Heal Your Gut and Master Menopause with Cynthia Thurlow

When women are low in estrogen, they're irritable. Sometimes they have trouble with brain fog, they have trouble with word finding, they have trouble with memory. There are a lot of women in perimenopause and menopause that suddenly that trauma that they suppressed, they pretended wasn't there, avails itself. I think this contributes to a lot of midlife divorces. I think it also contributes to a lot of health problems that women experience.

Women in their forties and fifties, what should someone pay more attention to or any attention to now that they're not?

Learn how to take a slow flow yoga class, get outside and walk in nature. Like I'm talking about simple things that we know on a very basic level are gonna improve your quality of life, but are also gonna have a positive net impact on the microbiome. Going to bed 30 minutes earlier. Sometimes it can be drinking more water. I mean, it's things like that that really do have a large net impact on how people perceive their life as moving in a more positive direction. If you want improvement in your symptoms, you have to be willing to change some things.

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So good to be here, JJ.

Yes, it's been a while since you've been at my house.

I know, I know.

I'm glad to have you back. I am super excited about this book. What a different take on menopause. How the heck did you get here with doing The Menopause Gut?

I think it had a lot to do with the fact that I have my own podcast and I'm listening to all these scientists science writers and physicians and other healthcare experts. And I kept thinking there's this void in the perimenopause and menopause space. I think no one is speaking about the changes that are happening in the gut microbiome. And yet I think it's equally important to all these other conversations about bone health and brain health and heart health. And why isn't anyone talking about it? And so I pitched the idea to my editor and she said, oh my gosh, run with it. She's like, I love everything about this concept.

Did you know what you were getting into when you said that?

No, no, I did not. I did not because I mean, doesn't life imitate art? And so some of us, as we're writing books, life is happening. And so I would say that as I was writing this book, JJ, it was probably the hardest 18 months of my adult life. And so I feel like it really is this incredible labor of love. I think it is such a unique perspective and one that is so necessary because I really think for most women, they think that perimenopause and menopause is just slapping on an estrogen patch.

And I'm like— Isn't that all it is? You just have your hormones go down.

Yeah, exactly.

Get 'em back. Get 'em back up and that'll fix everything. Well, what do you think that everyone's getting wrong about menopause and gut health then?

I think on a lot of different levels, we don't understand the dynamics in the gut microbiome in terms of what's happening beneath the surface as these hormones are declining. It's changing our metabolism, it's changing our immune system, it's changing our response to food, it's changing how much calories we extract from our food. It literally impacts everything that is changing within our bodies so dynamically. And yet it's kind of an afterthought. People are like, I don't even know what the gut microbiome is. I don't know where it is. I don't know why it's relevant. And yet a heart is tangible. A brain seems pretty tangible. Bones seem pretty tangible. And yet I think that the gut microbiome research has really kind of increased over the last 5 to 10 years. And we're talking more and more and more about these complex interrelationships between the gut microbiome and organs and cells and everything else. And so I think that there's just not enough clarity about why it's so important to be not only looking at it, but also supporting it.

So someone's heading into perimenopause and they're starting on their wild hormone ride, and depending on what's going on, progesterone's going down, estrogen's going down, and you're saying it's impacting the gut microbiome. Here's the big question. Is, in order to improve the gut microbiome, is it that you need to get the hormones back, or are there other things you can do outside of hormones that would make perimenopause a lot easier, menopause a lot easier. And you're saying yes with your face.

Good. Yes, absolutely. I mean, it is lifestyle and hormonal replenishment. And I think for a lot of people, they think that, you know, they can have that estrogen patch or the oral progesterone or the testosterone if they need it, and they don't have to change lifestyle. It is critically important because every single thing that you and I talk about, whether it's sleep or stress management, nutrition, exercise, they all impact the microbiome positively or negatively. And so helping women understand that as we are kind of navigating this hormonal decline, or depending on where you are in perimenopause, you might be high estrogen, low progesterone, helping them better understand their physiology. So it's like, oh, this is why you're encouraging me to get that sleep piece. This is why you're encouraging me to exercise a particular way. This is why you're encouraging me to eat more fiber. It is not just Grandma's Metamucil. There's so much more to the conversation. And I think in many instances, our traditional allopathic system doesn't have the time or the inclination to have those conversations.

Well, you think about it, and I've been in this world now for 30 years, so, you know, I've done my share of stool tests and adrenal tests and hormone tests, but the reality is, how often in an allopathic office is someone ever even ordered a stool test?

They're doing it for a couple main reasons. Guaiac, to look for whether or not you have hidden blood in your stool, where you came back from vacation and you have traveler's diarrhea and they wanna make sure you don't have a parasitic infection, ova and parasites. So not all that commonly. And I think in a lot of different ways that traditional allopathic medicine does a great job with specific things, but this is where I think integrative medicine does a really fantastic job of looking a little more deeply, looking at keystone bacteria and dysbiotic organisms and whether or not you produce enough hydrochloric acid or digestive enzymes or any of those things. And so I think for a lot of these patients, those insights can make a big difference in how people feel, because I can tell you a lot of these women that are on hormones, they're optimal on hormones, their numbers look good, and they come to me and they're still not feeling better. And I would say there's more to this conversation. I wish it was just as simple as you get your HRT and everything gets fixed, but more often than not, there are lifestyle components that aren't being addressed.

Now, in order for someone to understand this, would they need to do a stool test of some type to see the microbiome, or are there things that they could start doing right away that could potentially help?

