nature. Evening light. Connection to nature. If you can habit stack, go for a quick walk. If you're worried about the sun, damaging your skin, go in the morning, go in the evening.

Wear a big hat. Wear a big hat. Put on some mineral sunscreen. There's a lot of things you can do. And, you know, that's the fuel for your mitochondria in many instances. that is one of the big things that's missing and some crazy research that's out there. We've done some episodes on this,

but the people who get some of the most amount of sun and have some of the best reductions in all-cause mortality that's there. Obviously, you can be smart about it and make sure you protect your skin and other things like that, which people care about, but plays a huge role in sleep, plays a huge role in stress.

And I think about it kind of like, it's a good indicator, like fiber. There's many reasons why somebody may not be able to have fiber. You talked about your instance, right? But if you can't tolerate, let's say even a modest amount of fiber,

that's sort of a canary in the coal mine that something is major going on with your gut, right? And you got to figure it out. And there are some such extreme circumstances that, you know, people can't figure it out and they have to be on a very strict elimination diet like carnivore or something else for the rest of their life. And, you know, my heart goes out to those people.

I know a couple of people like that. In that same sense is that if you don't have time to get outside for a walk, it's a good indication if you can't get some sunlight at some point in time during the day and take some time for yourself. Maybe you're not by nature, but whatever your closest version of that is, is a good indication of like, whoa, whoa, we need to pause and take an audit of how life is organized. And of course, there's seasons.

a baby or this is going on or that's going on. But it's a good reminder that if there's not enough time to do that, we need to reset some boundaries in our life, you know, and try to see what are the underlying things that prevent you from having at least five, 10, 15 minutes to yourself in the day. Well, and I think it's so, it really speaks to the fact that the boundaries piece that so many of us forget about, you know, I was flying at 30,000 feet for so many years with young kids and, you know, working in the hospital, that has been traveled a lot. And one of the things that happened during the pandemic,

like I think it did for so many people, is my husband and I just got into this habit of taking her dogs out for a long walk every day because what else we were going to do. Yeah. And if I have a day where I don't get outside for at least 20 to 30 minutes, first thing in the morning, without sunglasses, outside in nature, I'm grouchy.

Yeah. And so to your point, you know, whether it's forest base, or, you know, just sitting on your porch and, you know, without sunglasses. Soaking in some sun. Doing something where you're connecting to nature, I think, is really important. I mean, there's solid science about grounding and forest bathing and just getting that connection to the earth that so many of us take for granted. You know, you might live in a part of the country where maybe there's not a lot of grass.

I mean, there's lots of ways to get exposure to nature that don't have to be as, you know, complicated as driving to a park or going to the ocean. I think for a lot of people, it is a sign. If you can't make time to support your body in that way, I think that it's a sign that there's probably something else. Like, do you need to be spending two or three hours binging Netflix at night? Or could you just wake up 15 minutes earlier and maybe get some sun exposure or ground? You know, here in L.A., you can probably do that year round. Where I am, we tend to have, you know, truly have four seasons. There are times in the year where I have a grounding mat

because it's a little too cold. I don't want to stand outside when it's 20 degrees and put my feet on the frozen grass. So I have a grounding mat to do that. But to your point, I agree that if you can't find the time to be able to support your body and support that kind of autonomic nervous system, I think it's a sign of something else

needs to probably shift and change. A lot of the women who are educators on this topic of menopause, talk about during this time period over here is actually stepping into your power of your confidence and your mindset to know that you feel a certain way about things, you feel like something needs to be addressed, reset,

you don't like somebody, the vibe is off, whatever it might be. Like, this is the time, not that it's not the time any other time, but even more importantly right now because your body, your stress response depends on this, is to speak up and be bold, right? And to take courage in the way that you can

to say that something is or isn't working for you. Is there anything you want to say about that? Oh, yeah. I think as a reformed people pleaser because that's really the way that I existed for many years, there's been many things about this time in my life that I have found humbly to be really incredible. But the finding my voice piece is really exciting

