unPAUSED with Dr. Mary Claire Haver - Gut, Brain, and Hormones: The Menopause Connection with Dr. Amy Shah

Episode Date: June 30, 2026

In this episode of unPAUSED, Dr. Mary Claire Haver sits down with Dr. Amy Shah, a physician trained in internal medicine and immunology with a nutrition background from Cornell, and author of the new book Hormone Havoc. Dr. Haver and Dr. Shah begin the conversation with the gut-hormone-brain connection, explaining how 40% of estrogen is recirculated through the gut, how the estrobolome, the collection of gut bacteria responsible for metabolizing estrogen, determines how much the body retains, and why declining estrogen in perimenopause and menopause triggers a cascade that loosens the tight junctions meant to keep food particles, toxins, and viruses from entering the bloodstream. This leaky gut drives inflammation that accelerates every symptom women are already experiencing, from weight gain and mood changes to sleep disruption and brain health decline. The gut-brain axis, the constant two-way communication between the gut and the brain, means that what is happening in the gut is directly shaping cognitive function, motivation, and emotional resilience in menopause. She also covers how 95% of serotonin is made in the gut, why chronic inflammation reroutes tryptophan away from serotonin and melatonin, and what that means for mood, sleep, and appetite in midlife. Guest links: Dr. Amy Shah (Instagram) Dr. Amy Shah (TikTok) Dr. Amy Shah Save Yourself With Dr. Amy Shah (Apple Podcasts) Books: “Hormone Havoc: A Science-Backed Protocol for Perimenopause and Menopause: Sleep Better. Think Better. Feel Better,” by Dr. Amy Shah To learn more about listener data and our privacy practices visit: https://www.audacyinc.com/privacy-policy Learn more about your ad choices. Visit https://podcastchoices.com/adchoices

What are some of the biggest myths that you see pertaining to gut health and women in midlife? That gut health is just gut health, first of all, that it doesn't have anything to do with your brain or with your hormones. And then that, you know, you can just take a probiotic or some kind of supplement to just fix it. So a lot of women don't realize that this is like happening in their bodies, like this big change that's happening. So when estrogen goes down, some of the bacteria that are dependent on estrogen, die. And one of the things that happens is the tight junctions and the gut become looser. And so you get more of a leaky gut. The views and opinions expressed on pause are those of the talent and guests alone and are provided for informational and entertainment purposes only. No part of this podcast or any related

materials are intended to be a substitute for professional medical advice, diagnosis, or treatment. So many women come to me in their late 30s and 40 saying the same thing. I woke up one day and my body felt different. They're not doing anything wrong, but suddenly their hunger is louder, their energy is gone, their weight won't budge, their sleep is off, and nothing that used to work works anymore. So many times they're told it's stress or aging or that they just need more discipline, and they're left feeling like they're failing their own bodies. My guest today understands exactly why that happens.

Dr. Amy Shaw is a physician trained in internal medicine who made a deliberate pivot into nutrition, hormones, gut health, and lifestyle medicine when she realized traditional care wasn't giving women the full picture. She's built a career translating complex physiology into practical strategies that actually meet women where they are. She is the author of I'm So Effing Tired and a new book, Hormone Havoc. This latest book puts language to what so many women are experiencing but can't quite name, the chaotic intersection of hormones, metabolism, inflammation, gut health, stress, and modern life.

It's about understanding what your body is asking for and responding with intention instead of blame. In this conversation, we'll talk about the gut hormone connection, what eating well really looks like after 40, and how movement and lifestyle habits can work with hormone therapy, not against it. I want this to be a conversation for everyone, but especially for those women who are tired of being told to try harder and women who are ready to understand what's actually happening inside their bodies. I'm Dr. Mary Claire Haver, a board certified obstetrician, gynecologist, and menopause practitioner. I'm also an adjunct professor of obstetrics in gynecology at the University of Texas Medical Branch. welcome to Unpaused, the podcast where we cut through the silence and talk about what it really takes

for women to thrive in the second half of life. Many women struggle to access quality menopause care. The access gap is real. Women often wait months to see a specialist, face a lack of local care, or feel dismissed when seeking treatment, all while insurance may refuse to cover hormone replacement therapy or HRT. The challenge has never been the medical. medicine itself. It's been getting effective treatment into women's hands. That's where Musley comes

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Visit Wayfair.ca. Every style, every home. Welcome to Unpause. Thank you so much for having me. I realized there's this huge gap in my knowledge. I mean, an OB, the only time I would even speak to a patient about anything to do with nutrition other than workout more either was when they were pregnant if they had gestational diabetes. Yes.

And we had the gestational diabetes diet, which had been written in 1963. And it was mimeograph. The sheets were purple. And like we go in the filing cabinet now. I'm dating myself. You know, before the internet, I mean, not internet, but you know, before you just have all these digital tools. So go to the filing cabinet.

It was almost illegible because it had been copied so many times. And because we were in South Texas, it was like two tortillas. And it was just the craziest thing now that I think about it, that we were giving pregnant women this diet that told them exactly what to eat every day. And that's the thing. Like all of this work in women's health, you do so much amazing work. And when I was looking at the nutrition research, I was like, that is so bizarre. We don't ever tell women how they're supposed to eat.

They're just supposed to like figure it out like from all the diets online. And I was like, there's got to be something. So I started to find that there was this gap in understanding how nutrition, gut health, and women's health kind of fit together. And that's what I started to talk about. Walk me through like that thought process. Yeah. Because I didn't really think about it.

until I was having this unexplained body composition. I called it weight game, but it really was a body composition change. My weight did not change that much. But suddenly I had a belly when I never really, outside of pregnancy, never really struggled before. And all of my patients, the vast majority, were complaining of the same thing. Everything I've been taught to say,

really, are you really parking six more meters away from the door? Are you really taking the stairs? Do you really counting your calories? None of that made sense because these were highly educated, motivated women I raised children with. I knew them. I worked out with them. I went to church with them. I, you know, ate out with them. And I'm like, they're not doing anything different. Something is going on. So that to me was like, what's happening? And maybe start really questioning my training. But so that was me. No, but that exactly happened to me. It's like I was noticing

my own body changing. And I thought it was just me that missed the memo about, you know, know how women's hormones and our gut and our brain changes. And so I was like, you know, asking my OBGYN and besties that I worked with. And I was like, did I miss something? And then they're like, no, you're just a mom. You're busy. You know, you're having kids. We were taught those platitudes. Yes. You were taught to say that. I went to my primary care doctor and I got a whole blood work. And it's like the same thing our patients go through. They were like, you're fine. Like, what's the issue? Like your blood levels are fine. And so I thought to myself, what is. it that I should be doing right now? What is it that we should be doing right now that's proactive?

That can help as our bodies are changing. And so that's when I started to look into my own, because I was like, we didn't even learn this in nutrition school. When I was there, it was, there was no talk about hormones and gut health and how that all in our place with nutrition. And then that's when I started to realize myself that I got to go back to this nutrition stuff and figure it out. So I was in immunology fellowship at Columbia. Let's go back to our listeners because she's not OBGYN. Yes, yes, yes. So walk us through your training a little bit.

So I went to undergrad. I went to the nutrition school at Cornell, the division of nutrition. And then I actually created my own major there because I knew that I was going to go to med school at the end of, so I did like something called human biology, health and society. It was like a nutrition and medicine kind of major, which was cool. I thought that's what I was going to do. I went to medical school. And then I was like, where's the like specialty that I can go into that's like nutrition

and medicine? They're like, no, that doesn't exist. That would be the dietitian we don't pay. Right. And they were like, that's a whole like being a nutrition major in med school at that time was like being a major in like dance. Like they were like, why did you major in that? It has nothing to do with medicine.