Yeah, I would say absolutely. You don't necessarily have to have a stool test right away. I think something as simple as adding more fiber into your diet, and I know the carnivore community— let's talk about this.

How has fiber become controversial?

It's the new F-word, JJ Virgin. When I tell you, like, I have literally had people say I want you to come on my podcast, but we can't talk about fiber.

Oh, that's so funny. Wouldn't it be better to talk about these things? Yes. I mean, I feel like fiber is the new lectins. Yes.

And here's the thing, like in 2019, before we even knew each other, I had a lengthy hospitalization. I got a lot of antibiotics, a lot of antifungal agents. It saved my life. But for how many years afterwards did I not tolerate fiber? And so when women tell me, I don't tolerate fiber, I'm like, well, it's a sign. It's a sign that something is off in the microbiome. And so I think for a lot of individuals, If they understood what was happening physiologically in their bodies with this decline in hormones, it also impacts a key signaling molecule called short-chain fatty acids. So something like butyrate, I'm sure most people have heard of, those decline. It— we change our insulin sensitivity, we change the inflammatory properties in the body, as long as many other things. And so fiber becomes critically important as we are navigating this hormonal decline. And so fiber doesn't have to look the same for everyone, but I always say track and then eat more. And, you know, the guidelines now say 25 to 30 grams a day.

They went down, man. They used to be like, I used to always tell people 50, and then I saw the latest one, I go, wait, when did our fiber guidelines go down?

Yeah, recently.

Why are we reducing those? And the other challenge with fiber, it kind of reminds me of like, you're talking about protein or fat, I go, well, there's essential amino acids, there's essential fatty acids, like, you know, there's different types of fiber. So you could say fiber and someone's just taking one source of supplemental fiber and they forget the fact there's soluble, insoluble, resistant, and prebiotic. So when you're talking fiber, what are you talking about? Are you trying to get all from food? Are you supplementing? What are you doing?

First of all, we want a baseline because I think that that is insightful. You know, the average American diet is anywhere from 5 to 10 grams, which is not sufficient to support the gut microbiome.

Right, well, look at ultra-processed foods.

Right. They're devoid of fiber. They contain carbs. Yeah, they're devoid, which is why people sometimes on an ultra-processed food diet don't poop at all. And that's a whole separate conversation, but When I am talking to patients, I would say like, let's try to get it from food-based sources first. Like whether or not it's a tablespoon of flax and chia in a smoothie, whether it's adding artichoke hearts, whether it's adding some beans or lentils, it doesn't have to be copious amounts. Here's the thing, that's what people don't understand. It isn't copious amounts of anything. It's just being thoughtful about consumption. Now, if over time someone doesn't tolerate a lot of fiber, sometimes those supplements can create more symptoms, which is why I'm a fan of trying to get it from food-based sources first. As opposed to things like inulin or psyllium, or even PHGG, which is a big fancy way of saying partially hydrogenated guar gum, which is an awkward kind of weird way of talking about supplements. But I think, you know, I'm a realist, and for some people, they just frankly can't get enough into their diet. It's always a good thing to kind of work towards, but if you can't get enough in, I would say like stick with things like psyllium, things that are simple, one ingredient, because unfortunately a lot of people find them bloating. And so sometimes like I don't tolerate any olive oil.

Well, the FOS ones, I was thinking, could be really challenging for a lot of people. It seems to me, backing up a bit, that if you're having challenges with fiber, that should be a big warning sign that something else is going on. Not just a don't ever eat fiber again. It's what's going on with your body that's not allowing you to eat fiber because fiber does really important things. In your body. So the answer is to never eat fiber again. The answer is to heal your gut so you can eat the fiber.

Exactly. And there was a study that just came out recently that was talking about a dose of antibiotics. And, and let me be clear, sometimes we need to be on antibiotics and we need to like let that go. But the net impact of a round of antibiotics on the gut microbiome can last up to 8 years. So I don't say that to scare anyone, but I can tell you as someone who had a lot of antibiotics in 2019, that the way that I kind of look at things now, I'm like, I'm still, I'm 8 years out. Yeah. And I can tell you, I had a colonoscopy in 2020. I had one in 2025, and my gastroenterologist came out and said, what are you doing differently? Wow. I said, I radically increased my fiber intake.

I'm big on fiber. I think fiber, to me, you eat carbohydrates for the fiber and the polyphenols. Yes. To fuel your gut microbiome. That's what I think of them for. Yes, we get the fuel in your muscles, but I love the fuel in the microbiome. But I also supplementally take resistant starch because I think that's the hard one of them to get enough of. 'Cause I just don't really eat slightly green bananas or cooled potatoes that much.

I'm one of those weirdos that I like those like green bananas.

The astringent bananas.

Yes, which my husband's like, "I don't understand." I'm like, "You don't understand, it's the only way I like to eat them." So I know that that makes me very weird, but cool cooked potatoes or cool cooked rice is a good way to get that in.

I've got it in the fridge. I'm like, eh.

It's just not your favorite.

I don't love it, so I just, that's how I cheat it.

And that's totally okay.

I do it that way, 'cause after that whole disaster, one of the big things that showed up was my butyrate was low.

