"What is the estrobolome?" with Cynthia Thurlow

Speaker 1 [00:00:00] Our ovaries set the pacemaker of aging in our bodies full stop. Why is no one talking about this? Because we have been looking at our ovaries solely as this fertility organ.

Speaker 2 [00:00:14] You

Speaker 3 [00:00:18] So another thing that we like to do every episode is something that we liked to call myth or method. And in this segment, we talk about something that's kind of come across our desk that we want to see, is it legit or is it BS? So I have a good one for you, Mel, and I think you're gonna like it. All right, so. Hit me with it. Yes. So I was at South By just a couple of weeks ago, sharing a little bit more about what we do at El Neutra with some of the leaders in longevity, nutrition and medicine. And I came across something that took me a little bit by surprise while I was there. I was sitting in a session with some leaders in longevity. Kayla Barnes was one of the people sitting there and she calls out that she started doing something where she was taking pictures of her poop and her pee in the toilet bowl. And she was using this tool. And I was like, okay, this is interesting. Everybody in the audience starts. Laughing like what they don't they can't believe that this is this is real and then fast forward a little bit i have a friend who starts telling me about this company called throne no we are not being paid by these people to say anything but um it is it was just so interesting to me it is this machine you can attach to your toilet bowl and it takes pictures of your bowel movements your urine it takes a bunch of metrics and so a long-winded way to get to the question of Do we really need something attached to our toilet to learn about our gut health through our bowel movements and our urine?

Speaker 4 [00:01:56] I'm gonna say it two ways. Yes it is not, well yes we do need to be paying attention to what is coming out in our toilet, both our bowel movements and our urine. Do we need, always need a tool? Not necessarily but I do like the other things that this particular tool is doing and I think if it's getting you to track and and bring conscious awareness to what is coming in your toilet then absolutely it's a worth worthy cause. There's so much that happens in the toilet. What is your specific question? What is your specific question?

Speaker 3 [00:02:30] Well, I think maybe that this is worth unpacking. So it is, from what I'm hearing, it is method to care about what's in your toilet. 100%. That is method. What can we do to make sure that we don't have to do

Speaker 4 [00:02:40] And we learn from what's in there. First of all, your bowel movements are, by the way, I'm a gut health dietitian. We talk about poop all day. You every day. I love talking about it. It is one of the most underrated. And I think because it is so embarrassing for people, which is why I'm sure all those people were laughing, people get weird about talking about, but it is the first and most important indicator of how well your digestive system is working and ultimately how well your health is.

Speaker 3 [00:03:08] And it's cheap and every single day, ideally.

Speaker 4 [00:03:11] Yes. It's a mirror into the inside. It is a mirror in to your inside health, absolutely. So there's a few things. There's a thing called constipation and diarrhea. They look different. Constipation might look like small pellet, well first of all, either not going at all. So frequency matters a lot. But you could also have these little pellet poops. That are indicative of potentially dehydration or lack of electrolytes, which help pull hydration into the body. So that's a really important sign that you need to make some changes or lack a fiber, which we talk a lot about on this episode. Having really watery stools and very frequent stools could be indicative of malabsorption or a food intolerance, a food sensitivity, some other type of allergy and immune response to food. That's a real important thing to track and indicate. Also, whether your bowel movements sink or float can be indicative of how much fiber you're getting in your diet, but also if it's sinking very heavy and when you flush it leaves a streak, that can be an indicative of malabsorption of fat or protein, which is also really important. Should we support your pancreas and your gallbladder? What's happening in your body that we need to support more with? There's so many things that your bowel movement can tell you. And also, I mean. Frequency in general. Color. Oh color yep if you definitely want your bowel movements to be these beautiful long brown logs if you are if it's too dark if it's turning into a red color you could be getting could be indicative of a bleed which is really dangerous go to the hospital Black is also problematic because that's probably dried blood. Yep. And it's been latent in your body, if it's getting to the green or even sometimes a white category, now we're looking at mucus and we're looking at immune response that is really important to track and take away from. So poop, method to track it, absolutely. And also, you know, I think the tracking your urine too is really important. If it's cloudy or if it is clear is more indicative of how hydrated you are and that will translate to your bowel movements too. So there's so much

Speaker 3 [00:05:15] And the cloudiness of urine, too, also speaks to kidney health, right? And so how foggy is it? What is in there? How foamy is it all of those things play into it, too. And I will say, you know, all of those things can be done for free every single day. I will see it again and again. You don't need a fancy tool to do it. I did think one thing, and again, I just was so impressed. That there is this one thing that you can't do with your eyes, or at least would be pretty hard to do with your eye, that this tool can help with, which is the speed at which your urine is entering the toilet bowl. And why does that matter? The slower it goes, and especially if it changes over time, and gradually decreases over time can mean that there's increased pressure on your bladder, and that can be a sign that your prostate is growing, and this is especially problematic for men. And so that is one thing that I think. You know, if you're really, really trying to optimize, that's where this tool could make a difference. But otherwise, you know, why don't do it yourself?

Speaker 4 [00:06:19] But also, I think, I work with so many patients who are so shy. And if it means that you have something that keeps you, that you can just do it and leave and it tracks what's happening, I that could be helpful to get you into the swing of things. But you know what else we did not talk about that I think. So in our upcoming episode, we interview the incredible Cynthia Thurlow. She is a nurse practitioner. She worked in the emergency room. She has a book coming out called the menopause gut And one thing that I think is that I do a lot in my practice, too, that I think is really underrated is you might be tracking your poop and you might be noticing changes in your, in the frequency or the texture or the, or what have you with your bowel movements. But if you don't know what it is, if like a lot of that is indicating what types of microbes are in your gut and are breaking down these foods or a lack of the right microbes in your guts that are struggling to, you know, So we need to focus on. So it's not just, you're tracking this information, but it gives you intel, at least if you're working with the right practitioners, it will give them intel, oh, we need to track this thing. Do you have candida? Do you a fungal overgrowth? Do you leaky gut or all of these things that could really impact things like estrogen? We talk a lot about on our episode today, so.

Speaker 3 [00:07:38] Yeah, you want to just share a little bit more about this episode that we had with Cynthia because it was

Speaker 4 [00:07:43] Awesome. We feel so lucky. Cynthia Thurlow is such an incredible woman. And she's out promoting her incredible book right now. But we did. We talked about the interrelationship and the correlation between gut health and estrogen and the indications of our ovaries in all of this and how they're kind of the, what did you say? The heartbeat of our pacemaker. The pacemaker of our. The pacemakers.

Speaker 3 [00:08:06] That's not me, that's Cynthia.

Speaker 4 [00:08:07] Yes. Yes. And we talk about HRT, hormone replacement therapy, whether to do it, whether to not do it. When to start. So we had a really dynamic, and we also talked about trauma and the, how, how integral stress is in the makeup and the composition of our gut microbiome and how that can impact perimenopause and menopausal women. So We've been

Speaker 3 [00:08:31] and out. We were all over the map today and I think that our listeners will think that I think they're gonna learn a lot from this episode. I certainly did. There was a lot of new concepts and words that I had to Google because I was like whoa this is this is awesome. So I am excited for for everybody to get to listen to all things that we were able to chat with with Cynthia and For any gentleman in the audience, this is still for you as well, whether it's for the women in your lives or for yourself, because gut health affects everyone. And do not poo-poo the...

Speaker 4 [00:09:08] Poopoo. Pun intended. I do think that Cynthia says this too, and I couldn't resonate more with me is that the gut is at the intersection of all things, of aging, of inflammation, of chronic conditions, and or lack thereof. So if you are not yet paying attention to your gut health, if you're not paying attention to your poop, if that's something that you haven't been doing, now's the time. This is your call. This is your moment. So we're excited to talk to you about it. And this is your episode. Yeah. We hope you enjoy. We have the wonderful Cynthia Thurlow on our show today. She's a nurse practitioner, has histories in the emergency room and trauma, but you've turned to intermittent fasting. Would you say you're a nutritionist?

Speaker 1 [00:09:53] Technically, no, just still a board-certified nurse practitioner, but I'm strongly interested in lifestyle as medicine.

Speaker 4 [00:09:58] Yes, but trained in functional medicine is one of the gurus of intermittent fasting specifically for women in perimenopause and menopause. You've had an incredible TED Talk back in 2016, I believe, and you have a new book coming out, The Menopause Gut, which we're excited to dive into today. Welcome to our show. Thanks for having me. I've been looking forward to this.

Speaker 3 [00:10:20] We also get to see you in your podcast. You have a podcast of your own. We learned a few things from you, so thank you. And then also, before this book, another book that was all on intermittent fasting as well that certainly is very aligned with what we do. So we're very excited to pick your brain today. Well, thanks for having me. Yes. So usually, we start with a question that we ask everybody. And it is, what is the hill that you will die on in terms of longevity? What does that mean? What are you screaming from the rooftops? What do you want everybody to know as it relates to health and wellness that you think that people maybe aren't giving enough credit to, spending enough time talking about? What is it? Sleep. Sleep. I would say sleep.

