The Menopause Gut: Hidden Reasons Symptoms Happen Exercise Won’t Fix

You wanna know the secret, the real secret to aging well? It's not what you think. And in this episode, I have my good friend and colleague Cynthia Thurlow back, and she is gonna tell you exactly what it's all about. You are in perimenopause, menopause, or postmenopause, and you're not slowing down. You're just getting started. But the old rules don't apply anymore. The workouts that worked before, they're working against you now. The advice you've been given, incomplete at best. I'm Debra Atkinson, and I'm the founder of Flipping 50, the pioneer in fitness for women in midlife. For more than 40 years, I've been in the trenches with women just like you, and for the last 12, right here on this podcast, and, and the founder of Flipping 50: The Stronger Way app and membership. Welcome to Flipping 50: The Stronger Way, where science meets strength, where you'll find the tools, research, and real talk to build the body and the life you want in your second half. Each week you'll get evidence-based exercise and nutrition strategies, conversations with leading experts, and honest answers to the questions your doctor didn't get answers to in medical school and doesn't have time to answer in an appointment. This is your show. Let's get stronger. I'm thrilled in this episode to welcome back our guest Cynthia Thurlow, who's here. We're gonna talk about her new book, but really we're talking about the guts of the book. We'll talk about how you can get your hands on it, of course, and you are going to wanna do that when you hear just how important your gut is to you. And let me tell you the interesting thing about this episode. So as many of you know, I often will do this intro to the show and the podcast after we've done the interview. And as I know we would and knew it before we started, we very easily flow through a conversation as if we're a couple of friends sitting in a room talking about the book and about learnings along the way as women and as practitioners in our, our, each of our individual fields. But we talked about not just the role of gut health, the microbiome, as you will, but its impact on our aging. On not just digestion and elimination, but also on our brain health and on our bones and so much more. And so if you've wondered about your gut, about why digestion or elimination are different, why you don't tolerate the same kinds of foods as you once did, this definitely is your episode. We're gonna start unpacking it, but I want you to stay to the very end in this one, because it is then that we're really going to reveal the most surprising thing for Cynthia Thurlow about writing this book, and I think it will surprise you as well. Cynthia Thurlow is a nurse practitioner. She's the host of the Everyday Wellness Podcast, an author and international speaker with over 15 million views for her second TEDx Talk on intermittent fasting. She has over 25 years of experience in health and wellness. She's a globally recognized expert in perimenopause, menopause, and intermittent fasting. She's the CEO and founder of the Everyday Wellness Project and has been featured on ABC, Fox 5, KTLA, CW, Medium, Entrepreneur, and the Megyn Kelly Show. She was recognized by Yahoo Finance as one of the 21 founders changing the way we do business. So also don't want you to miss her bestselling book, Intermittent Fasting Transformation: The 45-Day Program for Women, and her forthcoming book, The Menopause Gut: Balance Your Microbiome to Reclaim Your Health in Midlife and Beyond. Don't miss this episode. Stay tuned. So either lace up your shoes, pull on your lifting gloves, or make sure you're ready for a nice good commute because this one's definitely a must-listen. And if you would please do me and a friend a favor and share it with at least one friend if you found this helpful. Cynthia Thurlow is back in the house. It's always good to see you, friend.

So good to see you. Always a pleasure, always an honor.

And this book, oh my gosh, gold. But we have to know what prompted you to write this book? Because your first was so great and you really busted open intermittent fasting, I think, made it accessible and understandable and how it was helpful. But how did you pivot and get to this topic, which, by the way, is gold and so needed? And I'm like, "Why didn't somebody else think of that?" But How did you get here?

Uh, you know, I, I think the honest answer is I intrinsically felt like at the time when I wrote The Intermittent Fasting Transformation, that was the right book at that time for me. And I, I think since 2022 when that book was published, I have just been curious, like, what interests me? What do— are my podcast listeners interested in? And, you know, I would say episodically my editor would reach out and say, do you feel like there's another book in you? And initially it was like, absolutely not. And in 2024, when she reached out to me and I said, yeah, I feel like there's a blind spot in the perimenopause and menopause space. And let me back up and say, this space I've been in for 9 years. It just happens to be intermittent fasting is what people probably make a greater association with, but that's not the only identity I have. And so I, I think that I literally wrote a one-page pitch to my editor and said, I think there's a huge blind spot in the perimenopause and menopause literature and focus because of the podcast, because I get to interview all these experts. And it was just becoming apparent to me there was this commonality and common thread that hadn't been discussed. And when I pitched this one-page idea, let me be clear, my first book proposal was 100 pages. So just gives listeners some perspective.

Well, you had a little street cred this time too, though. That book kind of did okay.