because I think for many years, I was taught to suppress what I really wanted to say. And so now, whether it's on social media or personally or professionally, I really struggle when my kids will see this look on my face and they'll say, no, don't do it. Don't do it. Oh, God, she's going to do it. And I'm very polite, but I will tell people what I think. And to me, it's so freeing because when you suppress your emotions for such a long period of time, I think it is absolutely one of the contributors to why, thankfully, they're all in remission,

but I have multiple autoimmune conditions because I've suppressed so much and was kind of taught, you know, you're a lady. We don't speak up. We don't, you know, that's just kind of how I was conditioned growing up. I would say overall, being able to speak your mind in a respectful, reasonable way is it's like taking a monkey off my back. It's like, oh, I'm not trying to pretend that doesn't bother me. it's like I just come out and say it and I'm so much healthier for it. That's powerful.

And that's estrogen. Estrogen is the people pleasing hormone. It's like one of these, you know, think about it during the menstrual cycle, when are women, you know, during their menstrual cycle, when they're most likely to have sexual intercourse, just by virtue of alterations and, you know, not only estradiol, but also testosterone. It's like one of the contributory bonding hormones, but, you know, it's a people pleasing hormone. And so as it goes out the door, all of a sudden women are like, huh, I don't want to do that. I have no desire to be, you know, doing that activity with that person or I don't want to, I, you know, I think about how many friendships that were so important to me when I was younger that now I'm like, I wish that person well, but we don't have anything in common and I would

rather not spend my time with that person. Yeah, nothing wrong with that. Correct. Nothing wrong with that. You know, number seven on our list is something that we talked about throughout. So we won't go too deep into it. And in fact, I'll give you an opportunity to talk about anything that we might have missed. You know, there's so much inside of this book that's here or anything that's on your mind that you want to share with our audience.

And the seventh piece, just so we, you know, chat about what it was. Throughout the episode, we talked about how stress and trauma don't just affect the mindset. They shape the menopausal transition itself. And why you should care about it, as you've heard throughout this conversation from Cynthia, is healing and midlife often requires nervous system repair, not just supplements or hormone optimization, which those things can be great. Food can be great as well too. And stress is this hidden toxin that we wear on our back

and carry throughout life. Let's say women can have a way that they typically deal with that. Men can have that burden. You know, men don't speak up. They don't talk about things. They don't have friends as they get older often, which is very unfortunate. They have their own set of situations that are there.

But for women, it shows up in a lot of different ways. And as you mentioned, you know, it can be one of the main reasons why women, it's multifactorial, are 80% of autoimmune conditions is women, in addition to this hormonal milieu and estrogen and the gut landscape, etc. That's there. So we talked about that pretty in-depth.

So if there's anything you want to mention about that, or if there are any other big ideas that you feel that you really want to make sure that the audience leaves this conversation with as we're winding down here, I'll pass it back over to you. One thing that I encourage younger women to realize is that you may have suppressed things. Maybe you're not even aware if you suppressed a memory or something that happened to you when you are younger. Do not be surprised if as you are late 30s, early 40s, things start to bubble to the surface. And I would encourage you that if you're struggling with something or there's a memory that's come up or, you know, maybe an experience you had really bothers you.

get help before you make that transition because I've seen many, many women. We know that women initiate about 70% of divorces. I see a lot of people initiating divorces in perimenopause and menopause, and maybe appropriately so. I have several friends. I think they're much happier with new partners. But I think for a lot of women, if they were in initiating with things as simple as like talk therapy, but finding a really good therapist that you can talk to about things

that are ruminating in your head. I always say that, and I've said before, the body keeps the score. You may not even realize until you get into this transitional period when you have alterations in these hormones and neurotransmitters may bring things to the surface.

