Your Gut Is Destroying Your Hormones in Menopause (Here's What to Do)

So I need you to hear me on this one. If you are a woman in your 40s, 50s, 60s, and you've been dealing with bloating, brain fog, weight that won't budge, sleep that's a disaster, or joints that suddenly feel like they belong to your grandmother— like, what's happening there? What if I told you it might not be just your hormones? What if the real problem is hiding in your gut the entire time? Today I'm going to be talking with someone who literally blew up the internet with a TED Talk now that has over 15 million views. She's a nurse practitioner with 25 years of clinical experience. Her podcast, Everyday Wellness, is number 4 nutrition podcast in the entire country, and her new book, The Menopause Gut, is about to change the conversation for every single one of us in midlife. But here's what makes this episode and this conversation different. Cynthia did not just study this in a lab. In 2018, she had her own personal health crisis that nearly killed her— a ruptured appendix, 13 days in the hospital— and it was her own personal perimenopause that had quietly destroyed her gut and immune system without anyone catching it. That story alone is going to blow your mind. We're going to go deep today. We're going to talk about the estrobalome— yes, that's a real thing, and nobody has told us about it— why your ovaries age 2 to 5 times faster than every organ in our body, while only 4% of women are getting the hormone therapy they may actually need, and the specific supplements and lifestyle shifts that can change everything for you. Cynthia, Welcome to Midlife Conversations.

Thanks, Natalie Jill. So looking forward to connecting with you and your community today.

It's been a while since I've had you on the show. I always love talking with you, but I know— and I'll link past episodes below just so people can hear our previous conversations. Before we get into the science and what you've really dove into helping women with in your new book, I wanna take this back to 2018. While you were in Morocco, you got sick. What happened that almost killed you? What actually went down then?

Yeah, so it's interesting. We're on this romantic vacation. My husband and I were celebrating our 15th wedding anniversary. We ate the same exact food, and guess who got sick and who didn't? And I didn't fully appreciate it at the time until a few months later. I was like, what is changing for women in middle age that impacts our ability to fight off infections, impacts our immune system, and it's this decline in hormones. And so what's interesting is that experience in Morocco set in motion a series of things that, you know, I got a second bout of food poisoning. I then went on to have this lengthy hospitalization. And what I didn't know is that as estrogen is declining in our bodies, our immune system doesn't work quite as well. It means that we are just more likely to be inflamed. We're more likely to get opportunistic infections. And it explains why my husband ate the same food as me and had zero problems, and I went on to be violently sick for 3 or 4 days. And so I think for a lot of women, we understand when we're thinking about the aging process, yes, it's the, with the decline in estrogen, we might see changes in how our joints feel, we may have brain fog, we may have trouble sleeping with changes in progesterone, more anxiety, more depression, but no one's talking about the immune system, and no one's talking about the gut, and yet they are just as important. And all of it is going on quietly beneath the surface. And you may not even realize it until you have the experience that I had where whatever pathogen I was exposed to, which was probably Giardia, mounted this massive immune response and my body reacted appropriately. It was trying to get rid of what I'd been exposed to, but the lingering effects, and I can recall this being, you know, we moved from Morocco to Spain and saying to my husband, "I just don't feel right." I didn't feel right for months. And so, you know, kind of working backwards, my clinicians, including my physician, said, "We really think the insult that happened was September of 2018 that then led to that lengthy hospitalization." So there was all this smoldering inflammation, and, you know, this Giardia pathogen was kind of unwinding all of the issues that I was experiencing that were seemingly pretty subtle. But looking back retrospectively, I'm like, "Oh, I was bloated." I was definitely more tired, but I didn't really have the language at that point in time to understand what was happening physiologically in my body with this decline in hormones and the stressors that come along with a long hospitalization.

So here you are in the hospital, you're sick, you're not knowing fully what's going on. I mean, you're personally a nurse practitioner with 25 years experience, and even your doctors is missing this whole connection between hormones and gut and what's going on. It was missed for you, like you having the knowledge that you have. What does that say for the rest of us?

It means that most clinicians were never trained or ever heard about what happens in this setting of lowered estrogen levels. Because transparently, the first night I was hospitalized in the ER, they wanted to take my entire colon. They were like, we're going to take you to surgery. We're going to remove your appendix. It's already ruptured. We're going to remove, you know, this many centimeters of your colon, and I asked them, I remember saying, "I need my colon." They're like, "You don't need your colon." So I think in many ways, surgeons are thinking surgically, like we wanna remove the problem, but even they are not trained. And it's no fault of any one person. There is little to no education for most licensed medical professionals about the aging process in women. They talk about menopause, and that's as much as they hear about it. I think that's changing now, but most of these clinicians were never trained and I would imagine even an immunologist, someone that is— their specialty is the immune system. I bet most of them are not looking at sex-related changes that are occurring with the aging process. They just look at it as a broad generalization for both genders.

This is scary because I think most women in your situation, in pain, sick in the hospital, they look at the surgeon as the authority, and they would have done that. They would have just had their colon— parts of their colon removed. They would have had this done? How did you handle this differently, and what advice do you want women to hear from you around that?

Well, I think unless there's an emergency, like clearly this was an urgency, and I remember saying, can you give me a day? Are you willing to get, like, can we reevaluate this tomorrow? I knew that I was not running a fever. I knew from like my nurse practitioner side of my brain, I was like, okay, I'm not an unstable patient where I don't have a choice. I think asking, can we have a tincture of time? And that is something a lot of clinicians talk about, especially in hospital management, 'Can I have a little bit of time so that I can think about this?' Because this was on a Sunday night at like 10 o'clock at night, and I said, 'Can we wait until tomorrow?' Thankfully for me, a different female physician came in the following day, and she said, 'I absolutely agree with you. I'd rather wait. You're the type of person I do not want to intervene on for you because I think you'll have a better chance of fighting this if we give you a little bit of time.' So for everyone listening, when you are in a medical environment It is your right to ask for a patient advocate. It is your right to ask for a second opinion. It is your right to ask for an explanation for why someone is encouraging you to have surgery urgently or emergently. And I think many people in that situation, they're overwhelmed, they're scared, they're stressed, and they don't feel good. And so in many ways, we give away our power to medical professionals. And let me be very clear, I'm not being critical of this female physician. It was what she felt was the right decision at that time. And I asked her to pause. She was very upset with me. I can tell you that she was not at all pleased. She thought I was being foolish. The irony is the following day, the physician agreed with— the other physician, other surgeon agreed with me that giving a tincture of thyme was completely reasonable. And that is something all of us can do. That is not an unreasonable expectation to ask of a licensed medical provider.

You mentioned a patient advocate. I think a lot of women don't truly know what that means. What does that mean?

That means, so if you're in a hospital environment, there is someone who is tasked with that job and they can be called literally at any time. They are designed to be a buffer between you and the medical system. They may be employed by the hospital, but they are designed to serve as a resource person and also a buffer between the medical professionals and yourself. Now, sometimes I can be totally transparent, plenty of medical, you know, they can be called for a variety of different reasons, but they're designed to help explain things, and they're designed to act as your advocate. Now, sometimes people get involved because there's a lot of friction going on. Sometimes they get involved because people are asking for clarification. They need more information to be able to make an informed— not only informed decision, but informed consent, because that's another part of this process that's really important for people to know. Like, you are supposed to have a full explanation of benefits, potential risks of any procedure or any surgery that is done, or really anything that happens in the hospital. So those patient advocates can be an incredible— I always looked at them as they're beneficial for both sides because they're designed to be there to really kind of decrease friction between healthcare professionals and patients and their families. And I think 90% of the time they really do a fantastic job of making things easier for everyone.