And I was like, oh. Isn't that crazy? It was like so nobody had that background. Everybody was like chem, biochem. Like it was very like. So I chose. internal medicine because think about it like there was no I mean general medicine right like that's the only place I could think of and then as I was looking after I was done with medicine I was like okay

what's the fellowship or training I can do to like kind of meld this together so I ended up doing immunology and in America immunology and allergy and allergy and actually in our Columbia immunology allergy and pulmonology are all like one department and when I was doing my immunology fellowship. And for our listeners, what is immunology? Immunology is a study of the immune system, which seems like it has nothing to do with gut health, but that's where the story gets interesting. So I'm sitting in our journal club every week. We have two, which is like insane. For our listeners, Journal Club is a common practice in most academic institutions where we sit down and review journal articles together as a big group. Someone presents something. Then we kind of debate the merits. And we learned how to read journal articles and how to tell a good article for.

from a bad article and really how to look at evidence. Exactly. In a clear way. So when we're doing, we're looking at these immune system, immunology articles, it's all about the gut. And I'm like, so how does this work? And they're like, oh, yeah, because that's where the immune system is. The immune system and the gut are constantly talking to each other.

They're talking to each other and they're talking to the hormones. Okay. This sounds woo-woo to me. Right? Because no one ever taught me that. I know it now, but like this is revolutionary. Yes. So like.

It is literally like there's a trillion with a T organisms in there. And they're literally making the decisions for our hormones. They're making the decisions. They're deciding how much estrogen. 40% of our estrogen gets recirculated through the gut. And they decide there's an estrobilloma, a special kind of gut bacteria that decides if it's going to go back to us or if it's going to be excreted out. So it's hormone balance. Like when we talk about hormone balance, like that's what it is.

And it's deciding how the feedback that it gives our brain. So serotonin, there's melatonin. So we're creating these brain hormones? We're creating serotonin. 95% of the serotonin in our body is made in the gut. And serotonin and tryptophan, triptophan goes to serotonin or melatonin. But if there's a lot of inflammation,

triptophan goes away from serotonin and melatonin. And it goes to this chynurin pathway. Kineurin pathway is like an inflammatory pathway. So if you are eating foods with tryptophan, because we can't make triptophan. Right. If you're eating foods with triptophan. Like turkey. Yes.

And they are turning into your gut bacteria are like, yes, awesome, turning this into serotonin or melatonin to help our feel good, to help our sleep, help our hormones. But if there's inflammation or stress, the pathway actually goes to the inflammatory pathway. and it bypasses making serotonin and melatonin, which is why we feel like crap. So when we are eating badly or we're having a lot of inflammation, we're kind of not making enough serotonin, not making enough melatonin. So for listeners, serotonin does what in the brain? It's like the happy, the happy chemical. It is something that everybody kind of thinks of when you feel happy. That's like really, and the melatonin is the one that makes you sleep and so regulates your sleep and wake cycle. So those are like

the two big things that actually change, right, during a perimenopause. A perimenopausal woman. And so you have that happening. Then you have a cross talk. There's consistent walkie-talkie cross-talk between the brain and the gut. Okay. And so what most people don't realize is that the gut is constantly talking to the brain about what's going on in there, with the immune system, with the hormones and with what you're eating. And the brain is giving feedback down to the gut.

So it's like a two-way street. How does the brain talk to the gut? So the brain will say based on the information it's getting from the external world. So, for example, good things, sunlight, community, love, it's sending good signals down to the gut. And the gut feels relaxed and it's making more serotonin. And it's like happy, it gets really happy when we're moving, like exercise in nature. But then if it's having negative inputs like stress, you're sad, you're in a dangerous situation. it sends those signals down to the gut too.

It's a two-way walkie-talkie, constantly talking to each other. And so all of our decisions that we think are made by their brain, it's really that brain gut access, it's that's the center. And that's why I think it's so important for women especially to realize, like, if you want to move into this next stage of your life in the best way possible, you have to understand that brain gut connection because then your hormones get better, your immune system gets better, your mood gets better, and your digestion gets better because the center is there. So like during the Immunology Fellowship, I kept saying to myself, that's weird. Every single

article is talking about that interconnectedness, that talk, cross talk between the gut bacteria, the immune system, our hormones and the brain. But nobody in clinic was talking about that. No, I was taught, zero. No, yeah. Aster Bala, first time I heard of it two years ago. Yes. And I was like, let me read this again. Yes. Like what? I know. And the fact that they make, the gut bacteria actually make things for our body. So like they make serotonin. They make dopamine. Like they make things that actually function in our body. They're like a part. It's kind of like the Amazon rainforest. They're like coexisting with us. And so trying to kill them, be clean and take antibiotics and, you know, you know, get rid of bacteria is like the worst thing we could be doing to our health and our brain health and our hormone health because these guys are the fighters for us. Should we never be taking antibiotics? We should never be taking antibiotics unless we absolutely need it.

For example, there's the problem with antibiotics is imagine if you lit a fire in the entire Amazon jungle, which happens right? And now it's barren. And now it's going to take years to come. Yeah, to grow back. And so if, you know, targeted antibiotics, obviously those are the best, but there's really not a great way to get that barren land back. You can't just throw probiotics on it. And the thing is, we're losing gut bacteria generation to generation because in our last 100 years, we've kind of become very sterile. And even mothers are passing down less bacteria to their kids. And that's what we need to not get sick. That's what we need. to balance our hormones. That's what we need to feel our best. So it's a real problem. So we got to get that bacteria back. And so actually the whole book, the reason why I wrote it is that I was thinking to myself, this is basic thing, fiber, probiotic foods, and protein. Like you can be on any diet,

you can be a carnivore, you can be a vegan. But if you were able to grow that gut bacteria by feeding it, that's what fiber does. Or if you're adding more bacteria from probiotic, foods. And if you're eating more protein, which the gut also loves, gut bacteria, you are able to actually get yourself to that next level. Like, I think that a lot of women, this is the launching pad like perimenopause, right? What's an inflection point? It is. And it's like so many people either go and live out their dreams and their gifts. And then there's people who really go through a very tough time during that time. And I just want to equip women with something that might help them. And I feel like once I started to do it, the gut bacteria changes in three days. We have good data that it takes

just three days to actually change the entire gut microbiome. Wow. So you can change yourself in three days. So you talked about estrogen. Yes. You talked about serotonin. You talked about melatonin. And dopamine is our other kind of, some people call it a feel good hormone, but it's more like our craving hormones. So dopamine is the one that when you are, you are, really wanting something bad and you get up off your chair into your car, drive across town and go get it and you finally feel satisfied, that is dopamine in your brain. Like it is the strongest actual phenomenon that happens in our body. Like if you have a dopamine craving, you will do anything to get it. And that's why drugs and alcohol use, like, are so addictive because they use

that dopamine pathway. Okay. But we can use it too good too. Do dopamine pathway is also the one that makes this motivated to do more, to reach higher, to like, do more stuff. And dopamine is also really regulated. I was going to say, how is it connected to the gut? Yeah. So dopamine is also one of the things that the gut bacteria can make. They can regulate it. They can speak it.

So this kind of hormone gut brain connection is something I think that everyone, if they just understood it, they would be like, oh, this is why I have. have to eat better or this is why I have to take care of that gut bacteria. And then there's insulin. I think we talked about, we want to talk about insulin and cortisol. Yeah, insulin and cortisol. So yeah, talk to me. There's so much on the internet. Cortisol, cortisol, my feet is full of supplements or lowering, increasing. What is cortisol? Why do we need it? And how is the gut involved? Yeah. So cortisol is our stress hormone. Where is it made? And that's the thing. It's, it's an adrenal hormone, okay? And it is a good thing and it's a bad thing.