So if that happens, there's no shame in going to therapy. I jokingly say I'll be in some form of therapy for the rest of my adult life. And that's a good thing, ultimately. In terms of the book, I would say, you know, one of the things that I talk about

in the book that I think is really important is there's a lot of ongoing research in terms of looking at what's happening in the microbiome for women, what are the kind of key ways that we can support the microbiome as we're getting older. And there's some research that's coming. I think there'll be more, especially because it really is a burgeoning field. And so my hope is that we'll continue having conversations just like this where we're like, oh, two years from now, there's a conversation where there's this incredible bit of research that comes out at a think tank somewhere in the United States or abroad that suggests that, you know,

that H.R.T. is going to help modulate the microbiome in really unique ways. I think that is coming. It's certainly we're not exactly there yet. But I do think that H.R.T. will be one of these kind of key modulators of the microbiome that's going to have profound net benefits. And encouraging women to have those conversations earlier, you know, we know that women that initiate H.R.T. in perimenopause, it's generally more beneficial than waiting to five to 10 years into menopause. Having that conversation early, getting educated about it early, building your resources so you can enter into that world and feel like confident with the decisions that you're making. And it's great that obviously there was all these, you know, the government going on record,

Dr. Marty McCary coming out and speaking up about how this is one of the worst travesties that we've done to the population in general, but specifically women. It's getting a lot of, it's getting the tension that it finally deserves. And obviously it needs even more attention for people to be aware of it. Absolutely, because I think baby boomers have every right to be really angry because they're the ones that the net impact is probably greatest on them. And that's my mother's generation. So I always say that very humbly, my aunts and my mom have always given me permission to share the things that they went through as they were taken off of their hormone replacement therapy and how that's impacted their health. So I think that, you know, I love that we can share information like this to educate and inspire not just women, but also men.

because I'm sure there are men that are listening that have their significant others or loved ones that they want to better understand what's happening to their body so they can support them. I think that's really key. This is not just a woman's problem. This is also a men's problem and the people that they love. And so thank you for having an amazing platform where you get to share this information to help them too. Absolutely. Let's do a reminder around the things that we want to be looking at in our lives,

specifically talking to women who are thinking about this transition, going through this transition in their life right now, supporting friends who are going through this transition or family members that are there. What are the key things as a reminder because so many of them were mentioned inside this episode when we're looking at lifestyle factors

and habits and routines and it's not about being perfect or focusing on all of them at once, but at least some sense of if these things are there and we're continuing to make progress in them, we know that a lot of these challenges that make this transition of menopause

so much more difficult for some women are less likely to happen. Doesn't mean that you won't be navigating things, but it'll be maybe less impactful, especially when it comes to, you know, the gut microbiome, which plays the central role. So let's just do a little bit of a recap, if you wouldn't mind. Absolutely.

Around some of those key pillars and categories for people to be thinking about. And I generally find that it does two things. It helps people understand that so much of health is doubling down on the basics. Correct. I would say major in the majors. Don't major in the minors. Yeah. You're doubling down on the basics, and that's often where the most significant rewards come from.

Nothing wrong with sprinkling some other things here and there. But if we don't double down on the basics, we won't feel as great for men, women, anybody. But also, too, we're more susceptible to the marketing of the world, whether that's big pharma, whether that's big wellness, whatever it might be there. Somebody will always have something to sell you that will be the cure for what's, you know, ailing you. And there's a lot of really great cool things and test and stuff that's out there. but nothing beats doubling down on the basics.

So Cynthia, remind our audience with what are those basics that are so important for the woman that is paying attention to this conversation. I'm so glad they asked me this question because it's so important. It's foundational. So number one is sleep. The health of your microbiome and your body

is dependent on your sleep quality. Now, I'm not saying you have to go out and buy an aura ring or a woup band or anything like that. Just try to ensure you are getting in bed at a fairly consistent time and you're sleeping for no less than seven hours a night. Number two is managing your stress,

and that is not five minutes of meditation once a week. Find something that you like. I don't care if you put legs up a wall or you listen to a meditation on your phone, or you do grounding work, or you decide that you need to do yin yoga. Like find something that you like and do it regularly. Number three is anti-inflammatory nutrition,

which really means thinking thoughtfully about what potentially, if we look at what is the most inflammatory foods, obviously ultra-processed, thinking thoughtfully about eating more nutrient-dense foods. I'm not saying be perfect. I'm saying just eat less processed foods. Focus on protein. Add in some fiber. You know, the research suggests 30 plant varieties a week is great.