I recently was in Bali, which is a very underdeveloped place, and had an experience, not the exact experience, but a similar experience where I got an infection eating the same food that everybody else was eating. Me and one other person are the only ones that got sick. Nobody else did. Created a whole storm of problems, including a histamine cascade for a few months, just all types of things that took a while to resolve. I don't even know that it's fully 100% resolved, to be honest with you. I never put together the connection around declining estrogen and menopause. So, I want to go a little deeper there because I think most women do not because we think we're on HRT or we're not understanding. Is If you are on HRT, is this still an issue?

I think it can be because our hormones are not at the levels they were when we were in our peak fertile years. Like, maybe very, very clear. That's why we see skin changes. That's why we see alterations in bone health. That's why we see changes in cognition, heart health, etc. I think when you're taking HRT and there's no study that I have read that suggests that HRT is going to get your immune system back to where it once was because that's just part of the aging process. And I'm sure we can unpack that. But I think for a lot of women, you are less likely to deal with some of the sequelae of the aging process if you are taking hormone replacement therapy. Just think about vaginal estrogen as a really great example. It's not a question of if, but when. Eventually, we will all develop vaginal atrophy. We will have painful sex if we are not replacing the hormones that were once there. But it's never going to, per se, give us the vaginas that we had at 20, but it is going to lessen our likelihood of developing urinary tract infections, probably less than likelihood we'll have pelvic floor issues. So, I look at it as a really important way that we can support our bodies in many different ways, but it is not going to get our immune system back to where it was when we were 20. The immune system ages right along with us. And there's certain components that do shift dramatically with the aging process. That's actually what many people think is what's the primary determinant of the aging process. But I think women that are taking HRT are going to have less symptoms and less— I'm gonna use the term sequelae, that means complications or issues related to aging throughout our bodies.

I'm gonna ask you a lot of questions, uh, specifically about EstroBloom, and there's— I have a bunch of science questions here. But before I do that, I want to address sort of an elephant in the room, and that's our belief set and our mindset. And the reason I want to bring that up is I live this daily where I believe something to be true, and then it kind of comes to fruition. And I want to be mindful of that because we hear so much noise around declining as we age, menopause, bone loss. Now, immune system changing, all of that.

How do you—

because you're somebody who works from mindset, like you're very positive, if I'll use that right word. You're looking for possibility and you're thriving in midlife. How do you kind of balance this, like what's real and where I need to focus my mind? Does that even make sense what I'm asking here?

Yeah, absolutely. I mean, I think what you're stating is, you know, part of what allows us to continue living is, yes, we are aging every day, but I think our mindset is the most important component of reframing things that are changing in our bodies and how we feel in our bodies. I think if you think that you are going to ache, sleep terribly, not be able to manage your stress, not be able to digest your food, not have healthy interpersonal relationships skills, you will. It's what will happen. So I think part of what I have found to be helpful for me and, and for patients and clients is just, just find the reframe. Like, we all have days where we're frustrated or upset, and that is normal. But so much of what allows me to personally thrive in middle age is just doing the things like I would say major in the majors, like ensuring I get good sleep and helping to manage my stress and eating nutrient-dense whole food and making sure I'm moving my body. Those are huge differentiators. And, you know, eating fiber is another example. Like those are relatively big things, but they do have a lot to do with how we navigate the aging process. And what goes right along with that is mindset. Like, if you get up in the morning and you're like, "I'm going to have a great day. I'm going to be able to, you know, push through my workout. I'm going to see these very important people in my life. I know that, you know, my bigger sense of purpose beyond," I don't know, some of the metrics that people might use. You have to think about a higher purpose. I have to think about how your mindset contributes to how you think about yourself in time and space. I think that if you're looking substantively, then you're not focused on, "Oh, I noticed a wrinkle," or, "Oh, I noticed that I've got fat in a place I didn't have it before." And so I think that once we get ourselves out of our head and start thinking at a much more kind of constructive level, that can make a big difference. And Natalie, transparently, I think anyone that's doing personal development work is already doing the work. For every single person listening, you know, the aging process is not for the faint of heart. However, there's so many things that are beautiful about being like grounded and secure and happy in who you are, liking your partner, being happy. Like, I live in a part of the country where it's quiet and there's a lot of rolling hills and there's a lot of greenery. And that to me is incredibly nourishing to my soul. I have other people that might say, "I love being in a city. I love the vitality of the city." So I think part of the aging process is acknowledging what are the things that light you up and make you happy, and then how can you limit the things that make you feel differently. But I do think mindset is— mindset is everything.

Yeah. And I think too, learning information, um, we, we have to be aware. We can't keep our head in the sand and learn information about aging, but we also have to decide sort of that we're going to age well. We're going to age well. Because I, I think if we start saying it's doomsday, it's all these things are going to happen, we almost start bringing those things to fruition. Just—

Absolutely. Absolutely. And I think for a lot of people, maybe people that aren't as familiarized with, you know, personal development space or even finding those reframes, is that, you know, we are invited every single day of our lives to decide how we want to think about what we're doing day to day. And I think that, you know, I'll use an example. I was recently coming back from an event. I hate to use the word stuck, but I'm going to say I spent more time in a particular US city than I had anticipated because of flight delays, cancellations, etc. And I kept thinking to myself, like, I'm so fortunate, I'm so fortunate I get an extra day to, like, I can sleep in. And what are all the things I can do to find the reframe around the inconvenience of, yes, spending an extra day in a US city that I had not anticipated for, had not planned for. And I think that is so much around life is that it's like the acceptance of, okay, I can control only so much. And then beyond that, what can I do to move myself forward? And I think the people that are thriving in middle age and beyond are finding those reframes even amongst whether it's disappointment or frustration. It's like, that's just part of life. As Shawn Stevenson says, life is lifing. It's like that is just part of kind of the more common, you know, themes around, you know, life isn't always predictable. It's not always easy. But, you know, our mindset around the unpredictability of life is key for deciding how we want to thrive or just survive at this stage in our lives.

Makes total sense. Okay, let's talk about the word estrobolome. I hadn't— am I even pronouncing it right? I had never heard it before your book. So, what is it? Why does every woman listening need to know about this?

I just want to say I had nothing to do with the naming of the estrobolone, but it is an estrogen processing center in the microbiome. And why is this important? Because this is where our body— it's a main site for how our body breaks down and metabolizes hormones, in particular estrogen. Here's the key theme. Our liver and our gut are two main sites of detoxification in the body. If they are working well, we will break down estrogen in the liver, we will package it up in the gut, and we will poop it out. So, when I talk about like pooping, yes, I know we're talking about this, but it's such an important, very basic thing. If we don't break down our estrogen properly due to toxins, the types of foods we eat, chronic stress, et cetera, we will recirculate that estrogen. So, when women are in perimenopause in particular, when we know estrogen levels can be 20 to 30% higher depending on what cycle you're in. This explains a lot of the symptoms, the brain fog, the joint pain, the weight loss resistance, the breast tenderness, all the symptoms that are not fun to experience. So, big, big takeaway about the estrobolome, this is the estrogen processing center of the body. And if we are not breaking it down properly and pooping it out, guess what? It gets recirculated. And this can happen to both women in perimenopause, as well as menopause. And many people are surprised to know that, yes, there's a time in our lives when, as estrogen's declining, that you can be exposed to enough estrogen-mimicking chemicals in your environment, personal care products, and food that can tip off your estrogen balance in your body. Women will sometimes say, "How is it even possible that my estrobolone could be such a mess if I'm in menopause? My body's not making a lot of estrogen anymore." And I was like, "That is correct." But estrogen-mimicking chemicals can offset the estrogen receptors in the body. They can be 100 times, 1,000 times more powerful than the hormone itself. So when we talk about why it's important to be conscientious about what we're exposed to in those environments, that is why. But the estrobolome is a really kind of cool way of thinking about the microbiome.