Yeah, and butyrate's interesting. So it's the short-chain fatty acids, but it's a particularly important one 'cause it actually crosses the blood-brain barrier. So I remind people, these important signaling molecules, this is one of the very few things that naturally does that. And so it can serve as a secondary source of fuel. And so for a lot of people, they're like, oh, I just need to eat grass-fed butter. Well, yeah, that, that's great. But like, you'd have to eat a lot.

It's not— It's like going, and how much are you going to eat of that kind of food?

Like half a stick. Yeah, half a stick a day. No, thank you. That would not be my first choice. So I think that it's completely fine and no one should feel a sense of shame if they take a supplement to fill in a nutritional gap when they know that they have one, because quite transparently, it's impossible. Like, that's why I take urolithin A because it is, it's a postbiotic, but I cannot eat enough. And it's only like 25 to 30% of the population actually generates enough urolithin A in the setting of like strawberries and walnuts.

And raspberries and walnuts. I took the test. I'm not one of them. Yeah. I mean, how many pomegranates can you eat? Not many. It's not like they're that around.

No.

So.

Agreed.

That's how I feel about supplements too. So back over to this gut. Someone's heading into perimenopause. Would you recommend they do a stool test? Like, how do they take what you're finding here and put it into action? Is it just they start paying attention more and seeing if they have any symptoms of, of any gut issues? What's the action step?

So I would say a really good history. So if someone's working directly with me, it's like the bloating, you know, alterations in constipation or diarrhea, which is unpleasant as it is to talk about poop, it's really important. Someone who's having mood changes, someone who feels like maybe they're more anxious, they're more depressed, maybe they're on a little bit of progesterone and they're still feeling that way.

I wonder how you unpack what's the hormone and what's the gut?

It's a little bit of a trial and error process, honestly. I mean, obviously you can take a really good history, and I think, you know, I will tell students this also, that if you take a really good history from someone, you can oftentimes have a gestalt of which direction you need to go in. But I do think stool testing is very helpful. I think in the context of what are their symptoms that are driving whatever is bothersome to them, and for me it tends to be bloating and weight loss resistance are two of the biggest pain points for women at this stage of life. And what happens when you go to your traditional clinician, they're like, oh, you're 45 years old, you're 40, you're 42, you're 48, you should— yeah, it's normal. 5 pounds is normal. When, you know, for some people, 5 pounds is enough that they're even cognizant of it.

I don't know why we're like acting like 5 pounds is no big deal.

I'm 5'3". 5 pounds on me is a lot.

Even at 6 feet tall, 5 pounds is a big deal. Like, I think you should have like a 2-pound weight flux in what you weigh. And then if things start to go up, like, what's going on? This is why you need to have a bioimpedance scale and be able to see what's going on here. Yeah, especially if you're doing waist measurements too and that's going up.

Yeah, so I think, you know, first and foremost, really good history. Number two, you can look at the stool testing, but the other thing that I think is even more important is doing just a broad-based elimination diet. This isn't eliminate everything, eliminating the kind of key players. So I think about dairy, gluten, grains, I think sugar, alcohol. Yeah. And I mean, in all honesty, those things alone, if someone's symptoms decrease or go away just with an elimination diet, I'm like, okay, then we know it's food related. It really goes back to a little bit of trial and error to see what is responsive. It is unusual that someone does not improve significantly with an elimination diet, more sleep, managing their stress. Show me a woman who doesn't manage her stress and I'll show you one that doesn't sleep well. And I think for a lot of women, they kind of have spent their 20s and 30s, probably their teen years, all the things that have made them be a successful person up until that point kind of become maladaptive strategies. And so I think that lifestyle piece really has to be part of the conversation. And unfortunately for a lot of women, that's hard to do because they're like, I like my lifestyle as it is.

You can't have both.

Correct. And so I always say, you know, if you want improvement in your symptoms, you have to be willing to change some things. So sometimes it could be as simple as going to bed 30 minutes earlier. Sometimes it can be drinking more water. I mean, it's things like that that really do have a large net impact on how people perceive their life is, is moving in a more positive direction.

What if someone was not listening, they were not fortunate to be listening to this or grabbing the Menopause Gut book, what do you think their long-term costs would be? They missed this whole thing. They went to a doctor, they got on hormones, but never paid any attention to the gut stuff, was told it was kind of normal for them?

Yeah, I mean, I think there's a twofold thing. I think there are definitely people that it's like the ostrich digging their head in the sand. Like they're just unwilling to acknowledge that there's a contributing factor or factors that are impacting their quality of life. I mean, ultimately that's what it comes down to. Like, what is their quality of life? What are they willing to change? And so I think on a lot of different levels, when women are deciding for themselves, like enough is enough, like I'm ready to get out of my own way and change the way I'm doing things, so that I can improve my quality of life. But I think for anyone that is not 100% satisfied with where their health is going, they have to be thinking it's probably time to examine the gut and to think thoughtfully about the gut microbiome. And there's so much good information that's out there now. I mean, I feel like a lot of people are talking about this.

Maybe they're— They are just not towards this direction. I mean, it's like, it's being talked about, in terms of immune health, weight loss, but it's not being talked about here at all. Like, you are the first person here to be talking about it. I'm sure a lot of people will start talking about it, but someone going in to see their provider, where should they start? Should they start with the gut? Should they start with hormones? Like, what's the starting point?

