The Menopause Gut Health Fix You Did Not See Coming

Oh my goodness. All right.

If you're getting in here right now, I have to relay this.

I cannot keep quiet. I had such a hard time titling this podcast because it initially was one thing, but it came full circle around to such a rich topic. I'm actually getting chills while I'm doing this. So If you wonder, should I listen to this? Here's what you are definitely going to get that we, we saw it coming. And here's what I didn't see coming that you are also going to get. Here's why to listen. We're talking about all things, basically menopause gut. If you are struggling with constipation, gas, diarrhea, bloating, reflux, I have Esther Blum with me, an integrative dietitian. She is so much more than that, and I'll tell you more in a minute. But I wanted her to come on and talk about fiber, the wide continuum of how much do you need, and, but what if I'm doing keto and carnivore? They're not doing fiber and they seem to be doing fine. We're going to talk about that. The literal what is happening, how much, why, What is fiber and what is fibrous foods? How do you know the difference and what you need? We're gonna talk a little bit about collagen and what there is to talk about. We're talking about betaine HCl, stomach acid, and digestive enzymes, which you need, when you need them, and in what order might you want them. You're gonna learn so much more, but I wanna tell you where we went that I, I totally did not see coming. And that is, we've talked a little bit about the biology of trauma. I'll put the link to that book. Actually, we weren't talking about the book, but we literally were talking about you can't, you can't digestive enzyme away all gut problems. We often will clench at the gut if we have something else going on deeper. We've got trauma of some kind in our childhood or adulthood and we haven't dealt with, and we talk about how important that is. And Esther reveals a little bit about herself. We don't go deep in that, but we do address the fact that it may not be only a physical ail or a physical supplement or change of diet that you need. So stick around. That was a small or short segment, I'll say. Certainly not small, but big. And again, I, second time, I have chills because the power of this podcast potentially lays in the last 5 to 10 minutes. So stick with us, although I think your curiosity is piqued if you wonder about fiber, about collagen, about digestive enzymes, betaine HCl, if you're dealing in any way with a change in your gut digestion elimination since you started menopause, this podcast is definitely for you. So as we roll into this one, thanks for being here. I'm Debra Atkinson, by the way, and you're listening to Flipping 50. So I want to introduce my guests so we can roll right into the podcast. Esther Blum, as I mentioned, she's an integrative dietitian and she's a bestselling author, keynote speaker who helps women find the light at the end of the vaginal tunnel through nutrition, hormones, and self-advocacy. And can you tell she's got a bit of a sense of humor? But listen to this. She is prolific as a writer, several books, but she is known as Gwyneth Paltrow's menopause mentor. So she's appeared on the Today Show, ABC Good Day New York. Frequently she's quoted in Goop, that's Gwyneth Paltrow's company, Oprah Daily, Well+Good, and Forbes. She's kind of a big deal, you all, and she is here just for you. Welcome back, Esther Blum. Thanks for being in the house.

Thank you, Deb, for having me. I really— it's so great to see you again.

We are gonna unpack some things, and I think we're going back to the basics. I would say we're almost going back to the foundational things that that I know when I first started learning, number one, for myself, then wanted to share that with other women. I've been talking about it for so long and I think that we forget the beauty in those foundational things. And then you come back to it and maybe there's new ideas. And that's why I want you here to really bring in the new, the what's the research say right now, what do we know, and is there any harm? And maybe we can really put you on the spot at the end by saying, You know, if you were gonna do this and you had a limited budget, what would be first and what would be next? Because that, whatever's on your list, I'll have what you're having. So, appreciate you so much. So I wanna start with one of the things that is really messy when you're in the middle, and I think that's fiber. I think right now it is so confusing and we have this wide continuum of, you know, absolutely you gotta have fiber, you need to poop, you gotta do this, you should be getting this many grams, we're getting an average of far less than that. And our ancestors got like 4 times that. But then there's this whole group of, you know, carbs are not necessary and keto and carnivore, and they're barely getting a vegetable in, let alone anything with real fiber. Where do you stand? And based on that, where's the research? And why is this even a much more relevant conversation for the midlife women who we're talking to?