Like if we don't have cortisol, we die. Yeah, we need it. People who have Addison's disease are like, sick, sick, yeah, they need cortisol to just like stay upright because their blood pressure is dependent on cortisol. So like, if you wake up in the morning and you feel motivated and happy and like ready to go, bad is your cortisol. So like that's good, right?

but we just wanted to kind of trend down towards the end of the day. And the problem with us in our modern society is that typically we get all these signs to trend down at the end of the day. There's darkness and our bodies are programmed. Around sundown, you're kind of settling down for your last meal. You're kind of getting these clues to kind of calm down. You're not really doing many stressful things. You can't. There's no light, right? And so our cortisol is kind of trend down. And, and, at the end of the evening, you're like, I'm tired, I'm sleepy. I'm ready to go to bed and your melatonin is up, your cortisol is down. Okay. You're able to fall asleep. Enter the modern woman. And 7 p.m. is when the like marathon starts. Shit is going down. You are giving kids a bath or you're putting, helping them with their homework. Then you're trying to get your work done for the next day and you're maybe having a panic call with your mom or like some other sick relative. And then you are trying to watch a show with your husband and then you're, then you're trying to fall asleep. And you're like, I can't sleep. Like I, or I fell asleep, but I'm waking up. Yeah. Between two and five,

like a couple of times. And so that is your cortisol dysregulated. And I think a lot of women, especially women in perimenopause, will notice that they're having a harder time getting that cortisol down, both lifestyle and their own hormones are. So as you know, estrogen is really great at dampening cortisol. And so as you start to get erratic estrogen levels, you're going to have an issue with cortisol. And then on top of that, your progesterone's going down, which also helps with relaxing and anxiety. So you have like a double whammy. And then you have some dysbiosis in your gun. We'll talk about what that is. And that's kind of inflammation. That's raising cortisol. And so your mind is just full because we have a lot on our plate all the time.

And often people are taking care of both their children and their parents. And they're trying to get rest. And we're just not biologically wired to be handling that much cortisol in the evening. So like even when I talk to women, I always say like your evening time, if you think about it, really has to be coordinated with circadian rhythms. That's why cortisol becomes a big issue. because then people are like, oh, just take a cortisol lowering supplement. But it's like way more deep than that, right? Because people are being told, oh, all you need to do is take this bucket and stuff and we're going to fix this. Yes.

At the end of your evening, if you do a whole cortisol lowering protocol, which includes having some downtime from your phone, which includes maybe not having the excited conversation, happy or sad with your family members, maybe shutting off the emails before bed and having a routine, that all can help you bring that cortisol down. And also do things to increase your melatonin so that you naturally feel sleepy. These are eat good foods so you can make more triptophan goes to melatonin, get more sunlight so that you can start to get sleepy at the end of the day. And so those are kind of some strategy. So cortisol is really, really tightly wound in this gut hormone brain thing. and it tends to be really problematic

because this is a time of life where we're actually facing higher levels of cortisol, but we're also facing higher levels of stress and that's why it was so hard to tease out. Which is which. What about insulin? So as you know, women become more insulin resistant as they move through the perimenopausal years.

So that means that women tend to have a harder time keeping their blood sugars under control. There's a lot more women that are pre-diabetic and have issues with metabolizing their blood sugars. My dad has five brothers. They're five. All five of them have diabetes. And they were all diagnosed as skinny men, like in their 30s with diabetes.

And so when I went into paramedopause, one of the biggest signs, first signs, was my hemoglobin A1C for people who don't know. That's like your average blood sugars over three months was creeping up. Same. And I was like, what is going on? I didn't know about the home IOR score about you. Yeah. Yeah. And I was like, what is happening? So insulin and blood sugar regulation also becomes a huge

issue at this time. It has a lot to do with the dysregulation that's happening between that gut hormone brain connection also. But it's something that we all deal with during paramedopause. And this is a hot topic right now, but what about appetite? Yes. So that's another thing that estrogen helps regulate, right? Your hunger hormones. And so as you're moving through perimenopause, you're getting less of that satiety feeling and you're getting more cravings, which a lot of women will say, you know, your natural GLP1 is going down. And so you're really having more of an appetite to eat things lots of times that are unhealthy for you because you don't feel satisfied. And those are gut hormones in there. So there's a big cross-talk between what's going on in there

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That's L-A-N-G-E-H-A-R.com and use the code unpaused for 20% off at checkout. What do you think are the biggest sources of inflammation for women in midlife? Well, one is just that estrogen is going down. Estrogen is an anti-inflammatory hormone. And I know you talk about it all the time because in various settings, it shows up. But this is one of the biggest reasons we are getting inflamed. And it's kind of a chicken in the egg because not only does estrogen cause higher levels of inflammation, it also causes dysbiosis, which is like your gut bacteria change and your gut is getting more inflamed.

So not only is estrogen going down, but now your gut is more inflamed and making your estrogen, making the inflammation go up and the estrogen is going down, making your inflammation go up. Right. You're in this negative feedback. Yes. then you're also maybe, you know, your dietary habits aren't the best. And so that's why- You kind of got away with it. Because my patients would come in and say, I'm not doing anything different. And I said, the system you built for your homeostasis worked

great before your menopause. You cannot expect this internal system that you have to function the same way. So we need to make some tweaks here so that you can stay healthy. 100%. And so what that inflammatory state that we're in. So part of the reason I talk so much about nutrition is like, one, we can control what we can control, right? We can control our food. We can control how much negative media and people we hang out with to lower our inflammation. And we can really do a lot of things to kind of go out in nature, get sunlight, lower our inflammation,

get more sleep. But there's a real inflammatory state that's happening there. and it's part of the process. What are some of the biggest myths that you see pertaining to gut health and women in midlife? That gut health is just gut health, first of all, that it doesn't have anything to do with your brain or with your hormones. And then that, you know, you can just take a probiotic or some kind of supplement to just fix it. So a lot of women don't realize that this is like happening in their body. It's like this big change that's happening.

So when estrogen goes down, some of the. bacteria that are dependent on estrogen die. And one of the things that happens is the tight junctions and the gut become looser. And so you get more of a leaky gut. What does that mean? Yeah. So it's like these tight junctions, they're not supposed to let anything in. So they're not supposed to let any food particles. They're there to protect us, right? They're there to protect the inside of our body. So our gut is the outside of our body because it is literally from the mouth to the anus. It is a tube, it's only supposed to let things in that we want, but we have a very tight barrier into our body. And the gut bacteria, by the way, that forms six to seven layers of protection. And so

that's why we need them. Because imagine your six to seven rows of soldiers were gone. And now it's just you. And that's what happens when we have. or gut health. We're left with just our own gut lining, which becomes looser. The cells between themselves, they have these tight junctions, which, like, you know, how it sounds, they're tight and they hold them together, so nothing gets through. But as estrogen goes down, you have a poor diet, you're losing all this gut bacteria, and all these, like, you know, intruders are, like, like, trying to stab at you and trying to

get in. And before you had like this big, long, like lots of lush people trying to protect you, like seven, eight rows of people trying to protect you. Now it's just you. Lots of people have something where things get into our bloodstream. Okay. So viruses, little piece of food, toxins. And so that itself creates a lot of inflammation in our body. So women will often feel things like intolerances.

So now gluten bothers them, dairy bother. certain foods that they could tolerate before now your body because a little piece of it got into your bloodstream and your immune system was like, oh no. What is that? Yeah. We're going to build a whole system to keep this out next time. And so there's a whole inflammatory response that happens. So that's basically why you want to keep that thick gut lining with keeping your gut back

to your healthy and happy and present and ready to fight. So the strategies for nutrition, at least from all the bulk of research we have, basically says the healthier you can keep those seven, eight rows of bacteria, the better off your body will be because they not only produce those happy chemicals, they help regulate your estrogen levels, and they communicate with your brain. They're keeping the communication levels like very, very strong. and they're keeping you happy and healthy. So like we need to keep that like whole system,

those trillions of gut bacteria, happy and healthy. So is that what dysbiosis is? Yes. So walk our listeners through how we get to dysbiosis, what happens? Is it something they ate? Is it something they did? And then how do we get back to normal healthy gut?

Yeah, that's a great question. So dysbiosis, a lot of people don't realize what that means. it basically means that the gut bacteria are unhealthy. So that whole analogy that I was telling you with the six, seven rows of soldiers, it means that they're either no longer there or they're much less soldiers or they're injured, they're hungry, they're not fed. Like it's exactly the same analogy like the Amazon jungle, like thinking of the lush green forest and then thinking of like a desolate jungle where half the organisms are dead.

