433: The Perimenopause Gut Connection with Cynthia Thurlow

When we're looking at this loss of progesterone being secreted by the ovaries, our adrenal glands are like a backup quarterback. They will, on their own, step in to assist with progesterone production. But what many of us don't realize is that perimenopause we become less stress resilient. That does not mean that you're not a capable individual.

Welcome to Midlife Conversations. I'm your host, Natalie Jill, and I'm passionate about having amazing conversations that matter to us midlife women. On this podcast podcast, I do what I do best, taking complicated health topics and breaking them down simply so that we can optimize aging together. I share actionable steps to help you thrive in what I believe are our best years to come. Join me as I interview the most inspiring people living their best midlife years and dive into essential topics like hormone changes, health optimization, weight management, blood sugar, emotional well being, relationships, beauty, and so much more. Perimenopause and menopause, what is the difference? How do we know where are and what's the order of priority when we are navigating all of these crazy symptoms that go in midlife? Like what is the order of priority? Do we jump into hormone replacement? Do we look at cleaning up our gut? Do we need to start tweaking our diet? Do we need to just accept it all? What is the order of priority and where is. What are some actual tactical things that we can do right now to start feeling better? That's why I had to have Cynthia Thurlow back on the show today. I can't wait to have this conversation. Cynthia Thurlow is not only a nurse practitioner, she's got an incredible TED talk, that TEDx talk that hit over 15 million views. She was on the forefront of the concept around fasting and intermittent fasting. We're going to dive into that today as well and how that changes in perimenopause and menopause and if we should even be looking at that. But she is also not just a friend and a colleague. She is the host of Everyday Wellness Podcast. She is has an incredible new supplement line that's coming out. We're going to talk about today, too. Lots of great things to chat with her about today. A lot of questions for her. You're going to love her as much as I do. Thank you so much, Cynthia, for being here today.

Absolutely. I've been really looking forward to connecting again with you and your community.

So I want to dive back just a little bit because when I first learned about you and got to know you, and what a lot of people started to recognize you about was the whole concept of intermittent fasting. And maybe that's in my head, but is that sort of where you started or is that just something you got really passionate about?

Yeah, I mean, I guess the. If we look at the trajectory of my career, I spent 16 years in clinical cardiology as an NP. And almost nine years ago I got really frustrated and tired of just writing prescriptions. So I think many of your listeners probably understand traditional allopathic medicine. We treat symptoms with prescriptions. And I love cardiology, I love everything about the heart. But as I was transitioning into perimenopause myself this 5 to 10 year period of time prior to menopause, I was starting to struggle with health concerns that I'd never had before. I became weight loss resistant. I was exhausted and tired. I was over training, I was under fueling. And so I think I came to intermittent fasting, like many women do, out of a desire to change body composition. And the reason why I felt so passionately about it was that I physically and emotionally felt so much better. And so that was what kind of started that process. And as I was leaving clinical medicine and kind of creating my own practice, and at that time in my great state of Virginia, an MPs could not practice independently. So a lot of what I talked about was lifestyle, and I was happy to really focus in on that. So when I think about intermittent fasting as a strategy, at that point, I really felt like this is something that was intrinsically aligned with the way our bodies were designed to thrive. And I still fervently believe that it can be one of many strategies that women, and men for that matter, can utilize. But the longer I've been doing this, the more I realize is that I think we need to be a little bit more gentle with our bodies. I think that especially as we're navigating this transitional period in our lives, I think for most of us, yes, you can have a period of caloric restriction over time, but nourishing our bodies really needs to be the message and needs to be the focus. And so at that point, you know, when many people became more familiar with our work, that was a lot of what I was talking about. And I think that for every person that's out there, there's a reason and a season in our lives for certain things. And that was very much a reason and a season. And I still believe in it, but I'm kind of evolving into thinking about the way that we choose to eat and when we choose to eat, is really about nourishing our bodies and making sure that we're finding some degree of balance. Because as you and I both know, what we did in our 20s and 30s does not per se work. 40s, 50s, and beyond. And so I want women to be able to create sustainable strategies so that they can navigate the second part of their lives and do so in a way where they feel great. They don't feel like they're just surviving. They're actually thriving.

So good. Okay, I have so many questions that I want to ask based on that, but I want to point this out, something you just said, and I hope everyone really picked up on this. A lot of us in the health and wellness space, especially if we have an online platform or a book or a podcast or whatever it is we get, it's almost like a typecast. So you hit a chord. You struck a chord on a topic. You're leader in a some topic. But we are human like everyone else, and we evolve and new research comes up and we learn things and our bodies change. And so just because we believe or taught something, something as like, this is the answer right now. It's a right now. It doesn't mean it's forever. So I want to first point that out because as we talk today and Cynthia shares some new things that have come to light, some of you are going to say, well, but I saw her TED talk or but, but this, but that. And I just want to refer back to that, that it's okay and you listening should evolve and train and change, too. I think we all need to be our own health detective in a way and figure out what is going on and what's working. So let's, I want to kind of rewind a little bit. We're going to come back to fasting because it's an important thing. But let's start with perimenopause and menopause. I know this might sound basic to some of you, but let's cover it because it's important. What's the difference? And how do you know where you are?

Yeah. Such a good question, and one that I think even a lot of healthcare professionals don't fully appreciate. So perimenopause is the 5 to 10 years preceding menopause. You may not know, but our ovaries are the pacemakers of aging. I'm going to say this again. We are born with a finite amount of eggs that over time, each month, whether we ovulate or not, we are getting closer and closer to a stage in life where we are no longer fertile. And so I like women to understand that our ovaries define how and when we age, when we make that transition into 12 months without a menstrual cycle, which is really what defines menopause. But perimenopause is this very erratic. It's almost like reverse puberty. I always joke that I say I have teenagers in puberty and I was transitioning into perimenopause, where we have some of the most wild fluctuations of estrogen. In particular, it can be what drives a lot of the symptoms that for many of us can be incredibly unpleasant. But what kind of defines the beginning of perimenopause, which can be late 30s, early 40s. Yes, you can be in perimenopause in your late 30s. I certainly was, is that our ovaries are starting to produce less and less progesterone. So that does a couple of things. It may show up as the week or two before our menstrual cycle, we may be more anxious, we may feel depressed, we may have insomnia, we may have trouble sleeping. We may start dealing with heavier menstrual cycles, because estrogen and progesterone are these key sex hormones for women that are divine to kind of have this ebb and flow. It's like a seesaw effect. But as we are nearing that portion in our lives, when we are no longer become or becoming less and less fertile, we may find that weight loss resistance becomes an issue. Heavier menstrual cycles, breast tenderness, bloating, digestive concerns, brain fog. I mean, there are documented over 100 plus symptoms that we can experience, but those tend to be the ones that I see and I hear women discuss more often. So five to 10 years preceding menopause, it may start off with your cycles, may be pretty regular. Then as you get farther into perimenopause, you may start having other symptoms, like we call them vasomotor symptoms, hot flashes, night sweats, none of which are fun. No, I had all of them. Permanent. They do not have to be permanent. And a lot of us, to do with our, our hypothalamus, pituitary, ovarian axis. So brain. There's a gland in the brain called the hypothalamus. The pituitary gland is adjacent to that. It's communicating, it's shouting to the ovaries. Produce, you know, release these hormones. Release these hormones. And so it's almost like your brain is setting off an SOS to your body. And that can drive a lot. These symptoms for some people, they're very mild. I find for the women that have really capitalized on the lifestyle piece, and I'm sure we'll talk about this in depth, they generally tend to have a less bumpy ride. Women that have prioritized everyone else in their lives their entire lives. You know, we know these women. They prioritize everyone other than themselves. Suddenly, stress management becomes important. Sleep becomes important. The right type of nutrition becomes important. And, you know, as we're kind of navigating, some people do benefit from supplementation, targeted supplementation. There are things like Vitex as an example, that can be very nourishing. Some people really need to start with oral micronized progesterone to help, you know, that week before their menstrual cycle. Other women may get to a point where they need a little bit of estrogen. Some people need a little bit of testosterone. The point of what I'm making is our perimenopausal journey is as. Is individual, as we are. So Natalie and I may have had completely different perimenopausal journeys, but that is what is unique to each one of us. There is a genetic component. We know that if your mom went into menopause early, you very likely will as well. We know there's a racial component. We know there are things that will drive ovarian aging, like smoking, alcohol. We know people that have experienced a lot of trauma. And I've been very transparent with my community. If you look at the. They call them ACE scores. It's really looking at adverse childhood events. You can go online and look at these. These metrics. It's a very quick survey. People that have had significant adverse childhood events are more likely to go into menopause earlier because their bodies are under chronic stress. So I think that for many individuals, there's a lot of ambiguity. When is this going to happen? And then as you get towards the end of perimenopause, your cycles may be lighter, they may be less frequent. We know when you start going to three to four months in between cycles, you're getting close to the end of this aging process of our ovaries, but actually our ovaries drive the aging process, which I think is so interesting. I don't hear a lot of ovarian senescence is the fancy technical word, but ovarian aging is what we're looking at. And then when we have 12 months without a menstrual cycle, that is when we are considered to be in menopause officially. And this is a time in our lives where we're not dealing with a period every month our hormones may be more balanced. So I find a lot of women feel better in menopause because there's not chaotic fluctuation of estrogen as one, one indicator. Not every woman in menopause per se needs testosterone. But I would say the majority do benefit from testosterone therapy. So really looking at it from a 20,000 viewed thing, it's really focused on lifestyle to help women first and foremost and then optimizing, you know, detoxification, you know, are you pooping every day can be that basic then looking at hormones because I think that if your body isn't in an optimal state prior to starting hormone replacement therapy, this is when women will say things like I gained 15 pounds. And woman in perimenopause or menopause wants to be dealing with weight loss resistance beyond where they are. So I think for every woman it's perimenopause is this chaotic reverse puberty phase. Sure. On to menopause where things tend to be a little bit quieter. I will say that for women that tend to be very symptomatic in menopause, and by that I mean copious night sweats, a lot of vasomotor symptoms, just feeling poorly, they also tend to be people that are dealing with insulin resistance. So making sure that that's really worked up really well is also a very important consideration.