Is recycled estrogen, or when you get estrogen from other things, like not from your hormone replacement, you're getting it from soy, or you're getting it from— is it ever helpful, or is it always not helpful and creates a problem when it's recycled or coming from outside sources?

I think that's such a great question. I mean, from my research, I would say, number one, soy is one of these things that a lot of people bastardize, but we have cultures in Asia where they eat a lot of soy isoflavones. That's the kind of component of soy, and it's actually beneficial. So I think it's always context dependent. The other thing is, if you're someone that has lived a pretty clean lifestyle, I don't think you probably have to be as conscientious or obsessive about things that you're exposed to in your environment, personal care products, and food. But the average American unknowingly is just exposed and exposed and exposed. And I think that perimenopause and menopause oftentimes tends to be a time in a woman's life where they have to make some significant shifts because it's cumulative exposure over time, whether it's your mercury amalgams, whether it is, you know, the unfiltered drinking water, whether it is the ultra-processed foods, I think cumulative over time, that's where things become problematic. So I will remind people, like, if you go out to dinner, please do not stress that your $100 steak was cooked in a seed oil. Because, you know, over the— if 80% of the time you're eating clean and being conscientious, go out to dinner and enjoy yourself. But if you're eating ultra-processed food 24/7, and you're not at all conscientious about any of the other things that I've kind of alluded to, I think those are the people I get a little more concerned about because it's cumulative effects over time. And so to answer your question, I worry a lot less about like fermented soy, so like miso or tempeh, as opposed to kind of conventional soy. But in the grand scheme of things, there are huge communities in Asia that consume a lot of soy isoflavones. And do really well. So, I think it probably has a lot to do with the genetically modified variety that we have here in the United States, which, you know, we can make the argument that's a whole separate tangential conversation about the value of being conscientious about food quality, nutrient density.

So, do you feel that same about, like, xenoestrogens, things that you're getting from your products? Is that same type of thing? Like, if your baseline is good, it's not going to affect you as much? but if it's not, it's going to tip you over? And is it ever beneficial? Because that's a weird— I don't know how to answer that when people ask me that because they—

Yeah. I mean, I think, you know, I think you bring up a lot of good points. So I think we know that certain estrogen-mimicking chemicals, whether it's phthalates, parabens, they can disrupt our endocrine system. And so the endocrine system is what is responsible for communication and the symphony of hormones in our bodies. I'm oversimplifying it, but that is what they do. I think it's very dependent on the individual, like how does their body detoxify? And I'm not talking about a detox program in a box. I'm talking about, do you sweat? Do you breathe? Do you urinate and defecate? Like, do you do all those things effectively and well? Plus genetics, plus lifestyle. I personally try to limit the amount of chemicals I'm exposed to, but I don't obsess over it. I went through a period of time where I did, and I was, I was feeling like I was not enjoying my life thinking so much about every single thing I put in my body. So I think now if I were talking to a patient, I would say, "Be conscientious." Yeah. You know, even if you clean up your deodorant, your body lotion, and your toothpaste, those 3 things are gonna have a nice net benefit over time. Don't be obsessive about it because there's this other ugly side of the health and wellness space, like orthorexia, where people then become obsessive, like they can't actually enjoy their lives. And I don't want that for people either. It's like, let's be conscientious, let's work within your budget. And your sanity, because I think that's also very important.

You write that our ovaries age 2 to 5 times faster than every other organ in our body. I literally gasped when I read that. I had never heard that. Why is no one talking about that?

I don't know. You know, it's funny, when I was writing the book, and there's a whole chapter devoted to the ovaries, and I was like, I humbly sit back and say, "Oh my God, I never knew all the things they did." It's the most mitochondrial dense organ in our bodies, which means It's an organ that helps with procreation. It makes sense that they would be the most mitochondrial dense, not our heart or our brains, which is what I actually thought. Surprise on me. What I think is interesting is our ovaries are very sensitive to nutrients. They're very sensitive to stress. They're very sensitive to toxins. And yet we don't even think about our ovaries until probably when we try to get pregnant or maybe when we're getting close to menopause. We might be thinking like, "Where am I on the trajectory of like when is it going to happen?" And so when I was writing the book, I was like, oh my gosh, like this makes so much sense why smokers usually go into menopause earlier, because it decreases blood flow. Women that have had a hysterectomy are very likely to go into menopause earlier, even if they have ovary sparing hysterectomies, because they can disrupt blood flow to the ovaries, you know, too much alcohol. And so, you know, I think the thing that really struck me was the stress piece, because how many women of our generation, Natalie, have had episodes of episodic significant stressors in our lives.

Lots of them.

And, you know, how many of us have thought like, "Oh, my ovaries just tick right along with me. It's no big deal." But we now understand that the impact and imprinting of stress on the ovaries is significant and profound, enough so that people that have significant adverse childhood events are more likely to go into menopause earlier than people who did not experience, you know, the same stress, neglect, and trauma in their childhoods. And so when I wrote that chapter, it was definitely one of those where I would like write a paragraph and then I would text a friend and be like, oh my God, did you know this? And they're like, I don't know if I'm excited to know that or if I'm like frustrated that I never learned this before. Even as a clinician, I was never taught any of that, although I'm not an OB-GYN, so maybe they learned more about that than we did. But I found it incredibly fascinating and then also equally disturbing.

When you said that stress can affect how early— what I don't think women even know, like, what is considered early menopause? What is sort of the average? What is the ideal menopause age?

So in the United States, average age of menopause is 51. What is considered to be premature menopause is before the age of 40. What is considered to be early menopause is before the age of 45. So between the ages of 45 and 55 is considered to be normal.

Okay.

And yet I think anyone who went into menopause at 44 or 42 or 38 would tell you that it is not at all normal. And I think for a lot of women, it's been my clinical experience that my thinner girlfriends and even myself, I went in much earlier. I think that hospitalization I had, the stress of that on my body, losing so much weight, I went into menopause at 48. And so really, yes. And so I think for a lot of women, there's this lack of education about what to expect. And I mean, even on TikTok, I'll use this as an example. I have adult sons. And so, sometimes they'll talk to me about what they see on TikTok. And they were like, "There's all these young women that aren't getting their periods." And I was like, "Wow, that's terrible." Because what is different is that if you or I in our 50s and we're no longer making as much estrogen or progesterone, it's anticipated. But we've had many, many years where our bodies have had the benefits of those hormones at appropriate levels. If you're 25 or 30 and don't have a menstrual cycle, that is a cause for alarm. That is an SOS. That is something that needs to be evaluated. And yet for a lot of women, they're like, oh, no big deal. I have POI, which is premature ovarian insufficiency. But I would be the first person to say your menstrual cycle is a vital sign, just like your blood pressure, your pulse, your temperature. Equally important. And if someone isn't taking, or, you know, making, or providing enough attention for that vital sign abnormality, then you need to find a provider who will.

I was 54 when I was full a year of officially menopause. And I do know I was perimenopause for a good 10 years prior. Does that 10-year perimenopause window Is that for everybody? So like, if you go into menopause in your 40s, have you been in perimenopause those whole 10 years prior?