Yeah, I think it really depends on the symptoms they're experiencing. So if it's something that they say, you know, I'm in late perimenopause, I'm 48, 49, I'm close to menopause, menopause, that full transition, we gotta get their sleep dialed in because we know that the impact of poor sleep is not just on metabolic health, it's on the gut microbiome. That's why jet lag impacts the gut microbiome so dramatically. So number one, it's like, do you need some oral progesterone? Do we need to start some estrogen therapy so that we get you falling asleep and staying asleep? Yes, we can do a gut microbiome test, but there's probably in the interim We need to be looking more thoughtfully at some of these other parameters. And if you're not sleeping, we have to address that first.

Is anyone going through perimenopause sleeping?

I don't think so. I don't think so. I've actually had patients say to me, oh, I haven't slept well in 15 years. They're like 60 years old. And I'm like, what? That would be like an emergency. Like, I can't imagine. But it's part of that kind of patriarchal messaging that women shall suffer until proven otherwise. That is just the way that women have been treated.

I feel so blessed that I had all of these hormone docs around me when I started in perimenopause. I like had one month. Yeah.

Well, and it's interesting because I think the prevailing wisdom when I was in perimenopause was that you wait until menopause. And so that's why I always say like women that are 35, 40, 45, like for the love of God, ask for HRT earlier rather than later. There's no point in suffering.

Well, how would you know when is the right time?

I think when you become symptomatic. So if you're a woman that the week or two before your menstrual cycle, you're anxious, you're depressed, You can't sleep, you don't feel good. That is the time to say, I would like 100mg of oral micronized progesterone, which is dirt cheap. Like, unless you have a peanut allergy, you can start there. It's, it's not, uh, sustained release, it's non-sustained release, but it'll help. I think the other side of that is when women are low in estrogen, they're irritable. Sometimes they have trouble with brain fog, they have trouble with word finding, they have trouble with memory.

Two of our peers in And, you know, one was a woman who's not close to perimenopause yet. And I'm like, you just wait, you know, get, you know, there's no difference in metabolism.

Like, I'm telling you, it's a whole new world. I mean, I recall, and I will tell you this transparently, you know, I had two pregnancies in my thirties. I, within, you know, a year got back to my pre-pregnancy weight and did really well. And then I hit the wall of perimenopause and I was like, oh my God. Like, I didn't change anything, but now I can't sleep. I can't manage my stress. I can't do the same workouts. My body is like suddenly working against me. And everything that I used to tell my patients to do was no longer working. So very clearly the end of one experiment here, the end of one experiment across the table for me. Clearly we know things change. Yeah. And I'm sure that you've unpacked these topics, but I remind women all the time, there's like 10 reasons why. It becomes harder to lose weight. Your shifts in body composition are related to multiple factors, not the least of which, as your estrogen is declining, as you are more likely to lose insulin sensitivity, that impacts your metabolism, that impacts all these other factors that many people conveniently forget about until they've actually gone through it themselves or on the other side.

So what do you think for women in their 40s and 50s, What should someone pay more attention to, or any attention to, now that they're not?

Changes to certain foods that you eat, recovery from workouts. Yeah. Thinking about how your sleep is changing around your menstrual cycle, if you still have one. Thinking about your working memory. This is something that a lot of women will say to me, "I'm in the middle of a sentence and I forget the word." "I'm in the middle of a presentation and I lose my train of thought." Or, "I have so much brain fog, I can't think coherently or cohesively." And so I think when you start having those kinds of symptoms, it's a sign that your hormones are in enough of a decline that it's impacting your, your quality of life metrics. Not to mention the fact chronic urinary tract infections or recurrent urinary tract infections, painful sex, no libido. Like, let's be honest, we go through a period of time when we have little people at home where the last thing we think—

the least romantic thing ever.

Yeah, exactly. But like you get to back up on your feet, your kids are a little older. You should have some interest in sex, right? And so I think for a lot of people, it's, it's these kind of multi-layered issues that start coming about. But for me, I think the big indicators are don't recover from your workout. You change the way you feel when you eat certain types of otherwise healthy foods. And then the brain piece, like how many women wanna lose their train of thought or they can't remember things. And I'm not talking about like you didn't write it down on a list and you forgot it, but like you forget where you put your keys chronically and habitually, you lose You are driving home and you forget where you're driving to. Like, these are women sometimes that are in their 40s and 50s this is happening to. And I'm like, that's incredibly scary.

That's frightening. I've never done that one. I've walked into the room and gone, why am I in this room?

That happens to me occasionally.

Like, why am I here? What did I come here for? Some of it's ADHD combined with, you know, it's like the, the menopause ADHD brain. That should be a whole other thing.

Yes.

But not knowing how to get home, that's—

I've had a couple patients that have told me, and then I was like, we may have to do more cognitive testing cuz that, that isn't, necessarily the norm, but I think for a lot of women, it's the brain changes that they find most concerning, most bothersome, and then they automatically go to, oh, I'm gonna end up having Alzheimer's. I'm like, time out. And I've actually, I'm sure you've interviewed neurologists and people that say, or that like, don't automatically go there. It could be you're sleep deprived. It could be that you're stressed. It could be that, you know, where you are in your cycle, maybe it's the day before you change your estrogen patch if you're not cycling anymore. So I think there can be many different factors that contribute.

Well, what do you think of the carnivore diet? I just have to ask this one because I—

Well, transparently, and I have this on the record, after I was hospitalized, because I had, I know this is not a pleasant topic, but I had chronic diarrhea for a year. A year? Yes. And no one was worried about it. I kept telling them.

No one was worried about this?