Gosh, you just shared so much good information. And I want to point out a few things. If you were listening and picked up a few of the things that I picked up that she said. You, you had mentioned that sometimes people that live a healthier lifestyle in general, maybe no alcohol, not smoking, taking care of nutritionally, they might have less symptoms. And if you are listening and you're like wait, I am that healthy person and I have all the symptoms, I just want you to know I feel you because that was know. So I literally like I do all the healthy things and I still getting as I was getting close to menopause, hot flashes around the clock, like, like six, seven an hour, like constant night sweats, like beyond night sweats, gaining the weight, getting thick in the middle, the, the mood changes. But here's what I want to point out. We're gonna talk through like some different aspects of solutions here and what works, what doesn't. It's not typically one thing and I know you all don't wanna hear that, but it's not Typically just do this one thing and, and that's what I think bugs us sometimes about straight allopathic medicine. Because not all doctors, but some you go and you say this is happening. And they say, here's birth control pill, like just. Or here's a bipolar or not bipolar, here's antidepressants. And it's not a one time. Just fix the symptom. We got to look at what's going on. And I am, full transparency, huge fan of hrt. I'm on all three. I have been for quite some time. I'm never going off to pry it out of my 98 year old body at one point. I'm not stopping it. That's my. But I will say that there's an order of priority and looking at my gut health first, looking at the insulin, like blood sugar, all of that tied in first to be able to optimize hormones. So let's kind of rewind a little bit to that. You mentioned kind of that there's like an order of priority. Can you talk about that like someone's in the throes of all of this stuff? Like where would you even have them start to look?

Yeah, I would say first and foremost, sleep is foundational. So if a woman comes to me and she's not sleeping well through the night, that means you are sleeping seven to eight hours a night without waking up. I'm going to say that full stop, seven to eight hours a night without waking up. And one thing that I just want to dovetail into that because a lot of women will say to me, I wake up at night at least once or twice to pee. Understanding that as we are losing estrogen systemically throughout our body, we are also losing it in our vaginas and that can impact that night. We call it nocturia, nighttime awakening. So for a lot of women, something as simple as vaginal estrogen, which is not absorbed systemically. And so for a lot of women, when we're starting with sleep, it's like, okay, let's talk about if you're really getting up and you're limiting your liquids after six and you're being conscientious about that, maybe the next step is vaginal estrogen. And for anyone that is listening to this, to this podcast, you can be 90 years old and you can start vaginal estrogen. Like you can be a breast cancer thriver and start vaginal estrogen. It is localized to the vagina. It should be sold over the counter, but isn't. It has this black box warning which to me is criminal. But for many, many people, when we talk about sleep, if they're saying like, it's really disturbing, I have to urinate a lot at night. I think about diabetes, but I also think it could be as simple as your urethra, your vagina, your vulva. There is so much innervation of estrogen cells. And we know there's particular bacteria, there's lactobacilli, that thrive on estrogen. So when we have less circulating estrogen, the bacteria changes and then your bacteria impacts the mucus lining of the vagina. So there's a lot that goes on there and I'm sure we'll talk more about that.

And the side note on the vaginal estrogen, you can use it on your face too.

Yes, yes, you can.

I do. I mean, I was doing that and now I actually have a prescription for my face. But actually the same stuff it does there, it does for your face.

Yes. And estrogen is really so, so important. So sleep is number one. It's figuring out, are you sitting on your tablet at night in bed? Do you have a TV in your room? If you do, you shouldn't. And I don't say this to shame people, it's just we really need to create an environment that is designed and conducive to sleep. I sleep with a silk, with a silk sleep mask. I use blue blockers at night.

Me too.

I get into bed before I'm tired and I do these things very specifically. And when I'm working with women, a lot of people have just got into bad habits probably from the start of when they had children. They're just accustomed to getting work done late at night. They're sitting in front of the tv. So creating the sleep hygiene. And for me personally, I think that targeted supplementation to help sleep when you're doing all the other sleep hygiene pieces can be very helpful. We know we make less melatonin as we get older. And melatonin is not just a sleep hormone, it is also a master antioxidant. So I think about melatonin, I think about myo inositol, which can also help with blood sugar. But that is a very gentle helps. The sleep architecture, I think about, I'm very purposeful. Creatine also helps with sleep. It helps the sleep, sleep architecture.

So I did not know that about creatine. Interesting. Can you talk about that a little bit? I didn't have no idea.

Yes. So creatine is one of these. Creatine monohydrate is one of these supplements, we think about it for muscle strength, we think about maybe it helps with jet lag, but if we look at the research it can also be beneficial for brain support. So it can help with jet lag, can help with bone health at higher doses because we need a little bit higher dose to cross the blood brain barrier. But I start, I'm very much a person that likes a multi purpose supplement. Like if it does multiple things, great, that's one less thing I have to take.

So then are you, because like creatine, I mean I, I know from fitness days I would take that with my workouts, after my workout, like do you just recommend that women supplement with that daily? No matter, like not timed around a workout, just separately for this?

I absolutely do. And, and I've, I feel like I've inter enough experts that are doing the research to demonstrate that because it has so much multifaceted components to it, taking creatine on days you don't exercise is beneficial. Taking creatine if you're dealing with sleep challenges because you think about creatine is really helping with energy production, so helps with ATP production in the cell and for a lot of people can be an adjunct to sleep support. But I also think about things like adaptogenic mushrooms or adaptogenic mushrooms are not psychedelic mushrooms. Adaptogenic mushrooms are reishi cordyceps, things that are very calming to the autonomic nervous system. I think about other adaptogens like rhodiola, magnolia bark, which is also sometimes called relora or Ashwagandha. These are things that are very calming because we know that we become less stress resilient in perimenopause and menopause. And we have to do more to quiet that autonomic nervous system. And so autonomic nervous system we're looking at sympathetic side which is I'm being chased by a cyber tiger. Other side, parasympathetic is rest and repose. That's what we should be in when we're getting into bed. But for so many of us we are carrying the weight of the world on our shoulders and can be very challenging. And I can tell you personally, the last six months of my life, personally as a menopausal female have been the most stressful that I've had in a very long time. For me, those things that we just talked about really have helped with my sleep. My sleep has not suffered too, too much because I'm so diligent. And these are the things like when we're, when we're doing an Intake on a woman, I can tell instantly. Are you on hormone replacement therapy just based on the sleep? Because progesterone helps us fall asleep, estrogen helps us stay asleep. Now, these are kind of brought over generalizations, but they work synergistically. And some women will say, oh, well, I'm only allowed to take progesterone for a week prior to my menstrual cycle. I'm like, listen, if you are more than halfway into perimenopause, you're probably going to benefit from taking it more frequently. And the other thing that I learned from one of our friends, Dr. Anna Kabeca, is that if you are taking oral progesterone, it benefits to have one night off a week because you keep those receptors. So the receptor is kind of like the little targeted area on a cell that progesterone will dock. We want to keep those really sharp. And so I typically will say, give yourself off one night a week of that oral progesterone. And oftentimes you'll find your sleep is not negatively impacted. So sleep is number one. If you are not sleeping through the night, do not go and start intermittent fasting for 24 hours. Do not start doing extreme.