So like you, I too am in the midlife space, and there's two things I want to say about fiber just from my own practice, but also from the clinical research. So in my own practice, I run stool tests on my clients to see, hey, what's your microbiome looking like? What's your intestinal permeability? Do you have bacterial overgrowth? You know, are— and That gives me a real indication. I can— when I look at your microbiome, I can see if the bacteria that really rely on fiber are populating your gut. You can really tell when someone has a low fiber diet. And I've had clients over the years do keto or in particular carnivore. Right. And while, yes, they lose some inflammation, they lose a lot of bloat. But their microbiome, 'cause I'll test and treat any bacterial overgrowth, dysbiosis, or inflammation, and then we retest. And what happens on the retest is the commensals, or the foundational bacteria of your microbiome, they always decrease. I see this consistently. I see it in women, I've seen it in men. I don't treat many men. Sometimes I treat the husbands of my clients, and same thing, the microbiome, the commensals take a real nosedive. So practically speaking, you know, it's a very individual approach. It's not one that I typically recommend is to be that low fiber because point 2 is, because I treat midlife women, I love to approach fiber as acting like a sponge to really soak up and help us detox our estrogen in the gut. Most people, when they think detox, they may or may not think, oh, liver detox, right? Phase 1 and 2 detoxification in the liver. Phase 3 of detox is pooping, and women need to poop every day. And when they're not pooping every day—

mic drop, mic drop—

when they're not pooping every day, they're not detoxing estrogen. And all of a sudden they're like, oh, my boobs really hurt, and I'm achy, and I'm so irritable, and I'm crying at like any commercial, and I want to kill my family, drive you nuts. They're like enraged and moody and bloaty. And when you poop every day, you're taking out your metabolic trash every day. You're eliminating your excess hormones or just helping the ones you either produce or put in your body. Like, let's say you're using an estrogen patch or bioidentical cream. Those hormones need to move through your body every day. So from my perspective, I tell my clients, You know, aim for 25 to 30 grams of protein a day. This can be with flaxseed, chia seed added to a smoothie, cottage cheese. You can make flax or chia pudding with nut milk, dairy-free milk, and just getting a wide variety of fruits and vegetables and color, which again, I sound like a classic old-school dietitian, but the basics really do work with that.

So good. I love that.

Yeah.

And I think it's so important. Is there— so you mentioned, what was the number you said? 25 to 30?

25 to 30 grams of protein. And you can track it if you just log your food for 2, 3 days. You'll know if you're meeting your fiber goals or not.

A lot of people would say, and I often will have somebody do, okay, let's just use an app or drive yourself nuts and Google it all. Tell me what you're doing now. What would you say as far as ramping up? What's a safe amount so that you're not overwhelming your system and you're kind of just bringing it back online slowly so that you're going to feel good while you're doing it? Right.

Because the last thing you want to have is like more gas and bloat. So number one is just track your food. Just 1 to 3 days, just write down everything you eat, no matter what it is, right? Not to judge, just to gather information. And then let's say you're only getting 15 grams, then you can ramp it up 5 grams every 1 to 2 weeks. So you can go slow. You can even buy fiber supplements. But I'm always like, just have a red apple every day. Just start doing that once a week or one day every week. And then, you know, start adding in some broccoli at night and then start adding in half a cup of lentils or chickpeas or, you know, try having sweet potato with the skin. Just little bits, little increments throughout the day. Some people also find they cannot digest raw vegetables so well. So I'm like, use soups, use stews, you can blend vegetables into that. And that's a really nutrient-dense way to gently ramp up your fiber without overtaxing your gut. Especially because when we decline, when our estrogen and progesterone declines, and our cortisol goes up, we start producing less stomach acid as we age. So we want to make sure that— I agree with you, we should go slowly and not come fully charging out of the gate.

Okay. And that's— you're like, gosh, you're so good. That was like a transition. We're going to go there too. We're going to talk about stomach acid, but I don't want to pass this one too quickly. And this is one more thing I want to break down because I think You mentioned all these great sources of fiber, but I think that a lot of women think, oh, I eat tons of vegetables, but then they'll actually tell me what kind, and they're the non-starchy kind where if we look at the fiber count they're getting, it's still really low. It's kind of lots of fibrous foods. Can you just lean into that a little bit?