Speaker 1 [00:11:06] I would say sleep. That's surprising to me. Yeah, I wasn't expecting that answer. Well, because I think when you're younger, I'm sure that I probably said things like, I'll sleep when I'm dead. Teens, 20s, 30s didn't think sleep was such a big factor. But yet, I think it's oftentimes a missing link in the conversation about healthy aging, longevity. Because if you really look at the research, you dive deep into it, you can see. People that sleep more consistently, have better quality sleep, are more insulin sensitive, more metabolically flexible, they're making better food choices, they're able to be more physically active at a very basic level. And so I think that is the longevity hack that is not sexy, you can't wrap it up in a bow, but yet I think it is a foundational element to healthy living and definitely impacts longevity. And I think when we talk about longevity, what we're really speaking to is really quality of life. Because I don't want to live to be 100, if it means my last decade is a marginal decade. I want to fully and be able to participate fully in life, not just live to a certain chronology.

Speaker 3 [00:12:08] Well, we both got our master's degrees in health span and longevity nutrition, so we are big fans of not just living longer, but living healthier longer.

Speaker 4 [00:12:19] Saying that I want to hike Mount Kilimanjaro when I'm 99 on my 99th birthday. I'll go with you. She'll be 97 or 96, but yes, we'll do it together. So on that note, I'm curious, you talk a lot about the gut changes that happen with women in perimenopausal menopause being a missing link in not only managing symptoms and conditions, but what can you say or can you talk to what happens when you lack sleep also? Was there some correlation or? Some gut microbiome or some gut microbe that is missing in people that don't sleep as well. Can you go into that a little bit?

Speaker 1 [00:12:55] Yeah, so I think the biggest thing is, is helping people understand that we have circadian clocks throughout our body, including our digestive system. So the suprachiasmatic nucleus is in our brain and that helps kind of govern. Could have governed.

Speaker 2 [00:13:08] What?

Speaker 1 [00:13:09] The suprachiasmatic nucleus, or the SCN.

Speaker 2 [00:13:12] Okay.

Speaker 1 [00:13:13] Is kind of the brain central mechanism for sleep, it's like our master clock. But we have circadian clocks throughout our body, which is why if you eat a big bolus of food at nine o'clock at night, it is going to disrupt your quality of sleep. So sleep and chronobiology, sleep and the microbiome are all intricately interrelated. We know one night of poor sleep can shift the microbiome, we know jet lag can shift a microbiome. And I don't share this so that people are frightened, it's just to bring awareness that Our microbiome is so dynamic that it responds to stressful circumstances, whether it's lack of sleep or just overall stress, pretty readily. So when I think about helping people understand why sleep is so important, that's one of the mechanisms. So I always remind people that there's a lot that goes into the microbiome, but sleep is a big lever. And I think a lot of people, because it's not sexy, because its not pretty, you can't package it up in a bow, people kind of think of it as like, it's not a big deal, it doesn't matter. I mean, certainly. I worked in medicine for a long time, traditional allopathic medicine, and you're kind of conditioned to just go without.

Speaker 3 [00:14:17] Yeah, I mean, I definitely did certainly my younger days as well. I'm curious though. What is poor sleep? Is it just not enough hours? Is it not enough good quality sleep? And how does that happen?

Speaker 1 [00:14:32] Yeah, I think it's both. So I think that it's, if you look at the research, we want that seven to eight hours is a sweet spot. Obviously, there's a small percentage of the population that needs less sleep, but that's not most people, even if they try to convince themselves of it otherwise. But I think when we look at sleep, it's duration and quality. So we can look at different sleep stages, like REM sleep versus deep sleep. We know deep sleep is very important and restorative for the body. That's when the glymphatic system, It's such a. Intricate system that takes up so much energy, it can only be tapped into when we're asleep. And that's when our body's getting, it's like a brain toilet. When I'm talking to younger people, I'm like, it's a brain, toilet. If that's the easiest way to explain getting rid of towel particles, amyloid and other types of waste from the brain. But that's one deep sleep metrics. I mean, that's why that's so important. And then REM is also restorative, but I think it's the quality and the duration. And I'm not just talking about like, what is your OroRank spit out for you? Really understand that we need both and our sleep goes in cycles. It goes in waves throughout the night. And so if we have one night of not having stellar sleep, I'm not so stressed about that. It's the overall consistent patterns that we're looking at. And we know with age, we get alterations in sleep quality. If you look at the elderly, they generally have a lot less deep sleep. I know my grandmother would get up at four or five o'clock in the morning and she just didn't need to sleep as much. Well, she did, but she had convinced herself she didn't. But we know with changes in hormones, women in particular. And perimenopause can hit mid-30s, so let me be clear. It's not something of just 40s and up. Less progesterone will impact sleep quality around your cycle. Less estradiol will impact asleep quality. So there's definitely some hormonal mechanisms that will impact that duration and quality of sleep. And I think the other thing is, I think for each one of us, we probably have a pretty good idea of what feels like a good night of sleep, and it might look a little different for you and for you and possibly myself, but the consistent thing is you wake up rested. That's key.

Speaker 3 [00:16:29] I think that's what I've noticed myself, is that I can sleep the same amount of hours, I can go to bed at the same time, but I might wake up on that same day twice, totally different. One day just feeling exhausted and the other not. And so let's say one of our listeners notices that same thing. They're not necessarily seeing big changes in the time they go to sleep or the amount of time, but they notice changes in their alertness. What is that a signal of? What's happening in the middle of the night and how do we change that?

Speaker 1 [00:17:00] I mean, a lot of it can be influence of stress patterns. Like I think I jokingly say, show me, show me a woman who doesn't sleep well and show me a woman doesn't manage her stress. So cortisol can definitely dysregulate sleep quality. I think about food choices, especially alcohol, especially for women as they're getting older, alcohol may contribute to less REM and deep sleep, as well as a slew of other issues, blood sugar dysregulation amongst that. I think when I'm thinking about how we define where we are in terms of sleep quality. I'm thinking, where in your cycle? We know the luteal phase, when progesterone predominates, as you get closer and closer and closer to the start of your menstrual cycle, you may see alterations in sleep quality, I think a lot about temperature and environment. So I know when it's, I live in a very humid part of, I almost said the state, the United States. During the summer months, it can be because of the humidity. It can just be harder to stay asleep. It's much easier to stay sleep when it's colder. So cold, dark room, limiting light exposure, limiting sound exposure. If you live in a very noisy part of your city or your environment, little people. So when my kids were younger, it was frequently awakened multiple times a night, depending on how they were feeling scared, sick, or what have you. So I think there's life stages that can impact that. And then just overall stress. I think when we're talking about gut health, we have to talk about how there's an interrelationship between the microbes in our gut and that gut-brain access and the vagus nerve transmitting inflammation to the brain. There's a lot that goes on that I think can impact sleep quality. So I always say you have to pay a little bit of a detective work because much like allopathic medicine, when a patient would complain of nausea or dizziness, you're like, oh great, there's like 100 things that could cause that. I would say the same thing about insomnia, but you start with the big levers first, and then there's a lot more subtlety and nuance to the conversation that I think is really important.

Speaker 4 [00:18:51] Yeah, I was just going to say the interesting thing to me about, because I'm a gut health dietician also, and there's a lot that can be stemmed from the gut and that a lot of other things that can manifest in the gut and figuring out if it's external or internal. And then sometimes they play on each other, and now it's a self-feeding loop. Do you find that for women that you see with hormonal issues or who going through the perimenopausal-menopausals stage of life. That it is often an external variant that is causing an internal gut related dysbiosis or is it in dysbiosis meaning imbalance or is an imbalance from the gut that is contributing to the hormonal experience they're having.