And now, you know, you're trying to work like you're not. thriving with half of everything dead. So the real dysbiosis is basically that your gut bacteria are injured, dead or not present. There's lots of leaky gut happening because they're not present. And you'll get a lot of symptoms. Not only gut, but fatigue, you'll get hormonal symptoms. So this dysbiosis, because the gut talks to everything, will cause waves around your body. How do we make the diagnosis? So it's very, very hard. A lot of people that have SIBO, for example, What is Cibo? Small intestine.

S-I-B-O, small intestine bacterial overgrowth. So we're supposed to have this amazing Amazon jungle in our colon, our large intestine. We're not supposed to have a ton of those things in the small intestine. But when dysbiosis happens, meaning the wrong bacteria are there, less bacteria are there, they creep up into the small intestine and start to have, give you lots of issues, bloating, indigestion. And so CBO is like one part of dysbiosis. But there's lots of dysbiosis that are not diagnosed at all. Okay.

It's just IBS. What's the difference between CBO and IBS? So irritable bowel syndrome is when they can't really find Crohn's or disease like inflammatory bowel disease. But they, but you're having symptoms. You're feeling sick. You're feeling bloated. You might not either you're getting very constipated or you're having many bowel movements. And so a lot of times when you want to find dysbiosis, it's often just not even a diagnosis that you can find.

It's just that it's happening. And the reason I'm telling you about it or telling the listeners about it is that a lot of times when you actually recognize that, you recognize that in yourself or in your patients. And you're like, oh, so if you start to change that whole gut bacteria Amazon jungle in there, you can actually really not only help treat their gut symptoms, but all of their other symptoms that are happening. And then is there like a test? Like is there stool sample that you can do? It's really difficult. People have tried to do food sensitivity tests. People have tried to do leaky gut tests. What is a food sensitivity test? Okay. Do you do them? Yes. Food sensitivity testing has had a very, very difficult time because we all have them or lots of people have them.

but there's not a good test to look for them. Our immune system is very, very complicated. The tests we have right now are as good as flipping a coin. And a lot of people spend thousands of dollars. My friends have and been told they're allergic to all these things. Yeah, and things that they're eating all the time. And often you'll build an IgG to something that you eat all the time. And that's fine.

And what is IgG? immunoglobulin G is something like part of your immune system. So you'll have an immune response to a food that shows up on these tests. And they'll be like, oh, you're having an immune response to this food. But what we found is sometimes that immune response is a benign response. And it's your body was just like, oh, you eat this food all the time. Let me just build some antibodies to it. It's literally not a negative thing.

It doesn't, and it doesn't act on it. And so you're getting these test results that are, 50-50 chance of being right. So no, no good food sensitivity testing as of yet. And no good IBS testing as of yet. No good dysbiosis testing as of yet. So kind of like perimenopause. We don't have a great blood test for perimenopause, but you just have to listen to the patient, believe them, rule out the other things. Absolutely. And have it in your clinical acumen to make the diagnosis. Yeah. And if you arm women with this knowledge, right, then they can say, oh, wait a second, I didn't even ever think about my gut bacteria before. Like, I didn't even know they were

connected to my happiness and brain. And I'm like, look, the bulk of the science says if you're eating probiotic foods, like fermented foods, you'll be happier. Maybe you don't care about your gut, but you care about being happier, you know. And so that's why you should start eating them. And so that's why, like, I created this like plan in the book. It's like 30, 33. And it's basically 30 grams of protein in your first meal like breakfast, 30 grams of fiber throughout the day, and three probiotic foods. So I have a friend who listens to a certain longevity bro online a lot. And she's always quoting him to me.

And through one of his podcasts, she did this test that looked at her genetics. And like, you're looking confused. Like, I had never heard of it either. And she's a smart woman. Like, she's a dermatologist and she's going to kill me for saying this. So she took some kind of a test, the blood test or something she sent in that looked at her, DNA and said, oh, based on your genetics, you shouldn't be eating these foods. And one of them was gluten. And she swears up and down now that she's gluten-free that she feels a lot better and her gut is

healthier. And I was like, I need to ask Dr. Shaw, not this. There's no good DNA test. And I know, I know that they're available. She does feel better, not eating gluten. Yeah. And here's a thing. That's what I hear all the time. Because when we looked into this data and there's many, many reports on looking at how accurate These tests are looking at, you know, are there any accurate tests? Like, there's no accurate way of knowing what your immune system is doing inside your gut. This whole world that I told you about where they're talking to each other all the time, talking to the hormones, talking to the immune system, talking to the brain. We are just discovering that they even do that, much less what they're saying.

Like, we don't even know. Like, they're, I think. So save the money? Yeah. Like 2025 was the first time they even. discovered that the gut bacteria have a unique language, unique way of talking to the brain that is outside of hormones, that's outside of immune system. What are they? It's like, it's like a new way of communicating. Some signal that they're screaming. Yeah, that they have us. So not,

not only do they talk to each other in like five different ways. Now there's a unique other way. And we're just finding this out like in 2026. Okay. We can't predict what the immune system is going to do with a particular food or our genetics don't decide what a particular food will do to our system. You can tell your colleague that honestly, the best way to figure it out is by doing a food elimination diet like she just did. Eliminate a food from your life, the top foods, dairy, gluten, you know, and take them out for four to six weeks and then add it back and see if it comes back, that's intolerance. And that's the only, that's a gold standard.

is a food elimination diet. Okay. So doing a food elimination diet will save you a lot of money and a lot of time and will prove whether or not you are sensitive to that food. I want to talk about your pillars. The big three. And we are so sympathetico on this. Yeah. Protein, fiber, implant diversity.

Yes. Are those the three you think most women should start with? Okay. So actually my 3033 takes into account the protein, the fiber, but adds a probiotic. component. Okay. And that is separate from the plant diversity because you, yes, you want diverse plants, but you particularly want the fermented plants. Okay. Why? Why? Because fermented plants such as kimchi, sourcrow. And you can do fermented dairy too. Like yogurt is our favorite, easiest kefir probiotic cottage. Even raw apple cider vinegar is counted in that kind of probiotic

food, fermented foods. So fermented foods are really special. Every single culture in the entire world has some form of fermented foods. There's even evidence that before there was like rotting fruit and we would go for it. We would want to eat it because the fermentation that's happening in the rotting fruit, those bacteria actually go and help those that gut army that we have in there. And so fermented foods have been around for thousands of. of years, except that now there's no need for them to exist because fermentation is a way to preserve foods. And before we had refrigerators, and before we had other ways to kind of hold foods safe in bottles and jars, we had to ferment them. And that was the only way we could preserve things.

Yeah. And so every single culture learned how to do that. And it was really great for our gut, because we need more microbes. We need more bacteria. In fact, we have evidence that not only do you want to eat more bacteria, you want to be around more bacteria as much as possible because the more you can seed the gut, the more you can make it look like that Amazon jungle that's thriving, the better you will thrive.

Okay. I think those are the fundamental things that you need to do in your diet to actually thrive. So the fiber, 95% of people are not eating enough fiber. Okay. Let's break this down. How much protein? Yes.

How much fiber? Yes. Pre-fermented foods a day. Okay. So in terms of how much protein. So I decided for my framework that I was going to stick to just the morning protein. And I'll tell you why. 30 grams of protein in your first meal, make it breakfast.

it changes your brain. It makes you more motivated, more satisfied. Why? You get more leptin. You get more satisfaction at the protein at the beginning of the day actually has special impact. After a fast. Okay.

So you wake up in the morning and you have protein at the beginning of the day. It has a great effect on your body. Not only will you have more likely to get the total protein for the day, you're more likely to feel satisfied and not craving. Your blood sugars are regulated, so you're not super hungry. And then you're also most likely to feel energized for the day because protein actually helps your brain feel happy, satisfied. It's like those motivated focused feelings come from having adequate protein in the morning.