No. I kept saying, do you think maybe I'm not absorbing anything? I'm not absorbing anything I'm eating because I'm literally— Wow. So I was full carnivore for 9 months. And then I was carnivore-ish for another 9 months. And so I, I think for me personally, I do think they can be therapeutic. What I don't think— any real kind of extreme elimination diet like that, that shouldn't be a long-term solution. I just think that in the absence of fiber— and this is what the research will demonstrate, cuz I just interviewed an expert on the microbiome— she was talking about how in the absence of fiber your gut is left to have to ferment some protein. And as you can imagine, like putrefaction of protein is no bueno. And so I think a lot of people need to understand, like at some point, reintroduction of some degree of fiber is going to be very beneficial. And so I think it goes back to when someone tells me, "I don't tolerate any fiber," I'm like, "What is going on in your microbiome?" Because you should be capable, those microbes should be capable of digesting and fermenting some fiber.

I just saw this post that RFK does a carnivore diet plus ferments, and I'm like, oh, that's why he's doing it.

Yeah, so I think it's really interesting, and certainly some of my colleagues have told me about patients who've been like carnivore for 2 years, 5 years, 10 years, how they suddenly start having issues with, they're not, you know, they're not producing certain keystone bacteria in the absence of fiber.

Interesting to look at those microbiomes after like, I don't know how long it was, would take to get to that problem area.

They start losing insulin sensitivity. Like, he— I interviewed one who said, I just— he's like, I've got a handful of carnivores and they're otherwise metabolically healthy on paper, but all of a sudden they start slip-sliding into insulin resistance. And he's like, I think it's time to start reintroducing some fiber.

When you're just eating meat, meat, high-fat meat usually.

Yeah, I'm like, I— yeah, I could not imagine. So I think it always goes back to I think certain diets can be therapeutic. Like if you go from a standard American diet to a vegan diet, obviously you're gonna have benefits.

Standard American diet to any diet.

Right, it's gonna be better. But the, the goal is not to stay on that forever. It's to kind of get back to a, a more omnivorous diet.

Yes, I'm totally with you with that. Why do you think that there are so many high-performing, health-conscious women? I mean, women that are like watching all the shows, reading everything, doing all the right things. And they're still struggling. They're struggling with weight, struggling with digestion, energy. What's going on?

I think chronic or, you know, significant childhood events have a way of unwinding in perimenopause.

Mm.

You know, whatever adaptive pattern someone has created to be able to deal with what they experienced as a child or young adult becomes very maladaptive at some point. And I say this, lovingly as someone who has an ACE score of 9. I have quite a high ACE score. And so in perimenopause, the wheels fell off the bus, and it has a lot to do with these changes in hormones. All of a sudden, you know, whatever adaptive strategies you had before, it's like— it's suddenly like the getting up early in the morning and forcing yourself through a workout and not dealing with your stress, and all of a sudden these things start to come out. The autoimmune conditions really become problematic. So I think for a lot of people Underlying trauma and stress is at the basis for a lot of issues that I see in women in middle age that are doing all the other work and then not understanding that complex in a relationship. So think about how, how chronic stress and trauma rewires your autonomic nervous system. So suddenly you have someone who is, has a kind of sympathetic dominant state where they have elevated cortisol. Cortisol's not a bad hormone. It gets such a bad rap.

Oh, I'm so sick of the, the exercise cortisol situation online. Yeah.

And I'm like, Yeah, it's like, thank you. It's like hormetic stress. But understanding that, you know, if stress is persistent and bothersome over time, what does cortisol do? It catabolic, so it breaks down muscle. It impacts your immune system. You're gonna be more susceptible to opportunistic infections, more likely to develop leaky guts. I mean, cortisol can be caustic over time. And so I think for a lot of people, they don't understand how that kind of rewires your nervous system. And also impacts your health on such a significant level. So I think this is my working hypothesis. There are a lot of women in perimenopause and menopause that suddenly that trauma that they suppressed, they pretended wasn't there, avails itself. I think this contributes to a lot of midlife divorces. I think it also contributes to a lot of health problems that women experience. So I would say it is not just the gut health piece that's not being addressed. I would also say on the other side of that is this chronic trauma piece that is not being looked at. And I think, you know, even with all the experts that I know you and I have had on our podcasts, no one's really speaking to that. And yet I think it is something that is really pervasive and corrosive. And if you don't deal with your shit, it is going to come back to get you. It's stinky.

I'll link to, um, Amy Apigean. We've had her on a couple of times, but it makes me think of this. I, uh, like I literally said this today on a podcast. I said, you know, if I could go back and tell, tell my younger self, it would be learn how to manage your stress before you get into perimenopause.

'Cause if you don't—

'Cause if you don't, guess what? And so that's just taking it to the next level. I had an ACE score of 6, and I have not met someone with a 9. And maybe tell someone what that means.

'Cause they might go, oh. Yeah, so I think when we talk about trauma, I think most of us acknowledge, and I trained in inner city Baltimore, so I saw murder, rape, suicide, I mean, horrible things that we, there's no one's going to question that that is traumatizing. But I'm really speaking to the little t trauma, the insidious stuff, the addiction, neglect, whether it's emotional or physical, you know, other types of, you know, stressors, loneliness or bullying. And it's, you know, this kind of cumulative long-term effect of these things that can really impact us. And so certainly for me in my childhood with, I had an alcoholic parent who was on the spectrum.

I think we all had alcoholic parents in our age range.

Yes.