Speaker 1 [00:19:37] That's a classic question, the chicken or the egg, honestly. And so I think there are so many variables. I think that, you know, dysbiosis, this kind of inflammatory, non-beneficial bacteria that can grow in the gut, the question is, is it someone who's had chronic adverse childhood events, they had a lot of stress and trauma as a child. So they've had a brewing dysbiotic, you now, micro microbes for years and years years versus Someone goes on vacation, picks up a parasite, or picks up traveling diarrhea of some kind, and that's a throwing off. Is it the stress of a divorce, the stress a change in jobs, a stress of someone getting sick in your family? I mean, there's so many factors that can contribute. This is where I think a really good history. I always say to students, the best way to figure out what's going on with a patient is getting a rock solid history, like figuring out like, when did this start? What are all the things that make it better? What are the things make it worse? What foods make it better? What foods makes it worse? Is it cyclical? Is it something that you notice around your menstrual cycle? Is it's something that notice when you have an argument with your mother? Kind of pinpointing when things get worse. But we know by the time someone has a degree of dysbiosis, they've already had some degree of leaky gut. And so you start thinking about the fact that in middle-aged women are four to five times more likely to develop autoimmune conditions. And we as women overall are 80% more likely. To develop autoimmune conditions. So just by our gender, we are much more prone. And a thousand years ago, when I finished my in-peep training, there were probably 20 to 30 autoimmune conditions that were acknowledged. Now it's over a hundred, including long haul COVID and things like chronic Lyme. So I think from my perspective, I think the gut issues that we are seeing, including dysbiosis are really a reflection of our changing environment and our changing stress patterns. There's no doubt in my mind that we are living in a more stressful environment as human beings than we ever have before. And so I think that's what contributes to a lot of the health issues that we're seeing, not just in women, but also in men. Yeah. And our gut is the

Speaker 4 [00:21:39] seat of our immune system, it's the seat of so much of our neurotransmitter production. And just stress alone, I talk about this with my patients too, that just stress being the one variable in your life. If you otherwise have a healthy diet, healthy lifestyle, you're exercising, you are doing all the things right, but you have a moment of chronic stress or intermittent stress, that's enough. Our gut lining is one cell layer while thick, and if you have just that one... Interjection, that can be enough to tip the balance and to tip you into getting candida or getting a fungal overgrowth or whatever it is that you're experiencing. So it's also not to be dim about it, but it's true, it's a super important cog in the wheel.

Speaker 3 [00:22:23] What I think is super interesting, you called out early childhood trauma as an impact to our gut health today. So, how often are people capturing struggles in their gut health as adults from childhood trauma that has just remained with them all this time?

Speaker 1 [00:22:42] I think not enough. I think of people like Dr. Gabor Mate and Dr. Nicole LePere, I really credit them with bringing greater awareness to this as a country and through their great work. Certainly for myself, I had no idea because I trained in inner city Baltimore and I thought trauma, seriously, I thought trauma was big T trauma, rape, murder, suicide. I mean, things none of us are going to argue about are traumatic events. But what I think is equally insidious and is finally getting the attention it deserves is when we talk about addiction, abuse, neglect, bullying. So things that we maybe didn't see on the surface as children, but maybe we were exposed to. And I always say, our parents do the best they can. And I don't say that as an excuse. I just say that is like, we have to give them grace because they did the best that they could. But I think it imprints your nervous system. Children that have exposure to a high level of adverse childhood events are at greater risk for not only poor metabolic health, disorder relationships for food, certain types of cancers. They may then go on to have an earlier menopause. We really want to talk about stress that is corrosive in a chronic environment, but we know those kids are at great risk. It just really regulates their nervous system in a way that they are very sympathetic dominant. And I know traditional allopathic medicine doesn't like that terminology. But it's a really insightful way of identifying that the autonomic nervous system is not properly regulated or balanced. And what's interesting is there was a joint venture between Kaiser Permanente and the CDC and what came out of that was this score and this ACE scoring. So anyone who's listening or watching can go online, you get access to that. What I find incredibly insightful is when I have patients who have a score of seven, nine, or even higher, I already know, I already even if they don't tell me that they are stressed. That's not what their body perceives. And so it sets them up for more autoimmune conditions. It sets them out for this kind of corrosive nature to cortisol being high and elevated over time. So muscles become broken down. It becomes catabolic. Their immune system, they get sick more frequently. They're gonna be more likely to develop autoimmune condition. And so you just realize it's this domino effect. And I think for a lot of women that are very high achieving, very type A, I would certainly not want any of those. I was certainly one of those. And so I always think about it, like, do we really, have we really done a good job identifying some of these patients? I think there's greater awareness now. So there's probably more conversations that are ongoing, but I also think it predicts a bumpier perimenopause journey. And so these are women that as those hormones are declining, as those neurotransmitters are changing, I always say perimenophosis is a litmus test. So for a lot of these women. The wheels may fall off the bus prohibitively. And so I think that if we know ahead of time, we can be doing more for these women, getting them the support that they deserve to have as opposed to 70% of divorces are initiated by women. I really think women in perimenopause and menopause, if they don't have the language or the skills to be able to deal with these really profoundly uncomfortable feelings, it can make it a whole lot harder to stay in a marriage. It can make a whole a lot harder to stay a relationship. That would otherwise not has been as healthy. So I personally think, you know, ACE scores and adverse childhood events I think are one of those missing links for stress. Like when a woman says to me, yes, I do my meditation, I did my grounding work, I'm doing all the things, I do all these vagal maneuvers, I'm sleeping, I eat well, I exercise, their gut doesn't look too, too bad or maybe it does and they just don't acknowledge any symptoms. I'm always thinking about underlying trauma.

Speaker 3 [00:26:28] Interesting, and so just for everybody listening, that's ACE stands for adverse childhood events. Go online, take this test. Yep, you can do it. And anything you said over a seven is starting to.

Speaker 1 [00:26:39] I would say the higher, just by in general, if your score is two, that's very different than someone who's got a score of five, seven, nine or higher. Right. And it's out of how many? It depends on how it's scored. So I think that the way I look at it is best kind of score is zero. And I have friends that are zeros and ones. Thanks. So.

Speaker 4 [00:26:57] How convenient. I know. How lovely for those people. Maybe we should all strive for it.

Speaker 1 [00:27:02] When I took it, I was shocked, quite honestly, because I think, because even with my training, I was trained to believe that trauma is big T-trauma. Right. It's the little T-Trauma that's insidious.

Speaker 4 [00:27:11] I think I'm grateful, I'm super grateful that I think that our pendulum is tipping in that direction. We have more people going to therapy, more people talking about, you know, rifts in friendships that maybe we weren't talking about before that can be.

Speaker 2 [00:27:26] Mm-hmm.

Speaker 4 [00:27:26] Small t trauma, right? And all of this does impact, and it's part of the longevity conversation, I think, too, in terms of, you know, the balancing act that we're trying to achieve, this ability to find what works for us, draw our boundaries, but also have community and all of these things that are really important. I have a really kind of potentially detour of a question for you, but it just popped into my head when you were talking about the menopausal menopause trauma experience. We're also seeing young women going, getting their periods earlier too. And I think that that could be related to that. Have you seen any correlation between or ask your perimenopausal-menopausel patients when they got their first period, if there is any association with that?

Speaker 1 [00:28:10] I think we're seeing more early menstrual cycles starting because of the exposure to estrogen-mimicking chemicals. I think it's environmental. I also think we have an increasingly less metabolically healthy population of children. So I think its two-fold. I it is a metabolic health crisis. I think is also an environmental health crisis and so we know that there are certain endocrine mimicking chemicals that are a thousand times more potent than the hormone itself. That doesn't leave you with much of a chance. And where are those found? Just think about plastics, phthalates, parabens. I mean, it's cumulative. In our water. Right, and it's cumulative. Yeah, and I don't know of any filters that I'm aware of right now that filter out microplastics, but.

Speaker 3 [00:28:51] But reverse osmosis filters are the closest we can get at this point.

Speaker 1 [00:28:55] At this point, because they do the smallest microparticles. But I don't even think that, I'm not personally aware, and if someone knows, please let me know. It's an imperfect system. Right, and so.

Speaker 4 [00:29:04] The most we can do is reduce our exposure.

Speaker 1 [00:29:07] We can't expect to have none. For sure. And that's the biggest thing, is that we're not saying to go live in a bubble. We're just saying just bringing awareness. But I think when I see very young women that have breast buds that clearly are maybe seven, eight years old, I'm like, oh, boy. I think it is both an environmental and it is also a metabolic issue. And so I think that if we're looking at the average American is consuming most of their food in an ultra-processed state. So you've got people that are consuming more calories than what they need. I think there's multiple variables that are coming together. Now, I'm not aware of any research, and it might be out there, of anything that's the average childhood events. Now, obviously, if a child has significant abuse, I mean, they may find comfort in eating. That might be part of it. I've seen that in older women. I've that in a lot of women that will say to me, I only like white foods. And I'm like, what do you mean by white foods? They like mashed potatoes. They like bread, like truly like comfort foods, like foods that have been so broken down, like literally mechanistically, they don't have to do much to chew it and swallow it. And it becomes this comfort piece. But I don't work- Usually very high in sugar too. Right, right. Which is a dopamine trigger in the brain, right? Yep. And so, but I also don't work with children. So I think that there's, when I talk to my pediatric colleagues, there are some working presumptions of why we're seeing earlier menstrual cycles starting. And I think what a burden. I mean, I thought it was a burden when I was 14. Of course. Being, you know, 8, 9, 10 years old or 7, 8 9 years old, that's a huge burden on a child. Yeah. I think. Absolutely. You should be having fun and playing, not worrying about when they're getting in their period.

Speaker 4 [00:30:48] We're just being looked at the wrong way, I mean there's, you know, you presume when somebody looks older, that they are older, so they suddenly have more maturity when they're still babies, you know.