Yeah. So you want to make sure— well, A, there are a lot of fibrous vegetables. I mean, you eat artichokes. Those are stringy. I think of broccoli or cauliflower or Brussels sprouts, the really cruciferous vegetables, which also support estrogen detox in the liver. But yes, there are fibrous carbs as well. I mean, legumes, if you can tolerate beans and lentils, that is like the most bang for your buck with the highest fiber content. And certainly, you know, sweet potatoes. I'm thinking of— my mind is blanking right now. It's the end of the day. Sweet potatoes, you know, fresh fruits as well. Fruits are very high fiber. Avocado is high fiber. Right. So all of those can be, you know, and then again, I always am like, just throw in chia and flaxseeds. It's just so easy and you don't have to think about it.

Yeah.

So it doesn't have to be overly complicated, but if 50% of your plate is veggies and a quarter is protein and a quarter starch, you're going to hit your, your fibrous carbs for sure.

Awesome. Awesome. And yeah, even my dog liked that one. I know. All right, let's segue to stomach acid. So talk a little bit about that and why, why is that happen? Is there a why? Do we know why?

Yeah.

The mechanism for that. So we have less stomach acid, meaning we're just not digesting things as well.

I mean, so many women will describe they just feel heavy or feel like they're not pooping all the way, feel like they're not pooping all the way, feel like they absolutely have an aversion to red meat or don't digest it well. If you have developed an aversion to red meat, that means you are low in stomach acid. That's like a real clinical sign. Oh, you don't even have enough your body is instinctually telling you, I don't even want red meat right now. I can't digest it. So again, the hormones play a very intricate role in all of this. What most people don't realize is that progesterone is a real motility agent. So without— yeah, so without optimal progesterone, if you're super, if you're super constipated, that's a sign, hey, it might be a great idea to bring in progesterone. Also, with— it's kind of a chicken-egg scenario, right? Because what happens is our hormones start to decline. All of a sudden, our small intestine becomes a lot more permeable and we lose that firewall. Stomach acid is a firewall to keep out bacterial overgrowth, things like strep, staph, H. pylori. Now, H. pylori is pervasive in our population. About 50% of our population has it. In low levels, it really doesn't wreak too much havoc. But when the levels start to ramp up, H. pylori loves to make a nice cozy home in an alkaline environment. It will literally turn off and H. pylori is surrounded by biofilms, which are these microscopic balloons that really encapsulate it and keep it safe and protected. So it's harder to kill off. So H. pylori Says to yourselves, hey guys, you're not going to produce stomach acid anymore, so I can continue to squat in your real estate over here. Right. So when we lose our stomach acid, then it becomes a vicious circle. Or when our stomach acid production is low, because then the H. pylori continues and then there's a cascade of bacterial overgrowth and leaky gut and inflammation that ensues. So, in those cases, right, of course we wanna eat fiber. We want to eat a lot of red foods, cherries. We want to eat pomegranate seeds or even have some pomegranate juice. We wanna eat wild blueberries. Those foods fuel Akkermansia, which is a very beneficial bacteria in our gut to support blood sugar, blood sugar regulation. People who are obese are traditionally very low in Akkermansia, or, women who are insulin resistant in midlife and beyond are low in Akkermansia. This is really, it's very consistent in my, again, gut testing. So you wanna make sure, number one, that you're working with someone to test and treat the H. pylori. Treat from the top down. I always treat H. pylori first, Candida second, because H. pylori can actually hide inside Candida cells. So I like to give the one-two punch. I'll kill H. pylori first, then Candida second., and I do it with plant antimicrobials. There's some really amazing ones, but also, again, getting a lot of fiber. Got to cut out alcohol because alcohol will also— while you're doing any gut healing protocol, especially alcohol, if you do it, it doesn't work. Your alcohol is like an astringent and wipes out a lot of good bacteria in your gut. But all of this is treatable.. And you can regrow and repopulate your gut with healthy bacteria, but you just gotta put healing foods in, lots of fiber, lots of protein, lots of whole unprocessed foods, rich in color. And, um, you know, alcohol-free for a while. Could still have a cup of coffee or tea a day. That's not a problem. And when you reestablish, when you kill off those bacteria and then start adding in some digestive enzymes again, when they're gone, then it really, it's like a whole upgrade on your GI system and your body.