I think that I became pretty symptomatic probably 12 years ago. So, you know, since I'm someone that has thin phenotype PCOS, and I'm going to get a little bit in the weeds when I say this, anyone that has PCOS is very likely already someone who has some degree of ovarian issues. I didn't know this at the time, but when I talked to experts, they've said Oh, my PCOS patients, even though I was never insulin resistant, I was never obese or overweight, they're like, you probably inherited some ovarian issues that probably— because there's a whole slew of infertility on my side of the family. But when I think about, you know, what are the imprints that probably impacted when you went in at 54 versus me at 48? I think for a lot of women, it's those adverse childhood events. So anyone that's listening, this is a joint venture by the CDC and Kaiser Permanente. Anyone can go online and take the quiz. It's short. You get a score. Mine is quite high. And so, I think that my nervous system was imprinted at a very early age. So, my body was just much more stressed even though I might not have looked stressed. People always say, "Oh, you don't look like you're stressed." And I'm like, "Well, it's— I'm calm on the outside, not on the inside." But I think for a lot of women, they don't understand that if your nervous system's imprinted at an early age, And it could be, you know, neglect. It could be that you had a parent that was an addict. It could have been— it doesn't necessarily have to be big T trauma, which is like rape, murder, suicide. It's the kind of innocuous, seemingly innocuous little t trauma that can be impactful. So to answer your question, I think for a lot of women, your life experiences plus genetics plus lifestyle have a lot to do with when that will occur. But it's been my clinical experience when I'm talking to women, you know, ER physicians, GYNs that have been up doing traumatic deliveries in the middle of the night, many of them are going in much earlier and it's that chronic stress pattern that can definitely age the ovaries faster. Cortisol is not a bad hormone, let me be very clear, but it can erode your health over time, and sometimes in ways that are very subtle you might not even be aware of.

Yeah. Cortisol is a whole topic on its own, and it's very misunderstood.

It is incredibly misunderstood. And I always say it's not a bad hormone. In fact, if you don't have enough cortisol, you will die. There's something called Addison's disease. That President Kennedy had years ago. And so, I think for a lot of people, it's helping them understand not everyone's gone through significant adverse childhood events, but it could be maybe you went through a bad divorce, maybe you lost your job, maybe you had just some significant stressors that you had no control over that can definitely imprint your nervous system. And so, I think for each one of us, we have to kind of think retrospectively and thoughtfully. It's not all just asking your mom how old she was when she went into menopause, because you inherit genetics from your mother and your father. There's a lot that can imprint that.

You talk about gut-bone-brain access, and this is fascinating because a lot of women grew up thinking that bone loss was just about calcium, and it's not. What's actually going on?

Yeah, you know, it's interesting. We know that women lose about 5 to 10% of their bone mass the first 5 years of menopause. So this is where I would say, number one, every woman listening, irrespective of age, needs their bone health evaluated sooner rather than later, even if you've breastfed. Like, I had DEXA scans done in my 30s because I breastfed 2 kids back to back for such a long period of time. So number 1, you have to evaluate your bone health before you go into menopause. So, you know, if you need to do more than the average person. Number 2, when I'm thinking about gut health, I think a great deal about bone health. And I think for many people, we know that estrogen, like an estrogen patch, is primary prevention for osteoporosis. I mean, that's such a cool thing to know. The other thing that I think is really interesting is that our gut health is intricately interwoven with our bones. So, there's a gut-bone axis, which means if you have a leaky gut, if you have an autoimmune condition, you very likely already have compromised bone health. Now, I say compromised, that does not mean you have something documented that's problematic. It's helping women understand that if you've ever had lupus, rheumatoid, Hashimoto's thyroiditis, you need to be looking at your bone health because we already know you have an autoimmune condition. The other thing that's really interesting, Natalie, is that when we talk about the gut microbiome changes that are occurring in perimenopause and menopause, one thing that happens is there's an important molecule called short-chain fatty acids. They go down. We know that in menopause, in the setting of less estrogen, we start having more bone breakdown than bone buildup. Estrogen and progesterone are designed to both work in a symphony together. And what happens is in the setting of less estrogen, there's more bone breakdown. This is worsened in the setting of less short-chain fatty acids. So our gut microbiome short-chain fatty acids are— they actually impact the breakdown of bone. And so I tell people, when women say to me, fiber is irrelevant, fiber is not important, I'm like, oh, but if you look at the research, Fiber is so important for many reasons, but I want everyone to understand fiber is important for the bone health too. And I think that is a kind of common, not discussed often topic because it isn't sexy to say if you eat fiber, you make more short-chain fatty acids, which do lots of things in the body. They help with, you know, mucus in the digestive system, which seems kind of gross, but it helps protect it. They help with the immune function. They help with inflammation, they also help with bone health. So when women are thinking about their diet, don't forget about fiber and how that also helps support our bones.

Fiber is the most untalked about nutrient. It is wild how we have glorified carbs at times, fat at times, protein, but fiber has not had its day yet. And it's so important. I know that that's— of anything that I count, it's fiber grams daily. And I definitely supplement with it because it's so important. I mean, how— just, just common sense-wise, how are we moving things along without it?

Yeah, well, and it's funny, I now call it the new F-word because I've had podcast hosts say to me, I'd love to have you on, I want to support your book, but you can't talk about fiber. And I'm like, how do I talk about the microbiome and not talk about fiber? Like, it really would be very hard.

Why is it? Because they're carnivore hosts, or what's the—

what's going on there? Yeah, some of them are carnivores, some are keto. And I'm like, listen, I think one of the reasons why my gut was so decimated before I even got to that Morocco trip was I had been low-carb paleo for a long time. Too low carb for me. Let me be very clear, I think this is very bio-individual for me personally. And if you're not eating enough, it can impact the microbiome. Like, I have interviewed experts that have said in their patients that are hardcore carnivore, they, they've lost insulin sensitivity over time, their microbiome gets disrupted. They're not making, you know, keystone species of bacteria in the microbiome that help reduce inflammation. And so it has been my clinical experience personally and professionally. And I will tell you one thing. In 2020, I had a colonoscopy. I have them every 5 years just because I have a crummy family history. In 2025, I had my, my most recent one and my gastroenterologist said, what are you doing differently? I said, I massively increased my fiber intake. And he said, Cynthia, this was like a picture-perfect colonoscopy. I had your last records to look at. And so he said, I wish I could tell all of my patients the difference it makes. So obviously my 2021 came after that. I think you should do a before and after on Instagram of your colon. No, but it's so interesting because he said, whatever you're doing, keep doing it because it's a perfect colonoscopy. Like, I wish all of my patients' colonoscopies were like yours. And the only differentiator was more fiber. And I think for each one of us, it's the end of one. Like, Natalie, what you can tolerate might be different than what I tolerate, might be different than my neighbor. But if the average American diet is like 5 to 10 grams, that is not enough fiber to offset the changes that are happening in our gut as we're getting older.

And just don't add it all at once because that'll cause its own set of things.

Yes. Don't go from 5 grams to 30. You'll be really unhappy with us.

But slowly, you know, it's, it's, I, and this is going to, I know there's some people listening that are strict keto or strict carnivore and they're like, but I feel so amazing. I'm not denying you feel amazing not eating it, but what happens, we've eliminated basically every possible thing. We've never really found the root of what was creating our issues, and now we're going to create a more sensitive gut because we have zero fiber. So, it's just going to create a longer-term problem. So, whenever someone says they feel great on carnivore, I think it's temporary. I mean—

And I think it's like any elimination diet. I don't have a problem if someone says to me, "I want to do therapeutic carnivore for 3 months." I did it for 9 months, Natalie, because I had chronic diarrhea after 6 weeks of antifungals and antibiotics. Like, my gut was decimated.

Yeah.