Yeah, because that's like, the number first. I want to. One thing you also said in sleep that I don't want to rush over because you said it. And it's. This has been so transformational for me. So even though I'm on hormone replacement and I do watch my deep sleep and I take the supplements and I do all the things, the one biggest thing that has completely changed me and my husband's sleep on a whole nother level. And I never would have thought, this is blue light blocking. Like, I didn't. I don't understand. I didn't understand how much we were getting it in. And just by changing, like, wearing Viva Rays at night, that's what we do. And just changing our lights. Look, we have all those LED white lights. We stopped using those at night. We have red light by our beds. Just like those little changes. Changes. It's amazing, the difference of quality. So I was sleeping, but the quality of sleep has changed. So you said it, too. So blue light, y'. All. This is important. Like, it's coming from our cell phones, our TVs, our laptops, our LED lights overhead. Like, if you think back to the 70s and 80s, we had Amber lighting, and they weren't overhead. It was a very. And we didn't have all the computer screens and the phones. So that is another huge Contributor to sleep.

Yeah. And helping people understand, like what that blue. So during the day it's different. But as we are getting closer to dusk, understanding that we have this balance between two hormones, cortisol and melatonin. Cortisol is what gets us up out of bed, gets us moving. Melatonin gets suppressed. The more light we are exposed to in the morning, the reverse starts to happen at night. So you may go to a movie at night. I'm the dork that goes to a movie theater and brings my blue blockers, which embarrasses the family.

But I'm gonna do that now.

I want to be able to sleep. But what starts to happen is if you have a flood of artificial light in the evening, your body starts suppressing melatonin. Melatonin is a sleep hormone, but it is so intricately important. Or if you eat a massive meal right before bed and you don't sleep well, has a lot to do. We have melatonin receptors not just in the penile gland in our brain. We have them diffusely throughout our entire bodies, but largely in the digestive tract. So for a lot of people, understanding that, you know, being conscientious, like, I'm going to do a webinar on Wednesday evening this week, I will be wearing blue blockers. My people that come to the webinars are always humored. I'm like, listen, if I'm telling you that it impacts my sleep, I'm going to be doing it so that I'm kind of demonstrating good behavior.

Makes sense. I'm not as on it as you, but I, I will, I'm going to work on it. I think if I'm leading a webinar, I probably don't have them a lot, but you make a very valid point. I'm listening to. But I'm just even thinking today as we're recording this, you know, we have dinner plans tonight with friends that are in town. And my husband and I both, when they asked, we're like, well, can, can we go 5:30 or 6:00'? Clock? Like, we like to eat early. They can't meet us till seven. And already we're thinking like, oh my gosh, late dinner. Like we, I think of all that now. So it, those things all do affect us. I'm certainly not perfect at it, but. And I'm not expecting any of you listening to be perfect at it, but just to be aware of all that when we're saying we can't sleep, like, how are those behaviors going? So order of operations, sleep Is first. What would you say is second?

I would say having a solid stress management backup system. So when we're looking at this loss of progesterone being secreted by the ovaries, our adrenal glands are like a backup quarterback. They will, on their own, step in to assist with progesterone production. But what many of us don't realize is that perimenopause, we become less stress resilient. That does not mean that you're not a capable individual. That just means that what you did in your 20s, teens, 20s and 30s, you cannot get away with anymore. And this is where, you know, you're honoring as an example, you're mentioning your friends are in town and you like to eat earlier. We know that we just have to adopt kind of healthier biorhythms. So this might look like saying no more often. Like, I was one of those friends that said yes to everything, and I was totally worn out and exhausted and tired. So you learn about boundaries, you learn about, you know, preserving sleep, you learn about proactively managing your stress. And for each one of us, you know, there are people that love meditation. Meditation, for me personally, requires a lot of effort because I have a hard time quieting my brain. So I actually bought something called Muse. I have no affiliation.

I have that too. And I need to, like, start practicing.

Yes. And my husband, who's an engineer, that's how I got him to meditate. And I said, I think it's. It's a great tool to utilize, but it means connection with nature. You know, during the pandemic, there were a lot of things we couldn't do, but we have a couple dogs, and so we love getting out in the morning, getting sunlight on our. On our eyes, on our retinas, connection to nature, grounding PMF therapies. There's a lot of things that you can do just breath work. You don't necessarily have to buy a device or do something that's overwhelming, but finding things that you like that calm your autonomic nervous system. Because if you don't, stress is one of these things that if you are not properly managing it, it can erode not just your health, but it can impact your susceptibility to disease, impacts immune function, impacts your mental health, impacts the way that your body is perceiving the world. And I think for anyone, again, like myself, who has a significant trauma history, it's very easy for me to get triggered back into that fight or flight. It is finding the things that allow me to Feel calm, cool and collected. And it could also mean when you're talking about boundaries, it may be loved ones, it may be friends or family. You just decide you need to limit your exposure to that individual. I did a bit of a good cleaning up about five years ago around all this stuff that happened this past year, even more so because I had to get more deliberate focus on my key priorities. So stress management, I think is a solid number two. And then I would think about nutrition. And I know this is something you and I both really emphasize. I think it all really starts with food. I think for far too many of us. Like, I look at my teenagers, the way they eat, I keep telling them, I'm like, it's not.

I have a team too. Before you keep going into nutrition, because I have a lot of things I want to ask you about there. There's one thing on the stress that I want to share because we have some of the same friends. And I'll say her name because Amy is a good friend of both of ours, Amy Horneman. And she said what we did about meditation too. And so I turned her on. So I don't know if you do this already, but to 528Hz on like to listening to that frequency, it like. So if any of you are like listening and you're not a meditator, you're not a calm just by putting on. You can find on Spotify or iTunes 5-8Hz HC it like just that frequency of music will like help to calm you. I also wanted to share kind of something interesting about Cynthia. So I've known Cynthia for several years and we had actually scheduled to record these, this podcast a while ago. And she was going. She had something very heavy happening in her family. It was stressful for her. She was stressed. And what she said to me on a message, which I so respect. And so I want you to hear that she really does practice this. She said, I'm very consumed right now. And even though I have time to do the podcast, I just have to say no right now because I've got to prioritize taking care of things, meaning herself too.

So she.

What she just said about boundaries is very accurate. Like, I'm sure she did have space on the calendar to do a podcast and she realized how important what she's saying is. And so I just wanna share that what she's saying is very accurate. And we all get to practice doing that a lot more.

Yeah, I mean, it's interesting cause one of my podcast team members was Kind of giving me a hard time. She was saying, you know, your inventory is usually very robust. We have, you know, four or five months worth of inventory. And because of what happened with my husband and I did take probably five weeks off from podcasting because I needed to, it kind of put us in this little like podcasting pinch. But as I explained to her again this morning, I was like, I appreciate that, but that was a decision that I made because I needed to be fully present for my husband and what was going on with him. Because for me, one of the things I've found is that if I am not focused 100% on you as I'm speaking to you, then I'm not giving you the gift of a good quality interview. I'm just doing it distracted. And so for me, I hate being distracted. I'm definitely one of these people that when I'm talking to someone, I want to give them 100% of myself. And I think for so many of us, we go through life in autopilot. We go through Life focusing on 90 things at once. And actually we do best even as women, focusing on one thing at a time and doing it really well, as opposed to doing five things in a half assed nature. So good. And I say that with great love because I unknowingly did that for a long time. And even now, like, the best example I can give right now is I had a podcast I was on in Las Vegas. I actually took my 19 year old with me because I wanted that time with him. And I recall someone saying, oh, you know, you're just there for like 36 hours. And I said, I know, but I don't get a lot of concentrated time with one kid at a time like that. And to me that's a gift. So, you know, thank you for acknowledging that. But I think it's one of those things, like, if we understand the role of certain hormones in our body, like estrogen. Estrogen is a people pleasing hormone. I tell everyone I'm a reformed people pleaser. And so I think, you know, maybe one of the gifts of transitioning from perimenopause into menopause is that I'm, I'm, I don't feel, I don't feel obligated to say yes to things when I feel like it's not in my best interest or that individual's best interest. It's like I want to be able to put that time aside and ensure that it's protected. And then I'm showing up at 100. But how many of us as people pleasers find that as we get into middle age, we're like, oh no, I'm not like that anymore. True.