Amazing. So come back to betaine HCl and digestive enzymes, kind of the difference between the two. When would you introduce one or the other or both? To a woman? And let's say she's not working with you, she just is at home suspecting that, you know, my gut isn't right, I know it's not the same as it used to be, and she's wanting to help herself a little. What's, what's safe, safe for her to do?

So if you're having reflux, which is a big side effect of H. pylori— H. pylori causes reflux— So, if you're having reflux, even if you don't have H. pylori, you do not want to take betaine HCl even though ironically, it's a lack of stomach acid that can cause the H— pardon me, cause the reflux.

Right.

Because you need that stomach acid and you need some zinc to keep the lid on the can of the top of your stomach, right? So, ideally, I would not start with stomach acid though. With betaine HCl right away because you could have an H. pylori infection. So, you can take digestive enzymes without hydrochloric acid. Hydrochloric acid is the acid— betaine HCl is the acid that your stomach produces on a daily basis. Some women need ox bile. You can take ox bile if your gallbladder is sluggish and you're really, again, you're having a lot of issues with constipation. Your gallbladder may not be firing and releasing enough bile to break down your fats. So, and to help you poop, so you can take some ox bile and some pancreatic enzymes if you're leaning more toward constipation. If you're leaning more towards bloating, you can take digestive enzymes without betaine HCL, but ones that contain amylases, which break down starches, especially vegetables. Lipases to break down fat, and proteases to break down protein.

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The list is long.

Apple cider vinegar, where does that come in?

It's not my first go-to. Some people tell me it works well. I find where I usually come in at— and listen, if you're listening to this and you're like, this works for me, I would never tell you to stop what works for you personally. You're always going to be your own best doctor. Each of us is our own best doctor. So don't let some stranger's opinion derail you at all because you know your body best. But I love doing two things. One is if you're having a lot of reflux and you want to heal it, what works is two things. One is I love making aloe water where you take a 2-inch slice of an aloe leaf. You can get aloe leaf in Whole Foods, but I also get it in the produce section of Stop and Shop. Like, you can get it in an ethnic bodega. You know, you, you can find it more commonly than you think. So you take a 2-inch slice, you scoop out the gel, you throw it in a blender with like 12 ounces of water, and you drink it 20 minutes before a meal or like 2 hours after a meal. So that really, if you think of what aloe does for burns, it's very healing. The gel is very soothing, very cooling. So that's a wonderful reflux remedy. You can do that 1 to 2 times a day. You can also do raw celery juice and you can, you can always add the aloe in there as well. But celery juice, you ju— you juice an entire bunch of raw, ideally organic celery, and you drink that first thing in the morning when you wake up. And that also gives you a good liver flush. It's super high in antioxidants. It's very hydrating because celery contains natural sodium. You drink that first thing in the morning. A, it promotes a bowel movement. It's great for chronic constipation. But B, it also really helps heal reflux. I've seen my clients who've been on Prilosec for months and months, and they can come off it in 2 to 3 weeks on just the celery juice. Wow. That's pretty amazing. And if you hate celery juice, cucumber juice is a close second. Or I'm like, just do the aloe water. Ever so slightly chalky, the aloe vera, but otherwise you could just chug it. If you've done shots of Jägermeister in college, ladies, you could do a little, you could do a little aloe water, trust me. Anything, anything goes. Yes.

Do you have to, I don't know the answer to the question literally, so do you have to juice your own celery or can you buy celery juice?

It oxidizes, you know, within 12 hours, definitely 24. So I'm like, if you're super busy and you have to get up early and get the kids out and get, get on the road, then make it the night before. Just store it in like an opaque, you know, a shake cup, and then you could drink it first thing in the morning. But yeah, it separates anything you see that's store-bought. And long as separated, there's— it could be a week old. It's not fresh.

It's not going to do anything. Okay. So I want to ask you about this. And behind the scenes, we've talked about this a little bit. There may or may not be enough data either way. But collagen is such a hot topic, and total disclosure to anybody, we sell a collagen product, so I'm going to let you know that. So, and I do it not for hair, skin, and nails as much as I do it for joint support. So there's that. But let's talk about what does the research say, what does the data say, yeah, about it, and Pros, cons, what does it help?