And I slowly started reintroducing it. But when someone says to me, I do not tolerate any plant fiber of any kind, I'm like, okay, we really need to take a look at your gut because I think this is something we can re-engineer. Because I certainly, between 2019 and now, I mean, there's been— it's going to take me probably 10 years to get my gut back to probably where it would have been had I not had the stress of a hospitalization and all those many, many, many weeks of antifungals, antibiotics.

Plus all the antioxidants, all the phytonutrients, like you're not getting any of those when you say you're not gonna have any plants.

Exactly. So I think that these elimination diets, whether it's vegan, whether it's keto, whether it's low carb, people feel great. For a lot of people, they've reversed metabolic health issues, which I think is fantastic. People feel symptomatically better. But I think when we're missing the bigger picture is that our body is not designed to exclude an entire class of macronutrients. Yeah. And so I would say like, get rid of the processed carbs, that I 100% agree with. However, we are designed to eat protein, fat, and carbohydrates, and fiber is part of that.

Do you— are you a fan of people adding things like psyllium husk?

I think if they tolerate it. So, so here's the thing, when I was writing the book, I remember saying to my editor that I wanted to make sure I was meeting people where they were. I'm like, try to get it from food-based sources first. But for some people, they're like, "I just can't eat enough of the cruciferous vegetables or enough of flax and chia seeds." I think that if you're choosing to take a supplement, I would do one that is very simple, whether it's psyllium, whether it's PHGG, which is partially hydrogenated guar gum, whether it's inulin, which I don't tolerate that well.

I don't do well with inulin. It's horrible on me. I don't know.

It blows me up like a balloon. Me too. It's funny. Every once in a while, I want a Lily's dark chocolate. Oh, yeah. I—

if I see that ingredient, I have to stay far away.

No, no. And it's funny, my husband was saying, oh, I bought you some, put them in your Christmas stocking. I was like, yeah, you don't understand. If I eat like a square, there's enough inulin in the square that it just blows me up like a balloon. But I can eat other fibrous foods. And so I think for everyone listening, there's probably someone that's like, yay, I do PHGG and I do great with it. Awesome. This is that bio-individual approach. But like Natalie and I are talking about, for so many of us, it's like, it's really valuable to say, I don't tolerate inulin, so I don't do well with that. So I read food labels and if I see it in a keto or a low-carb or low-sugar item, I'm like, "I have to pass because I know I'm going to blow up like a balloon." It took me years to figure that out, by the way, because I'm celiac.

So, I always was like, "Did I somehow eat gluten?" And then, I thought inulin had gluten. It was a whole thing. But, I do find a lot of celiacs do not tolerate it either. So, there's something there.

No, and it makes sense for sure.

Krauts makes a really inexpensive psyllium husk. It's clean. It's good. I do 4 big tablespoons every night of it in addition to fiber. And I think I've worked up to that, but I think it's a very inexpensive supplement and it's just pure psyllium husk.

Yeah. And I mean, if you tolerate it, it's great. I mean, my kind of go-to that I recommend that's pretty gentle is a tablespoon of fresh ground chia and a tablespoon of fresh ground flax.

That's great.

And like, for whatever reason, that is so gentle. I even have my husband on it now.

You said fresh ground. That's the key. Just eating your seeds, you're not going to digest those.

So it's like helping people, you know, understand like this is a really gentle thing that you can do. And holy cow, it gives you like gold star. You know, you get every— you get all the things you need to do. I know nurses love to talk about poop, so I try to be good.

I like to do gold star poops when you eat that.

Yeah, no, no, it's, you know, anyone that's familiar with the Bristol stool chart, the poop chart, it's a number 4 gold star. It's perfect. So, I tell patients all the time, it's an easy way to bump up your fiber without getting super bloated and miserable.

I'm going to add that.

Because ultimately, yeah, it's like ultimately we have to find what works for our bodies.

I'm going to add that. Okay. I want to talk about serotonin for a minute because 90-95% of serotonin is actually made in our gut, not our brain. People didn't know that. So, when women in midlife are being prescribed antidepressants for mood issues, are we looking at this wrong?

Well, you know, it's interesting. I was reflecting back on like when I learned pharmacology both as an undergrad and grad school, and a lot of those drugs, the selective serotonin reuptake inhibitors, SSRIs, you know, Paxil, Prozac, Zoloft, Lexapro, etc., etc. I mean, they're good drugs. They do work effectively, but they're acting on receptors in the brain as opposed to the gut. And so when I started to kind of put things together and realize why was I seeing so much anxiety and depression in my patients, as well as irritability. Progesterone helps with the mood piece because it upregulates GABA, which is this main inhibitory neurotransmitter, kind of like the kissing cousin to serotonin. And estrogen and serotonin go together, really, they intertwine with one another. So, as estrogen is declining, even depending on where you are in your cycle, we get really irritable. And so, I think when I talk to patients, the ones that feel the best in this perimenopause and menopause transition, yes, HRT is important. There are women that still need an antidepressant or an anti-anxiety agent. But the other thing that is not always part of the conversation is that what we're eating matters. So, if you are eating a processed diet, you are not going to have the same neurotransmitter profile as someone that's eating nutrient-dense whole foods. And for me, I think you've been speaking about this for many, many years. I've been speaking about this. So, when we go back to what makes— what are the components of a healthy— making up healthy neurotransmitters and hormones, it really goes back to sleep, stress management, and I mean, exercise, nutrition. This is not to shame anyone. If you are taking an antidepressant, anti-anxiety agent, that is appropriate for you. But at a very simple basis, as these hormones are declining, we see an uptick in mood disorders, we see an uptick in suicidal ideations. And I think a lot of that has to do with alterations in both hormones, neurotransmitters, and not being appropriately managed. Number one, there's a degree of shame, which should not be there, shame and secrecy around how people feel and feeling comfortable enough to disclose that to a licensed medical professional. But I also think it's this other kind of common, you know, it's a very much an allopathic mindset of that everything needs a hammer. So every single symptom requires a medication. That's not always the case. I think that, you know, when I talk to mental health experts, friends that I'm close to that are working with middle-aged women, they're like, "A lot of what women need to have addressed in middle age is hormone replacement therapy, full stop." Like, when a 38-year-old is suddenly experiencing debilitating anxiety the week before their menstrual cycle starts or significant depression, the mindset should be, "Yes, she might need some temporary help, but she probably needs some progesterone." Just like, I can tell when my estrogen patch is wearing off because I get irritable. Like, I was laughing last night. I was like, why am I so irritable? I'm like, oh, tomorrow I put my new patch on.

Mine does not even last the full— I have to do it. It's like I get 2 full days from it and then it's— so I started overlapping. So, yeah, and using cream because we're all so different. Those patches say, you know, twice a week, but one of them is more days than the other. It's, you got to— yeah, it's a whole thing.

So, yeah. But I think that the biggest thing is I'm not going to shame anyone that needs medication because if whatever you need to feel good is what's most important. But I sometimes find the other thing about HRT that I think is interesting, Natalie, is that there are a lot of prescribers that are prescribing too little of a dose. And by that, I mean, they give you like the teeny tiny dose of estrogen patch, like 0.025.

Which just does nothing.

That's probably not going to get your estrogen levels where they need to be. And in fact, I would argue, like I was actually just saying to my provider the other day, I'm like, I think we need to bump up my patch because I feel like I'm getting 2 days of feeling, you know, not irritable. And then I have one day where I'm irritable and I'm like, I don't like feeling that way.

And I'm on 0.1.

Yeah. Oh, so I'm on 0.05. And so I said, I really think I need that next bump up. And that whole other conversation about people struggling to find estrogen patches right now, which—

that's a whole thing. Yeah.