Okay. And then you're going to have fiber. Fiber is like, I think we get 12 grams on average. Yeah. So 95% of people are not getting the 25 to 30 grams that are recommended. I say 30, 33, because you're getting 30 grams of protein in the morning and then you're getting 30 grams of fiber throughout the day. And 30 grams of fiber, I believe, can really transform your life and your hormones and your brain. Most of us don't even realize what fiber, like what fiber is.

Like when I talk, when I do speaking engagements, a lot of people are like, great, fiber. Like what supplement? And I'm like, what do you mean? Same. Yeah, and it's good to, I mean, there's a place. There's a time and the place for that, right? But we have not been educated enough about fiber, about that. Like when I say blueberries and raspberries have fiber,

avocados have fiber, people are like, what? That's what I love about your social media content. You give these really snackable, no pun intended, digestible solutions. Like, here is what this looks like. Here is how to get this in the diet. And here is why. We don't need to have a very complicated diet plans or like, you know, longevity protocols, as we say. We need to have things that are going to make a big difference.

that we can do in our everyday lives. And I mean, the data on fiber is like if you have one tablespoon of chia seeds, which is five grams of fiber, five grams of fiber added to an average person's diet is going to improve their longevity. And their cardiovascular health. I mean, it's really amazing when you look at the quartiles of like how much fiber is a person eating and what is, how likely are they to get Alzheimer's? Like that article blew my mind because, you know, my mother and my grandmother spent, you know, my mother is in a memory care unit and we're college, she's about to go into hospice. Oh, I'm sorry. So, you know what? She's had a great life, but this last few years has been a slog. And so I'm very invested in like, what can I do for

Alzheimer's prevention and what is the majors and what are the minors? Yes. That's exactly right. And so fiber is a major. Yeah. Like huge. Also for my heart health, you know, and my gut health and all of it works together. And your hormone health. Keeping the estrogen I'm sapping through my skin in my system. Yes. Yeah, exactly. I don't think people realize also that even if you are taking hormones,

like you say you're on menopause hormone therapy, you need to keep your gut in really great shape so that this can be absorbed so their body can interact with those esterbalome can get rid of what's not needed and add back what's needed to absorb to thrive. You actually need a healthy gut microbiome. And so I think that is fundamental for brain health, for hormone health. And then the probiotic foods, I think, is such a new concept, but it's not. It's like an ancient concept that's coming back.

I always think of probiotic foods as like the sunlight thing. Like it's simple, free and it was so available all the time to everybody before. And now it's like we have to seek it out, right? Like we have to seek out time to get sun. We have to seek out time to actually find fermented foods because we don't really eat them in our diet anymore. And getting, I picked three because that's what the research shows is you should be having three to five. And I'm like, go through the list again of fermented food. Yes.

Okay. So kimchi, sourcrow, yogurt, probiotic cottage cheese. So like the Dannon, like strawberry flavor? The one with the chocolate chips, like skip it. There's a lot of yogurts in the U.S. that actually don't have probiotics in it. How do you read the label? Yeah. If you look at the back of a label in the U.S.,

it has to write if there is live bacteria in there because they need to disclose from their food rules. And it says acidophilus, right? It will say whatever bacteria, acetophilis is one type. Bifidobacterium could be, it could be, you know, lactobacillus, it could be any bacteria. But it has to say that there is live bacteria and what the type is. Like it's a labeling rule. And so that makes it easy for us. If you're looking for something probiotic and you look at the back and there's no bacteria in it,

it's not probiotic. And so kombucha is a great probiotic. Raw apple cider vinegar, like I said, is a great. With the mother. Yeah, you'll see the stuff floating on the bottom. Yes. It looks. Those are great probiotics. I love yogurt and cottage cheese because they're so easily accessible.

And cottage cheese also, you have to make sure you're getting probiotic cottage cheese. There's non-probiotic cottage cheese. Again, you have to flip the label over and read. And often they'll say probiotic cottage when it's actual probiotic. And then kefir is like. like fermented yogurt, which is another thing that's very common in Europe, but not very common in the U.S. And so you can get that now from really any grocery store. I've seen it in basically every single grocery store. So there are some more options for people to incorporate.

And honestly, three servings is like one spoon when you're doing like kefer. Wow. It doesn't take much. Yeah, you don't, it's not like you're eating like a full huge bowl of kimchi. You know, it's like one tablespoon of kimchi, you might be adding a like two tablespoon of kefir into your yogurt, half cup, and you're having, you know, like, it's very, very easy once you put your mind to it to even get one or two. So in getting

three is like kind of a goal. Same with the 30 grams of fiber. It's really a goal that you're working towards. So I think of your probiotics is restocking the pond. Yes. You know, and then fiber is the food. Yeah, it's the food for the fish. But what's the difference between I read about soluble fiber and and are they both important? Because I literally

was at QVC with the weighted vest. Yes. And there was another physician there selling some supplements. And I heard come out of his mouth, well, you shouldn't be eating insoluble fiber. It's unhealthy for the gut. And he was saying soluble was healthy because he had insulin in his supplement. And then you shouldn't be eating all this insoluble fiber. It's unhealthy.

And I was literally in the green room going, no, no, no, no, no, I think you're wrong. Yes. You want both types of fiber because, you know, you're insoluble. I'm like, did I miss something? I know. So your insoluble, like makes you poop. And the soluble one, like the one he was referring to, like the inulin or like the chia seeds, for example. What they do is they help regulate blood sugar.

And they help make you feel fuller. And they have a lot of roles. They even modulate cholesterol. So there's a lot of rolls for soluble fiber that are great for you. But you need both. You need roughage and you need soluble fibers. Like think of your blueberries and raspberries. and then the insoluble is like the rougher fibers,

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Taged in a million things that I'm sure you do too. So walk me through the biggest nutrition myths you think are harmful. Because there's some things that are like, eh, neutral, but like what do you think we're getting it wrong on the internet? Okay. So there's a few things. There's, I think the cleanse trend is really coffee in a man. Oh my God. It's so critical. crazy. So I'm all, yeah, I think cleanses in general. So like, I just did a whole thing on. So there's Sena in a lot of these cleanse pills. And what is Sena? Sena is a natural. So it's a lot of these are natural cleanse, you know. And Senna is a leaf. Basically it gives you diarrhea. It just makes you poop. Sena cot. Yeah. And so it's great if you're trying to like one time poop. But what happens is when you're

taking a lot of these cleanse pills maybe for a week, two weeks, three weeks, you are actually causing a problem in your gut because what it does, it actually forces the gut to contract. And when you start to force the gut to contract and you stop using it, your gut doesn't contract anymore. And so you're like, oh, shoot, I need that stuff again. I need the cleanse stuff again to go again. And then you're taking it again. And now you're dependent on it. If you looked at the inside of your colon, it turns black and it looks like a spotted, we call it a Louis Vuitton colon. It looks like a spotted Louis Vuitton bag. And basically because some of the cells on in your gut die and fall off and create this kind of dark area. And that's from chronic Sina use. Yes. Yeah. And so one

time here and there, no big deal. But that is like a lot of the cleansing that we're doing, even the colon cleanses, the cleanses with Sena, the coffee enemas. I mean, that kind of stuff is really dangerous and can do a lot of damage to the body. Well, one nutrition myth I think it's like that we're just talking about here is that that hormones are completely separate from nutrition, that there is nothing you can do to help your hormones through nutrition. I think or that it's its own little category is something that I think a lot of people need to understand that, hey, like, this is really, really important. It's a fundamental thing that you need to be doing.

We put food in our mouth at least three to five to seven times a day and you have this chance to actually change the trajectory of your life because it's going to help your immune system. It's going to help your hormones. And it's going to help your brain. So that's a really big one. All right. Let's talk about fasting. Yes. I think you were fasting MD for a long time.

And I was a huge, you know, back when I was putting a toe in the water and nutrition and learning and looking at what studies were available, I was very positive about fasting. But I have to say back then, my whole focus before I really understood nutrition and body composition was weight loss. Yes. You know, to be honest, women were getting weight in menopause. I was getting weight in menopause. And there was decent data I felt on fasting. but I've not had a reversal, but I've had to, like, expand my understanding of aging and nutrition and what our goals are. But when is fasting good and why?