Yeah, yeah, yeah. And so She literally read it and within 24 hours said, um, I want you to run with it. And so I told my lit agent, I was like, I think this is the universe's way of telling me it's time to write about this. And so I literally spent 8 months writing my book. And when I say writing my book, blood, sweat, and tears writing my book, because I felt like there were a lot of unanswered angles and questions that I had. Why was I seeing commonalities between lab work and complaints and symptoms in women in perimenopause and menopause that I didn't fully understand and appreciate. And I just followed— I was like a bloodhound. I just followed the research, the literature, my curiosity innately. And what came out of it was The Menopause Gut, which I initially balked at the title because I was like, it's a double entendre. It can be taken multiple ways. And I didn't want it to be What many of my female patients get frustrated with is the menopause gut, menopot as it's sometimes called. Right. Then on the other side, I was like, it's so clear what it's about. Like, it's so clear. Like, you look at the title, you look at the COVID which is masterful. It's like, as soon as I saw the COVID I was like, that is the COVID And so to answer your question, I think it was part organic interest I feel like just the right podcast guests came on and they just started showing me little slivers of why we need to be more focused on the gut microbiome in this transitional time in a woman's life, and literally how it impacts every body system, how we age positively or negatively, and how we feel and perceive ourselves. And so that's how that book came about. And I'm really— I feel like this is the work that I was meant to do, although it was really hard. I will transparently tell I think writing this book was one of the hardest things I've ever done. Why?

What was it about this one so hard?

Um, you know, it's funny, I wrote The Intermittent Fasting Transformation and wrote a course at the same time, and that just felt like that just kind of fell into place. Whereas this juxtaposed with one of the hardest years of my adult life was, you know, the death of multiple family members. My husband got sick. You know, I had all these like sad things and happy things, and I had to kind of write in between. So part of the writing process was cathartic because it allowed me to focus on something other than sad things. And so I think that, you know, when life gives you opportunities to step up— because like many other times in my life, what no one would have questioned if I had said, you know, time out, I can't do this right now, I don't have the bandwidth. And my kind of personal philosophy is, well, when it gets tough you work harder. So that's kind of— that was my prevailing thought process, was I'm going to bring this book in on time because writing for 8 to 12 hours a day is what allowed me to feel like I had control over something. There were a lot of things I had no control over at that time. And so I think that it was part therapy, and then also it was just frankly hard. Like, I think there are people out there, Debra, that write effortlessly and easily. Like, writing a blog post or a social media post, that's very different than writing this and trying to strike the fine balance between being research and evidence-based, but also not being— like, I'm not writing a— my editor kept reminding, you're not writing scientific textbook, so keep that in mind. You want people to be able to read it and understand it. And so trying to find that, that happy balance was challenging. I'll be completely transparent. And then, you know, really exploring topics that I didn't know as much about, like the immune system, was just, it was challenging. Challenging in a good way. Like these are the things that make us smarter. And, you know, learning is really important at this stage of life to keep our brains sharp. But it was, I would be lying if I said to you it was an easy process. It wasn't. Like when I finally got the second manuscript accepted, I think I did a massive exhale and said, thank God. I was like, thank God that's done, and then I can move on to the next thing.

So I love it. And I, I would have to say, both for me and for someone else who's a mutual colleague, you know, in really hard situations in life— I remember somebody asking me after a death in the family, and it was maybe a month and a half later, and somebody said, How are you still running the business? And, you know, I didn't know it at that moment, but it was the escape from it. It was the relief from that. Yeah, you're absolutely right. Thanks for sharing that piece. So in this book, I want to ask, so is there a course together with this one coming too?

In my mind, yes. I mean, the good thing is that because I wrote the book, I jokingly said to my team, I said, it's really just organizing my thoughts. And so, I gave them— I was like, after Thanksgiving, then I have the energetic capacity to think about the course, which should come together fairly easily in terms of content. So, yes, there will be a full-on Menopause Gut course that will be for clinicians, but also health and wellness experts so that they can kind of broaden their perspective. And we'll go a little deeper into the science for those that want and need that opportunity. But yeah, I think that for all of us, whether it's escapism, sanity-inducing or not, I think that when life gets challenging, we're given opportunities to show up. And so you and I show up because that's who we are. Yeah, right.

Because there's other that are crawl under the covers. Yeah.

Yeah. Yep.

Okay. So you got my attention though, and I hope that no one else skipped past it. Because I think when we think of menopause gut, and yes, I think, yes, there's the belly, but using the word gut really clarifies it. And so many women though, I think might pass this off as like, this is a nuisance and this is inconvenient and I don't like it. But when you say this impacts the way we age, that is a whole different level of let's acknowledge that this is a thing here we need to address. So speak into that, and how is it that the gut and the gut health actually impact the way we age?