Criminal. I was like, they don't run out of erectile dysfunction.

Of course, they don't, or Viagra. Yeah, they don't run out of Viagra. That would be a nightmare, right? But yeah, estrogen patches. But for those of you listening, they're like, I cannot get my estrogen patch. You can get cream still. So, you can get compounded cream. So, I always have a bottle of the cream as a supplement. So, just in case you have that.

Oh, that's really smart.

Okay. I want to talk about HRT for a minute because you just, you kind of led into that. And you have a whole chapter on that and you don't hold back. And I know about the 1990s. Most of us listening know about what was happening with 40% of women being on it, it then being pulled overnight because of a flawed study with Women's Health Initiative. I don't want to go too into that because we've, we've covered that so many times on this podcast. But then it dropped to 4%. It just like, it literally dropped to 4%. And I think just recently with the black box label being lifted, now we're on a backorder here of estrogen patches. There's a couple questions I want to ask you within here. And I'm going to start with this question. You're probably not expecting me to ask it anyway. Every time we talk about hormone replacement, I know there are women listening that say, "I understand the research. I hear the research, and still, I had estrogen-positive cancer. I have a family history. I understand the research. I choose not to do it." There's a lot of women, or their doctor doesn't want to put them on it. Can we speak to them first for a minute? I don't want to shame them into HRT. I want to let— give them some hope too. And then, I want to talk to everybody else too.

I would say number one, two resources. I've interviewed them both on the podcast, Dr. Avram Bluming and Carol Tavris.

Okay.

He's a medical oncologist. She is a clinical psych— she's a clinical researcher. They wrote a book called Estrogen Matters. Avram's wife and daughter were both diagnosed with breast cancer. They are both on estrogen replacement therapy after treatment and doing well. He feels strongly— he's a medical oncologist. That one of the contributors to why we're seeing so much breast cancer rates that are increasing— there's many things, but he said, "I think women in a low estrogen state are more susceptible." So, that's number 1. And he talks about why HRT can be very beneficial for women post-cancer treatment. Number 2 is Dr. Corinne Mann. She is a GYN. She was a young breast cancer thriver. So, she was diagnosed when she was in her medical training. She's now in her 40s. She takes HRT as well. Those are 2 great resources. They are both very, very solid in their research to demonstrate that those hormone placement is not going to precipitate a recurrence. So I would say for anyone that's listening that is on the fence or feels uncomfortable, those are two medical researchers as well as physicians who have a lot of experience in this area, far more than I do. It has been my clinical experience that most individuals that have had breast cancer treatment or any other types of cancers do really well with vaginal estrogen. And most people are comfortable because we know that for the most part, stays localized to the vagina. And it prevents so many other issues, pelvic floor issues, urinary tract infection, etc. I think that is where we're getting to, like providers are now getting comfortable prescribing for those patients. I think that every woman listening, irrespective of background, deserves to have a fully informed conversation with a menopause-savvy provider. And there's lots of MDs, nurse practitioners, PAs, etc., midwives out there, because everyone deserves it. If you decide that that's not the right decision for you based on all the information, pros and cons, then that's a decision that we have to respect. Yeah, I agree with you that we shouldn't shame women into saying that their decision is wrong and ours is right. It's just, you know, look at all the information and decide for yourself. The other thing is you can change your mind if you decide 5 years into menopause, you're like, listen, the night sweats, hot flashes, vaginal dryness is ontennial. I can't tolerate this. It's okay to change your mind. And, and for those that have already been treated for breast cancer, you have a right to have that conversation. And if you can't find the right provider, they are out there. That's why I always recommend Corinne Mann. She still takes patients. She's excellent. I think she is in Washington, D.C. area, if memory serves me correctly, but she's still working with patients. And there are a lot of physicians and NPs who work with these specific patients.

So I think women listening, they keep wanting my guests to say, "It's okay. You don't have to do it." That's what they want, right? And I want to be compassionate to that. However, I want my listeners to hear the reason none of my guests are saying that is it's so critical. It's so important. It's so important. So I'm feeling for people listening going, "But I can't, but I'm scared, but my doc—" this and that. But that is why so many experts are saying, "No, no, but listen, but listen, at least the vaginal estrogen, at least that." Absolutely.

And, you know, I get it. I mean, I finished my nurse practitioner training in 2001. I was listening to all my patients telling me how awful they felt being taken off their hormones. And then, I was told by my colleagues in cardiology to stay in my lane. So, the biggest takeaway from that question should be everyone deserves to have a fully informed conversation, even if you're scared. It's okay to be scared. I think I probably, because I was still mentally in shock that I was no longer menstruating at all. Like, I remember at the end of 2019, I was like, "Oh my God, I don't even know if I can say this out loud." That's how silly I was, the conversation, because I was so shocked. I was like, I didn't expect to be that young. But then the next thing I was thinking about was, "Oh, I need to protect my bones, my brain, my heart." Like, that was the next thing I was thinking about because of the conversations I had been having with experts that certainly suggested every woman deserves to have that conversation. And it's not to suggest, like, I do interact there. There's a naturopathic physician who despises me on social media and loves to come after me. I don't know why. I'm like, I think she might need some estrogen because she's really—

I know exactly who you're talking about. But okay, she's really irritable.

And so every time she comes after me, I'm like, I'm just gonna say a prayer and bless her. Um, but, but I think for a lot of women, it's like, I get it, I get it. I was one of those people. I probably at one point was like, I don't need this. And then all of a sudden, I was like, I started having all these symptoms. And I was like, I also don't want to have those symptoms because it's not going to make me fun to be around in my house. Like I'm looking at my poor husband and my kids. Yeah.

Oh, I don't think my husband would stay married to me, nor would I have any friends. And I would be sweating 24/7. There's just absolutely no way.

There's no way. Yeah. I was like, I just, I don't think I could. Well, I mean, you can see I'm struggling to find the words. I very clearly I would not be thriving. I would be just surviving. And that's not a good place to be. And I think for a lot of women, they don't realize that how much better they will feel. Like, I always describe it as it's like the lights got turned back on. Exactly. Like, I feel like I would not be able to do the kind of work that I do if I didn't have the benefits of hormone replacement. Because I always say, like, I have a litmus test every day to see if my brain's working well. Like, do I struggle to find words? Am I forgetting things that I'm saying. Thank God, no. Yeah, but it just reaffirms for me why it's important. And if there's nothing else to consider, in 2024, I, I, my father died, and then my brother and I were required, required. We loved my stepmother. Let me be very clear. She was not in a position she could take care of herself. She had end-stage Alzheimer's. And I remember my stepmother last lived another 4 months after my dad. And my brother and I would go visit her, and every once in a while she would have a moment of clarity, and she would say, "My brain isn't working right." And I would tell you one thing, if my stepmother could tell you today, would she have been willing to do just about anything to not spend the last 10 years of her life not knowing who she was, who we were, who my kids were, or being able to take care of herself? She would have said, "If there was something to prevent that, I would I would absolutely have done it because we had conversations around that when she was still more mentally clear. But it was, you know, taking care of her in the last 4 months of her life was really sobering. Like, it just reaffirmed for me why these conversations are so important for women.

My mom is 80, and she was one of those that was on it and yanked overnight and never revisited it. And I watch it. I watch it. Like, she looks younger, but I watch the bone. I watch the bone. I'm watching her shrinking. I'm watching memory. I'm watching all this and I'm thinking, "I want to change that." And I feel sad that she was yanked at that time and never given options. For those of you listening that are like, "But my doctor won't," find a naturopath. There's always— naturopathic doctors would. So, find that. So, Cynthia, our gut is a mess. Our hormones are tanking, clearly. Nobody told us any of this. What is your menopause gut plan, actually? What like?