Yes. Well, okay. First of all, if you're getting collagen from a homemade bone broth, right, which is so easy, I'll give you the recipe in a minute. But that is just a nutrient-dense food in general. You're going to get amino acids from that as well. It is great for hair, skin, and nails. Truth be told, I have not done a deep dive into research around collagen. But if nothing else, certainly anecdotally, I've heard women say, yes, it really helps me grow gorgeous nails. It's helping my skin looks better on it. But I'm a big fan of if you can make it, it's literally, you know, I use 3 pounds of either chicken feet. Yes, chicken feet, ladies, or knuckle and neck bones from a cow. I'll put it in my slow cooker and add water along with a tablespoon of sea salt. I'll add in carrots and onions. I'll add in— if it's the bone broth, I add in, you know, a couple tablespoons of cider vinegar to pull the collagen from the bone, or just a little bit of lemon juice for the chicken broth. And chicken broth, I add fresh dill. And then you put them low for 19 hours. That's it. And then you refrigerate it. The fat rises to the top. You skim the fat, and then you can freeze it. And it's like meat Jell-O. Like, it's so rich in collagen. So Nothing. There is nothing wrong with collagen. I just truly don't know. I'm not literate on the research around it, but for joint pain, I mean, geez, I would rather see you take that than like aspirin or Advil or Tylenol for sure.

Right.

For sure. But I just don't know. What do you know? What research have you seen?

You know, I— it's more anecdotal, honestly. It's, you know, people who— and I think placebo effect is something we have to consider here. Like, I think if you believe that it Helps. I think we can both agree that, that there is nothing we've heard that it's negative about taking it. So I think the decision for anybody listening might be, do I need to invest in that? If I have a limited budget, it's probably not on the top of the list. It's cover some other bases first before you get to that. And if you have extracurricular money, then, then there's that. Maybe I like to also stack You know, so if I'm doing collagen, I'm not just doing collagen, but I'm adding it to another protein source or meal. So it's like elevating all of the essential amino acids. It's not an only— like, like bone broth instead of just regular broth, you know, as the soup base. Um, so all of that. But I've had people say, I feel like, you know, I sprained my ankle, or literally I fractured, and I've healed so quickly, and I swear by— I'm so I've been taking collagen. You know, I've had good athletic friends, not so athletic friends, both in that boat. So it's just been interesting to watch that they went there voluntarily. It wasn't, wasn't questioned, but somehow they tied their good fortune or healing to that piece. So, but yes, I don't know a lot otherwise. Hair, skin, and nails, I can vouch for that. But I also want to say that I but in our defense, those of us who are doing collagen, we're probably doing all the things, and your nails are growing because you're an active person and you're sweating. So, you know, I'm just gonna challenge, is it what we think it is, or, you know, is it all combined and we're having a hard time sorting it out?

So yes, and also don't forget the immune benefits too. Like, I always— this is why I always keep bone broth in my freezer. If the minute I start coming down with something, feeling run down, I just chug a lug, a couple of mugs of that, and within a day or two, I'm really back on my feet. And that's without like— I don't always love taking a million supplements either, so sometimes I just want to do food first. So, um, you know, our gut function is directly linked to our immune function. I mean, 70% of our lymph nodes line our small intestines. So, and it is budget-friendly if you don't want to invest in the collagen product. The bones are, you know, $8 for a pack. So, you know, that's extremely cost effective.

Yeah. And I— yeah, we talked about the fact that it's like the Thanksgiving Day phenomenon. Like you walk in and your house smells so good. There's got to be oxytocin that comes from that.

There must be. Yes.

Yes. Okay. So unpacking all of this, I want to— I want to ask you this. And there's a couple more things, but one of them is, you know, I think women still struggle in midlife with the '70s and '80s diet culture, and intermittent fasting has played right into that for a lot of women. So when we are really shortening a window, or we still— and we're shortening that window and still are maybe depriving and really skimping on calories during that window, there's no real feast. It's, it's a challenge to get adequate calories in. Talk to me about that. I mean, just unpack it. You see and talk to so many women about their diet who need and want support. Where do we stand? Yes. What are we collectively doing right now?