Uh, alcoholic dad.

Yes. And a narcissistic mother. And so growing up in that environment, uh, the way that I adapted was to be like the good kid. So I got good grades and I was popular and, you know, I never gave my problem, my parents a problem. But, you know, it gets to a point that's very heavy to hold for a long period of time. And so I think for those of us that have experienced those things, we adapt to our environments. Probably why I became a nurse and later a nurse practitioner, because I wanted to help take care of others. And so the service to others kind of mentality. But I think for so many people listening, whether you experienced overt neglect or other things, I think it imprints us and it becomes much harder to wear that mask as we get older. The mask comes down in the absence of hormones. Estrogen is a people-pleasing hormone. I can tell you as a reformed people pleaser, I don't know how I ever survived in the absence of, you know, that degree of estrogen that I had when I was still in traditional allopathic medicine. But I think for a lot of people, the mask comes off in perimenopause. People find their voice and suddenly they really start standing up for themselves in a way that I think can be very positive and uplifting. It doesn't have to be negative.

Yeah.

But you have to put the work in. And so I think this is that time where people have to put the work in.

If you're that busy, stressed midlife woman.

Mm-hmm.

And now the mask is coming down. What would move the needle fastest to get you back into some kind of homeostasis?

Yeah, I would say first and foremost, you gotta sleep. So that's usually the first thing that we're addressing. You need to find some form of stress management that you can do consistently. And what might, might work for you and I may not work for someone else, whether that's putting your, your feet in the earth, whether it's getting the connection to nature in the morning, whether it's taking a walk. Dogs. Yes, dogs. We both have, between us both, we have 6 dogs. Learning how to say no. Like, how hard is it as a people pleaser to know how to say no and not explain yourself?

You know, when estrogen comes down, you say no to everything. Like, it's, it's that beautiful switch that once these things come down, even with hormone replacement, they're not the same. Nope. And all of a sudden you're like, oh, you don't like me? Don't care. No, I'm not going to go there just because you asked me.

No, it doesn't, doesn't work that way.

Don't need to.

Yeah. But I mean, I think having boundaries is a way to preserve your sanity and your stress management. I think other things that I think about that are kind of like low-lying fruit, like learning how to eat less often. You know, we as a nation eat, you know, anywhere from 7 to 10 times a day. It's like, it doesn't, you don't have to intermittent fast, but even 12 or 13 hours of digestive rest. Those are simple things that people can do up front. Well, simple in that I'm saying it is simple. Sometimes the sleep piece is elusive and takes a while to tease out. But I think for a lot of individuals, I'm not talking about buying a gadget or doing some complicated diet.

Although I've been using this Pulsetto. I love Pulsetto.

I'm obsessed with this thing. Do you know, did it impact your HRV? It's the only thing I've ever used. It's dropped my, my HRV's gone up.

Yeah. It's the, I will tell you, I've tried all the gadgets. Mm-hmm. Because they send me all the gadgets.

Me too.

I'm like, this didn't do a thing. I, and I'm so hopeful. I'm like, oh, please do something. This one does something.

Yeah. My HRV has gone up, which is what I'm saying. I've been telling people, I'm like, I was almost hesitant to say anything because I didn't know about it when I wrote my book. That's number one. Um, number 2, I was like, I'm cautiously optimistic. Like, oh my God. And, and I'm someone that I know when my HRV goes down because it impacts everything else. But I think for a lot of people, they want us to say a gadget.

And I'm like, you can do breathwork, whatever the thing, like box breathing.

Like, instead of doing CrossFit 6 days a week with no— or Orangetheory Fitness 6 days a week with no recovery, like, learn how to take a slow flow yoga class or Get outside and walk in nature. Like, I'm talking about simple things that we know on a very basic level are going to improve your quality of life, but are also going to have a positive net impact on the microbiome. This is before we even get to complicated stuff. I mean, I run the gamut in the book. I mean, that was, you know, I spent a concerted effort to make sure it ran from simple free stuff all the way up to, you know, interventions that involve other experts and hiring people to help you and stuff like that.

So let's deeper dive on estrobolome.

So this is your estrogen processing center of the microbiome. It is really important. It's important both in before menopause and after, but it's where your body— you know, the, the liver is this primary site to break down things that you're exposed to. I'm going to oversimplify things, but to break it into water-soluble compounds where it goes to the gut, and it's supposed to get packaged up like a present and pooped out of your body. But what can happen is If you don't have the right microbiome constituency, you're eating a garbage diet, you're super stressed, it can get re— your estrogen can get recirculated. And these are the symptoms that make women really unhappy in perimenopause. This is when breast tenderness, weight loss resistance, brain fog, rashes, digestive concerns. I mean, it runs the gamut. For me, from my perspective, if you understand that the estrobolome is nurtured by the way we manage our lifestyle and the types of foods that we eat and the way we manage our stress, we've talked about stress like this Goldilocks effect of stress, like beneficial stress, right amount, right time, versus chronic stress, and how the estrobolome is so important for managing and mitigating how we excrete our estrogen. And here's the thing, even in menopause, even if you're on HRT, if you're exposed to a lot of estrogen-mimicking chemicals in your environment, personal care products, or food, that can throw off the estrobolome. So it does matter what we use in our personal lives It is not irrelevant. It is not woo-woo. You know, we know that these estrogen-mimicking chemicals can be 100 or even up to 1,000 times more potent than the hormone itself. So if you think it's not important, I always remind people like, don't be paranoid, but just make conscientious efforts when you're purchasing deodorant or you are drinking your water. And I acknowledge, like, when I travel through airports, I don't stress about getting a bottle of water. It's like, yes, I'm exposed to some microplastics, but I need the hydration and I'm not going to stress about it. But I think for a lot of people, they assume it's just irrelevant.