It's true. Okay, so let's talk about the nutrition aspect. Because you said that was the third thing, which I agree. And when you're, we're talking about that, I really want to dive into the fasting situation and why, where, where you stand on that now and where that changes with perimenopause and menopause.

Yeah. So let's talk about food first. I think about the most inflammatory foods and I think about the things that a lot of people don't like being told to take or eliminate out of their diets. I think about gluten, I think about grains, I think about dairy, I think about processed sugars, I think about alcohol. A lot of people don't like hearing that. And that is very triggering. And for every individual, it can be very different. Like I have friends who tolerate dairy. I have more friends that do not tolerate dairy. I have a couple friends who tolerate gluten. Most of them do not tolerate that. I have a few friends that continue to drink alcohol and they're like, I'm willing to accept I'm going to take a hit on my sleep. I'm not one of them. So for each one of us, it's figuring out like eating a protein centric, nutrient dense whole foods diet. So that means you are eating more protein than you think you need to be eating. That's number one. Number two, you're eating less processed foods. I am not perfect. I have a propensity for gluten free cookie brownie cake. I just don't keep it in my house.

Yeah, I'm the same way. Go get it if you want it, but don't keep it here.

Exactly. It's like it's the flour it gets into, you know, it spikes my, the dopamine in my brain. I feel really good and then crap afterwards. But for each one of us, like getting really honest about what your diet looks like. Can you clean up your diet? You know, I think for a lot of individuals, they think diet doesn't matter. They think that, oh, I'll dial in on sleep, I'll manage my stress. I'm still going to eat my Chick Fil a five days a week and I'm going to do my half acid workout and that's going to fix all the things. And I'm here to tell you the way I eat now at 53 is very different than the way I ate even 10 years ago. And I don't see it as a restrictive way of eating. It's just, I'm honoring my body. I know what I need to eat to feel good. And that's what I tend to focus on. And I try to help women navigate figuring out like the power of the n of 1, like what makes you feel good. And that's what we want to focus in on. I don't believe in the concept of cheat meals. I think that that can derail a lot of really good work. But I do think, like, for me personally, I love dark chocolate. I allow myself to have a little bit of dark chocolate every day because I can moderate that. Yeah, the gluten free bounty is a disaster. Like, I will eat too much and I will, my. I will make myself away. Yeah, exactly. And I'll feel good in the moment and then, and then afterwards I'll look at my, my husband and say, why did I do that?

I do that too. And then my husband says, well, I told you not to. And you, you insisted. So I, I do the same thing. You said something that I don't want people to. You said, you can't just eat chick fil a and do these things. But I, I know a lot of you listening, you're not doing chick fil a. Like, that's not what you're doing. But you, here's the mistake I do hear with women our age, in our age group, they think they're eating healthy, but they, they think they're eating healthy and they're adding these other things. So what you just said was so gold. You mentioned the inflammatory gluten, dairy, alcohol, grains. And you didn't say sugar. But I'm assuming you say sugar too. Processed sugar. So though all five of those things are inflammatory. So you can be defensive and throw daggers at us all you want about your alcohol and whatever, but it wouldn't be fair for us to not tell you that those are inflammatory. No, I also do not, I don't consider myself a drinker. But I'll say, when we were in Italy this summer, we definitely had some glasses of red wine with our dinners. And so it's not a never, never, never. It's just a what are you doing the majority of the time. So if you're listening and every day you're having that wine, just think about that. Is it. That's affecting things. So it's not a never ever, ever. It's what you're doing majority of the time, if I'm hearing you correctly.

Too.

That's what you're saying.

Yeah. And I think it's, it's, you know, I think that mod, you know, the concept of moderation, I think it depends on the individual. So you'll moderate, don't, don't deprivate. But I think that it has to be about like, what can you moderate? I can moderate dark chocolate. I don't moderate that gluten free brownie. So I don't keep it at home. If I'm going to enjoy it, it's going to be in a restaurant and I'm going to share it with my husband and then it's over with. Same thing with alcohol. You said I enjoy a couple glasses of wine when I'm traveling. When you travel, you should enjoy the pro, enjoy the food, enjoy what you're doing. You're probably doing a lot of exercise. You're probably active. That's true.

You're doing like 20,000 steps a day walking around there. Yes.

And then I think about women, you know, during the pandemic, in the neighborhood that I lived in, just because we were walking outside, we'd see, you know, people's recycling bins and it was just full of alcohol bottles. And I think for so many of us, we were working through the stress of being in the pandemic in different ways. And I say this with, without judgment because I've taken care of hundreds of thousands of patients over the years. When a woman says to me, I can't de stress without two or three glasses of wine at night, my first question is, what do we need to, what do we need to change about your lifestyle so that you don't feel like that's your only way of relaxing. I think it's different when someone says, I have a glass of wine once a week on Saturday night. That's different. We know that there is no physiologic benefits from consuming alcohol. I know people don't like to hear that.

They hate it. They get super stressed hearing it. In fact, I keep it in my pro. I tell people I don't write it in my programs, but I tell people in my programs, I'm not taking your alcohol because that's the last thing I'll take from people. Just because I understand how defensive and how hard that is for people. I get it.

Well, there's, there's actually an acronym of a series of questions that as a healthcare provider, you ask patients to, to really get a sense of how much they drink. And if a patient told me they drank five drinks, they probably drank 10. So whatever the patient would disclose, it would give me a better sense and kind of viewing that objectively. The other thing about alcohol is it's one of the few things that the consumption of alcohol like regular consumption, not the I go on vacation, I have two glasses of wine. We know that increases your risk of breast cancer. It also increases your estrogen levels in your body. So if you're taking hormone replacement therapy, it will increase your estrogen levels in your body. It kind of magnifies because your body prioritizes the metabolism of alcohol over anything else. So if you're sitting down and you're at a bar and you're having like wings and nachos and other things, you know, these kind of kind of high calorie, non satiating kind of fun foods, the alcohol is going to get prioritized first and then the rest of that will get stored, generally speaking, as fat. So I like to just help educate people about, you know, alcohol can be a slippery slope. If it's an occasional thing that's very different. But if you feel like you have a relationship with alcohol that requires some additional support, definitely want to help find resources to help kind of navigate that.

I don't know if you follow or know my friend Charlene Johnson. She is so she one of my good friends, but she also has a as a podcast and she also has a patreon where she followed. She was somebody who would drink a glass of wine every day like and she is like healthy lifestyle, all the things. But that was her thing. But she decided to give herself a challenge and shared this publicly on her patreon. It was pretty fascinating. And she shared her whole journey of giving it up for 30 days and the changes that she experienced and felt. She won't, doesn't want to go back to it now. She's not saying I'll never, ever, ever have one again. But she realizes was she was in denial about how much it was affecting her life. So another just a cool asset. If you're listening to this that you might want to check out, it was just fascinating to listen to her journey talk about the fasting change because this is important because you were like fasting, fasting, fasting and now you've changed your stance. Can you I want to first share what you used to teach about fasting, like what you believed and where that still has a place and now where you've sort of evolved with that.

Yeah, I mean I think I tell everyone fasting is still a great strategy at the right time with the Right person. And if you're still getting a menstrual cycle, there's a whole strategy around that if you're no longer getting a menstrual cycle makes it a little less complicated. But what I found over time is that we know the role of muscle loss with aging is a real one. And I've been one of those people. I mean, I'm an ectomorph. I have to work really hard to build muscle. I'm not like JJ virgin that she braids and she's a mesomorph and she just seems to like put on muscle effortlessly.

Think I'm like you, like, we can do it, but it's a lot, it's just a lot more work.