Well, again, let's just look at the research there. When I wrote my paleo diet book for women that came out in 2017, Cave Women Don't Get fat, right? Back then, I looked at 78 studies on intermittent fasting. 13 were done on women. So it's really not a lot of data. Um, I think it would be really interesting to do studies on intermittent fasting in postmenopausal women because we're in a steady state. Like, if you listen to Dr. Mindy Peltz, she'll talk about fasting the first half of your cycle versus the second half. And I, I do agree with that just anecdotally because I saw— I see in my practice, like, blood sugar goes wonky when you're in perimenopause. It's, it's a real roller coaster. And that is very difficult to be intermittent fasting during that time because you're not meeting your caloric needs, you're not meeting your protein needs. Most women are not. Most women I see The, the bottom line, the bottom foundation of protein is 100 grams a day. Most women need 120, 140 and struggle enough to meet that.

So, okay, well, whoa, whoa, whoa, whoa, whoa, whoa, whoa. You know, my walkers out there would be like, they've stopped in the trail and they're like, don't just step over that. So you said the bottom, bottom line is 100 grams. And I'm so glad you said it. Dr. Donald Layman kind of lays this down also. Yeah, but I think everybody wants to know what, what makes you say that? Why 100?

Why is that the minimum? So I got my nutrition degree back in 1992. Let me tell you, the RDA— I joke it's like the recommended death allowance. It is so woefully inadequate. It is. If we followed those RDAs, we would all lose muscle and bone. And Dr. Layman has such beautiful new research. Gabrielle Lyon's books highlight his research, too. And, you know, it's— the research is out to show that we need more protein as we age, not less. And we lose the greatest amount of muscle and bone in late perimenopause, not even in menopause, in late perimenopause, those 2 years at the end. We're losing it at such a rapid, rapid rate. And women are cutting calories, they're cutting carbs, they're intermittent fasting. And what I see in those cases is the thyroid shuts down because the thyroid is very rich in estrogen receptors. So, okay, our estrogen is roller coaster. It's peaking, it's crashing. We're not getting a steady state of estrogen. So the thyroid starts to shut down. And here we are slowing our metabolism down further, continuing cutting calories, continuing underfeeding ourselves, continuing to under-eat carbs. So again, what I also see anecdotally in practice is I end up refeeding women. They come to me between— I've seen as low as 900 calories a day, but most women are at 1,100, 1,200 calories a day. And they think, "Oh, well, I'm tiny. I don't need that much more." I worked in hospitals for the first 5 years of my career, and people on ventilators lying there just breathing, their minimum calorie intake was 1,200. Most people just lying there when they're doing nothing. I mean, they're not doing nothing, they're trying to heal their bodies, but they were getting 1,500 to 1,800 calories a day in tube feedings or intravenously in our TPN solutions. So I can tell you that as an able-bodied female, yes, you may be sedentary, but going below 1,200, you know, the intermittent fasting is great. You can be in a deficit a few months, but after that, You really do need to eat more, exercise more, strength train more, not eat less, exercise less, or eat less, exercise more. That model doesn't work in midlife. A, most women are exhausted, their blood sugar's all over the place. So taking away more food instead of putting in fiber-rich food and putting in protein to stabilize your blood sugar, that's how you restore sleep. That's how you restore energy. Then you have the energy to work out and feel human again. Then the brain fog clears. And most women, you know, we think, oh, I'm so irritable. It's my hormones. It's also because most of us are starving ourselves and we're just incredibly hungry. I'm not someone who's ever missed a meal because I forgot to eat. That's like so rare for me. It's not true, but it's very rare for me. I always eat. I fuel my body because my body So much happier, but it's not my personal bias that's driving this. It's truly the science and it's working with women. I do have a few women, of course, there's always a small percent of the population that are the outliers that do better with intermittent fasting, that feel better, and they're like, "I don't have time to eat." You know, but most women, when we ramp up the carbs, we get T4 to convert to T3, which is the active form of thyroid hormone, and boom, they lose weight increasing their carbs. They're like, "I can't even believe this. Like, I can't believe how much I'm eating and I'm still losing weight." Yes, yes. Which is fabulous. It's the best-case scenario. And I get women, you know, from 1,200 to 1,800 calories and they're lifting, they're losing weight, they're doing their steps, they feel great.

Yes, and not deprived. And the chatter is gone. Because if you're cutting down and you're hungry all the time, you're constantly fighting the battle of, I have no energy to do that. I should wanna go do that. I don't wanna go do that. And it's all you can think about is what you won't eat. Right?