Speaker 3 [00:30:59] Things have changed a lot, even over the last decade, never mind 50, 100 plus years. And so, you know, does all, is all of this changing environment and social status and all these things that are changing, is that what prompted you to write this book or what prompted this as a now book? We have the book.

Speaker 1 [00:31:21] The menopause gut. We have the book here. Yes. The honest answer is I have my own podcast, and I interview all these incredible experts. And obviously, my first book is about intermittent fasting. And what came out of that was this incredible opportunity after I had a TED Talk that went viral. This book is... I've been talking about perimenopause for 10 years, and my first TEDx was actually on perimenops. A lot of people don't know that fun fact. But I think for me, what has been left out of the conversation when I talked to these researchers and science writers and clinicians as... No one's talking about the gut and the changes that are happening because I think this is the missing link. I think is the conversation that is being missed when we're talking about we're doing all the right things. We're sleeping, we're managing our stress, we're eating nutrient-dense foods, we're trying to exercise as much as possible, we've slapped on our estrogen patch, we're good to go. And then I'm still don't feel better. And I'm like, I think it's a bigger conversation. And so I think. The gut microbiome is a little more nuanced. Obviously, I didn't learn anything about it in my medical training. It's really been the last five to 10 years that there's been greater awareness. And as I started having these conversations, I kept saying, gosh, there's something being missed in this bigger conversation around perimenopause and menopause. So to me, all the vignettes, all the things I've learned over the past 10 years are really part of this book, including the role of adverse childhood events and stress, but really speaking to it from a deeply science-driven level. It would have added 20 pages to the book, but my publisher asked me if I would put it on my website, largely because I really wanted it to be, you know, a really good example of what is the research saying and what have I seen clinically and what other experts seen. But I think for women that are looking to age well and are looking to feel good in their skin, it's really talking about the microbiome changes because... Microbiome is dynamic. I mean, when depending on how we're born, like whether we're a vaginal delivery or C-section, whether we are formula fed or breastfed, those dynamic times in our lives, puberty, pregnancy, perimenopause, all shift the microbiome in good ways for the most part. But in perimenops, we get a lot of changes that can impact inflammation, insulin sensitivity. Our risk of autoimmune conditions and so much more. So really important conversation. Can you share?

Speaker 3 [00:33:40] A little bit more about what those changes are in perimenopause and menopause to the gut that you break down in the book.

Speaker 1 [00:33:47] Yeah. So I talk about how we have a certain amount of keystone bacteria in the gut, you know, things like acromansia, lactobacillus, bifidobacter, and many others, but we start to see changes in diversity. So we have, you, know, we plant a beautiful garden with fruits and vegetables and what starts to happen is we're growing more inflammatory species in between. We start seeing dynamic dysbiotic changes. We see more inflammation, like at the basis of aging is So, this whole immunosensence, aging of the immune system, is part of what ages us. And so it's helping people understand that we get changes in short chain fatty acids. And for all my carnivore friends, they hate when I talk about fiber. Fiber is probably the longevity nutrient I should have mentioned as opposed to sleep. But as we are seeing reductions in short-chain fatty acids, we see more inflammation. We see alterations in insulin sensitivity. We see changes in mucus. I know mucus is kind of a gross topic, right? But mucus important for protecting the digestive system. We also see alterations in being able to have these important signaling molecules that across the brain brain barrier like butyrate and it goes on and on and so it's really making the argument for why the microbiome is so important, why we need to focus on it and then we also touch on the astroblome which is not a word I came up with. I actually had a guy last week held in his strobe below me, and I was like, I will never forget that. Thank you very much. But how we break down and process estrogen also changes at this time in our lives. So it really just walks us through the science. And when I say the science, like nerdy in the weeds science, but making it very accessible. Like the immune system, I learned many years ago, but it's like I had a big whiteboard as I was writing the book because I was, like, got to keep all this stuff straight. But there's so much change. Like I'll give you an example. The immune system ages right along with us, but as the immune system age is, we are more likely to get opportunistic infections, including viral infections. We start seeing alterations in responsiveness to vaccines. I don't say this to be political. I'm just saying like, that's why when you go to CVS and they offer you a shingles vaccine, because I'm over 50, shingle vaccine, ammonia vaccine, they offer a flu vaccine every time I go. I'm like, for the love of God, stop asking. But it's because they know we are becoming less resistant to. To, you know, vaccine efficacy. And so there are all these changes that are happening, and it also increases our likelihood of autoimmune conditions. It's at four to five times more likely. And we think about autoimmune condition as not being a big deal, but they are, because once you have one, you're more likely to have others. Who is saying that? Oh, every people say it's a silent disease. I'm like, I've had four. Well, silent disease is the most deadly. Correct. I have had four in my lifetime, probably because of the way I grew up. But I share this not to evoke any type of sympathy, but just to say that you can change the course of the way the direction your life is going with lifestyle, plus or minus some other little tricks in the bag. But I think the gut microbiome truly is this missing link. And it's why I lovingly devoted 18 months of my life to writing the book, because I really think it's really a groundbreaking book. It's really the first time I'm seeing this information presented in this way. And I think it is going to be very impactful and helpful, just not only for the lay public but also for clinicians. Absolutely, I mean when I

Speaker 3 [00:36:53] to Google estrabalome and I was like what is this and then I found out that because I assumed you you did make this term and then I'm like oh wow it's been around for 12 years or something like that I mean but no one's talking about it so it's not sexy you wrote this because we need to know

Speaker 4 [00:37:12] Well, I think having regular bowel movements is pretty sexy. I don't know, I'm all about like, you know, not having a healthy gut is truly not. So why wouldn't you strive to have a really great digestive system? Oh, yeah, I was interested.

Speaker 1 [00:37:24] I interviewed a lovely Harvard-trained gastroenterologist who just wrote a book that just came out talking about pooping, which I thought is just wonderful, and she's lovely. And I said, how do you, as a gastroenteroidologist, how you define constipation? And she gave me a very different explanation that now has forced me to think differently about this conversation. Oh, okay. We must point. I know. So, yeah, so I literally said to her, thank you, because now you have forced me think differently. It's whatever you think is okay for you. So meaning like, if you say to me, Cynthia, I poop four times a day, and it's all at socially acceptable times and that doesn't bother me, that's okay. If you tell me that you poop four time a week, not at socially inappropriate times, and you feel good, then that's OK too. Now, do I think most people feel better going to the bathroom more frequently, like at least once a day? Yes. Do I think that most of my patients prefer that? Yes. But... Apparently, there's different ways of looking at it. And so I'm now looking at is, does it bother the patient? And if the patient isn't bothered, then you can kind of say, okay, well, we need to maybe explore this more. Yeah. Maybe you don't have enough hydration in your diet. Maybe there's not enough fiber in your day. Maybe you won't exercise. Like those are the things that might slow things down.

Speaker 3 [00:38:30] I think about, like, my dad. We're going to call it my dad this time. There's no world where if my dad has some not cute poops, he's going to be like, this is a problem. He'll just be like no, it's fine. No, no problem. And so I think maybe, yeah, I don't know. I think it may be also person to person. Like I would I would tell my dad if you've got like Bristol Stools scale one or, you know, seven. If you have a change.

Speaker 1 [00:38:55] If you have a change, we need to talk about that. I mean, look at all the young people that are getting diagnosed with colorectal cancer. And I think there is a stigma around bowel movements and pooping, and it should be no different. Like I've now raised two adult sons. And so you can imagine the amount of conversations around bodily habits from when they were little. I mean they do things now, I'm like, please don't do that. Like we're in public. Like there are people sitting at a table, and they think it's, I mean obviously, I'm not saying that they're being crass on purpose, but- Growing up in that environment and also being a nurse and a nurse practitioner, I'm probably a little destigmatized to it, but I do agree with you, there's a generational thing. Like my father-in-law, before he passed away, unfortunately used to say, I'm no one's ever doing a colonoscopy, no one is ever putting anything in my butt, I'm never doing a colinoscopy. And so I think for a lot of people, it's just, they get uncomfortable and they don't wanna talk about it.

Speaker 4 [00:39:45] I empathize with that. My parents are both Western doctors, and our dinner table conversation was always fun. So I think the interesting thing that you mentioned, though, that I talk about a lot in my work is I do think there's a difference between what's normal for you and are you actually tapped into what's going on in your body. Because somebody, when I hear somebody going to the bathroom three to four times a week, I'm asking lots of probing questions. How are you sleeping? What is your energy like? Do you actually have bloating and gas? I mean, because usually the body literacy that people don't have is leading them to think that something is normal when it actually isn't. So anyway, that's a longer conversation for another time. But that's...