Okay. This is a great time to talk about circadian rhythms because I'm going to be talking about fasting in accordance to circadian rhythms. Okay. So circadian rhythms are our day and night cycle, and our bodies, 75 to 80 percent of the processes in our bodies take input. from the circadian rhythm. So when our thyroid hormone gets released, when our melatonin gets released, basically every single hormone in our body depends on circadian input. And so we need sunlight and we need darkness. And we need to get that because we need to feel attentive. We need our hormones to work well. We need our gut to work. Even those gut bacteria that can't see the sun,

they get input when you get sunlight and they get super happy. So the sunlight is really, really important. We also need time to repair and renew. So we need darkness. And with darkness should come fasting. So the reason I say this is that, again, the way our bodies were programmed pre-internet were programmed, around 8 o'clock is, and you look at every study, it's around 8 o'clock-ish in your local time that your body starts to shift into a different mode. And so your, you're insulin, your pancreas is told to turn down the insulin and to start repairing because you can't do everything all the time. If you were getting guests all day to your house, like you would never be able to clean or repair anything. And so this is a time that your body naturally says like, all right,

it's dark. You know, the human probably finished their dinner. There's not going to be much coming now through. This is our time for us to repair renew. So our gut is going into repair mode. Our muscles are going into repair mode. Our brain is shutting down and going into a different mode. It's still active, but in a different mode. And so when you order Uber Eats at midnight and you have this huge, like, dinner with five courses,

you are really giving your body a big, big load at a time that it's already shut down all its processes. It was like, if someone woke you up in the middle of the night and asked you to do a complicated math problem, you would be like groggy, you might not be able to do it, you might be able to do it, but it might take a lot longer.

And then in the morning, you're like annoyed and tired because you got woken up in the middle of the night. And that's exactly what happens when you're eating this huge meal super late at night, when you should be sleeping and resting and renewing.

So long story short, then if you're trying to time fasting, you should eat an early dinner, have two to three hours break. before going to bed. Okay. Then you're sleeping and you're getting up and you don't need to roll over and have a pop tar. Like you can wait one to two hours.

Again, very, very evolutionarily, you would wake up in the morning. You might for it. You might have to make breakfast. You know, like there's a little bit of break between the time you wake up and you get something in your mouth. And so that's the fast. Is coffee okay? Yes.

Okay. Your fast is really based on circadian rhythms and based on your biocating rhythms and based on your biology, not anything else. Is it different between men and women? Yes. Yes. Women, we have a spidey sense for stress. Okay.

Meaning that women, when they sense that our body is undergoing stress, it kind of shuts down. Fertility, it's going to shut down. You know, there's a lot. Put you in a preterm labor. Yes, exactly. Stress. Women are, uh, handle stress differently. And we think biologically is because of our ability to carry.

children, our ability to get pregnant. You wouldn't want to get pregnant during a war or a very stressful time, right? So we're very attuned to stress. And so that's why doing stressful things, especially in perimenopause, because not only are you more wired to be stressed about things like this, you are also more likely to be stressed in perimenopause. Your stress resilience goes down. And so the same hit workout that you were doing every day. day without enough sleep and you're fasting 16 hours. It may have worked for you back then and it's not working for you now. My most difficult patients, or at least the ones who have the hardest time to like understand what's happening in their bodies and understand what's being

rewired are the athletes who were like, uh-uh. Yes. I was always in control of my body. Yes. My body did what I told it to do. I was an elite athlete and they, especially the triathletes, you know. They have a hard time. hard time. I don't know if you found the same thing. Yes. Women athletes. So there's a lot of people on the internet actually who say women must eat before they work out or they shouldn't fast at all. But I believe that biologically we're very varied. And day to day in our cycle, we're very varied. Right. So if you wake up and you're starving, yes,

absolutely go and you don't have to fast at all. If you wake up and you're like, I can go for my walk, my morning walk and eat after, great, do that. There's a lot of people that think that, like, you cannot fast as a woman. That's not true. Or that you should fast as a woman. That's also probably not true. And so you want to be really listening to your own rhythms according to your own part of the cycle where you are in perimenopause. So what about postmenopause? Does that change at all? Yeah. You have a little bit more stress resilience at that point. Your hormones are more stable. And so if you want to try a lot of my patients who are postmenopause have an easier time doing a longer fast without as much of a pushback from their body. And so I think everyone should be

doing a circadian fast. I think every single person, whether it's 12 hours or 14 or 15 hours, at some level, you need to fast while you're sleeping. You need to give your body a little break. I mean, when they looked at time logs and they looked at people's blood sugars and they actually saw how many hours a day people eat, they're not, most people are not stopping food for, they're only stopping for eight hours or seven hours. Literally just, they're eating right the second they go to bed and the second they wake up. So even if you stretch that out, like 12 hours sounds like easy, peasy, but it is not based on what most Americans are doing. So I tell my patients, listen, you know, they're like, oh, I love fasting and live fasting, but as long as you can reach your nutritional goals.

Yes. In that window, if you were struggling to get enough protein and get enough fiber and, like, give your body enough of all the vitamins and minerals and nutrients, you need to open that window up to make sure you can fit everything in. And Mary Claire, in the last few years, one of the things that's also changed my mind so much about like OMAD, which is one meal a day, is that study after studies coming out, whether it's intentional or not, the people who skip meals all day have worse health outcomes. diabetes, cardiovascular disease, brain disease. It's hard to do causative. Like some people don't eat all day because, you know, they're stressed. So maybe like there's lots of other factors playing into it. But study after study that looks at people who skip meals all day, they just have worse

outcomes. It's just you are meant to be eating when the sun is out. Just like roughly. We don't have to match it. You're roughly meant to have the biggest meals of your day in the day-time hours. and you're roughly meant to be fasting in the darkness and nighttime hours. And how you time that, for me, the way I've told people to do it, is that two to three hours before bed, just stop eating.

It's great for your digestion, great for your blood sugar, great for your brain, great for your sleep. Two to three hours before bed. So if you eat dinner at seven, you're going to go to bed at nine, probably want to take a walk or something before that, help your digestion, help your blood sugar. And then you're going to wake up and you're either going to be. going to eat right at nine, which is 12 hours, or you're going to eat at 10 or 11, you know, stretch out that fast a little bit so that you have a great night of rest and repair. And that's how you should time it. And then if the next night you want to eat dinner at six

and you get hungry right when you wake up, like go eat. If you're hungry eat is why I tell my patience. Yeah. Like listen to your body. Yeah. And if you want to, you know, stretch it out to 15, 16 hours one day, go for it. As long as you're not stressing your body out too much. So like I feel the same way about high intensity exercise. So I used to go to one of those popular chains. Orange dairy. And I would skimp on sleep. I just thought sleep was like for people who were unmotivated

and that I would sleep when I was dead. I'm an obstetrician, I get it. Yes. And I was wearing this like the title of like, I'm a martyr for my patients and my family and like I need to never sleep. So I would go to this workout every single day. And I would have tons of coffee after. and I would have a stressful day all day long, pick up the kids, super stress, and then I would

repeat the next day. And I was like, why am I not getting the results I want? Like, I'm not getting stronger. I don't feel like my clothes are fitting better. I feel more depleted than ever. And that's the same concept. Like, your body is needing a recovery from these kinds. I think this is where women are driving them. So I find there's like two camps. And there's, there's, there's very little middle ground. Some women are just like, I have no time for this. I have no time to work out. Like they're so stressed out that they are eating whatever's available and fast and quick because they're struggling to find the time to meal, you know, they don't know how to do it. And, you know, this is fine. It's said healthy on the package. So here we go. And, you know,

so hyper-scheduled with everything they have on their plate, there's no time to like focus on exercise. Or people who are like so rigid driving themselves, giving themselves medals and badges for suffering, basically. What is the middle ground? I know. I'm struggling every day. Honestly, I'll be honest with you. This is the reason I wrote the book.