Would you be looking at, say, a urine hormone test? Like, how would you know if this is working correctly?

Yeah, I mean, I would say we base it off of symptoms, but there's also in stool testing, we look at things like beta-glucuronidase, which is this important enzyme that goes in and kind of helps break down the estrogen. And if it's elevated, it can be a sign that maybe things are not optimal. I think for a lot of people, it's really just getting a sense of symptoms, and then we can look at blood work. Are they metabolizing things properly? But that stool testing piece I think can be very important. And then I would say that is where I think stool testing can be really helpful. And it doesn't necessarily mean that everyone has to run out and get a stool test, but I do think having a sense of whether or not the estrobilum— I'm laughing because someone the other day called it estrobilomi, and I was like trying so hard not to laugh when I was talking to this person. I was like, I get it, it's kind of an awkward way of describing the estrogen processing center of the gut microbiome.

So they called it that the entire time.

It's sort of like strobolomi and I was like, and you didn't tell 'em. I was like trying so hard. I was like, it makes me think of baloney. And I was like trying to, I was trying very hard not to like correct them. I was like, afterwards I was like, it's strobolomi. They're like, oh, I thought it was a strobolomi.

It actually is easier to pronounce as strobolomi. Yeah. Anyway, if you could delete one piece of advice that women have been given about menopause, what would it be and what would you replace it with?

I think I would encourage women to be their own best advocates. So this kind of patriarchal environment where you go to your provider and they tell you what to do.

I love that women are being that way. It's like, come on, women.

Yeah. I mean, it goes, and it, it can even be from female providers. Right. They go and they, they, and they don't, their, their providers don't wanna be challenged. They don't wanna be questioned. I'm like, aren't those days behind us?

I thought they were.

So I think that if you are a middle-aged woman and you're seeking really good care and the person that you are seeing is not providing the care that you want, I give you permission to fire them. I've done it. I did it.

You know, the old days where you had an insurance plan and you had to go to this person on your— like, that is not— you are now hiring someone to do it for you. It's a free agency. Yeah. It's like the COO of your, your health. You're the CEO. You better choose wisely.

Yeah. No, and I would be the first person to say that, um, my husband had a healthcare hiccup in 2024. There was someone who really dropped the ball for him. And I, I recall having a conversation with this person this person. And I was like, I'm not gonna report you to the medical board, but I am gonna make it really clear that what you did was completely, uh, beyond the standard. It wasn't even within the standard of care. And so I think for a lot of individuals, I share this to say, even as a licensed medical professional, it has happened to me in my family. And every woman listening deserves to have really good care. So I would say throw it out the window that you think you have to stick with that GYN who was great when they delivered your babies and was great with postpartum care, but now doesn't know his butt from anything else and is trying to mansplain you about how to manage hormones and how you have to accept things as they are. You need to find someone that is compassionate, kind, knowledgeable.

That was the other wild thing to hear, that this was not really part of med school training for the OB-GYNs. No.

I'm like, what? None of us were trained. And that's the really sad thing is that I think the, the explosion of interest and training that's going on now, I think it's changing for people who are med students now, but you have people for 25, 30+ years that were getting no information, and they're expected to know through the lens of their particular field. Like the ophthalmologist, they weren't trained about menopause, like what happens.

I mean, my dentist was the one who knew I was in menopause. Really? My dentist. Wow. A male dentist.

What a fantastic man.

Amazing.

We should celebrate him.

Periodontist. And yeah. Palm Desert. Craig Conroe, we love you. Yeah, literally, I walk in, I go, my gums are bleeding. He goes, low estrogen. I went, what?

Wow. Wow. No, that's incredible.

Yeah. Women in midlife are often told, usually told to accept decline as inevitable. And you hear this with popular people on podcasts, you know? And I think from what I've heard from you is that you are not agreeing with this. No. You reject this. Absolutely.

And why? Women deserve to have a high quality of life throughout their lifetime, full stop. And this mindset or thought process that as we age, we have to accept aches and pains, we have to accept poor sleep, we have to accept crappy digestion, uh, we have to accept that our— we don't think quite as clearly, we don't have a sex life anymore. I, I just think that that further contributes to this kind of ageism. You know, there's so much focus on young people, which I think in many ways— I mean, you have sons, I have sons. I'm happy there's a focus on young people. But by the same token, like, we all want a high quality of life. Like, why would we accept things any differently? And so I usually cry BS. I'm like, first of all, that's bullshit. Like, no one should have to accept that they have this eventual decline. And even people that I won't name anymore that talk about this, you know, marginal decade, marginal decade, marginal month.

My mom had a marginal month and my grandmother had a marginal, like, week. Yeah. And my dog had a marginal month. So I'm like going, there's no marginal decade.

Yeah, no.

And, and when you tell these types of things, and for what we're talking about is this idea that, you know, you're gonna have this, this slow decline that's the last 10 years of your life, you're gonna be all this stuff. And, and if people hear that, then they start to build that into their limiting beliefs. Yeah. So I just do not, I was like, you know what? And then I kept hearing, oh, you'll be at your peak in your 30s. Like, what if I could be in my peak at 60?