Speaker 1 [00:40:30] Very interesting. Well, I think your norm is what you think is normal. And that's the biggest distinction, but I do agree with you that a lot of women in particular are so disconnected from their bodies, like I'll say to them, your stool testing was horrific. How do you feel? I'm fine. Yeah. I'm muscling through. You shouldn't be fine. Right. Right.

Speaker 3 [00:40:50] Well, I do want to ask you also.

Speaker 2 [00:40:55] But remember to ask them.

Speaker 3 [00:40:56] I actually still wanted to talk a little bit more about perimenopause and the gut, because one of the things that jumped out to me is you called the ovaries a pacemaker, right? And so they are essentially controlling the amount of estrogen that's released. We always think estrogen, it's all fertility, right, but it has so many more functions in our body. So we enter into perimenopause-menopause, estrogen starts going down. And now our pacemaker is no longer our pacemaker because its tool is no longer in our body. So it shifts to the gut. Is did I get that right? Tell me where I went wrong.

Speaker 1 [00:41:43] What is going on here? So our ovaries set the pacemaker of aging in our bodies, full stop. It's the most mitochondrial dense organ in our body, full-stop. I think anyone that works in medicine would probably say the brain or the heart. So when I realized that, I was like, oh my gosh, there's a larger, again, a larger conversation we're not having. But yes, they set the pace maker of aging. They determine when we go into menopause. And again, it's this gut ovarian access that no one, I've never heard anyone talk about it, but I started looking at the research and I was like... Oh my gosh, there's this very intricate relationship. So the health of our gut influences when we go into menopause vis-a-vis the health the microbiome itself. And so what are the things that can accelerate aging? What are the thing that can accelerate aging in the ovaries? So like smoking, other toxins, chronic stress. So I just think when I was looking through the research it almost made me incredibly sad. I was like, why is no one talking about this? Because we have been looking at our ovaries. Solely as this fertility organ. And it's really a longevity organ. And I do agree with you that I think about the gut as a longevity Oregon and I think about the ovaries until they go into, they're like, I'm in overtime. I'm done, I've done my job. I'm tapped out. We're born with a finite amount of eggs, unlike men that can replenish sperm on the regular. And so our eggs, whether we're ovulating or not, whether we are in puberty or not we get, we're born at a certain amount, they drop off in puverty and then it continues up until you know, that menopausal transition where we still have some eggs, but where the eggs are literally they're not the kind of eggs you want to fertilize. That's why a lot of women in those perimenopause to menopause years may need to have donor eggs to get pregnant. And that's a separate conversation. I'm sorry for the tangent, but what I find fascinating is the gut intersects with every single organ in our bodies, with every single cell in our body. Does it make us at all surprised to learn that the quality of our gut is going to burn. The quality of the ovarian function. It's a contributing factor. And so I think that that to me was again, one of these, you know, aha moments as I was writing like, oh my gosh, why aren't we talking about this? Because I think even as a clinician myself, I thought of the ovaries as like, we call it bikini medicine. Done. Like, they're just there so that we can have babies. And then that's all we think about, but it's far more powerful than that.

Speaker 4 [00:44:00] The estrogen itself is not just for, you know, ovulation. No, there's the receptor. Yeah, also for protecting the bone, for muscle, all of it. Immunity. Well, think about it.

Speaker 1 [00:44:11] Well, think about it, you all were talking about the one cell layer thick of the small intestine. Well, if you look at, if think about is a brick and mortar system, the mortar is estrogen. So as estrogen's declining, guess what you're losing? You're losing that tight junction ability. So that's why you see more leaky gut, more endotoxin, more, you know, inflammatory issues, more immune system activation, all because estrogen is declining. Estrogen and the immune system are like, they work together like, terrible analogy, peanut butter and jelly. Like they go together. And I'm just gonna make that analogy for today, but helping people understand that as estrogen's declining, like you're losing your superpower. And so it becomes really important. Women will sometimes say, well, I don't feel bad in menopause, I Don't need HRT. And I'm like, everyone deserves to have a conversation. That's important. And everyone deserves to understand what are the pros and cons of not going on HRT so that you can make a fully informed choice. But the women that say, yeah, I dont feel bad, therefore I don't need it. I'm like. Okay, let me give you some statistics. There's something called genitourinary syndrome of menopause. It's not a question of if, but when. All women will eventually, in the setting of menopus, develop this issue, and the lack of awareness around just using vaginal estrogen, something super sexy, right? Vaginal estrogen would reduce 70% of the hospitalizations. Wow. What is genitourenary? I'm gonna explain. Please. So, you can get this. After breastfeeding, you can get the severe on oral contraceptive. So it's when the vagina and the urinary system is kept in a low estrogen state. Painful sex, friability, chronic urinary tract infections, pelvic floor issues. It sounds great, right? Yeah, no thanks. So what can help with that? Prevent it? Vaginal estrogen. So like sometimes women will say, I don't wanna do regular HRT. I'm like, oh, but you do want vaginal estrogen because what many women don't see that I have seen is that grandma gets a UTI. Grandma ends up in the hospital because she has a blood infection called sepsis. Grandma then ends up the ICU, and that's when I oftentimes saw her and took care of her. And so if we know that that can simply ensure that you don't ever end up with chronic UTIs, which is what most of my cardiology patients had, like I'd say, why are you on chronic antibiotics? Oh, because if I stop, I get a urinary tract infection. Which is the worst for your gut. Oh my God. No, no. So, yeah, so it's a domino effect. And you're saying like one round of antibiotics impacts the microbiome. I saw estimates while I was writing the book of 18 to 24 months, I just saw a study talking about eight years. What? Eight years. So there is no gut, there is no microbiome left. No, but here's the thing, I was the first person to say there's there's an appropriate and judicious use of antibiotic therapy. That's in some instances saves our lives. 13 days in the hospital in 2019. I spent six weeks on antibiotics. It has taken me probably seven years to get my microbiome back to where it was. From the one time. It was six weeks. I mean, it was a long time. And it was IV. It was really powerful stuff. So the reason why I mention all this is to say, if a woman says to me, I don't want HRT, I'm like, for the love of God, at least use vaginal estrogen. For all these reasons, I just entertain. Because it's not a question of if, but when. We will all get it. Usually by 60, it's like 75% to 80%. So you can imagine at another 10 years, you'll definitely be there. So not to give away the end of the book.

Speaker 3 [00:47:33] There are some things we should.

Speaker 1 [00:47:37] Happy things. I promise you, there's very little conversation around that. But I just want to plug it because I think people need to be aware. Yeah.

Speaker 3 [00:47:45] So are there things that you think that our audience should really be aware of to improve their gut, especially during midlife?

Speaker 1 [00:47:53] Oh, absolutely. Number one is sleep. Like I mentioned, that's like the number one thing, full circle moment. Really thinking thoughtfully because the microbiome responds to, like when I travel overseas or you all travel, your microbiome is trying desperately to respond to the changes in light dark cycles. Stress management, and it's not just five minutes of meditation once a week in middle age. Like maybe in my 30s that's what I got away with, but now I have to be much more thoughtful about it. Nutrition is... Also super important. And it's not to say that you necessarily have to ascribe by a particular philosophy. You don't necessarily have to be keto or paleo or primal, like whatever it is that you decide to do. Protein-centric with adequate amounts of fiber. As I mentioned earlier, fiber becomes a very important conversation for everyone. And I know that makes my carnivore friends very upset.

Speaker 4 [00:48:41] Eating protein that has fiber, AIE, lentils, legumes, yeah.

Speaker 1 [00:48:47] Yeah, yeah. You could do both at the same time. Yeah, and I'm like, be omnivorous, that works both ways, thinking thoughtfully about exercise. And then, you know, then we layer in like HRT and peptides and supplements. But I always say major in the majors. We get so focused on the quick wins, the shiny objects, the next device. And I'm, like, listen, the majors are not sexy, but they are so important. Like before my patients start getting fixated on an aura ring or a whoop band, sorry be calling these names out, but I'm just giving you examples. Like people are like, I want the next great gadget. I'm like, I understand. But what you need to do is prioritize your sleep. You need to manage some of your stress. You need eat better. The foundations. We need the foundations to be strong. Major and major. Exactly. And so that is what is not sexy, but it is what effective. And something as simple as get outside and get sunlight on your retinas in the morning. Like those things are gonna be much more powerful than 15 different supplements that you're taking.

Speaker 3 [00:49:43] Totally. Well, and you can make that fun. I mean, like, it's just really about setting this routine and saying, okay, every day for the next XYZ two weeks, I'm going to make it a point to go outside in the first, you know. The ultimate biohack.

Speaker 4 [00:49:55] Yeah, this is actually using the land and the earth and our circadian pattern to biohack our own bodies.

Speaker 3 [00:50:04] My last question before we shift to one of our favorite topics. Is it ever too late for someone to make changes to improve their gut, specifically as it relates to the changes in perimenopause and menopause?