Yeah, it's such a good question. And I think when I reflect on kind of the major gestalt of the book, you know, the things that are such important, big, salient takeaways, it's understanding that nothing in our bodies exists in a vacuum. As we would like to believe in traditional allopathic medicine, that, you know, your cardiology or gastroenterology or pulmonol— like, everything exists in a silo. And I'm here to share with everyone that there's nothing in the body that does not communicate with the gut. And so as we are navigating the aging process, you know, we go through peak fertile years, we go into perimenopause, we go into menopause. The gut microbiome, which back 1,000 years ago when I was in my medical training was not even a thing, um, that has really come to the forefront over the last 10 to 15 years. We just understand it's this incredibly dynamic, sophisticated ecosystem of bacteria and viruses and fungi and protozoa that are constantly communicating with every system in our bodies. Like, as an example, did you know there's a gut-bone axis? So the health of our bones is deeply and intimately connected to the health of the gut. And so when I about what is changing in the gut microbiome as we are navigating alterations in progesterone and estrogen and testosterone. And those are not just sex hormones. I think, you know, I try really hard not to say sex hormones anymore because now we're trying to really emphasize that these are systemic hormones. But estrogen in particular is intricately interwoven not only in the immune system but also in the gut microbiome. Like, as an example, it is part of the glue that allows our small intestinal lining, which is one cell layer thick, to stay together. So as we are losing estrogen, we are more likely to develop things like opportunistic infections. We are more likely to develop leaky gut. We lead to more inflammation. So when women say to me, I used to be able to eat gluten, grains, dairy, whatever it is, but now when I eat it, I get bloated, I feel, you know, I've digestive distress, part of that is because we have these alterations in hormones that are impacting our ability to fight off infections. Women in menopause are 3 to 4 times more likely to develop autoimmune conditions because of key changes in our immune system. And I don't share this so that anyone is frightened. It's more like these are why— this is why we have to be more conscientious about how we treat ourselves. The word pause perimenopause, menopause is designed to have us be more reflective about our lives, what serves us, what no longer serves us. And so when I think about perimenopause, I always say, I think for so many of us, we are driving at 1,000 miles an hour until we start getting symptoms. And then the symptoms make us think, and then we pause. And in most instances, we start to fight back about these changes. We get frustrated, whether they're physical changes, emotional changes, diet changes, sleep changes, stress management changes, menstrual cycle changes, we push back because we don't intrinsically like change. I mean, most of us don't. And so I just invite listeners to consider that as we are navigating this second half of our lives, that we embrace the changes that are happening and better understand them so that we know how to adjust our lifestyles to be able to accommodate. And I don't say this like adjust, like accept things, sit back and say, I love this. We have instances, we are human beings, you know, I have days where I'm like, you know, I don't like this. But I'm like, where's the reframe so that I will better understand the things I can be doing that will allow me to thrive and not just survive this chime in my life. So So when we think about on a very basic level, as we are navigating these changes, so in the gut, as an example, we get changes in diversity. So the, the key microbiome constituents, we call them keystone bacteria, they start to shift in response to these hormonal changes. We don't make as many anti-inflammatory short-chain fatty acids, and a lot of people will tell you don't need fiber. I would actually argue that if you don't tolerate fiber, we need to figure out why. But fiber is really important because it feeds these colonocytes, which go on to make these short-chain fatty acids, which have many, many, many, um, very key roles, including like reducing inflammation, but endogenously creating our own GLP-1. So these GLP-1 drugs are very powerful. And very impactful, but our bodies actually make endogenous GLP-1 vis-à-vis specific keystone bacteria's integration with these short-chain fatty acids. So things like butyrate, I'm sure many people have heard of butyrate, propionate, acetate, those are some of the more common ones. But we get changes in diversity, we don't make as much short-chain fatty acid, so we have a little more inflammation. We are more likely to have this ratchet up in inflammation, which leads to more oxidative stress, which leads to leaky gut, which leads to more food sensitivities. We may experience alterations in how our bowels perform. So you may get more diarrhea, you may get more bloating. Bloating is super common. You may have more constipation. There are changes to the estrobolome, which is this awkward term that basically speaks to the way that our body breaks down and assimilates estrogen. And so people will say, Well, if I'm not making as much estrogen, why does it matter? Well, we get exposed to estrogen in our personal care products, our food, our environment, and also our body makes a weaker form of estrogen called estrone in fat tissue. Now, our body makes more of that in menopause because our body is looking for a solution. So we're making less estradiol, predominant form of estrogen our bodies make prior to menopause, and it's like, hmm, we're going to find a solution to not having as much estrogen. We're going to make more estrogen in fat tissue. So, those changes in body composition are frustrating, but when you understand that your body is simply looking for a solution, and if you were obese heading into menopause already, you probably have quite a bit of estrone, but the estrobolome doesn't work as well in menopause unless you are supporting it. And so, there's lots and lots lots of changes that happen with regard to the gut microbiome, just vis-à-vis these changes in estrogen in particular, but also progesterone and testosterone. And I think for a lot of women, it's more than just— it's more than just lifestyle. It's really, you know, being strategic about nutrition. It is being more proactive about managing your stress. And I jokingly say it's more than 5 minutes of meditation once a week. It is important that you're doing the right types of exercises. I know you do such a beautiful job discussing on this podcast. And, you know, making sure that you are finding ways to, you know, just do things that bring you joy. Like, I think a lot of women forget that it's not just about nutrition, exercise, sleep, and stress management. Like, there's so much more to that, you know, on top of even addressing underlying trauma. For a lot of people, it might not be until middle age that they finally deal with their stuff. And I speak from personal experience that if you don't deal with your stuff, it will come back and it will make things harder. So I always kind of humbly sit back and say, listen, I always hope that people learn from my own mistakes, which I try to be very transparent about. But it all comes back. It's like reflux. It never goes away unless you ultimately deal with it. But that's kind of a big level oversight. You know, the gut microbiome interacts with our brain, our gut, our bones, our ovaries, you know, when we go into menopause. I mean, it is fascinating to me when you look at the research. There's been a lot of research about this, but no one was really putting all the pieces together. And I kind of, like I said, being on the podcast, I was just like, there's this huge blind spot that no one's talking about.

