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So I actually, I didn't tell her this before. I'm going to surprise her now. I looked back because she was one of my first guests on the show. Episode number 15 filmed April 1st of 2025.
No.
And we are filming today. I know this isn't publishing today, April 1st, 2026. And I did not know that. I just told my wife Queenie right now before I walked in here. I said, I'm not going to tell her until we get on.
Well, do you wanna know the significance of today?
Yeah.
April 1st, 2016, I left traditional allopathic medicine. So it's been 10 years. Wow.
Yeah.
It's like I always remember saying, it felt like I've been talking about it on the podcast and how this is a big milestone, but if you'd asked me 10 years ago where I'd be right now, I don't know if I would've been able to wrap my head around it.
Unbelievable. Well, I feel extra blessed not only to just have you, but to celebrate this with you and celebrate all the things that you have going on and, and everything. It's, it's always so nice to see you and talk to you. And I don't have an intro to do you justice. I'll give you a, a little rundown here to everybody, but it's not nearly enough. But she is a nurse practitioner. She's the host of the amazing Everyday Wellness Podcast. She's an author, she's an international speaker. She's been a TEDx talker. She's got 25 years of experience in health and wellness. You can't miss her when you see her face. And even if you're listening to audio, you probably recognize her voice. So without further ado, Cynthia Thurlow.
Thank you, Dylan. It's such an honor to be back, and thank you for being as incredibly gracious and accommodating as you have been given the demands of my travel schedule up to this book launch. So thank you for that.
Well, as I told you before, I will help you and take advantage of any opportunity I have to even speak with you whenever I can. So it is, it is my pleasure to do this with you today and We have some big news to get into for you today. You know, we, we definitely want to talk about your, your book that's coming out. I know the amount of time and effort that you've put into this, but beyond the time and effort, the meaning and the purpose behind it, I think is the most important aspect of it. So what I would like to do is get into some of that. You know, I have learned the past year how difficult it is to write a book, the task that it really takes on, the time, the effort. The dedication, but also the meaning behind it. So I'd, I'd like to start first, just give us the title of the book and give a little bit of background on the purpose of it before we get into some of the parts of it.
Yeah. So the book is called The Menopause Gut, and it's really unpacking the changes in the gut microbiome that women go through navigating the perimenopause to menopause transition. There's a lot of attention right now on perimenopause and menopause topics, which is fantastic. But there's more to this middle age transition than most would lead you to believe. And so when I say that, it's really speaking to the gut microbiome interfaces with every single organ system in our bodies, men and women, but it takes a dramatic shift in the response to a decline in hormones. And so I will oftentimes say to patients that there's more to hormonal replacement therapy than. Bone health and brain health and heart health. There's a lot to the microbiome that is equally important. And I think because I have my own podcast over the past couple of years, I've just been synthesizing and absorbing comments that researchers and clinicians have said to me that led me to believe in 2024, when my editor came to me and said, do you think you have a second book in you? And after I wrote my first, I swore I wouldn't do it again.
But you know, you get this beautiful amnesiac effect. Much like when you have childbirth, women say, yes, I want a second or a third child. And then you forget until you're in the midst of it that the birthing process is a whole lot harder than you anticipate it to be. And so I pitched this idea to my editor. She gave me a green light. She said, start writing immediately. And the really cool thing is that I was able to really synthesize an entire trajectory of my career as a clinician, as a woman in middle age myself, but also really spotlighting really interesting voices in this space that have contributed to my knowledge base and my evolution as a clinician and a, and a female. And so this is easily the thing I've done professionally that I'm most proud of. This book was really hard to write because, you know, we all know life imitates art, but in the midst of writing this book, I had family tragedy. I had a loss of two loved ones. My husband got sick and writing became a distraction from from a lot of the sad things because all of us, I mean, we're in the sandwich generation.