Speaker 1 [00:50:20] Absolutely not. The gut is so dynamic, it can change in days. And that's why I think it's really important. Like we talk about these big concepts and people are like, oh my God, there's so many things I need to change. Unlike small habits, like something as simple as taking four to five deep breaths. Like we used to say grace before we ate dinner in my home growing up. Four to five, deep breaths before you eat your meal. Something that simple, walk for five or 10 minutes after you eat. I didn't want to take a really deep breath. Yeah. I'm getting to the parasympathetic now, I mean, in all seriousness, like those kinds of simple habits do have long-term ramifications. In fact, my husband and I used to joke about the couples that were probably we are now, at the age we are, now that would walk in the evening. Yeah. I'm like, oh, they're actually brilliant.

Speaker 3 [00:51:05] That's so brilliant. So romantic. I like it.

Speaker 1 [00:51:06] I like to call it the fart walk.

Speaker 4 [00:51:09] It's like a thing now. It's the metabolic walk for in our family. Get that glucose utilized. Yeah, for transporters in your muscles. Yes. For fart. Same thing. Same, same, same. Okay, so I've been dying to ask because we only have a couple more minutes before we go to our mailbag then asking you audience questions. You are the intermittent fasting queen. I know that your stances has has changed a little bit over the over the years. Curious or no? What is your go-to standard for perimenopausal menopausa women as it relates to intermittent fasting? What is the timeline that you recommend for most? Obviously, this is not a one-size-fits-all. There's obviously always personalization, but what is your recommendation?

Speaker 1 [00:51:54] I am pretty comfortable advocating for 12 to 13 hours of digestive rest as a starting point because if I have a woman who's not sleeping, over-exercising, too low carb, too restrictive, adding more gasoline to the fire is not a good thing. Now if I had someone who's obese, overweight, not metabolically healthy, then a 16-8 is what we're going to work towards. And I'm very, very clear. If you cannot get 100 grams of protein into your feeding window, you have no business doing a really tight short feeding window. And I think that muscle is so precious, that I would say you are better off doing 12 to 13 hours and making sure that you can get 100 grams of protein in and you're still getting physiologic benefits and then thinking thoughtfully if you need to do longer fast. Because what I find is, just as I'm guilty of this myself, with the way that I think, I'm like, if a little bit of fasting is good, more is better, you know? And so I think what I've found is, there are a lot of women who got stuck because cortisol is one of the few hormones that goes up. This is what's cruel about middle age. One of the hormones that go up and not down is cortisol. And we, for all the reasons I already talked about, catabolic, leaky gut, more auto-immunity, more lowered immune system function. These women, it's like getting really granular about how much stress are you really under? Doing Orange Theory fitness or CrossFit six days a week, no recovery. And then 18 hours a day of fasting, and then you're eating no carbohydrates because someone told you that carbs are terrible. That's a recipe for... That's the myth.

Speaker 4 [00:53:24] That's a myth, essentially.

Speaker 1 [00:53:24] Especially for women, please eat your carbs thoughtfully. I did a whole Insta story this morning showing my omelet and some roasted potatoes. And I'm like, I'm sure someone's going to be like, you need all those potatoes.

Speaker 4 [00:53:33] So much starch.

Speaker 1 [00:53:34] I was like, I do well with protein and carbs, me personally, but for each one of us it's different.

Speaker 4 [00:53:39] Figure out the carbs that work for you. I mean, not everyone does do well with certain types. I see that in my world a lot too. But it goes to say, you know, waking up cortisol, cortisol when you wake up is supposed to be elevated. When you rise in the morning, it's supposed to get you out of bed. But then you want to pull it back down, which is why it's so important to have a protein-rich breakfast and something within the first couple hours of eating. Do you agree with that?

Speaker 1 [00:54:01] I do. And I mean, breaking your fast could be two hours after you wake up, it could be three. I think for a lot of people, like for me personally, I'm trying to stay on East Coast time. So for me, you know, it's seven o'clock in the morning here, it is ten o' clock in the mornig on the East Coast. And that works. And you know I encourage women to experiment, to find out like where is your threshold? Like I think about thirty grams of carbohydrate in a meal is good for most people. If you are not you probably need less. But the protein piece generally stays at a certain amount because we know we need more with aging, not less. And I think that's an important distinction. So to kind of recap what I said, 12 to 13 hours of digestive rest works for everyone. I think if you are not metabolically healthy, then intermittent fasting is something worth thinking about. But if you can't get at least 100 grams of protein in consistently, then you need to rethink that strategy.

Speaker 3 [00:54:50] It's interesting because both Mel and I, of course, watched the TED Talk and as dietitians that work a lot in the fasting and fasting-mimicking community, we were like, oh, wow, but this is a TED Talk that was done quite some time ago now. You're a trailblazer, Cynthia. So I was so curious. I mean, it already sounds, just from what you just shared, that your perception and your recommendations around fasting and intermittent fasting have changed. Are there other things that have changed in the way that you recommend fasting, intermittent fasting, or even just nutrition in general since you started?

Speaker 1 [00:55:24] Oh, yeah. I mean, I think the sign of an intelligent person is that they change their minds. And I remember in 2024, I lost my dad and it hit me in a way that I think it's hard to lose any parent. But the one thing that it left me with was if I don't start doing something different, I'm going to end up being just like my dad. It was frail and tiny and, you know, had a series of falls and his head. And that was a whole other story. But the reason why I'm sharing this is I was like, I'm not consistently getting enough protein in every day. So what do I need to do differently? And so I hired a personal trainer to kick my butt twice a week and I opened up my feeding window and I was able to put on four pounds of muscle which is not easy as a late person. So I now encourage other people to really reflect like it's okay if you change your mind. Like I think sometimes people are so rigidly dogmatic that they're like, oh, I can't do that. Like I started with paleo 12, 13 years ago and I really low carb for a long period of time and I can actually get away with a good amount of discretionary carbohydrate. What I can do personally is a lot of fat, I just don't feel good when I eat it. And I have a healthy gallbladder, I'll just interject that. So I think that for each one of us, it's acknowledging that we can change our mind and then we present the evidence to say, this is what I found, even if it's just anecdotal, like this is the end of one, but what I've seen consistently is, we have convinced a lot women that carbs are all bad. So they're afraid to eat fruit. They're afraid eat anything with fiber in it. And I'm like, listen, ladies, we have to get realistic. Like first and foremost, a piece of fruit is very different than having a piece of pie. Yes, even if it's fruit pie. Right.

Speaker 3 [00:56:58] Some people will tell you otherwise. Oh my gosh, I've been watching some.

Speaker 1 [00:57:02] And that makes me, yeah, it makes me crazy. Like we aren't designed to exclude entire food groups. I think if you do a therapeutic diet, like after I had all those antibiotics, I was full carnivore for nine months because otherwise I had loose stool. Like just be totally transparent. But I was missing vegetables. Like I very much missed vegetables. So someone were to say to me, I'm gonna give an autoimmune AIP or I'm going to do a carnivor diet for the next three months because I want to reduce inflammation and I want see if my autoimmune markers come down. Like that's fine, but at some point we need to have a plan to talk about increasing some fibers and some vegetables and legumes and other things. Because when someone tells me I tolerate no fiber, as someone who had a period of time in my life where that happened, I was like, that's because your microbiome is decimated. I didn't tolerate fiber. I was oxalate sensitive. I mean, it was awful. Everything upset my stomach. But now I'm back to a point where I can have about 50 grams a day of fiber. It's always a reflection of something that is imbalanced in the microbiome, something that can be fixed. It's not like a static issue, just like I don't like anyone fear-mongering about plant-based offenses. I'm like, I don't care if you soak your nuts and seeds, if that's what you need to do, that's awesome. But to suggest that these are not designed to ever be eaten, I'm, like... Yeah, right. I think that's a problem.

Speaker 4 [00:58:19] Well, I also think you're tapping into something that's very near and dear to my heart, in that people get so emotionally attached to the thing that they are doing, and then they think, oh, well, this has always been my thing, and I will always do it this way, and this is what works. I'm like, well hold on a minute. Your stress changes, your body changes, your hormones change, your work changes, your relationships change. All of these things require you to also adapt with what is working with your food. You might need more carbohydrates in a stressful situation, because carbohydrates deliver B vitamins. B vitamins are needed in a stress time. You might more protein if you're healing from something, if you have a gut dysbiosis, because you need more of those proteins to repair your gut. Anyway, so I think it's really problematic when people get very, and I can tell when they start to get real passionate about the thing that they do, I'm like, okay, well, that's wonderful, and I hope that when your body changes, because it inevitably will, that you will also change your mind.