I so agree. And, you know, I think we're looking for a quick fix when it comes to this. Like, women who are dealing with constipation, and I think there's an awful lot of them, you know, they're potentially taking magnesium citrate so they can poop, but they're really not getting to the gut. What's the core, the root cause of the problem, and fixing that? So in all of this, how important is doing stool testing to, to really look at what is going on instead of simply saying, okay, I'm going to throw probiotics or prebiotic foods at this and this will be better, or seek out the 30 different plants and vegetables that you need every week. And we see the women who put carrots, broccoli, and cauliflower in their cart every week, and that's what they're eating over and over. We know that's not happening, but is stool testing important? I mean, does that emerge as a part of the solution for improving gut?

That's such a great question. I like quantitative information, and part of that is because I'm a clinician, and I've, I've been a clinician for, gasp, 25 years. I was just telling someone the other day, I was like, I've been an NP for 25 years. How is that possible? But I'm, I'm very data-oriented. So yes, the lifestyle piece is very important. And if you're listening to this podcast, please every week buy some different vegetables. Like, don't just get the same. Like, monogamy is good, right? Like, food monogamy, not so good. Like, monogamy in general, yes. Food monogamy, no. I always say, like, we want some diversification. But I think stool testing can be incredibly valuable, both from the perspective of addressing latent infections. So infections that maybe you're having a lot of gas and bloating, but you don't know it's because you've got an underlying H. pylori infection, or you have significant dysbiosis, which is weeds in the garden. I would say proverbial weeds in the garden, non-beneficial bacteria that don't belong, that have overgrown the healthy bacteria. So, from my perspective, I think stool testing is critically important. Um, it's important for a variety of reasons. Number one, it can drive treatment decisions and recommendations and make them much more personalized. Number two, it is, however, very dependent on the individual reading your testing. Please, please, please make sure the person that is using that type of testing, that they looked at hundreds and hundreds of these tests because there are lots of over-the-counter tests that are out there. And I always say, like, I'm always open to the possibility that the tests that I work with, there might be a better one. So I'm like, I'm always open to that possibility. But what I do see in kind of in the functional integrative, integrative medicine space is sometimes there are people doing testing who don't really know what they're doing, and they end up costing you a lot of money. And then you get an evaluation and you don't know what to do with it. And I say this lovingly and with, with respect, but sometimes these patients end up in programs and we interact with them, and then their provider will come to us and ask us, can you, can you give me like a— we call it a curbside consult— would you be willing to look at their labs and provide some context or information? So to answer the question, I think that stool testing, if done for the right reasons, uh, with the right intention, and with someone who has plenty of experience evaluating that test, I think can be very, very powerful. Do I think that you can get by with some lifestyle changes up front, whether it's for bloating, whether it's for constipation? And I agree with you a hundredfold. There are far too many women that think constipation is normal. Constipation has been so normalized, and there's typically probably more than one reason why that's happening. I will tell you a funny story. I have a family member who I jokingly refer to as the non-public pooper, and this individual knows who they are when I say this. And in fact, they get upset when I talk about it. But this individual, unless they are in their home, they cannot have a bowel movement. I'm like, how do you travel if you can't?

Sounds like my son as a kindergartner. Yep.

And then they realize like you have to be able to find another safe place to go to the bathroom. But I tell people like, if you can't go to the bathroom anywhere other than your home toilet as an adult, that's a problem. Like that's a— your brain does not feel safe. So there has to be this evaluation of why that's occurring. And I would be the first person to say, I say that respectfully, but this family member thinks it's 'It's normal.' And I said to this individual— I don't even say their gender because I want to make sure I respect their privacy— but I was like, 'I can't imagine with the amount of travel I do, if I had that problem, I would want to fix it.' So, it's not normal to poop once or twice a week. Like, let's make that very clear. And stool testing can be helpful for a variety of reasons, but stool irregularity or lack thereof can be a sign that there is something that's it's off in the gut. It's so good.

I'm so glad you brought that.

Non-public pooper. Yes, right. MPP. Yes. Okay.

And I want to ask you, because as— I mean, you wrote the book on intermittent fasting, you've written this new book. If you were kind of marrying them together, is there, is there benefit to— we know that fasting can improve microbiome when it's done like on the right person for duration. How does that fasting timing and that window positively or negatively improve gut microbiome? I mean, that's asking a very targeted question, but do the best you can with the answer. Before we get started, there is one thing that I recommend you do, whether we're talking your fitness level, your micronutrients, or your hormones, and that is Test, don't guess. There are a lot of people out there telling you a lot of different health options, but randomly trying any of them without knowing where you are to begin with is like throwing darts with a blindfold on. So I personally test regularly, and I advise my clients and members to do the same. But look, I just moved to a smaller city in a Midwestern location, and I no longer had a lab testing site 6 minutes away wait for my house to do testing until this— Cyfox. Comprehensive at-home blood testing delivered to my door. No lab visits, no waiting rooms, and in my case, no 70-mile commute. Painless upper arm collection that takes about 5 minutes. And if you're squeamish, stay with me, you really don't even have to look. Results include a personalized action plan, insights, and supplement recommendations. Included in membership are 4 unique panels for longevity, thyroid hormones, and heart and metabolic. It's not just about the results that I got. I personally can't stop talking about the customer experience every step of the way, from video calling a coach who was on standby at 6 AM when I wanted to do the blood draw and talked me through it step by step The FedEx return label and then the communication after I dropped it off at FedEx telling me it's en route, it was received, it's being analyzed, and within less than a week I had my results including my biological age, personal action plan, and those supplement recommendations which I'm currently following through with two of those and I'll retest in 3 to 6 months to see how they're impacting my health. You too can get your convenient test kit from Cyfox Health at cyfoxhealth.com/Flipping50 and get 20% off at this link. That's Cyfox, C-Y-F-O-X, health.com.