Yeah, it's a, it's, it's a heck of a lot harder. And so, you know, in conversations with my internist, and then the power of the NF1 realizing, like, if I want to put on five pounds of muscle, which has been my goal for the last six months, that's what I wanted to do. Over time, I was like, I need more protein and I need to work harder in the gym. And so that turned into I need to have not an 8 hour feeding window, I need a 12 hour feeding window. And so I've been very transparent with my community to talk about the fact that it's not that I don't see the utility in fasting. I think for many women, maybe they fast two days a week. Maybe women fast, you know, seasonally. They fast. 12 hours of digestive rest is what I think is optimal, I think for every person. And even my teenagers can do this. So I feel like, you know, this is something that all adults can kind of abide by, but really giving your body 12 hours of not eating so that you can still.

Six to six or eight to eight. Yeah, yeah.

And that's kind of what I do. And that has allowed me to start kind of changing some body composition. I'm not gaining weight in the terms of. Because we do bioimpedance scale. So we're looking at, you know, fat free mass versus muscle mass. So I can look at the changes that are starting to happen. I was actually a little bit surprised when I did my first bioimpedance last summer that I had 27 body fat. You would not know that from looking. No. But it just goes to tell you this very slippery slope. We start to lose muscle. Yeah. Readily. Even with hormone replacement therapy, even with lift, lifting weights.

And so mine too, I had my, my scan and mine said well, it's going to sound different than yours, but I was even upset about mine, said 20% and I was confused. I'm like 20%, like I just thought I was, but so I saw that same trend though, of that changing. Can we back up a little bit though on the fasting? Because some people have never heard about fasting at all. So I just want to, I just want to rewind a little bit when we talk about intermittent fasting. Some people put it into four hour window or six or eight. So what is that? Like what's the true way and what were the initial benefits and why did people have benefits from fasting? Let's start with that.

Yeah. So number one, intermittent fasting is choosing to eat within a prescribed window of time. So it can be. So fasting, intermittent fasting can be, you know, 16 hours with an eight hour feeding window. It can be 20 hours fasted with a four hour feeding window. It can be, you know, 14 hours fasted with a six hour feeding. So it's like you can look at this as it can be anything that you want it to be. It needs to be something that's sustainable. And so I think the kind of classic is 16 hours fast with an 8 hour feeding window.

Okay, so that's like the standard. Okay. And then why does fasting, why does it work? Is it because of the insulin stuff? Like you're not secreting insulin. Like what's your thought process on why it works right there?

Yeah. So I think there's a couple things that go on. So number one, when you're in an unfed state, over time your body can utilize different types of fuel substrates. So what does that mean? Whether it's stored glycogen, which is stored carbs, whether it is stored fat, which is fatty acids, whether or not you get to a point where you get metabolism of ketones which can cross the blood brain barrier when your insulin levels are low in the body, that's when your body has the ability to switch gears in terms of what type of fuel it uses. The unfortunate thing is most Americans we know, 92 to 93% of us are not metabolically healthy. Most of us don't ever get to use the benefits of stored fat. And so it's almost like I always use the example of if there's anyone listening who likes to top off their gas tank when they get you a 3/4 of a tank. It's the same kind of mentality. It's like you never get the opportunity to use the stored fuel because you Keep topping it off. Whether it's from over consumption of food, whether it's from too frequent feeding. We know the average American is somewhere between 10 to 12 feedings a day. Whether that's a snack, a sugar sweetened beverage, whether that's an actual meal, most of us are eating too frequently, eating too much. So number one, when it comes to intermittent fasting, if you are able to get to a point where you can tap into fat stores, you can utilize stored fat. It tends to be much more fuel efficient. So you can go longer in between eating. You have more mental clarity because your body is utilizing a better stored form of fuel. Ketones are things that can diffuse across the blood brain barrier. A lot of people get improvement in blood pressure, their lipids, blood glucose. So blood glucose and fasting insulin are very important to monitor, especially for women in perimenopause and menopause. Also the lipids piece. We know that we get improvement on digestion. So for a lot of women will say to me, oh my gosh, I only fasted 14 hours and I don't have the bloating, I don't have diarrhea, I'm having less constipation. So it gives our body an opportunity to go in and utilize. Not just optimizing digestion, there's something called the migrating motor complex, which is like a janitor in the gut. If we're eating too frequently, we don't actually have the benefits of this, this migrating motor complex. It's like a street sweeper. It's just moving things forward in the digestive tract. If you're eating more frequently, it doesn't allow that to be optimized.

So if you think about this, most of midlife women, I mean, at least those of you that are interested in health and have paid attention, we thought in the 80s and 90s, we thought if we didn't eat every two hours, we were going to eat our own muscle, remember? So we trained our bodies to constantly be in the state of being fed and a surplus and secreting insulin. So I feel, I feel like there's a link there into some of the problems that we've created is by eating that way. Guys, I know when women come into my communities, we have to unwind, that we have to undo that learning.

Yeah. And I think for a lot of individuals, and certainly, I mean I was taught as a, as a nurse practitioner and even as a nurse eat to stoke your metabolism. I would go to work, I'm not kidding, on days I was in clinic when I knew I could eat regularly. I would have a shake before I went to the gym. I had a shake, right? Two hours. I'd have, like, you know, egg whites. I mean, it was just this kind.

Of regimented thought process, like pancake. I remember making, like, egg white pancakes with whey protein. Like, what the heck? Like, stuffing them in.

Yeah. I don't want my body convinced. This is what's going to help me, you know, help me maintain body composition. So, number one, it's helping people understand that we can get by, you know, safely four to five hours in between meals. That's what we. Ideally, that's where we should be going. But we know that when you're not eating as frequently, you're reducing inflammation in the body. How many women in middle age have chronic joint pain? They have chronic indigestion. They don't realize that one of the reasons why they have reflux, if they ruled out, you know, H. Pylori and other things, is because they eat too frequently. And so I think for a lot of individuals, it gives them, you know, food freedom. That's the other thing that a lot of people don't talk about is when you're not focused on when your next meal is, you get to go run the errands, you get to go, you know, your, you know, do these interviews. You get to do all these things without the first thought being, oh, if.

You'Ve listened to my podcast for any amount of time, you know, there's been lots of guests and lots of talks where we've chatted about what to eat, getting enough protein, eating healthy, the importance of it, why we want to eat organic. But I want to share that as we age, it's not just what we eat, it's what we digest. Even if we eat super healthy, clean, organic food, we can still not have the best digestion. You see, our natural ability to digest food declines with age. This is because your body produces fewer enzymes, which are the proteins responsible for digesting food. And when you have fewer enzymes, this means more difficulty digesting our food. So even organic, healthy, or what you think are perfect foods won't provide enough enzymes to properly digest them. So this is especially true if you cook your food, which most of us do, because cooking kills the enzymes. So if you've ever wondered why you might have digestion problems even after having a healthy meal, it's because your body just can't produce enough of the enzymes to get the job done. So this is where supplementing with high quality enzyme supplements can be a huge help. So I personally use and recommend a specific digestive stack from Bioptimizers which includes their mass zymes which is a best in class supplement loaded with full spectrum enzymes for digesting proteins, starches, sugars, fibers and fats. So when you take this enzyme daily, and I personally take them with each meal and replace the enzymes your body is no longer producing, you're able to eat all sorts of things and digest them quickly without the bloating, without the feeling, you know, puffy, without the leaky gut issues, all of that. So when you digest your food properly you're actually getting all of the nutrients. So I've got an exclusive offer for all of my listeners if you go to biooptimizers.com NatalieJill again bioptimizers.com NatalieJill you can also use coupon Natalie Jill to save. You'll see my recommended stack which includes the mass times, the HCL and the probiotic.

It's a really, it's a really fine line and that's. I want to dive into this a little bit because like I'll speak for myself. I naturally, since I undid like that eating every few hours and I cleared out a lot of inflammation the last few years, I mean I had my explant, I did a whole bunch of deep dive work, my gut health and I naturally now just don't want to eat as much like I'm. Because, because my gut health is cleaner. I know we're going to talk about that in a minute. And because I got rid of the inflammatory things I had going on, I'm. I'm just naturally not that hungry anymore and so I don't really find myself wanting to eat really more out of an eight hour window. Not deliberately. I just, that's just how that's worked in my life, six to eight hours. But the detriment of that. So yes, that reduces inflammation, yes, that increases focus, yes, there's all these benefits, benefits and the detriment is it's a lot harder to maintain and build muscle. So this is a really important fine balancing thing that I want to figure out too because we do not want to lose muscle as we age because that's how we end up having bone loss problems and that's where we start having the sagging and the drooping and the, we get injured a lot easier. So what have you sort of figured out there and how, what are you doing? Because this is, are you finding you have to like stuff food in or how are you, how are you doing that?