We have aging parents and if we have children, our children are getting older. So your responsibilities, you're pulled in different directions and that's life. And so in the midst of life, lifing, as Shawn Stevenson says, I was writing this book. So I'm pretty excited that it's almost here. The whole process just, it seems like it's gone by in a blink of an eye, but it really hasn't. It, it has really been like 2 years worth of work to bring it to fruition. And so I'm really excited about it.
Well, I'm glad that you had that outlet because I understand what it's like when things go on because it's just inevitable. And then to have an outlet and to kind of be able to let it out on paper.
Mm-hmm.
And to take your mind off of it, I'm sure was soothing for you, or at least like you said, distracting. And do you feel like during those distractions and those moments that may have actually brought out the best in you in what you were doing to, to, to pull you away from what's going on and to put that down.
Yeah, 'cause I was forced to be very present. I mean, when you're writing, it's, it's really hard to write if you're not focused. And so I think because of my background and the events that I, I had as a child and young adult, I think I have an ability to focus under pressure unlike a lot of other people. And so my husband kept saying, if I ever needed to have acknowledgement that I know what you do when, you know, you're, you put your blinders on and just focus. And so I would spend anywhere from 8 to 12 to 15 hours a day writing in the midst of taking care of everything else. And it really was a, a distraction, but it was hard. I mean, I think there are people out there that write easily and effortlessly, and I think it can be incredibly challenging to take complicated concepts and make them really accessible. Like I had my editor in my ear saying, you're not writing a science textbook. You don't have to go into that much detail. I know you know that much. But let's just, you know, dilute it a little bit so that we can make the information accessible and actionable.
And we'll just continue adding to your 20 pages of references, which are now housed on my website because they didn't want to add 20 more pages to the book. So I say with great, you know, with great appreciation, I really made sure that this book is really a reflection of the science, but also making the information actionable, which I think in many instances when we have books that are out there, they don't have to be unique to the health and wellness space. But sometimes the information's just information and there's nothing tangible that people can take away from it. And so that ends up being, you know, I, I think it just makes it more practical and therefore people know what to do with it as opposed to just regurgitating a bunch of facts. And then people are like, well, that's great. What do I do with that?
So I would, you know what I'd like to do with you is just get a little behind the scenes on what goes on when you actually write your own book as opposed to like a ghostwriter doing it or you talking and telling somebody because Sometimes people have this, this idea or this thought, and then they gain a bigger appreciation of, of the book itself when people are, are critical of things or make comments and they don't realize the time and effort and work it went into that. So I got a, I got a couple like spitfire questions for you, I guess, so to speak. So the first thing that, that comes to mind for me that I think a lot of people do is, well, is it difficult? To pack in 200-300 pages, or do you find that it's so long that you have to condense it down? Because some people, you know, this are like when they go on and on and on when they talk, I'm like, oh man, if they wrote a book. So for you, did you find it difficult or was it like, man, we gotta shorten this up?
You know, it's interesting. I had a, a guest on the podcast recently who said her first draft was 800 pages, which was like, whoa, that's a lot of information. I can tell you transparently, as we were getting towards the end of me writing, I felt like we were trying to think of things to make sure that we struck the right chord. So my book is over 300 pages, which to me is about right. Mm-hmm. Any less, it might feel a little short. Any more, it might feel really lengthy, and then people might not be quite as apt to, to read it. I think that there's this constant balance of making sure that you're not shortchanging any one chapter. You know, the bulk of the book is really focused on actionable items, and so I think when we got down to it, we ended up adding some recipes just to kind of round out providing people with some tangible ideas of things that you could eat that reinforce the tenets of the book. So I think the recipes kind of rounded it out, but not in a way that, let's be honest, a lot of books when they throw in recipes, it's 'cause they're struggling to hit their 80,000-word limit, or that's the benchmark they have to hit.