It's a very important one, and, and I have been very transparent over the last year. I lost my dad in 2021. And that shifted my perspective about 180 degrees because one of the things that contributed to my father's death was frailty due to sarcopenia. And I very much look like my dad and have a similar body habitus, which is both good and bad. I'm like, I think by the time my dad passed away, I was jokingly saying to my kids, I think your grandfather and I wear the same size pants. And so we found out that we did. So my dad was very frail because he didn't eat enough protein, didn't function, didn't focus on weight training, unfortunately. And so my perspective on fasting has shifted 180 degrees, and I share this very, very transparently, very openly. Fasting is one of many strategies. It may not be the right strategy for you if you are diligently working on building muscle. And so since June of last year, that has been my, myopic focus is building muscle. In a 12-hour feeding window, I can get 3 meals. If someone is morbidly obese, obese, overweight, not metabolically healthy, insulin resistant, I think fasting can be a great strategy used in a very targeted way, meaning you fast for your menstrual cycle if you're still getting a cycle. It means you don't fast on days that you haven't slept. It means you don't fast on days where you've had a particularly brutal workout. We know when you wake up in the morning, you're catabolic, which means you're breaking down muscle. That's not the day to go out and do a half Ironman. And so when I talk about fasting, it's in the context of right strategy at the right time. So there's still a place for it. There's still a place for how it can be helpful and beneficial in supporting the microbiome. However, on the other side of that is what are your goals? And for a lot of women in middle age, it is to build muscle. And so I transparently say 12 hours of digestive rest is very important. So you're still giving yourself a break from eating, but you are probably being a little more targeted about protein boluses. You are probably being really conscientious about strength training. You are probably being more conscientious about managing stress and sleep. And so I think the other piece is— and it's not just unique to my message, but I think many people in the intermittent fasting metabolic health space have, um, and I may have been guilty of this as well, so I want to be clear and transparent— you know, fasting is a good strategy But we have to be honest with ourselves about what our main goals are long term. And so does that mean that I, that I fast occasionally when I travel? You better believe it. If I'm in an airport and there's nothing good to eat, sometimes I will just get on my next plane ride and worry about it when I land. But as an overall, like, philosophy, I, I'm eating 3 meals a day, which means I have a wider feeding window. And I encourage people that are listening if your goal is to build muscle, you may want to open up that feeding window. And, and honestly, look at yourself. Like, look at your— track your macros. I have no affiliation with Cronometer or Cronometer, however people like to pronounce it. I'm like, track your macros for a week and see how you're doing. If you're getting in 60 grams of protein, please, please, please don't overly fast. I mean, I think that's the message I want to share. Fasting has a place, I do think fasting can be beneficial, especially for people who are not metabolically healthy, provided that they are not also getting up by on 2 or 3 hours of sleep and then fasting for 20 hours, because it's like adding gasoline to a fire. And we just know that we are in a slightly more inflammatory stage in menopause, so we want to be gentle to our bodies. So I never want the message to be, I want you to— everyone needs to fast, and fasting is right for everyone. I think what I want to say is digestive rest works for everyone.

Yeah.

And then adjust from there. So I like to admit, like, know better, do better is a prevailing philosophy in my life. And so I humbly sit back and say there are aspects of intermittent fasting that I think are still very important, but always in the context of what is your— what are your main goals right now? And then getting really clear. And I will share transparently, so my dad died in June of last year, you know, we're 18 months later. I will share transparently, it's taken me about 18 months to put on 6 pounds of muscle and lose some body fat, but that's been very, very diligent. And actually, my trainer would objectively tell you, I work out much harder when I've had 2 meals on board than I do on the days when I've had 20 grams of protein at 9 o'clock in the morning. So, kind of reevaluate and don't be rigid or dogmatic that because you did something 5 years ago, it has to work now. I think as humans, we should evolve, shift, and change throughout our lifetime. And so, that's how I would honestly answer that question as I sit back and I just say, you know, there's a period in my life where I did a lot of fasting. And, you know, I would self-flagellate almost, you know, thinking like, I'm going to get to 18 hours every day. And, And now I just kind of shake my head and say, okay, well, that worked at that point, and now that doesn't work for me.

Yeah, I love that. And I just want to clarify for listeners, so when we— when Cynthia said the term, if you're eating 60 grams of protein, I'm going to insert the word for her that if you're only eating 60, that's not enough. Okay, so do you agree? Are you an advocate for a gram of protein per per pound of ideal body weight? That's kind of a good goal, or where are you?