No, I mean So I think you bring up so many good points. I felt like probably 10 years ago I noticed a distinctive difference in my appetite. And so I think intermittent fasting for me came about at a time where I was like, oh, I can get by with one or two meals, not a big deal. So now I'm very conscientious about having a sense of where am I in time and space. Like, did I have two good boluses of protein? If I don't, then I'm like, am I going to have a protein shake? Like whey protein shake? Am I going to have some essential amino acids? I'm not a huge fan of that being a habitual thing, but there are certainly days like when I'm traveling, it's, it's near impossible in an airport. I mean, I don't care if I.

Oh, it is, I think clean.

It is so hard. And like as an example, when I was traveling the other night, I told my husband, I was like, yesterday was all about getting enough macros in because I could tell my body was really hungry from not eating at kind of those normal, you know, every four to five hour intervals. So to your point about, you know, is my appetite changing? Is that impacting my ability? So that's why I really focus in on those two good sized meals with protein.

Yeah.

And some vegetables. That is what seems to work best for me personally. But I also totally don't beat myself up if I have a day where I get in under a hundred grams of protein. If that happens, I'm like, it's, it's consistency over time. So I think I have a hard.

Time getting it, I'm telling and I know I need to get more protein and I just, I'm gonna say I have a hard time. I have to like really work at getting more than 80 grams because 80 grams is about what I, my body wants in a day. But if I'm working at getting 120 or it's, it's, it's work. One thing I did just pivot to recently, if this helps anyone, you know, Since I was 12 years old, I didn't eat red meat. I just for whatever. I loved cows. I would have had one as a pet. I still would have one as a pet. So I ate chicken, fish, turkey, whey praise, you know, eggs. But I recently like my body was craving it probably because of this change and I started eating red meat. And I find it a lot easier to get in my protein with that. It's like my body is just sucking it up. And just to give you all a little notice, like, we went out to dinner last night, the other night, steak dinner. And I was looking at the menu at what I would have ordered before versus what I was ordering. And I ordered, you know, a filet which had 500 calories. And like, I want to say it's like 60 grams of protein. Where I used to get a lobster tail, which I didn't realize is only like 50 to 100 calories like you're getting. So just like shifting the type of protein we're eating even can make a big, big difference.

Yeah, I mean, I think that, you know, there's also ways to do it in a complimentary fashion. So I'm a fan of salads. You know, like, I may have the steak, but I'm going to have some salad and I might have like a serving of pistachios and I may have some lentils. I mean, I just make sure.

Getting it in different ways.

Yeah, right. And I think the whole concept of, of, you know, a plant variety is important and kind of looking at brightly pigmented fruits and vegetables because to me, I can be very food monogamous. I could eat steak and like broccoli or steak and asparagus or steak and cauliflower, like almost every day. But I think it's important to like, I love bison. Like, one thing I figured out pandemic is that there are some. Maybe bison isn't considered to be exotic anymore, but like bison and ostrich, like, you know, if I can find some of these more exotic, sometimes it's helpful to have some degree of variety and then really thinking as an omnivore, like, like, yes, the protein's important, but also making sure that you're getting some plant fiber.

Yes.

Other things, you know, we call the phytonutrients so brightly.

Yes. I cannot stand when people eliminate fully vegetables and, and fruits. I'm like, we need our phytonutrients to age well. And the people that really out are really outspoken. I'm not going to call it names that really outspoken about being strict carnivore or super strict keto. And they eliminate all that. I just want you to look at how they're aging. That's all I'm going to say. Just watch how they're aging because that, that we need those phytonutrients.

Yeah. And I think what's also interesting is as. As I'm kind of doing research on this, this book that I'm writing, it's understanding like protein is important for us as we're getting aging, so is fiber. The people that are the most satiated, the people that are doing the best job detoxifying hormones that are eliminating, you know, things that do not belong. And I'm sure that we'll probably touch on this. Sorry. With three dogs, every once in a while I get a bark. Really focusing in on the fact that these plant nutrients are important. Now for full disclosure. I had a nine month period of time after being in the hospital where I could only be carnivore and I like meat, but I don't want to eat just me. So when people tell me they're bloated, they're gassy, they can't tolerate a lot of whether it's fruits or vegetables, I'm like, okay, what we're really speaking to is there's something going on in your gut microbiome that we need to address proactively because you should be able to, you should be able to consume some plant matter, you should be able to consume some fruits and vegetables. And you know, one of the things that I also did very transparently as I've been trying to, you know, do less fasting, more this digestive rest concept, more protein, is I've been eating more carbohydrates. Like you know, roasted potatoes with my.

We have potatoes almost every night. We just put them in the cut up, put it in the air fryer. That's what, that's our thing.

Super easy. And I have no problems eating fruit. I mean I, I track with a gaset gm, no issues with fruit. I think we've convinced a lot people to fear carbohydrates. We're not talking about these types of carbohydrates. We're talking about the bread, the pasta, etc, the process, overuse of it, the.

Excessive amount that we eat of it.

I think it's important just to be like cognizant and aware because the one thing that many people may not realize is when we're consuming those plant sources or that fruits we're helping to feed microorganisms in the gut microbiome that go on to have other health benefits. So we talk about probiotics, there's prebiotics, there's postbiotics, there's all different types of things that go on in that gut microbiome. And so the gut microbiome really is at the forefront of our health. I think so many of us think of it as being this intangible, like where is it, how does it work? It all starts to shift and change as we get older. One thing that I'll just point out to you, I'm not sure if you're aware, is that as we navigate perimenopause and menopause, our gut microbiome starts to resemble more of a guys than are. Than a female. And it's because of these changes that are going on at a cellular level with regard to shifts in estrogen predominantly, but other types of sex hormones, has a really huge net benefit on the health of our overall body, but also the gut microbiome.

So I'm assuming gut is sort of your next area that you would say. And I. I used to really, like, tune out when people would talk about gut.

This is.

And this is me as a nutritionist. I'd still be like, I don't have bloating. I don't have gas. I'm fine. My gut's fine. What I didn't understand was how unfine my gut actually was and that I had leaky gut, and that when we have a not healthy gut biome, you might not have all these symptoms that you're noticing as that, like, you're not associating it with your stomach or your gut. But what that was changing for me was how my hormones are being processed, like, how my own hormones are being metabolized, how also how any toxic toxin that came into my world, my body was not processing it the way that somebody with a healthy gut biome would process. Like, we could. We could go out and eat the same salad, same organic salad that maybe had something on it, and Cynthia's would process fine. It wouldn't survive in her gut. Mine would start thriving in my gut, that bad bacteria. So I. So if you. If you're wanting to tune out to gut, I want you to hear what she shares, because this is a critical component.

Yeah. And it's interesting to me. The more that I understand, the more it makes sense. So that's why, you know, I know that you've been very transparent about your parasite journey. I've been very transparent about how all the travels I do, I picked up a particular bug that made me quite sick back in 2018 into 2019. And it had a lot to do with, like, where I was at the time of my life. Like, if I had been 35, probably wouldn't have been impacted because I was in my 40s, my immune system was starting to change. Again, vis a vis this gut microbiome, all the communication just makes you more susceptible to opportunistic infections. So whether it's parasite, whether it's H. Pylori, whether it's.

It's dysbiosis, ruptured breast implant. Like I had what that was doing.

Yeah, yeah, absolutely. And so it can kind of magnify our body's reaction. And I think especially for someone as healthy as you are, it probably has been super humbling to kind of navigate these changes and say, oh my gosh, retrospectively I didn't realize what I didn't know until I can look back now and reflect on how I felt.

Cynthia, I've read redone like literally all my programs. I stopped selling. I like went back to the drawing board and I redid everything because I have such a different perspective now because I three years ago.

Wouldn'T have understood any of this. I understood it, but I didn't think it was part of me or as important. Now I really see gut biome as critical. Can you talk a little bit about gut and then the hrt? Because I know, like me, you are a believer in bioidentical hormones, you're not against them at all. But where does that tie together and where it's the order of priority there? And why is this gut piece important to look at with what do you want people to know? There's.