I think for a lot of people, that's kind of what they're working towards, but we really tried to make it practical and actionable. So. I, I think that what I would say to you is it's hard to get started and then it's hard to end. Like those are the two points that I think are most difficult. Once I get started, I'm good. And then at the end, you're so tired of writing and you're so tired of looking at the manuscript. You're like, I don't wanna look at it one more time. I don't wanna see anything the copy editor's written. I don't wanna review anything. Don't ask me to explain it. You're just tired of looking at it. So I would say it's always the extremes, beginning and end. I think are definitely hardest in the process. But once I get started, I'm, I'm usually pretty good.
I would think the beginning would be very, very difficult.
Yeah. It's because you don't, so I can tell you the first time I wrote a book, I had a 100-page book proposal, which is a lot of work. Second time around, my book proposal was one page. Wow. That made it harder because I did not fleshed out like, this is gonna be chapter 1, this is gonna be chapter 2. Instead, I was looking at the computer going, Where do I wanna start? How do I wanna start? What's the most important thing to start with? And so, you know, you start having those conversations. I think it took me 2 months to really get a solid outline done. Like, it took that long.
Well, that was my next question. In the process of doing this, you come up with the idea, give it to somebody, then they shoot you either back like, they like it, let's work with this, and then make edits, or like, how does this process work so you can see how long it takes to even get writing? Because I know it's a big process to even start, 'cause I think people just think you get down, sit at the typewriter and just start typing random stuff, and that's just not it.
I think that, I think everyone has a different process. I mean, for me, I actually have to, like, I literally have legal pads. I mean, that is how I flesh out ideas, like in general in my life. So I, I generally don't sit down and start typing out a draft. It's more like, what are the high-level ideas? How do I organize it? And so for me, there's a, there's a certain degree of, you know, that fine motor skills of actually putting your idea to paper that really helps me solidify the direction I want to go in. But the cool thing is that my editor tends to be, uh, she's there and accessible, but she's not, she's not someone that micromanages me, thank God. But it's more like she'll touch base, say, are we on target to meet this deadline? Are we on target to do this? Um, I, I think for a lot of people it depends on how you work. Some people do best under pressure and admittedly because so much life stuff was happening throughout the fall and the summer of 2024, it just got harder and harder and harder to get started.
And so by the time I really got started in September, I was very much under the gun because, uh, you know, you, you have a, a timeframe. Are you gonna bring in it? Are you gonna bring the manuscript in on time? And you always want to, I mean, at least I want to, cuz I want the monkey off my back. But I recall in February thinking like, oh my God, if we don't get this done, I need, like, I, I felt like I needed more bandwidth. I felt like everything gets compressed in the midst of writing a book. Like the luxury of friends of mine that have a year to write a book. I'm like, oh, the next time I do this, I'm gonna negotiate differently. Like I, I said last time, I need more time than the first time. And then this time I was like, I want more time, but the time got eaten up by life happening, you know, the loss of my father and then caring for my stepmother. And it was like every time I sat down, I didn't feel like writing. So you have to be, you have to want to write, otherwise it feels like you are, it just feels, it just adds another, um, another layer of complexity and challenge to the writing process.
And so I think that we all know ourselves. Some people do better under pressure. Some people need a lot of time to. Daydream and lollygag and, you know, walk around and try to, you know, for me it, I was very much, there was very much a process of I would get up, we would walk our dogs, we'd feed our dogs, I would exercise, I would shower, I would eat, and then I would start writing. 'Cause I needed to get all of that self-care stuff done. As I have friends that would like get up in the morning and then just write furiously for hours and hours and hours, and then they'd forget about taking care of themselves and exercising and eating and I just knew that I was going to be much better off if I could start the day with a degree of self-care as opposed to just jumping into writing where I always feel like I'm not, or my brain's not organized yet. It's like I have to do all these other things before I'm ready to work.
So the process for, and before I go, I'm sorry about your dad. I know what that feels like. And I'm, and I'm just, I want to say that before I even go on. Of course. So the process start to finish, and I'm talking the idea for the book, all of the BS you had to do before, and then the writing and everything to publish date. Is that like a 2-year thing, a 1-year thing for you on this one?