Yeah.

That's why when I went and I was like, I'm gonna go get a DEXA scan and I'm gonna go what I knew where I was in my 20s. I'm going right back to that and better.

Yeah.

And you can, it's just, you can, you absolutely can. Don't let people tell you.

Well, I'll tell you, like JJ, because I'm short when I fly.

You are?

Yeah. I'm only 5'3", but it's interesting when I fly, for whatever reason, chivalrous men always wanna help me get my, they want you to suitcase up or down.

No, they try to help me with my suitcase.

And so I always— and it's— so yesterday I said to the very nice man, I said, thank you so much, but I need to be able to continue doing this. And he was like, okay. He's like, I just always offer. I was like, I appreciate that. I'm so appreciative. But I still have to be able to lift my suitcase and carry my stuff and do all these things because I don't want to be a frail old lady. I want to be a strong old lady. Well, and it's interesting, those body composition readings I think are incredibly valuable Because sometimes our weight goes up because we put muscle on, which is great. That should be celebrated. Right. But yet women have been so conditioned that that number on the scale is so representative of their self-worth. And I think that that in and of itself is incredibly disruptive and destructive.

That's my goal to change that. That's like my, my biggest legacy work is that we will realize that the scale has single-handedly destroyed more women's metabolic and mental health than any other tool out there. And that we have to only look at body composition. We have to celebrate increasing fat-free mass and muscle strength, and that we do need to start to focus on being powerful. And it's great for women to be powerful.

Yeah. Well, I mean, powerful emotionally, mentally, and physically.

It all goes together. It all does. Okay, let's go through them. Some speed rounds before we do that. And these you get to like, first thing that comes to mind. But before that, I just wanna give one kind of tie a bow on it. For the woman listening today who feels like her body is not— it's turned against her. It's not what she knew, doesn't recognize it. Her digestion, her metabolism, her energy. What's the one truth you want her to understand so she can take her power back?

Oh, I think first and foremost, you are your own best detective. So the N of 1, the power of N of 1, trying different interventions personally and then in conjunction with your medical provider. Is one of the most potent ways to be able to move yourself through this. I feel like I've had at least 2 episodes over the last 10 years where I was like, what is going on? I don't understand. And so through that kind of N of 1, figuring out like different, you know, different types of foods, try different types of sleep measures, try different types of hormones. Maybe instead of transdermal estradiol, you need oral estradiol. Maybe instead of, you know, the oral micronized progesterone, you need the, you know, sustained release version, or maybe you need peptides. I mean, there's so many interventions. And I, we could talk for days about GLP-1s and HRT, but I, I think for a lot of individuals, it's just the reaffirming of knowing there are answers for you out there. Don't stop with one provider telling you that you are as they are. That's not true. And the other thing is lean into how you feel with different interventions.

If someone listening feels overwhelmed, what's the first thing you'd have her do tomorrow morning to support her gut?

I would, uh, ensure that they get outside and get some sunlight on their retinas because that will set up sleep and sleep and your microbiome. The health of your microbiome is largely dependent on your sleep quality.

What's one habit that's wrecking women's gut health in midlife that they think is actually helping?

Alcohol.

Do people really think at this point that alcohol's helping their gut?

I think that there is a huge mommy drinking culture and their thought process, I'm stressed, I'm gonna drink alcohol, it's gonna make it better.

What's the most underrated thing women can do for their metabolism? Through their gut?

I would say that number one, uh, track your fiber intake and slowly increase it.

What's something about menopause and gut health that still surprises you even after all of your clinical experience?

The influence of stress and trauma.

If you could upgrade just one daily habit to improve gut health, what would it be?

I've already said fiber, so obviously I'm not going to do that. I would say take 4 to 5 deep breaths before you consume a meal so that your body gets into parasympathetic state, because many people don't realize is that that parasympathetic state is what allows your body to secrete hydrochloric acid, adequate digestive enzymes, also bile, which helps break down and emulsify fat. So something that simple can be very impactful.

And for people who are wanting to learn more, tell them everywhere you are. I'm going to put this all at jjvirgin.com/menopausegut for your amazing book that people can grab anywhere and everywhere and at Amazon. But where can they find you?

Yeah, probably easiest to go to my website. So www.cynthiathurlow.com. You'll get access to my book there, my podcast, Everyday Wellness, all of my social media links. And I have been plugging Substack because Substack has become this like new way of expressing opinions on things that I really love. And I've been unpacking things in, in a lot more depth than anywhere else on Substack. So you definitely wanna check that out.

Cool. All right. We will put that all in the links and grab your copy of The Menopause Gut. And thank you so much.

Thanks for having me.

One thing people forget about on their fat loss journey is digestion. When you're changing what you're eating, how much you're eating, when you're eating, your digestion changes too. You may be feeling any of these things. You feel backed up, a little bloated after your meals, maybe some cramping or just overall One of the foundational things that I recommend during this time to support your gut is sodium butyrate. So what is sodium butyrate? So butyrate is a short-chain fatty acid that's produced by your beneficial gut bacteria. And it's actually one of the primary nutrients for all the cells that line your gut. And when those gut cells are supported, digestion, comfort, regularity, it all works. Works better. And that is why I added BodyBio Butyrate to my daily routine. If you're in the process of upgrading what you're eating, how you're eating, when you're eating, head over to bodybio.com/jjvirgin to start supporting your gut today.