So, so true.

So true. I wanna ask you this. So looking ahead, this whole connection with gut health, you know, and gut and hormone science, what do you think is like in the future? Like what's coming? And maybe for the women who are listening who are, you know, on average, probably targeting. And if you're an outlier, I see you, it's okay. But between 45 and 70. But I think we're all thinking, if this is my gut now, what will it be like in 10 and 20 and 30 years? So what is the gut hormone science, not just for women in midlife, but for those of us in it who are gonna look at— we have fewer ahead than behind us.

Oh, God forbid. Okay, well, there's a couple of things, and it may be broader brush brushstrokes than just gut science. But number one is normalization of a discussion about hormone replacement therapy. Like, the research is there. I've looked at so many studies. I go to conferences. I'm trained by physicians. The research is there. Whether or not you decide to work hormones into your life or not should no longer be fear-based. It should be not personal bias, not causing cancer, fear-based. We now know that women who use HRT, for example, have a 60% reduction in the incidences of cancer expression, so especially breast cancer. So women can make informed choices. And I think genetic testing is a huge part of what's coming down the way and should also be part of every conversation that goes far beyond just the BRCA gene, but that looks at nutrients, that looks at methylation or detoxification patterns, because that does impact the gut as well. And then the third is normalization of, um, plant medicine in healing from trauma, because the gut, it's not just about hormones and what we're eating. This drives everything in our endocrine and hormone systems. And if women do not work through their trauma by the time they hit their 40s and 50s, believe me, when we lose— when our estrogen drops, the filter comes out, the crone comes out. And that the crone is a powerful, wise woman, not some shriveled up weirdo bird lady. But, um, and you know, we have to step into our power. And we're, we're not, you know, if our our voice has been shut down, or we've been ashamed our whole life and had disordered eating and eating disorders, now is the time to really heal and do the trauma work. So I do believe, you know, HRT, genetic testing.

So in winding up, if I ask you, like, what's on the frontier in regard to hormone and gut health and that connection, but not just for all women, in midlife? Because I think those of us in this midlife right now are looking at, if this is my gut health now, what will, what will it be like in 10 or in 20 or more years for me if I don't get this under control? What does that look like?

Well, I'm going to speak in broader brushstrokes than just gut health because we are continuums. Our, you know, what goes on in the mind also affects the gut. Hormones have a huge effect on the gut as well. So number one, I really want— what I see turning, and I see that Gen Xers are the alchemists of what is happening right now, is a real normalization of the conversation around hormones. The minute a woman is in perimenopause and says, I'm starting to feel really off, my periods are off, the second half of my cycle is really off, Immediately there's a conversation around hormones, whether or not you decide to introduce them into your life. And we should also be, of course, not skipping ahead with hormones, but nailing down our diet, our activity, our sleep, our exercise. Of course, we want the big rocks in place, but we also want to start having access to hormones early. Because we want to offset the side effects and we want to smooth out the roller coaster of menopause. So this means introducing some bioidentical oral progesterone in the second half of a woman's cycle, even if she's taking birth control pills, or, you know, so that she can sleep, she can control her anxiety and her mental health, she can control her motility and not be constipated. All of a sudden in midlife because progesterone is a motility agent. Progesterone is also a corticosteroid, so we can offset some of the achy joints and pains and inflammation. Okay, so that's number one, is introducing the concept and the education around hormones early. And I can tell you, for those of you thinking, my doctor told me hormones cause cancer, Biochemical messengers that have been in our bodies our entire lives don't all of a sudden just start causing cancer, number one. Number two, the riskier link to cancer is long-term birth control pills. Those are the synthetic forms of estrogen and progesterone. Those have a far greater risk factor for clotting and strokes. And we have no problem taking birth control prescriptions from our doctors or drinking alcohol every day, but we're terrified of bioidentical hormones, even though the research is out there to show that women taking bioidentical hormones have a 60% reduction risk in breast cancer. So I want to make sure that, you know, I, I really do believe the tables will turn. Medical schools still aren't teaching it, but I do believe a lot of doctors are going to say, hey, all of my patients are asking about hormones. I better wise up and educate myself because the studies are out there. The research is out there. You can go to a website called PubMed, PubMed.com, and Google, you know, safety of estrogen, estrogen risk, breast cancer, da da da. And there's a lot. I mean, you really have to be a little educated in this before you do your own research, but The research is there. The published research is there. I have 100 studies in the back of my book, See You Later, Ovulator, to get started. There's, there's a lot of research out there. Number one. Number two, I think genetic testing is also going to be really important in understanding our genetic expression. That goes beyond the BRCA test for breast cancer. So how we digest and absorb nutrients, nutrients, how we detox our hormones or drugs, how our body interfaces with the world, what are our genetic pathways. That's a really important piece too of all of this because, for example, I see women who aren't great methylators. They don't detox their estrogen well in the gut or the liver. So we put them on nutrients and a diet that is going to best support those pathways in the liver and move estrogen through properly. So genetic testing is wonderful. There is a wonderful test. It's 3x4. It's 3x4. I have no financial ties. It was started by a brilliant PhD dietitian, Dr. Yael Jaffe, and it's a wonderful test I've started referring to in my practice.. The third thing, Debra, and I think this is the most important, is introducing plant medicine into healing. Because I see, you know, a third, one in three women has experienced sexual abuse in her lifetime. I am one of those one in three women, and we have to heal our childhood traumas, either lowercase t or capital T traumas. When we don't heal them, the research shows we have far worse journeys through menopause. And we also suffer. We're angry, we're depressed, we don't know why we lost, we can contemplate suicide. It's really important to normalize and destigmatize the shame around sexual abuse. It is so common, and if we don't break the cycles in ourselves, we will continue to pass it along to our children and generation after generation after generation. And so it's really important, I think, more than ever to normalize the use of plant medicine. And that means ketamine, it could mean MDMA and psilocybin, it can be facilitated journeys to really rewire the neural pathways in the brain and really heal our nervous systems.