Yeah, so. So I would say first and foremost, it's not like we let women suffer before we offer hormones. It's that we want to make sure the lifestyle is dialed in so they're going to get the best results. So as an example, like progesterone, I don't see as being an issue. Like if a woman needs to take that for a week or two in the month, I'm not as worried about really looking at the deep dive in the gut microbiome up front. However, when we're looking at estrogen as an example. So we've talked about how we have some of the most wild fluctuations of estrogen and perimenopause and we do our ent lifetime. So when estrogen is high, we may see all those, you know, non flattering side effects. You know, breast tenderness, weight loss, resistance, heavy menstrual cycles, brain fog, all these symptoms. Estrogen is a hormone that had like any hormone that has to be broken down. We do most of the breaking down. There's for phase one and phase two detoxification that occurs in our liver. So liver health is paramount. And when we use the term detoxification, I'm not talking about something in a box, a bag or a can. I'm talking about these are the things we sweat, we pee, we poop, we breathe, those are all helping our body detoxify. We have a third level or phase of detoxification that occurs in the gut. So if our gut is not healthy, meaning if we are recirculating our estrogen, that's designed to be broken down. So phase one takes compounds, hormones, breaks them down into water soluble compounds for phase two. Phase two is looking to push things along to phase three to break them down further and then eliminate them in our poop. Right. So that's, that's how things should work. But there are specific enzymes like beta glucuronidase, which is a specific enzyme that's designed to help kind of go in and break down estrogen.

Mine was a mess in my gut. That one thing. Yeah, yeah.

If it's really high, if we do diagnostic testing and it's very high, can be a sign that we're recirculating these estrogens and that can further exacerbate these symptoms. We're experiencing perimenopause. So first thing is, is what's going on in the gut microbiome, Are we detoxifying? If you're a woman that is constipated, remember I said sleep is super important. So is pooping every day. And after every day, we're not going at least, at least twice a day. My question is why?

Yes. My friend Laura Frontero, you know her, she's, I call her the gut genie. But she said you should be going the length of your arm, the length of your forearm, from wrist to elbow, every single day, whether that, that's one time, two times, whatever, that much every day. Otherwise we have a problem.

Yeah, I mean, I have a lot of female patients that do not poop every day because they are chronically stressed. You know, we have to be in that parasympathetic rest and repose side of the brain. So for a lot of women, they're stressed all the time, they can't relax when they're in the bathroom. Some people need a squatty potty, some people need to be hydrated, some people just need to eat more fiber in their diet. Some people need less fiber in their diet. I mean, there's a lot of different variables and there are many tricks, tricks that we utilize to get people every day. But elimination is critically important. So if you put a woman who is not properly breaking down her estrogens because of what's going on, because the gut microbiome is not hospitable, these are the women that will come to me and say I was put on hrt. And I don't say this to scare anyone. I'm just saying, like, there are definitely women that are not in an optimized situation. They'll get on HRT and they gain a bunch of weight and then they're really.

Exactly. Yes. And I just, I'm laughing because this morning I'm not laughing, but I had an Instagram message message and I had that I happen to see, I don't see all my Instagram messages, everyone, so don't start messaging all the things on Instagram. But I happen to see this one. And she said, I, you know, listen to your podcast regularly. I, I went to the doctor, I'm on HRT and I can't stop gaining weight. Help. And I'm thinking, I'm not. First of all, I'm not her doctor, but that was the first thing I thought of is like two things. One, you're probably on the wrong dose. And two, they didn't look at your gut health first. But I obviously said, go back to your doctor. But that's literally what came up for me.

Yeah. And so like looking at the gut microbiome, we can look at it from the perspective of looking at stool studies. And you know, there's Genova, there's GI map, there's a lot of different companies that do a really beautiful job and they're looking at what's the content of the stool. Are you, do you produce enough digestive enzymes? Are you unable to break down your fat? Do you have a parasitic infection? Do you have a lot of dysbiosis? Do you not have keystone bacteria like Aquifer moxy? Is this one keystone bacteria that has a lot of benefits, not just for mucus production, which, although that sounds yucky, it helps protect the lining of the small intestine, helps with endogenous GLP1 production. So GLP1s are like the hot new yes that people are utilizing to lose weight and improve metabolic health. But we make it endogenously within our bodies and this keystone bacteria is instrumental in doing this. It's also important for butyrate production, which is one of these short chain fatty acids. So when I think about, are you optimized to start using hrt? It's the lowest possible dose to start to see how someone tolerates it. I find a lot of women do better, like starting with a little bit of progesterone, then maybe they're doing some estrogen and maybe a very low dose patch. And the nice thing now is that many, many people do just fine on the generic covered by insurance stuff that they can get the local pharmacy. I think that unfortunately, whether I have intent, unintentionally done this, this I've talked a lot about what works for me. Yeah, tell everyone. Listen, for every one of us it may be something different. I personally do better with compounded progesterone because I get the sustained release versus the stuff at the grocery store or at the local pharmacy is immediate release. And for those of you that maybe aren't at the point where your sleep isn't impacted significantly, I need the sustained release. I need working for more than a couple hours to get me to sleep. And the estrogen piece. For a lot of people, compounded estrogen works just fine. For others, the patch is cheap.

I mean I just, I love the patch.

I've never taken for three months of my patch so I need to obviously.

Go get my patch from CVS versus my compounding pharmacy because I'm spending a lot more. But I just figured it out that I can get it there. You know, I want to share this about because I've got some great listeners that listen to so many experts I have on and I have experts on that have different opinions about things always. That's just like you do on your podcast. And I'm going to share. I think Cynthia and I are actually very aligned with how we eat a lot of things that you said when it comes to hrt, there's so many different trains of thought here. What I personally do, I personally use bioidentical patch, progesterone compounded and testosterone injection. That's what I do. I personally don't do high levels of any of it. I do enough to get me out of symptom a little bit more than what my doctor probably wanted me to do. But I'm not in the like I'm going to go back to 30 year old levels. But I also know I have some amazing, amazing guest on that talk about optimizing to that level like a whole different, different level. And just like Cynthia just said, we're all unique and we all have to do what's best for us. So I just encourage listeners, listen, learn, do your own research and then don't just take like one person said this or my one doctor said that you have to be your own health detective and say what makes sense for me. For me, I know when I go up a lot higher on a patch which I, I was experimenting in, I don't feel good. It doesn't it doesn't feel good to me. So I stay at the level where I don't have hot flashes, where I don't have night sweats and I feel good. But I just want to be really clear that it's not just because one guest said this or everyone is unique and we have to be our own health detective.

Yeah. I mean, and it's interesting. Like, I also take testosterone and I wanted to share. I spent so much money having laser hair removal. Many years ago, I started using a new.

Transdermal testosterone.

Yeah.

Guess what? My hair started growing. Are you serious?

So bad.

I was like, wait a minute, I don't want hair on my. That I have to worry about shaving. And so I'm now in discussions with my GYN to say, hey, could we try to use some subcutaneous testosterone?

I love the injection.

I love it. I was like, I'm, I'm kind of like trying to, to push her a little bit to let me do that. Because I was like, listen, I spent.

All this, yeah, I'm not doing the cream.

I know first world problem level. But I think for a lot of people, you know, for me, you know, not having to shave is just one of those things prefer.

But also the, the when we put it on our, when we're using this because I used to use the estrogen cream and it, first of all, bias did nothing for me. Like literally nothing for me. But also I'm thinking it's getting on my husband. So I'm just aware of that stuff. But it's all unique. And when people ask me my amounts, I'm always like hesitant to say because doesn't matter my amount. It's all based on our lab work.

So like, well, and I think, you know, it's interesting. So, so on my podcast, I have interviewed so many different people. Some people like to test labs, some people don't like to test labs. They just go based off of symptoms. The longer I do this, the more I think it is important for our mental health to focus more on symptom control than lab work. Because for me, I, I'm, I'm osteopenic, probably again, genetic. I'm, I'm small boned. And so I said I don't want to be obsessive about having to hit a certain estrogen level to feel like that's conferring the most benefit because I'm doing all the other right things. I do think it's interesting. Like I'm on the lowest dose estrogen patch and I feel Great.

That's great.

I've been in a position where I've been on too much estrogen and it made me.

So that's how I am. If I go too high on the patch.

Yeah. And I was like, I don't want to feel like that again because I felt fluffy. And the word fluffy should never be associated with any middle aged body. It's just not a good place. Place to be. But I think for each one of us, it's the power of the n of 1. Like I have some friends who do well on the super cheap peanut oil, micronized progesterone from the pharmacy. They do fine on the patches that are bioidentical.