Yeah, I would say I want everyone to take this to heart when I say that you want to major in the majors. Do not get fixated on the bright, shiny objects. We know that sleep quality— sleep is foundational. Sleep quality helps the microbiome. Stress management helps the microbiome. Nutrient-dense foods help the microbiome. Exercise— the Goldilocks effect, like you talk about— right amount, right time, strength training, etc. Helps the microbiome. Not to mention the fact dealing with your shit, you know, allows you to have a healthier microbiome. So, I'm like, if perimenopause is this litmus test of how well you take care of yourself, understand that your adaptive strategies used in your teens, 20s, and 30s that allowed you to be as successful as you are probably aren't going to bear well for you in your 40s, 50s, and beyond. So, I always say the wheels fall off the bus in perimenopause. And so, you know, whether it's therapy, whether it's Reiki work, whatever it is that you need to do so that you can show up for your loved ones becomes really important in perimenopause. And although we didn't talk a lot about it, like fiber is so important. The research definitely demonstrates this is a primary food for the colonocytes. So, although let me back up. Microbiome is 40 trillion bacteria, viruses, fungi, and protozoa in the large intestine. So, when I talk about the colonocytes, it's the little cells there. So, when you eat fiber, it goes through your digestive system, gets to the large intestine, and they ferment. And this is food for the colonocytes, which they go on to produce those short-chain fatty acids. And so, remember that fiber is important for estrogen metabolism. We talked about the estrobolome. It's important for reducing inflammation. Although you may not feel inflamed, one of the things that happens with the declining hormones is you get more inflammation. It's also important for insulin sensitivity. A lot of us aren't talking about this. So, think about fiber as a metabolic regulator. If you can't think of any other way to think about fiber, it is not just grandma's Metamucil. Like, you and I grew up in a generation where they had those gelatinous orange drinks. My grandmother—

I still can taste what that tastes like.

Gross. So gross. But for everyone to understand, like, fiber is our friend. And, you know, if you look at the research, they say anywhere from 25 to 30 grams a day. You might not be there, and that is okay. Just eat a little more. Like, track your Macros for a couple days and then just eat more. So if you're eating 10 grams a day, try for 12 or 15. And do it slowly because the microbiomes, like the microbes in the microbiome, they have to acclimate. Like, they're there to help you, but if you increase your fiber too quickly, they can't acclimate. It's almost like they're not ready. Like Natalie and I were talking about, inulin blows us up. Our microbes are like, nope, pass, give me another type of fiber, that doesn't work for me.

Can you help people like understand how much, like, other than supplementing, like when you're realistically, when you talk about, um, the chia seeds or the— like, how much is— what equals grams? And like, you have a salad, how many— how much fiber? Can you help us understand that a little bit? It's interesting.

It's funny, people always say salad. I'm like, you actually do better with like half a cup of berries or quarter cup of legumes or a quarter cup of beans. Like, you know, that in itself may have 5 to 8 grams of fiber. So just think strategically. Like, when I go to Cava, I don't eat out a lot, but sometimes on a Friday night, Neither of us, my husband and I, want to cook, and so we'll do kava, double protein, and I always have them add some lentils. So, I have arugula and lentils. That's the basis. Okay. So, just think of sneaky ways to add a little bit more fiber into your smoothie, into your salad, into your dinner. Most of the fruits and vegetables that we think about have got a good amount of fiber in them. And people will sometimes ask soluble versus insoluble. I'm like, "Don't get caught up in semantics. Don't worry about—" Does this piece of fiber have soluble? Don't even worry about that. Just try to eat a little more. So, when I'm talking about eating more fiber, it might be starting at a tablespoon of beans. If you're really sensitive, you feel like beans make you bloated, then maybe you need to soak your beans or maybe—

Beans is good for your heart. The more you eat them, the more—

Exactly. That's from our generation. But I think for a lot of people, it's like, don't overcomplicate it. I think today I used a cup of berries. Berries in a smoothie because I was on the go. Yeah. Um, but I think for a lot of people, it's tangibly, you know, artichoke hearts. I mean, there's so many— you can just get creative with adding things to meals and don't feel like it has to look picture perfect. That's the other thing. I look on social media and people will put these plates out, and I'm like, my plates don't look perfect. I mean, when I'm saying perfect, I don't make it look Instagram-worthy. I just put it together. I'm like, where's the fiber? Where's the protein? Yeah. If I've hit those two metrics, then I don't worry about the rest. It'll all fall into place.

Now, I personally don't eat beans. I just, for a lot of reasons, but I— what you're saying, berries, fruit, cruciferous vegetables. So I'm going to start adding the chia, like you said. Um, super easy. Yes. So, so simple adds throughout the day. I know I, every morning for breakfast, I add blueberries, strawberries. I'm, I'm constantly thinking, how can I add that for phytonutrients too? It's not just— I'm not just looking at any antioxidants, not just the fiber. You mentioned something called keystone bacteria. What is that?

These are, if you want to think about, they're like the major players of the gut microbiome. So, things like Akkermansia, I think this has gotten a lot of attention. We know that Akkermansia muciniphila is one of the bacteria that's responsible for, in conjunction with short-chain fatty acids, responsible for creating mucus that helps protect the digestive system, also responsible for insulin sensitivity. So, there's probably 5 to 7 keystone bacteria, and over the course of our lifetime, we can nurture them or we can starve them. And so, the research is certainly suggesting that a healthy microbiome has at least some composition of these, uh, Magix 5 to 7 bacteria strains. But it's interesting, they're impacted by everything I've already talked about. All the, like I always say, major in the majors, how well we sleep, how we manage our stress, whether or not we eat nutrient-dense foods, whether or not we over-exercise. And I think one thing that I realized is I was I was advancing in age, my intensity of exercise needed to change. It's not to suggest I don't work out intensely, but I don't do it for a prolonged period of time. It's short intervals are what is better for me at this stage of life. So, understanding that all the fiber, all those things are definitely playing into that healthy microbiome and those keystone beneficial bacteria that we want our body to be able to thrive. And also understanding there's a lot of things that influence this depending whether it's puberty or pregnancy or perimenopause. All these alterations in hormones have a direct effect on the diversity and the amount of beneficial bacteria we have in the gut. I mean, it's all kind of fascinating.

Something I forgot to ask you about, I want to ask about this. Back when we were talking about bone loss, you are very open in the book talking about how on and off for 10 to 15 years osteopenic. Am I even saying that right? Osteopenic, you on and off, and you're doing DEXA scans, you see this, and you're doing all the right things. So, what are you finding as kind of keeping that balance of staying out of that in it.