I'm so glad you said that. I, and I want to bring this book up. We talked about it not too long ago. It was just released this fall by Dr. Amy Apigian, The Biology of Trauma. And, and so often I've worked with women too who are so deserving of every reward. They literally have changed their mindset about what the habits are and then changed those lifestyle habits and they deserve it. There's no reason I can, I can find that they shouldn't be getting results. And so we get to that point where it's like, have you, have you looked at this? Is there a reason why you might want to? And, and yet just today, or within the last 24 hours, I'm sure I saw something, some post that I have to go back to because it almost made me alarmed because it said something about exercise can help you forget traumas. And I was like, you know, that doesn't sound— no, it sounds like maybe bury them, avoid them. But, you know, I would be right. How do you get past it? Because I find women, it's physically making them blocked or sick or something. And I think we have to deal with it. You can't go over it or around it.

You gotta go through it. That's right. And you look at chronic IBS. IBS is one of the hallmark signs, or just a bloating, or eating disorders, right? And worthiness. Some cases obesity, because that fat is a protective padding against— Right. You know, predators. And there's so much shame. There's just, you know, and the thing is, we really want to unpack that. And, you know, it's, it's really, really important because it does, it does block you. And on many ways, on many levels, it does block you from receiving, it blocks you from healing. And a regulated nervous system And inner peace is the greatest flex of all. And the mindset has— it's everything is top down. So what goes on here affects your gut, affects your hormones, affects your thyroid function. Thyroid is in the throat chakra. And I see more thyroid cancers and thyroid dysfunction from women who have been abused, been cheated on in marriages, go through horrible divorces. And it's unbelievable how we can heal from autoimmune conditions, how we can heal from severe thyroid dysfunction when we do speak our truth, when our throat chakra is clear and empowered, when our vagus nerve is settled and regulated.

It makes a huge difference. Amazing. This has been such a rich discussion, but now you have really created a problem for me. So all of you will know I have solved this or I haven't, because coming up with a title to do this one justice is going to be a real problem. But while I ponder that, tell everybody where they can find and follow you. Okay.

Well, thank you. Gorgeous, gorgeous Esther on Instagram. Esther's E-S-T-H-E-R. And I'm launching my new podcast, The Midlife Realignment. So we're going to go deep on all of these topics as well.

So amazing. All right, everybody, you will go over to Flipping50.com/podcast and you will see the show notes no matter what it is I end up calling this because I have not decided yet. It was always, always great to catch up with you. Thank you for this rich, rich convo. Thank you.