Speaker 1 [00:59:17] Well, there was a fairly high-profile podcast that was on this spring, and I really liked the physician and were friends. And I had said to him, I was like, I know some of what I'm going to say is going to piss off some of your community. And he didn't have a problem with it. But I stopped reading the comments on YouTube because I was, like, it's fine. But I mean, that's part of the problem is that we become so rigidly dogmatic that we are completely unwilling to entertain the possibility that there might be another answer. And that's what I refuse to do. So I can tell you in 2024, when I started talking about this, about less fasting, wider feeding window, more protein, to the credit of my community, they were like, I respect you so much more because you want to be like, You're not going to tow the party line just to make us happy. You're going to actually say, hey, I want you to consider for yourself, is this still serving you? Because I had been fasting for, you know, at that point, like 10 years. And so I think that irrespective of whether it's a nutritional paradigm or another strategy, it's okay to change your mind. Just like I did a video one day talking about cold plunges and I was like, I know I'm going to get a lot of hate, but guess what? If you're a super type A person, please don't go being cold plunging. And to the credit of most of the people. I was like, there's a role of hormetic stress, right amount of stress at the right time. Some of you are just overwhelming. Don't try to do what the dudes do. You're not a dude. Yeah. Acknowledge the fact that our physio-

Speaker 3 [01:00:40] technology is different. And that's why we're, I mean, obviously we're big fans of the fasting-mimicking protocol because it is a less stressful way to get the benefits of water-only fasting.

Speaker 4 [01:00:52] And it's also intended to only be done a couple of times a year. It's not a chronic situation, which is very different. I think a lot of people are taking it on a daily, like, you know, calorically restricting daily or doing these stressful things daily. We're talking about

Speaker 1 [01:01:04] We're talking about five days a week, five days a week twice a month, they're fasting, and I'm like.

Speaker 4 [01:01:09] Why? I was like, at the expense of muscle? Like, that doesn't make any sense. Yeah. So if I do believe you and I fully respect, you should be changing your mind. You should be challenging it based on you are your own best experiment too. I mean, you know, what works for you and is going to change throughout your life. So thank you. Mailbag. Yeah. Let's go to our mailbag. We're so excited. Thank you. That was such an incredible conversation. We appreciate it. I know we have. We've already taken a little peek at our mailbag. And I know that there's some HRT things in here. Do you want me to kick it?

Speaker 3 [01:01:42] Us off? You can absolutely kick us off. I wonder if we should also just let the audience know that if you guys want to send us your questions, please send them to us on Instagram at Prolon and we will make sure that we get to them at some point.

Speaker 4 [01:01:57] Yeah, well also we like to, we'll post and give you a heads up of who we're talking to so you can you can ask the questions you want to ask. Okay, I'll kick us off and right here, question number one. If I am perimenopausal, which is better intermittent fasting or prolon's five-day fasting mimicking program? Are there symptoms that would indicate one or the other is better for you.

Speaker 1 [01:02:20] I think at this point, what I would say is before you are thinking about doing, whether it's a fasting-mimicking diet or intermittent fasting, I would be checking in what's your sleep like, what's you're stress levels like, where are you in your cycle? You're going to be a bit more stress resilient in the follicular phase when estrogen predominates as opposed to the week before your cycle starting. What's your nutrition like? Are you on point with your nutrition that you can go to start thinking about that? Remember I talked about that 100 grams of protein. And are you exercising in the right way? Because I know I had to radically change the intensity of my workouts in perimenopause. I was doing every, I would say like, I was the card carrying token example of what not to do, which is why I crashed into a wall, literally and proverbially. So I think the answer really comes down to you isn't that bio individual approach and really looking honestly and transparently at your life. To decide, can you add a little bit of hormetic stress? And it can be okay if you say, maybe it's not this month, maybe it is next month. And I think that's absolutely fine. But it's nice to have options.

Speaker 4 [01:03:24] I would also add, and tell me if you agree with this, but if you're fresh to a lot of these concepts, if this is all very new to you or you haven't practiced these things before, intermittent fasting, which can be done pretty simply in a 24-hour period of time, is generally a good place to begin, I would say, to kind of dip your toes into the water and get some of those metaphors. Get into the practice of when you're eating versus just what you're eating and things like that is a helpful first step, I think, for a lot of people. Although, the FMD, the five day, is intended to be for people who have never started. Well, also who have ever started fasting before and would never do water fasting. And I mean, none of us really should if we have the FMT available. But do you agree with that? Yeah, I agree with.

Speaker 3 [01:04:13] I think I also would add, when I'm trying to think, okay, intermittent fasting versus five day, because we're talking not just ProLon generically, we're taking about the five day. The difference for me is also just a deeper, longer fast with a five day protocol, where you get to really activate autophagy. And that can, for some people, be something that's really necessary for a lot of that cleanup. I mean. The literature on what you can achieve with the five-day protocol in just realistically, like five days, maybe three times, up to maybe six times in a year is really impactful as opposed to doing intermittent fasting every single day. So I would say also it is based off of what your goal is, right? I use intermittent fasting protocols more frequently with like weight management, insulin sensitivity improvements and things like that. And the five day more for like longevity, like punch, like really, really good longevity benefits, autophagy and some of that just done a few times a year. Sure.

Speaker 1 [01:05:19] I think it's also, yeah, and I think it's always in the context of the individual, because I've had some patients who, you know, they do a five day and they get to like day three, they're just too physically active and it's just not enough, like, they really have to curtail the type of physical activity they're doing, like substantially to be able to get through that. For sure.

Speaker 4 [01:05:37] For sure. Personalization is key.

Speaker 3 [01:05:39] Absolutely. I want to do this one because I'm so excited about this question and we've been skirting it. Okay, so what do you think about the removal of the black box warning on HRT and is this something that I should try? That's what they wrote. Yeah.

Speaker 1 [01:05:55] I was going to say, you're probably too young. I think it's really important. Marty McCarrey is a physician, actually trained at the same university that I trained at. But I think because he was originally involved with some of the original WHI data, it became very apparent to him. In fact, his book, Blind Spots, he spent a whole chapter talking about what came out of the WHI, the Women's Health Initiative. And how he felt like that had really been a travesty to women. So I think it's really a testament to the fact that he already had that in his mindset before he even accepted that position. I think, it's very important. Removing that black box means, first and foremost, women will get better access to hormone replacement therapy. That's really important. Number two, it probably means that things will move forward, hopefully, that we'll actually get a FDA-approved form of testosterone for women. We don't yet currently have one. Number three, I think it just de-stigmatizes hormone therapy as hormonal replenishment and not as something that hormones cause cancer, which is what the kind of mindset and philosophy was post-WHI when I was a new nurse practitioner. So from like 2002 until 2015-ish, maybe even later 2018-ish. Like that entire timeframe, people were fearful to prescribe hormones, women were fearful take it. And so it's really my mother's generation that I think has. Born the brunt of it. So I think it is a very encouraging, positive step. And for the woman who was asking, is this right for me to do, I would highly recommend you work with a menopause savvy provider. I'm actually certified, but there's many of us out there. You can go onto the North American Menopause Society. You can look through the clinicians, find one that's in your area so that you can have an informed conversation.

Speaker 3 [01:07:35] And is there a?

Speaker 1 [01:07:37] Too early and was my question No, actually, we're too late. No. So it's interesting, things have shifted because it used to be right before you go into menopause, that's when you start or in menopausal. Now it sounds like women are doing much better, starting with like oral micronized progesterone. Maybe they're starting their late 30s, early 40s, like the week or two before their cycle starts. And that improves symptoms for them substantially. So my question is, you started when you feel like you're ready for it. Number one, mentally ready for it. Number two. You know, are you symptomatic? So a lot of women, you can be in your mid to late 30s and be in perimenopause. And I think that's a common misconception. You're too young, no, you're not. Most common endocrine disorder in this United States is PCOS. So for any woman that has PCOS or has a presumed luteal phase defect, you're probably gonna need it earlier than most other people. And so I think that you start it when you're ready and start it when you become symptomatic.

Speaker 3 [01:08:33] And is there something that you're testing? So maybe I don't fully feel symptomatic, but I am ready. And I'm noticing maybe even just like a little more brain fog or sleep issues or some of these things, right? Super controversial.

Speaker 1 [01:08:45] This is super controversial and I say this lovingly, there are lots of people out there like you don't test hormones and perimenopause because they're all over the place. You can still test hormones, you have to be very strategic about it. You know, it might be that you're checking estrogen on day three, it may be you're checking progesterone on days 19 through 20. It might be you are going based off of symptoms, like if you say, Cynthia, every single cycle, the week before my cycle, I have more anxiety, more depression and I can't sleep. Well, that to me, we don't need to test your hormones. I would give you a progesterone, oral micronized progesteron. Same thing, if you're farther into perimenopause, there's this common misconception that because estradiol can be 20 to 30% higher, that we don't need to give an estrogen. Well, sometimes you do, because it can swing high and then it can swim low. And so for a lot of women, they are experiencing mitochondrial dysfunction, mitochondrial decline. That is what's driving a lot of those symptoms, the brain fog, et cetera. For me, it is a multi-layered, get a really good history. I don't think you wait for women to suffer. That is, unfortunately, has been the prevailing kind of patriarchal perspective, is that we let women suffer enough, and then we give them relief. My feeling is your generations are going to be asking, you're going to asking the right questions, you'll be asking sooner. And I think there's zero problems in starting HRT sooner. Now what I don t like is there's a lot of like pill mills and pellet mills out there that are convincing young women that they need pellet therapy, which is not standard care. Number one. Number two.