I say 100 grams minimum day. And so when I say that, that blows people's minds. They're like, well, wait a minute, I know I'm not eating that much. And so I think that for each one of us, we know that we need at least 30 grams with each meal because that is what helps trigger muscle protein synthesis at this stage. But if you look at all the research, Protein Leverage Hypothesis, all this research that's being done as our FSH, follicular stimulating hormone, is going up, as estrogen is going down. If you don't get enough protein, guess what happens, people? You're going to be in your pantry at 8 o'clock at night wondering why you are snacking, and it's because your body is hungry. I think that we have an entire generation of women that we were given a lot of mixed messages. We were kind of told thin is in. I mean, how many times did I hear that? You know, it was like people were praised for being skinny. You know, no one was talking about muscle.

Can't be too rich or too thin. Correct.

You know, the Nancy Reagan era that all of us grew up in. Who was anorexic. And I think about how that messaging has evolved. But I think for a lot of people, it is very much a mind screw when all of a sudden you're like, whoa, wait a minute, I've been playing competitive tennis 5 days a week for my entire life. Now you want me to lift weights? And now you don't want me on the scale every day? And now you want me eating more protein? And I will always say, you need to understand what 30 to 40 grams of protein looks like on a plate. For a lot of people, that blows their mind. They've been eating teeny tiny portions of protein, and they'll say to me, I can't gain— I can't gain muscle mass, I'm tired all the time, my hair's falling out. And I'm like, you're just— you've been chronically undernourishing your body for your entire lifetime. And I think that on a lot of different levels, it's just having these frank, honest conversations with ourselves. Like, I was telling my husband last night, I'm not opposed to having a whey protein shake at 6 o'clock at night. If I've had a day— like, today's a good example. It's my third podcast today. There's been a lot of talking. I can tell you I've had two good-sized meals, but I will probably at the end of my day have a whey protein shake. There's no shame in that. I'm gonna make sure I buffer my protein intake before I go to bed. And that's why I think that, you know, these kinds of discussions are so important for women to hear Number 1, please nourish your body. Number 2, please stop obsessing over the scale. I'm not suggesting that bioimpedance scales aren't helpful or getting a Bod Pod, but get an evaluation of how much lean muscle mass you have to fat mass. Because some of what people get caught up in is that they're like, "I want to weigh what I weighed at 18 years old." Right. "Do you know how skinny I was at 18? Like, it was on my college ID back then." They actually put it it on our college ID, which I ran across it one day and showed my kids and they were like, "Oh my God." Wow. Yes, my weight was on my college ID. And so I remind people, I don't want to weigh what I weighed at 18. I don't want to be, you know, I don't want to be that tiny. And so I think it's like helping me understand, like, I want to be able to get off the toilet when I'm 80. I want to be able to lift things and get up and down stairs and ensure that I can put my suitcase in the overhead. I don't let my kids do that, or my husband. I always say, thank you, I appreciate that, but I need to be able to do that. I think about the functionality that we need to be— we need to be focused on, like, strong. We want to be strong. We want to build muscle. We want to be able to be independent for as long as humanly possible. And so I think that it's vitally important that we examine a lot of what we have commonly accepted as being normalized as not being normal at all. You know, whether it's eating disorder behavior, chronic, you know, RED-S, you know, this relative energy deficiency that women have probably been existing in for a very, very long time.

Agree.

It's important that people just bring greater awareness because I would imagine there are probably people listening that are like, oh my gosh, I didn't realize like all these years I just wasn't eating enough. I wasn't giving my body enough nutrition to be able to do the things that I wanted to do.

Yeah.

And it's like better to figure that out sooner rather than later, right?

Right, right. And I think we've potentially gotten away with it at one point in our lives and we're just not going to anymore, I think, which is great. And I want to circle back to what you said about your trainer will say, you know, I'm working much harder. But I think truthfully, maybe efforting, but also you're working much closer to your potential, which is it can, it could feel hard. Like I think for a lot of women, they're fasting and working out and it feels hard. Like I'm working really hard and I'm like, I don't argue that, but I'm guessing that you're probably not working at your capacity hard because you're capable of so much more, but if you don't have the fuel in the tank, that just can't come out. I think that's also an important distinction. Yeah. And, you know, as much as we're talking about menopause openly now, it's, you know, it's a word we're saying out loud in mixed company, doesn't matter. But also, I think normalizing the things you've just referred to in the disordered way we've thought about food and the disordered way we've eaten, whether it was a full-blown eating disorder or it wasn't, you know, we've all got this relationship with food that is complex in it, and it— how could it not be? But I think speaking about that in a safe place among women, or with a practitioner, or simply with friends, really an important part of this whole menopause-gut conversation that you've opened up. So thank you so much for doing that.