I actually looked at the Menopause Society clinician handbook. No chapter on nutrition. Okay. I looked at all of the information for women's health. No information about, it's like very general. Like eat healthy. We have no, you know, like, I was like, how are people supposed to know if they don't even.

know what healthy is, like you said, like if it says healthy on the package, does that count? Like, yeah. You know, so what is healthy? So the 30-33 is basically my attempt to say, hey, looked at all the literature, looked at everything that we could be doing. These are the three things that if you had no time, you could try to get to. You don't have to get 30 grams every single day on your first try. You don't, you know, 30-33.

You can, at least you have a framework to work towards. And you can be vegan, you can be paleo, you can be carniv or whatever you feel like. doing, but get there. And that's why, because I thought to myself, I drove myself crazy. My patients drive themselves crazy. Nobody's giving us this information. And where are we supposed to go? There's no guidelines. There's guidelines for pregnancy. There's guidelines for children. And you said, even the guidelines for pregnancy aren't great. Antigrated at best. At least the last time I did OB, which was about 10 years ago. So there's no guidelines for women. It's really confusing because there's like a thousand other messages that we're getting in the meantime.

So I was like, what if we like cleared out all the dust and like just said, where's the evidence the strongest? And that's there. And then you mentioned plant diversity. I talk about that in the book. But I didn't include that in the 3033. And the reason why, one, there's just, then it's just too many things. And two, it seems overwhelming. So the data, as you know, it shows that you should be having like 30 different plants.

A week. A week. I mean, that came out as always data. Yeah. And everyone thinks, oh my God, like, I could never do that because they don't understand that, like, spices count and, you know, herbs count. And, like, you, if you use a Trader Joe's, like, everything but the bagel seasoning I counted, there was, like, six in there. You know, so it's not so hard to get that, but it's real, I mean, you tell it very stressed out, like, my old me would have been like, I'm not doing that. Like, there's no way I'm doing that. That just seems too much.

old me was like less. Everything is less. You need to eat less. Less. Less. Less. Like the concept of smaller. Yes. It's so new. Yes. And so free. Yes. How do you feel about body composition? Or do you use the scale? Yeah. Okay. So lean. We know that we lose lean mass and gain adiposity in the wrong places. That would be fat. Yeah. Yes. And we get fat around our organs. And we get fat around the midsection, which is the dangerous area, and we lose lean muscle mass, which is our little bit of muscle that we had that peaked, you know, at 30. Yeah, exactly. And then we've been kind of fighting against the loss of that. So I do think it's really important to know your bone density, to know

where your lean body mass is. How early should someone, and I'm not talking about the guidelines. Yes. I think we agree that the guidelines do not serve women for bone density as far as when to screen. When do you screen your patients? I mean, I think nobody gets screened until usually like their 60s and 70s. It's like insane. Most women don't get screen at all. Yeah. And they get the first time they get until they break. Yeah. And so I think perimenopause. My mother has never had a bone density scan in her life. Well, my mother only had it because her, her mother had multiple fractures from osteoporosis. And so they were like, oh, you might be at higher risk because, but she didn't get it until she was in her 60s.

So where should start this is perimenopause? Have you had one? I have had one. I have perimenopause. Yeah, I agree. We need to be watching that. Yeah. You need to know where you're starting.

Yes. Because naturally, we have our peak bone density in our late 20s. And then it just time, aging process, we lose. So if you were a child athlete or a gymnast or did something where you were constantly having resistance training, you're going to have higher bone. math typically. I have so many patients who were incredible long distance runners and they are really struggling with their bone density. Yeah. And the bone density thing. So tell me what your thoughts are because when it comes to exercise, for example, you know, we're always trying to tell people to really pull, you want to pull on your muscles because they pull on your bones and you get more

bone density. And there's certain exercises that really help obviously weightlifting. Yeah. So lift more trial. They did squats. They did dead lifts. Yes. They jumped and then jumping pull-ups and then let go and fell. And they did a couple of other things. I think those are really great. But I think the debate happens when it comes to like Pilates and yoga and all those things. And I think that there is a very good place for Pilates and yoga. But I think it has to be mixed in with the weight treat.

Right, right. Variation is the key to. It's like 30 plants a day. Yes. It's like 30 exercises a week. I've really had to rethink. And for my patients, too, you know, really rethink. because again, before, it was thin, thin, so I did a ton of cardio. I was a runner. I walked. I, you know,

those are all great things for my heart, right? And so when I talk to my patients, I'm like, are we, what are our goals here? You know, so we need to have a strong heart. We need to have strong bones, strong muscles, strong brain, and those are all different things. Yes. Right. So in general, we say 150 minutes of some cardio around zone 2-ish. Okay, we have great data on that, great data on women, great down on women and menopause for heart health. However, for bone and muscle strength, we need to add to that at least two days, not three, of really serious resistance training. We still need to do some sprints in there. Doesn't have to be much to get that V-O-2 max up. Like, this is what it takes. I like to have it stack. My daughter habit stacks, you know.

And so like I'll be walking on a treadmill while I'm working. I'm doing Zoom calls, elevated with my weighted vest on so I can hit more of those goals all at once because I don't have a lot of time. Yeah. I actually did a framework for exercise too because I knew that if I was going to give nutritional framework, I have to give some kind of thought. And I basically said what I do. Basically, what happened is when I looked at the research, it looks like you're right, three days of weight training is ideal for women in parameda. So I have a four, three, two, one. Okay. So four days of four days a week, you're going to be doing the movement that you love, the walks, the hikes, the dancing, the thing that you can do well into your 80s and 90s, like the things that when we look at

longevity and we look at people who are really thriving and they've, you know, swam all for 25 years. Yeah. So if you love nature walks, for me, it's nature walks or hikes. Like, great, four days a week at least you want to do that. And then, if not more. And then three days a week, you want to do the weight training slash resistance training. So three days a week, you want to definitely incorporate that. The two is new for me in the last couple of years. It's heat therapy, hot, either sauna or hot yoga or something that gets my core body temperature up for 20 to 30 minutes.

What does the data say about that? Yes. So sauna, we have finished data. So in Finland, almost everybody uses a sauna. and their health care system is great. They have data on hundreds of thousands of people. And they have great data on the association of sauna use and cardiovascular disease on brain health and on longevity. So what do you think the, what is the physiology here?

Why is me sitting in a hot box going to be helpful? So when you raise your- I hate sweat. When you raise your core body temperature, something called heat-shock proteins get produced. And when heat shock proteins get produced, it's usually after about 20 minutes. They think that it's not like immediately, but when your body's starting to really warm up in the core. And these heat shock proteins, it's protective for our brain health, for our cardiovascular health. And they don't even know exactly why that would be.

Some people think it's like exercise where, you know, when you exercise, you get this. Not only are you moving your muscles, but you get the secondary benefit on longevity. and heart health. Okay. And so it's secondary benefit, anti-inflammatory benefit. So that's the mechanism of action. So what they found is even if you,

in Japan, they have data on hot tops, like in a hot bath, 103 or 105, that was the same thing. They show that they produce heat shop proteins and then that has a protective effect on their brain and their body health.

And so, and then they found it with other various forms of heat therapy. So the data is pointing to the fact that there is some kind of association between heat and raised growth hormone. Okay. Protective inflammatory, anti-inflammatory compounds, these heat shock proteins. And so incorporating this into your life two days a week is something that I've started to do over the last few years. How do you do it?

Either hot yoga or sauna, dry sauna. Dry sauna is where the finished data came from the drug. dry sauna data. So if you want to follow how they did the protocols, it would be like 167 degrees in a dry sauna. There's not a lot of debate now that there is good data on heat therapy and all these outcomes. The exact methods to do that are still debated. Like does red light, you know, saunas, infrared sauna count. Does, you know, going on a run in a hot like day count, you know, there's a lot of like that. We don't exactly know, but we do know that there's a lot of, lot of association between heat and longevity and better outcomes in heart health. So we want to do that.