Speaker 3 [01:10:11] And just for anybody listening, pellet therapy is when they're actually putting something below your- It's underneath your-

Speaker 1 [01:10:16] It's underneath your skin, it looks like a grain of rice and they stick it usually in your bum. But here's the issue, it gives you super physiologic dosing, so way higher than what your body would make. And if you have a problem, you're stuck with it because it's several months later. So I like to use more predictable options that maybe they're not going to give you that massive rise, but they should improve things. And I think that what's most important is that women are getting a really good history from their provider because it is not just about. Slapping on the estrogen patch or giving that oral progesterone. It is figuring out, is this young woman super stressed, and that's what's driving her hormones down? Do we need to manage the fact that she's not sleeping, she's got three kids under the age of four, she has a spouse that's never home, she is so stressed out that she cannot see straight, and really what she needs probably, she probably needs someone to help her with her kids, not to say that she is not incapable, that's a lot. She needs to get several weeks of good sleep. And she probably needs to feed herself. I think that part of it is figuring out, what is your biggest issue? And sometimes we don't take the time to say, are you nourishing your body? Well, maybe that's why you have brain fog. Or maybe it's because you're drinking half a bottle at night because you have alcohol because you are super stressed out during the day. So it's really getting granular about where that person needs support.

Speaker 3 [01:11:38] I can see that kind of like in the, you know, what we're seeing with GLP ones, like a lot of people are just taking it as kind of this Band-Aid, well, this is going to be the easy way out and they do nothing else. I'm assuming with HRT, you can run that same risk, like I'm just going to do this and I'm going to Nothing else.

Speaker 1 [01:11:53] You still have to do the other work, and it's interesting because the research certainly shows that if you do HRT and a GLP-1, you'll have better body composition. So I think without question, these drugs are changing the narrative of conversations on a very substantive level, all the way down to super, like people are like, I just want to lose weight. I'm like, i respect that, but you look at all the other things that these drugs are impacting. And I think for a lot of people, you know, we have conditioned our patients to for a pill. Or medication to address symptoms, which that's the way traditional Western medicine works. However, lifestyle still applies. And as you get older, lifestyle becomes even more important. Like my teenager, well, I have one that's a teen. I have an 18 and 20 year old. What they can get away with right now is not what I can get it away with or my husband. And so I remind people it always goes back to majoring in the majors. Sleep, stress, nutrition, exercise are gonna trump just about any other intervention. But now. Can you take HRT and be doing all those right things and I bet you you're gonna feel a whole lot better? Absolutely, same thing with a GLP-1. But if you're prescribed a GLp-1 and your practitioner is not saying to you, I want you to eat at least 100 grams of protein a day and lift weights, shame on them, because that's setting you up for long-term issues.

Speaker 2 [01:13:08] Mm-hmm

Speaker 4 [01:13:10] Last question for you. I'm worried about chronic stress from 20 years ago that feels like it's catching up to me now. Can I fix it? I wasn't clear if that means that the stress is still pervasive, but do you have an answer to that?

Speaker 1 [01:13:22] Yes, but I think because that's kind of a vague question, it's hard to say, like, was this like you had a PTSD from 20 years ago? I would say there's a lot of somatic practitioners. I certainly talk, I unpack this a lot in the book that, you know, there's a lot that you can do. Do I think that, the imprinting from 20 years ago is impacting your health now? Possibly. Are there things you can do? Absolutely. I think the bigger question is... What is still bothering you. For some people, they have shoved those, their uncomfortable feelings have been shoved down that it's been replaced by a shopping addiction or drinking or gambling or porn addiction. Sugar. Or sugar addiction. I mean, you know, any addiction, correct. All these things. So it's like, you working with a practitioner is gonna be able to kind of figure out like where are your pain points and get you the resources that you need. I always say, we can always course correct. You know, this is never about like, Oh, I had this. 10-Year gap in my adult lifetime where I did not take good care of myself, that is not, you're not writing off the rest of your life. It's just understanding we can always be making improvements that impact our gut microbiome and otherwise that don't necessarily have to be onerous. But a lot of it's not sexy, like people want a magic pill and I'm like, there are no magic pills. You know, if you believe that, that's unfortunate, but you really have to put in the work and then that will come back to you a hundredfold. Yeah.

Speaker 4 [01:14:46] Yeah, I think we all need, I think the message I'm hearing from you is there's foundations that we need to, that you cannot get around a cracky foundation or cracks in your foundation. You have to work on your foundation first. Sleep is so important, what you're feeding yourself. And also we're human. I think that it, I think it's easy to forget that we are human and that we have, lifestyle is always going to play a big role. And I do find it very empowering to know that we can make changes at any time. We are not. We're never gonna be too old to see changes from even small things in our life, from drinking more water, to getting up and walking down the street a couple times a week when you haven't done that before. So you're never too old. I think there's always room to get better.

Speaker 3 [01:15:34] And to learn more, which is why I think this is so great that it's finally here. When can people get the menopause kit?

Speaker 1 [01:15:42] It's on pre-sale now, but it's officially published on April 28th.

Speaker 4 [01:15:45] Hooray! Congratulations to you. We're so excited and we're wild. Yes. Like what a big feat and what a big like congratulations to you and to all of us for getting to being able to adjust this and learn from you. Thank you for being on our show Cynthia. We are so grateful. You're such a wealth of knowledge.

Speaker 3 [01:16:03] I learned a lot, even just before you got here, just scouring the book and everything and just getting to pick your brain has been just so great. So thank you for being here. So nice to meet you both. Thank you. Cynthia Thurlow, everybody. We're so happy to have had her on. I know, and she was somebody that we went out of our way to wrangle in. We got so lucky that she was in Los Angeles and man, I mean, it paid off.

Speaker 4 [01:16:28] Yes. So in this episode, we kind of ran the gamut. We talked about gut health as it relates to perimenopause and menopause. We talked about trauma, how that can impact the gut. We talked about hormone replacement therapy.

Speaker 3 [01:16:43] Intermittent fasting, fasting, and some of the things that have changed over time since she recorded her TED Talk of like 15-plus million views.

Speaker 4 [01:16:52] And the power of changing your mind, power of changing what you're doing throughout your life to make sure that you are adjusting the best way that your body is how in how your body is changing. But I think one of my favorite pieces from our conversation and I think the resounding theme was you aren't going to get anywhere if your foundations aren't solid and those can be those really are the the basics of nutrition, lifestyle. Sleep, stress, all of these things, if you don't seal in those cracks in the foundation, it's going to make all of this other adjunctive components to life a lot harder to manage. So I appreciated that.

Speaker 3 [01:17:33] And you see, we're always so opposite. I'm like, my favorite stuff was all the new stuff. Talking about the estrabalome and all these things that I had never heard of before and how those are impacting our health, how it's impacting aging, all of these components and these synergies between our gut health and perimenopause and aging, especially as it relates to aging of the ovaries. This was, I mean, very, very new for me and so interesting. Yes.

Speaker 4 [01:18:04] And I think the, you cannot bypass your gut. I mean, gosh, I've been talking about it myself for a long time and you were just nerding out over there. I love it. It's such, I really could geek out to the gut all the time but it's true. Your gut is the seat of everything. It's the seat how your estrogen's working, your microbes play into your neurotransmitter production and all of these symptoms that we have in perimenopause, menopause time are influenced to our immune health. All of it by the gut and the interconnection between the estrogen and the gut microbiome, I think is going to be a really compelling conversation for everyone to watch in our conversation with Cynthia.

Speaker 3 [01:18:43] We've been hearing about perimenopause a lot and menopause finally, and we've been hearing about gut health a lot, but we're not hearing about them together, and it finally gets.

Speaker 4 [01:18:52] Brought together. What about the ovaries being the pulse? Oh, yes.

Speaker 3 [01:18:57] We've got to call this out because it's so good.

Speaker 4 [01:19:01] The Menopause Gut is an incredible conversation, we hope you enjoy it.

Speaker 3 [01:19:15] Thanks for listening to Almost Forever, our podcast about what it actually takes to live a long and healthy life. If you love the show, hit subscribe on YouTube at Prolon FMD or wherever you're listening and share it with someone you love. We'll see you next time. This is Almost Forever brought to you by Prolon. New episodes every other Wednesday drop on YouTube or wherever listen. This is not intended as medical advice, diagnosis, treatment, or a substitute for professional health care services.