Help us with that. Yeah. So the thing that I thought was interesting was that I think episodically throughout my 30s and my 40s, I was, you know, without any bone issues and then I would be osteopenic. And I think some of it in my 30s was related to breastfeeding. So we do lose some bone mass while breastfeeding. And that's why I always recommend women get a baseline in their 30s. Don't wait till you're 65. A DEXA scan might be like under $100 depending on where you're going to, and it can just be valuable information. What are the things I do? Well, estrogen patch, because that's primary prevention for osteoporosis. Number 2, strength training. Number 3, those protein needs. And then, also being really conscientious about jump training. I know Dr. Wanda Wright talks a lot about this. I'm not jumping up on a 3-foot-tall box. I might do 1 foot or 2 foot. Sometimes I do it outside my house. I'll jump on and off my porch, although my My husband thinks I look like a nut and probably my neighbors do too. But, it's like you want to do things that are creating stress on those bones. Yes. What's interesting is I've had conversations with my integrative med doc about, you know, because we're trending it, I have bone— it's not just the DEXA scan, there's also bone indices, there's bone labs that you can do that show if your bone mass is stable. And, mine is, which is why he's not too worried. He's like, "All right, yes, you're osteopenic, but you're also thin, you're Caucasian, you have a family history." Some of it's genetics and some of it is lifestyle. I do not think intermittent fasting has contributed to this. I get asked that question a lot. I'm like, that has nothing to do with it. But it just speaks to the fact, like, I have to continue doing all of these things to make sure that my bone, uh, health does not decline. The other thing that I think is really interesting is I think about fiber now, because when I started seeing this interplay between gut and bone health, understand that fiber and short-chain fatty acids play a role in stabilizing— I'm going to nerd out and use the word osteoblastic, excuse me, osteoclastic. Sometimes I— blast is build, clast is breakdown. Stabilizes osteoclastic activity. And so, it's also helpful for stabilizing bone health along with the gut stuff that we talk about in the book. I think for a lot of people, they're surprised because they're like, "Oh, I just need my estrogen patch and that'll fix it." No. No, no, no. We have to think comprehensively and thoughtfully. Yeah.

One thing, you know, it's funny, I've been on this whole bone research. That's been my new fascination lately, interviewing people around bone loss prevention. And I was walking with my husband and he wears these same shoes all the time that he just turned me on to. They're like completely flat, wide toe, but you can really pound the ground. And I was wearing a lot of the trendy fun sneakers with the big gushy stuff. He said to me, "They're terrible for your bone." And I was like, "What? How? What do you mean?" And he didn't have any answer. He was just saying, "I don't know." But I started asking doctors that I've interviewed about it and they said there's something to that because think about how kids slap their feet as they— that pounding, that slapping is helping your bone. So, I switched all my shoes to very flat. My workout shoes are flat, no cushion. And I want that with my jumping, with my walking just so even walking, If we're walking on clouds, it's not helping us, but we're walking on and we're hitting our foot, it's a big thing.

So, you know, it's interesting, Natalie, as I was interviewing Andy Galpin, and he was saying that because I think I had been led to believe that, you know, peak bone building for women is, you know, in our 20s and 30s. And he said, actually, the research suggests what you do as a kid, ages of 6 and 12, has a bigger predictive value on bone health. He said, so the kids that are really sedentary, like our generation, we weren't allowed to be No. Sedentary. Jumping on beds. Yeah. We were outside. We were doing stuff all day long when we weren't in school. And so, he was talking about how, like, he expects this generation to have more bone health issues because they're more sedentary than previous generations. So, just something to think about. The other thing that I think is really relevant, certainly to my generation, our generation, is that your use of oral or of contraceptives has a lot of impact. If you are missing out on peak bone and muscle mass building because you are kept in a low estrogen state, late. And by this, I mean, if you're starting oral contraceptives, for whatever reason you were starting them in your teens— well, I was on them from— I was like for 30 years on them.

It was crazy.

I was on them forever until I got married. Or if you take Depo-Provera, which actually has a black box warning, but is reversible within 2 years. I think about, you know, the research is starting to kind of fall into place. But how many people from our generation were on long-term oral contraceptives kept us in a low estrogen state, we missed out on peak bone— You're right. —mass building. And so, I'm always asking my integrative doc, I'm like, "Do you think that contributed?" He's like, "Potentially." But he's like, "I don't think we know enough yet." Yeah. I think Depo-Provera is one of these, you know, you get it 3 or 4 times a year, but I recall that when I was in my training, it was marketed towards certain population of patients because it was a set it and forget it. You get the injection, you don't have to think about it for for 3 more months. But I think for a lot of individuals, not understanding that we can be kept in essentially like a menopausal state to ensure that we are not ovulating, but could be worsening bone health. So, that's like the bigger question that I have now is how many people from our generation are osteopenic, not because they weren't doing the right things all the way along, but by virtue of being kept in this very low estrogen state for a long period of time.

Gosh, I remember taking birth control pill called low estrin. Like, it was literally low estrin. And, you know, there's so many things we're learning, like SHBG. We're learning that a lot of that high— if we've got high SHBG, it could be from long-term birth control pills too. So many things. I want everyone to go get her book, The Menopause Guide. And first of all, I want to read some stats for you all, but I want you to get this book. And I'm going to tell you, I'm going to read you some stats. We covered some of these in the show, but I just want you to hear these again because this is where— why it's important. We've got to all be our own health detective and learn. And Cynthia is one of those people I have constantly turned to, to learn from, not just her podcast, which is incredible, but all of her books and her, her most recent one is incredible. I always say, don't just get one book, literally get 3 because you want to give it to your girlfriends too, so you can talk about what you're reading. And that's how it sticks. But just to go over some of these again, your ovaries age 2 to 5 times faster than every other organ in your body. We need to be aware of that. 90 to 95% of our serotonin, the thing that controls our mood, our sleep, our happiness, it's in our gut, not our brain. So, we need to understand how to work with that. 70 to 80% of our immune system lives in our gut, lives in it. So, menopause starts to wreck our gut and that can wreck our immunity. So, we've gotta be aware of that. We can lose 10 to 20% of our bone density the first 5 to 6 years after our last period. And the CDC and insurance companies don't even recommend we screen until age 65. That's insane. It's like too late to do anything at that point. So, get that screen. In the 1990s, so if you're Gen X, you had a mom that did this, you saw 40% of women were on hormone therapy. We knew it was good. It got yanked for wrong reasons that has been proved inaccurate, flawed studies. Today, only 4%. It's increasing because black box warning's been removed, but doctors are still catching up. 80% of all autoimmune cases happen in women, 80%, y'all, 80%. And, we're just connecting that now to gut health. And, estrogen, this is really important, has over 400 roles in the human body, 400. So, it's not just a reproductive hormone. So, this is important and we need to understand how to work with our bodies. And, her book does such an excellent job connecting the dots for us. So I'll put it in the show notes, but Cynthia, where do you want people to go to get, to get your book?

Yeah, probably most easy to go directly to my website. So www.cynthiathurlow.com. There's a banner at the top. You can click on your favorite retailer. I always say if there is a brick and mortar retailer that has the book, you want to give them your business. I think poor brick and mortar stores have really been hit hard over the last couple of years. I'm active across social media, probably most active on Instagram. And I love Substack. That's become like my new favorite place to kind of share things. A lot of the topics that we talked about, I do discuss there in greater detail. Just giving people kind of my personal kind of gestalt and insights. And of course, my podcast that Natalie's been a guest on multiple times, Everyday Wellness, is probably one of my favorite things I do within my business.

You're my sauna friend. I listen to you in my sauna most nights. Just so you know. You know, we spend 30 to 40% of our life in menopause. So I just want to kind of end on that note, like 30 to 40% of our life. And it doesn't have to be this downhill, over the hill, you know, our ovaries are out of business and we're retiring, we're done kind of thing. We can make this transition a lot smoother. I love that you are tying so much of this in, the menopause gut balance, your microbiome to reclaim your health in midlife and beyond. So, everyone go get it. I'll put the link in the show notes. Grab 3. Promise me you'll grab 3, y'all, because you got to get them for your— every time I have a good book, I get it for my friends too. I don't know about you, Cynthia, but that's what I do. I know. I'm going to be talking about it anyway, so I get it for them. Thank you so much, Cynthia, for being here today.

Thank you. Thanks for having me. [MUSIC] [MUSIC]