Absolutely. And I think it's also, you know, our relationships with food are so complex, as you astutely stated. You know, the first person we probably learn about food is through our parents. And I recall when I went off to college, I said this the other day to one of my boys. I said, you know what your grandfather said to me when my parents were divorced for a long time? You know what your grandfather said to me? Before I went off to college, he was like, don't gain the freshman 15. That was like the big message. Not don't get pregnant, don't, you know, don't do drugs. It was don't gain the freshman 15. And I remember thinking like it was like an oh so subtle acknowledgment of his fears projected onto me or my mother who has, has has her own issues with food, as most women do. Let me be clear, it's not unique to my mom. But the kind of the prevailing pejorative things I would hear my mother say about other women that we internalize, that we then realize like, oh, this is why we have so much shame around food and around eating and how much we've eaten. And so I've done a lot of therapy, so there's nothing I'm sharing that I haven't like worked through. But I do find that when you talk to women, like, on a very deep level, not on the superficial kumbaya, we're all together and it's very light. But when you really open up conversations around food, relationships with food, shame, eating disordered behaviors, which is a spectrum, it's not like good, bad, or indifferent, it is what it is. It's fascinating to me how much we absorb as sponges. Like, I remember when I was in college, I was part of a big sorority. And there was a lot of eating disorder behavior. And I was kind of clueless, truly. Like, I didn't understand why certain people ate a lot of peanut butter at the end of their meal, and it was because they were going to go back to the room and vomit. Or the people that would push food around on their plate because they never really ate. So I think that, you know, each one of us has our own peculiarities about our relationship with food. But if you don't deal with your stuff by the time you're in middle age, it will rear its ugly head because middle age is a wild ride. Like, everything that used to work, like the things I used to tell my patients— eat less, exercise more— of course, you realize that's terrible advice. Um, the things that I used to tell my patients should be effective didn't work for me, and I was like, ha, joke's on me, I'm supposed to know all this stuff and I really don't. I think that it can be very challenging to navigate if you don't invest the time in finding reframe, finding ways to support your body that don't involve restriction, flagellation, or extremes of behavior.

Amen. We've got to figure it out. Yeah. And I, I do agree that at midlife we see this resurgence, and potentially health coaches and trainers who might be listening you see it up close and personal and you know something is going on. But it's like working with 18 to 20-year-old young women was back in the day, at least when I was there. The same thing can occur again, you know, anywhere between 45 and 55. You see it happen again and again.

Yeah, it's interesting. There's a registered dietitian that I follow and, and she talks talks a lot about this behavior, that there's not enough emphasis on eating disorder behaviors. Like, maybe they've been quiescent, you know, maybe they've been, you know, they've been functionally with a previous history that really rears its ugly head in perimenopause and menopause. And I think some of it's hormonal, like all of a sudden you can't dampen down on that anxiety, depression, you might just have perseverating thoughts, that are pervasive and problematic. And I think it's the internal dialogue that we have with ourselves that can be both good and bad, like being reflective, but being reflective to an extreme. And if someone is listening is really struggling, there's lots of really good providers that are out there that address these kinds of concerns in a way that helps you find methodologies and structure to be able to move through that. And this is also why I try to speak very openly about my evolution around intermittent fasting also for this reason, because I started to find that a lot of women that were embracing it just weren't eating at all.

Yeah, yeah. So both combining intermittent fasting and caloric restriction. Yeah, it's, it's so easy. And I think it's, you know, an easy way to mask it, like, and normalize what you're doing because of— there's something to hide behind. If I could ask you one more question about the writing of this book, was there something in, I know you commented it was hard, and I imagine there's probably a lot of research that went into this and behind it. Was there something that was like a huge aha or a surprise for you that sticks out?

Yeah, I would say the role of trauma and ovarian aging. So ovarian aging, ovarian senescence, which means the aging of our ovaries. Our ovaries actually set the pacemaker of aging. Aging for our bodies. That was something that was never really emphasized in my medical training. And so now we're getting a lot of longevity research and emphasis on this underlying childhood trauma. So adverse childhood events, you can go online, you know, it's a joint venture that was done by the CDC and Kaiser Permanente. You can get the screening tool online for free. Underlying childhood trauma that ages you faster because you're in this chronic sympathetic state high cortisol will age your ovaries. So I think about it's not just big T trauma, it's the chronic unrelenting stuff. So when I was in my medical training, we talked a lot about murder and suicide and rape, and those are big T traumas and those are significant, but it's almost time— it's almost times the little t trauma, you know, the chronic abuse that people sustain or sexual abuse, emotional abuse, physical abuse, abuse, growing up in a home where, you know, someone had a mental health issue or there was chronic drug or alcohol use. If you grew up, your autonomic nervous system is kind of primed for this fight or flight response. And so I have a very high ACE score. My ACE score is 9. And I went into menopause a whole lot earlier than most people did.

I'm guessing 10 is not the goal.

No. No. You want it to be 0 or 1 or 2. Zero, you know. Okay, you want it to be really low. And so we can, we can look at the research of adverse childhood events and earlier ovarian aging and earlier menopause. So there was a research that was done looking at women that were sexually abused as children who go on to have children who were also sexually abused will actually go into menopause 7 to 8 years earlier than their peers. So average age here in the United States is 51. It really speaks to that chronic sympathetic overactivation, the role of cortisol, and the impact on our ovarian aging. So there's certain, you know, we have these ovarian aging clocks, you know, they can be accelerated by like smoking. I mean, these are things that can hasten the ovarian aging, but trauma is something that every woman listening needs to think about. It doesn't mean that you yourself underwent trauma, but if you know of people that are at risk, risk or have dealt with a lot of trauma growing up, that may be a clue. I mean, I was not 51, I was 48. So I was definitely younger. And it's interesting, I have a cousin who had similar circumstances growing up. She's a GYN, she went in at 48. And we're healthy, you know, people always assume like, oh, you're going to go into menopause later because of your lifestyle. And I like, yes, but. Yes, and. You can't second-guess the internal stress that people experience. Yes, I'm very successful, but my autonomic nervous system was really primed at a very early age and programmed to constantly be surveilling, to be in this, you know, kind of like my little body was in an SOS all the time because I had a narcissistic parent and an alcoholic parent, and you grew up in that environment. And it just primes your autonomic nervous system. Early autoimmune disease, I hate to say disease, disorder, you know, those kinds of things are signs that you might be someone that's at greater risk. Like, obviously now we're learning more about longevity and learning more about ovarian aging, and there's a lot of really cool research that's coming out, but that is what I found most surprising. So when I say that the book was hard for me to write, it was the realization of I understood myself better, and a lot of my patients. I was like, wow, this makes sense to me. Maybe it didn't before, I didn't put all those pieces together, but now I think this is not only going to be helpful for other providers and for patients, but just greater awareness to like— everyone's aware like trauma is pervasive and impactful.