And then the last four, three, two one, the last one is the sprint. Five percent of people, like 95 of people don't sprint after school age, you know, after college. Isn't that crazy? The data around that? It's crazy. It'll never run again. Yeah. And I thought about it for a few minutes. And I was like, you know, it's so funny because when I switched from my high intensity workouts that weren't working for me and I started to do more walking and like weight training, I wasn't really sprinting at all. Me either. Yeah. I realized I wasn't my V and I went and got my VO2 max and it had dropped. And I was like, I'm not doing sprint training anymore. And you need that as. Yeah. And so women, we were getting more and more, you know, studies coming up that's like like women actually benefit. So how much, how often,

how long, what does the one mean? So one means just one day a week because I was like, everyone's doing zero days a week. So we got to do one. And because of the data, actually, I think it's out of U.T. Southwestern, the study that you can reverse the age of your heart by 20 years, up to 20 years, by doing a exercise protocol. Four by four. So it's the Norwegian four by four sprint that they put in there. So there's basically what happened for people who don't know the study. They took people who are sedentary. And they put them on a two-year exercise program. And for the first year, they just worked up. Like, they just started to do little ways, little cardio. But at about the year and a half point, they started to add in one day of a sprint workout. And this was the

Norwegian four by four. And they, at the end of the two years, they tested everyone's hearts. And from the beginning of the study to the end of the study, they saw drastic differences in how their heart functioned. And it looked like their heart had anti-aged, like 20 years from this exercise protocol. And what I, what the researchers kind of said, like that last little piece seemed to be, they think, was the thing that really pushed them to the next level. So what does a Norwegian 4x4-4 look like? So everyone's like Googling it right now. He's listening. Norwegian 4x4 is really difficult. Okay. I don't recommend that you start with that. Yes. It's four minutes of high intensity work at 85% of your max heart rate. So that would be like running or, you know,

doing some kind of heavy, high intensity workout, cycling, running, whatever, for four minutes and then giving yourself a break for three minutes and then going back to doing the four minutes and doing that four times. So that's a really, really intense high intensity workout. How I would start is I kind of talk about how I started because I was like, or I can't, four minutes. like running as fast as you can for four minutes. That's like a lot. Yeah. So what I did is I went for my first sprint.

Like I did a jog, walk sprint. And I would do 30 seconds of the sprint and then take a break. And then I did that for eight minutes. So you got four minutes of sprinting in there. And that's how I started to work myself up to that protocol. I still don't use that exact protocol. Yeah. I still haven't made four minutes.

Yeah. I basically, you know, I do like a 15-minute warm up before I start hitting the weight. It's not every day. And I will, you know, walk for the first lap, like on my treadmill. And then I'll always want to do it on an incline because I'm always trying to grow my leg muscles. And I will just sprint flat out until I think I'm going to die. And then turn it down until my heart rate comes back down, stable for a minute and then go back up. That's exactly right.

And I'll do that for five, four or five rotations. Yes. And that usually takes about 15 minutes. Yes. I do this thing called Crazy Eats. I don't know, it's an old exercise, but it's the same thing. Like every, do this sprint eight times for like 30 seconds to a minute, however long you can sustain it. And keep it at 85% of your max heart rate.

So you're really pushing your heart to the max. Like that's like the goal of this is trying to grow and strengthen that muscle. Okay. That is our heart. Let's talk about hormones. Yes. You've said that lifestyle matters, but it's not a replacement for medical care. How do you help your patients and your,

followers understand the role of nutrition alongside with HRT because everybody wants a quick fix. Yes. Tell me what to take. Tell me what to do. But I think they're missing the symphony of this. Yes. It's an and. Yeah. And you do this so well. I think for far too long, we were kind of like not given that option of hormone therapy. And so I think having that discussion with your physician is extremely important and to have that option and to know what your options are. And that goes along. That doesn't mean like you don't do the nutrition part. And it doesn't mean if, you know, you do nutrition, you can't do hormones because, you know, it's natural. Some women are being told all this, but I just want to lay that to do that right now. But I do

people to understand if you go on hormone therapy, it's going to stop your hot flashes. It's going to keep your vagina healthy if you do local and all that. But if you're really looking at longevity and you're not covering that lifestyle piece, the heart health, the bone health, the muscle health, the brain health, you know, through your nutrition exercise and your lifestyle choices and the like really intentional cortisol lowering things. Yes. Then your likely hormone therapy is likely not going to affect your longevity more than 18 months or so.

Yeah. At best. And I think that's, I'm so glad you said that because I think there's a lot of confusion around, you know, do we do one or the other, do we do both. Some people are very against doing, you know, know, hormone therapy, but I think there's a lot of swing the other way, meaning that a lot of people are very excited about hormone therapy, but then it's really hard to do the other stuff because, you know, you can't tell you how many DMs I get. Like, I started HRT and I haven't lost any weight.

Yes. And I'm like, oh, God. Okay. I know. We got to start over. I think perimenopause is a really good time to optimize your diet and lifestyle and start to really dial that in so that you can actually separate what's happening from your hormones because going on a really healthy diet and changing your exercise protocol and even decreasing your stress is not going to stop hot flashes. They might get a little better. They're not going to stop, you know. You're not going to stop menopause. Yeah.

And so like you can make it. Yeah. It's like you can maybe make yourself as well prepared as possible during perimenopause. And you can make yourself, you know, give yourself the best chance to. thrive, but you need both. And I think at, you know, perimenopause is the perfect time to prepare your body for that. What's one thing a woman can do this week to improve her hormone balance? Oh, gosh. Or five things. Okay. Eat the 30-33. Okay. Just takes a couple of days. Like I said, your gut is super forgiving. It forgets. It actually dies off very quickly.

Now their half-life is very short. And so you'll start to get benefits right away. And then another thing that I think it's surprising thing I'm going to say is that morning sunlight. Like getting your circadian rhythms in check is going to improve your hormones and your energy levels and your mood within days, if not a day. So getting that morning sunlight is something you can literally do. What does that look like? Do you have to stand in the window? Do you have to go outside? Do you have to, you know. Two to ten minutes. Okay. You can do more if you have time. I like I love it when I have a little time to go for a walk in nature. But if I don't, it's brushing my teeth outside for two, three, four, five minutes, right? And you want to be outside. Their glass blocks some of those

rays that you need through your retina to your super chasmatic nucleus. So you want to get it straight. I've done it and I know other people will do it where I lower the window of my car for like a couple of minutes. And I'm like, looking at how. because that's all the time I have. Yeah. But ideally it was like it's, you know, get a couple of minutes, have some, do some mindfulness. Do you brush your teeth.

Do your stretches. Do your jumps. Yeah. Just get your body moving for two to ten minutes. And that's it. Morning sunlight. And then you're done. You want to get total of one hour total a day for optimal health.

And but that can be broken up into pieces of 10, you know, dog walk, whatever. So when you want to really optimize your horse. hormonal function, your digestive function, your muscle function, try to get as much sunlight, natural light as you can. And you don't want as much as possible, you want that straight to your skin, not in your eyes, not through a glass or sunglasses as possible. Anything else you want to share with our audience? How can they find you? Okay. So the book is called hormone havoc. It is available everywhere books are sold. And my Instagram handle is Dr. I, Amy Shaw at Dr. Amy Shaw. And that's TikTok and Instagram, although I hang out more on

Instagram. Me too now. Yeah, you're kind of fun both. And then Amymdwellness.com is my website. Okay. Thank you so much for coming on on pause. We've learned so much today. I'm so grateful. Thank you for having me. You can find full episodes of Unpaused on YouTube at Dr. Mary Claire. I'd love to hear from you about this topic and anything else that's on your mind. You can find me on Instagram at Dr. Mary Claire and get honest and accurate information on health, fitness, and navigating midlife at thepawslife.com. Unpaused is presented by Odyssey in conjunction with pod people. I'm your host, Dr. Mary Claire Haver.