Yeah.

Some of them don't need testosterone. Whereas I have other friends where everything is compounded for them.

Yes.

No, that gets expensive. Like my thyroid medicine is compounded not because I wanted.

Yeah.

There's nothing conventional that was like fitting the widget. It was like we had tried everything and when I was like, people that.

You want T3 and all the. Everything tied out, you have to get compounds.

I have a super, like a super specific dose and there's nothing on the market that does that. My functional med doc and I just got to a point where I said, I just, I give up. I'm just gonna take the compounded stuff because it's the only thing that makes me feel better. And it's okay if you take, it's okay if you take just Cytomel. If those things work for you and your labs are good and you feel good. That's what you should focus on. Don't, don't be comparing yourselves to the rest of us.

Yes. I don't want to open up a whole can of worms, but there is one more thing I want to ask you about because I'm just, it's such a like hot topic and then we'll, we'll kind of wind down the conversation. But I have to ask you your opinion on GLPs and microdosing or that like how. What's just your opinion on all of that?

Yeah. You know, it's, it's funny, the more I've learned about GLP1s, the more open minded I am. And the reason being, I think that they are life changing for many people.

Me too.

GLP1s do not just act on specific sites within our digestive system. They act on the brain. Especially the second generation, the tirzepatide drugs. For a lot of people, they need to quiet the noise in their brain. They need to get out of that, they're craving food constantly. You know, there's a lot of research that is certainly compelling me to look at it from a place of interest, objectivity. I know that we have friends within the health and wellness industry that are taking micro doses, so teeny, tiny doses.

Like almost everyone I know to be real, like, like literally very common now.

Yeah. And. And I've had some very thin friends tell me they're doing it to take the edge off their appetite. So I think you have to be careful if you're taking a GLP1 and you're already at a, at a healthy body weight to make sure you're getting enough food in. Because again, we go back to the intermittent fasting thing. I started to see a lot of people that were just undernourishing their bodies. We never want the message to be that we're not properly nourishing our body. So I think the GLP1s have a right level of utility. I've seen incredible progress. I have several shared patients. We have done everything, when I say everything, we have tried metformin, we have tried berberine, we have tried myoinos, we have tried everything that is available until we got to a GLP1. I have so many women that with the addition of the GLP1 Finally, I feel like we're turning, like we're literally we're starting to see changes in body.

Composition, like the A1C changes finally. Yeah.

A1C is. They're fasting glucose, fasting insulin, are all improving and that then means their lipids look better and then they feel better physically, so they want to move more. And so.

I think there's a lot of people that have a lot of opinions about GLP1s and I think for me personally, I would say in the right patient, with the right provider monitoring them, I think it can be life changing. What I think is concerning is that it's very much becoming a have and a have not. The people that can afford to pay for compounded wow can still can still pay for them. There are a lot of people who, their insurance won't cover it because they're not heavy enough. They're not.

Or they're giving that too high of a dose. Like they only prescribe the pens, which is just like, can be like an overkill of how much you need.

Correct. And so I think that there's the other side of it, which, you know, when you think about, if you look at the drug manufacturers, they're making a killing off. And so I think when I, when I look at, and I'm in a lot of Facebook groups and so I see a lot of things that women are asking. They're like, like I was told my BMI isn't high enough so my insurance won't pay for it. And yet they're like, I'm desperate, I've tried everything else. And so those are the kinds of things, you know, that the have and the have nots are what I get frustrated about. Like the people who really need the drug, can't afford the drug and the people who maybe they don't necessarily need the drug, but they're using it because they're biohacking or makes sense to, you know, take the edge off their appetite. And I use that in air quotes because that was what was said to me by multiple people. Yes, I think that we have this disparity. And so I'm hoping at some point things will get better. What's interesting is with the experts I've interviewed, more often than not what they say is it's a long term drug. It is not a I get on the drug, I get off the drug. I think there are people that are having some success, but most clinicians are feeling like this is going to be a long term, rest of your life kind of drug.

Yes, makes sense. But so would insulin be for a diabetic. So it's like, it's all how we look at it, I think. Like I, I do think in some cases it might be really necessary for some people.

Yeah. Well, I mean, you think about it, if the option is to end up with, you know, the sequelae of poor metabolic health, you have diabetes, you end up with heart disease, you have a stroke, you end up with chronic kidney disease, you lose eyesight and vision or people that are at risk for certain types of cancers because of lifestyle. I think that when you look at that, it's like, what's for the greater good? So I look at it very non pejoratively. I'm like, what is the greater good? The greater good is these drugs have great, have more benefits than they do cons. I think when we start hearing reports about people having an infarcted bowel or people who, you know, have the, the side effects, it's because that provider is dosing too high too quickly. And so I think going low and slow, much like my thought processes on HRT is, you know, don't hit someone with a really high dose of estrogen so that they're suddenly bleeding and feeling fluffy and uncomfortable. Yeah, let's Start low and slow, see how the patient responds, and then we move forward.

I have a friend who's in her 60s, post menopausal, like 10 years post menopause, and she was seeing the bone loss and she was looking at the benefit. She wasn't on any hrt and she wanted to start hrt. And so she went to a doctor that does not go low and slow and went like full force. And it was like, just like you said, all the negative stuff. And then it's like, well, I don't ever want to do it again, you know, that kind of thing. So I. I second that. On the, on the low and slow until you. And if you want to keep going higher and that's what you've decided to do, but there's no reason to start so high. Like, just start cranking it up.

For so many of us that were on oral contraceptives, I was on, like, oral contraceptives from, like, my late teens until married. I was always in a low estrogen state my entire life, which is probably what's impacted my. My bones. And I tell everyone, like, I was never one of those people that had wide fluctuations of estrogen until I went off the pill and perimenopause. Cause I remember saying, like, if I had been like this in my, you know, younger adult years, I would have been. Personally, I would have been miserable because I do better not having these crazy wild high doses or production of estrogen. So I think we used to take.

One called low estrogen. That's the one I was on for years.

Yes, I was on the one. Like, it's the, you know, one of the lowest level ones that was out there. And I felt good on it until I stopped taking it. Then I was like, oh, I don't actually have PMS if I'm not on the pill. I know that.

So wild. Cynthia, so much good information where you tell us a little bit about your supplement line. That's because you seem to fully get it. So I know people are going to want to learn more about that.

Yeah. So this is a supplement line that's really designed. It's called the Midlife Pause, which is.

I love that name.

The free Facebook group I have. It's the name of my book that will be coming out in 2026. And so it's. The flagship product is a creatine monohydrate, which I had created that product a few years ago. But this one is better because it's got nootropic agents, so things for the brain Like Alpha gpc. It's some taurine, has some B vitamins. And based on a lot of feedback, we have individualized packets. So I'm really excited about that. But we also have, you know, things that I think are really important. We have vitamin D, we have collagen, which I tell everyone it's great for hair, skin and nails. We have adaptogenic mushrooms. So remember I was talking earlier about the benefits of mushrooms for, not just for stress, but immune function, gut health. And then lastly, the last product that we started with was a prebiotic. So for a lot of people who, who can't get the vegetables in or they feel like they're really struggling to get those in, it's something that you can take as a supplement. I always say, like start low and slow, but a prebiotic fiber capsule.

And so where can people find all of this? Or when can.

Yeah, if you go to the midlife pause. Okay, it's up and it's running and we're super excited about it. We've gotten some great feedback already and great. I think the biggest thing is this supplement line is designed to support women in our age and it's all research based. Like we, we have spent a lot of time and effort creating blogs. So we have blogs that are coming out each week that are really talking about like, what's the research behind this? What are the things? Like as an example, you know, creatine and jet lag and sleep architecture are huge. So when I travel I, I high dose creatine so I have zero jet.

Lag, which I've never tried that I.

Need to like made a big difference. There's a, a creatine expert slash researcher, Dr. Darren Kandao. And he's kind of, of taught me a lot of these like side note research things that are ongoing. And so for the jet lag I was like, oh my gosh. I went to Portugal with my family in April and they all were all like, oh my God, how are you sleeping? Nine? And I'm like, oh, I'm like a duck to water. I sleep so well.

Amazing. Cynthia, thank you so much. I'm sure I'll have you back on. You always have so much great information. Thank you so much for being here today.

Thanks for having me.

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