Yeah, yeah. And I think it comes up for us so very often in terms of fitness and exercise and why Why do I keep getting hurt? And why won't this chronic thing go away? Because it's an -itis. We know it's a chronic— chronic to come on, but it's supposed to go away. And with some, it just doesn't. And, and there are women who I've worked with long periods of time, and they deserve success. They've, they've done the work. They're not just thinking they've done the work, they've done the work. I've seen it. And it's like, okay, I've got to ask Is this something you want to explore? You know, and a lot of times it is in their background and they know it. It's just they haven't wanted to open that closet.

Yeah. Yeah. It's— unfortunately, I think perimenopause and menopause will force you to examine it, look at it, unpack it one way or another. I think that's also why you see a lot of divorces in your forties and fifties, and 70% of divorces are initiated by women. I think for a lot of women, it's like they wake up, like the people-pleasing has left the building, and all of a sudden they're like, well, wait a minute, this doesn't work for me anymore. So I think on a lot of different levels, trauma is a generally unexplored contributing factor to our health issues.

So, so when I ask you about that— excuse me— so in regards to the increased rate of divorce at midlife, you see that as a plus, that women are acknowledging that they've had trauma and now no, no longer willing, or that they're running from it?

I think it could be both. Okay. You know, as someone that when I had a healthcare hiccup in 2019, I totally dissociated. I didn't even process what was happening. And so I think some people, depending on like their way of dealing with stress, you know, some people go right at it, some people run away from it. You know, fight, fight, flee, fawn. I dissociate. That's been my main way of dealing with things. So I think there are absolutely people who probably are in very unhappy relationships and it's for the best. I think there might be others who it's easier to flee than it is to deal with the issues that the two people are having together. And I have several people I know that I would say definitely fill that group. And then I think there's also this tendency as women, we are such such people pleasers. And that was how I navigated my childhood and young adulthood was being a people pleaser. And so I got into my 40s, and I was like, I'm tired of doing what everyone else wants me to do. And so I think that we should be examining what we're doing and what we're saying. But it doesn't mean that we necessarily need to leave our relationships. I think that there's— there are probably a percentage of people who are in an unhealthy relationship and need to leave that relationship. And then there might be others where they just don't want to stay and they don't want to work through whatever issues that they're having. And sometimes it's— we live in a society where things feel very disposable. It's like easier just to like cut my losses and run and do my own thing. But the grass is rarely greener. And so I will oftentimes say to people, you know, whatever the decision is, it's the right one for you, but make sure you've exhausted all of the options around that to make sure that's the right decision for right now. Because, you know, some of these things are— once you make the decision, it's— you can't go back.

Hmm, so good. We could talk all day, but I want to make sure that every listener gets their hands on this book. So tell us, I'm guessing everywhere books are sold, but tell us otherwise. Tell us if there's somewhere else secret that they should be going, and And where, of course, can they find you? And if they've been living under a rock and are not aware of your podcasts, where can they listen?

Thank you. Thank you. So, "The Menopause Gut," it's out on April 28th, 2026. You can get it where all books are sold. I always encourage people, if Amazon, if you can shop somewhere other than Amazon, think about your local bookstores because the brick and mortar people are struggling right now. And so, I always encourage people to go to your local bookstore and ask for the book. Um, you can find me across social media. I, I would say, had I known 9 years ago when I started social media that I should have had the same handle at every location, but now it's impossible to change all of them, I'm told by my team. My podcast is Everyday Wellness. I am Cynthia Thurlow, NP. Um, I probably am most active on both Instagram, um, Substack, and then I would say I have a free Facebook group called the midlifepause/my name. That's a great place to find me. I actually do answer questions in there one day a week, and then my team does on another day. And, if you message me on Instagram, I may be the person who responds. I have not gotten away from— I did for a while have someone that was responding for me, but now I try to be— I'd rather just take a couple days or a week or two to respond and let it be me authentically because it also gives me a sense of what people are curious or So thank you so much for having me today. It's been a pleasure as always.

Of course. Fantastic. And thanks again for writing the book.

Absolutely.

The information shared on Flipping 50 the Stronger Way is for educational and informational purposes only and not intended as a substitute for medical advice, diagnosis, or treatment. Always consult your physician or qualified healthcare provider before beginning any exercise program, making changes to your diet, or adjusting any medications or supplements. Individual results may vary. Debra Atkinson and Flipping 50 are not responsible for any injury or adverse outcomes resulting from information presented on this podcast.