That freaks everybody out. I'm like, listen, make a salad bucket a couple days a week and just throw a couple, you know, put 10 different herbs, spices, nuts, seeds, and some vegetables in there, and you're good to think thoughtfully about your relationship with alcohol because that can wreck your sleep, that can wreck your gut microbiome and lead to leaky gut. There's so many things about alcohol that if you're going to drink, do so rarely and very responsibly. I think about exercise as being important. I think so many of us think about it's important for, you know, strength train is so important

for maintaining muscle mass and all these other things. The research certainly suggests that exercise is important. for the health of your microbiome. It's very much the Goldilocks effect, meaning if you're going out and doing iron man's, that's going to definitely be probably more intense than what we're looking for, but consistent movement throughout your week. I would say another thing that's really important is deal with your stuff. And when I say deal with your stuff, I say that lovingly. But if you need to go talk to someone about your stress or concerns or something that happened to you as a child, find a licensed provider, whether it's a therapist, a psychologist, a psychiatrist, get a referral from someone that you

know, love and trust, deal with your stuff because it will continue to come up. It's like it almost bubbles to the surface. I would say, in addition to that, if hormone replacement therapy is appropriate for you, start the conversation early. Again, as I mentioned, most of the research it's out right now about HRT is talking about benefits in terms of bone. It's still ongoing about brain health, although it's heading that direction. Heart disease, but I think the research will head the direction about being beneficial for the gut microbiome. And then the last piece that I would kind of add in there, kind of a high level thing, is thinking if you can't get enough fiber from your diet to think thoughtfully about supplementation, but as you astutely stated, the power of the

end of one, that bio-individual piece is so critically important. For some people, you know, they're doing a really good job with their diet, but maybe the health of their gut microbiome doesn't allow them to make enough of a very important postbiotic called urolithinae. And I talk about this in the book. There are supplementations for that specific kind of signaling molecule, which is really important. I also think about polyphenols. So those are those brightly pigmented fruits and vegetables, try to get them from your diet, but, you know, looking targetedly at supplementation, if that's appropriate for you. I think those are kind of the key themes of the book. I never want the message to be that I want people loading up on supplements or majoring in the minors, as I jokingly

say, all the cold plunging and all the infrared sonnas as beneficial as they are and whatever bright-siny object is in the, you know, is really exciting right now. I'm not suggesting you have to go to that extreme, but just major in the majors, major in the things that I'm kind of talking about that I think are accessible for most people. And then if you want to have the bright, shiny object when you've mastered all these other things, have at it and enjoy it. Amazing. Cindy, we always love having you on the podcast. You make it all so straightforward in a world where it can feel very complicated. And there are a lot of layers, but the path forward is focusing on what matters the most. And you helped remind our audience today about that. And the book is out there. People can get it.

We have links to all the great websites that are out there. I'm sure you'll be doing some fun stuff, some lives on Facebook, other things. So please follow Cynthia on social media. And the book is the menopause gut. Balance your microbiome to reclaim your health in midlife and beyond. Cynthia, thank you for being here. Thanks for having me, Drew. It's always a pleasure. Hi everyone, Drew here. Two quick things. Number one, thank you so much for listening to this podcast. If you haven't already, subscribe, just hit the subscribe button on your favorite podcast app.

And by the way, if you love this episode, it would mean the world to me. And it's the number one thing that you can do to support this podcast is share with a friend. Share with a friend who would benefit from listening. Number two, before I go, I just had to tell you about something that I've been working on that I'm super excited about. It's my weekly newsletter. and it's called Try This. Every Friday, yes, every Friday, 52 weeks a year, I send out an easy-to-digest protocol of simple steps that you or anyone you love can follow to optimize your own health.

We cover everything from nutrition to mindset to metabolic health, sleep, community, longevity, and so much more. If you want to get on this email list, which is, by the way, free and get my weekly step-by-step protocols for whole-body health and optimization, click the link in the show notes that's called Try This or just go to Drew Perot.com. That's D-H-R-U-P-U-R-O-H-I-T dot com and click on the tab that says, Try This.