Yeah, I, I would say it started in June of 2024 and then my publication is April of 2026. So almost 2 years. But you have to remember my first manuscript was submitted in February of 2025. And then there were edits and edits and edits, and then the manuscript was officially, uh, accepted in July of 2025. So even though you're done doing the bulk of the writing, the process just never ends cuz you have copy editors, like people that are far better writers than I am going in to massage and manipulate words to make it sound better. Like I always say, like, that's a skill I do not have. Like I, bow at their temples because they just make your writing stronger and they're making very subtle changes. But every time there was an iteration, an edit, something that needed my eyes on it, and then towards the end, I was like, I don't want to see this manuscript anymore. I'm done. Like, I literally put in my very last edited manuscript, the last manuscript from Cynthia, because I was so tired of looking at the manuscript because you get to a point where you're no longer objective.
You're just so immersed in your work. That you're like, I don't even— I'm not even objective anymore. I'm just so subjective while I'm reviewing my work for the 1,000th time. And the irony is, I just finished my audiobook. I just finished the edits. And as I was saying the words out loud, I was like, oh, why didn't— why didn't I say— why didn't I say that differently? And then you can't say it differently because it's already in written form. But there's— I think there's constantly an iteration. You're— maybe you're never 100% satisfied, but you realize that you get to a point where you can't have those perfectionistic tendencies because I think that they can be destructive. So I always say good is better than perfect. And so I think this is the best work I've ever done, but when I was doing the audiobook, I was like, ooh, I would've said that differently. Sometimes when you say words out loud, you, they hit differently than when you write them.
You and I are so alike. Every post I do, I, I can't tell you how many just Instagram posts, I've gone back to be like, oh, I gotta fix that. Oh yeah. And then I stopped doing that cuz it, it is, it, it actually, it degrades the work if you do it too much and overanalyze. Plus it's not good for your mental stability, but no, analysis paralysis.
I think that happens to the best of us.
So, okay. And I remember when I was trying to get in touch with you when I was, you know, in the early stages of my podcast, you had this going on cuz I remember it being brought up to me how busy you were and at that time a year ago, so. We are at crunch time. So that then, that brings me to this. So I had the opportunity to look at bits and pieces of your book. Unfortunately, I didn't get it till more recently. However, what I've read, and of course is very impressive, but I want to kind of touch on some of the topics because you and I talked about some of these before, but not all of them. And you have talked quite intricately on many podcasts about things and your knowledge is always appreciated, appreciated, but let's talk about some of the parts in the, in the book that maybe you and I haven't talked about together and you don't talk about as much when you're out and about. I would rather get into that and really showcase your knowledge base a little bit and intrigue other people. 'Cause like you said, I've talked about menopause a ton.
So have you way more than me. But you know, you've got some things in your book that, that I saw. Senescence was one. You talked about gut-brain axis. We did some circadian rhythm and sleep disruption. I'd like to get into some of, some of those topics with you. But first, how did you select the different topic pieces that you were going to go through? Like, what was your process in saying, well, to me, this is the most important? Was that through what you've seen and gotten feedback from people that you've observed, or your experiences, or podcasts? Kind of get into that with me a little bit.
I mean, I think, you know, I start the book off talking about this, you know, romantic 15th wedding anniversary trip to Morocco and how I got deathly ill from food poisoning, but my husband didn't, even though we'd eaten the same food. Mm-hmm. And so I'm kind of setting the book up to say, these are the things I didn't know about perimenopause that are already changing how opportunistic infections impact us as our hormones are declining. So when I was setting up kind of the infrastructure for the book, it was like, okay, we start with the story because it gives people context. And then we talk about like, what's the most mitochondrial dense organ in a woman's body? Our ovaries. What drives aging in a woman's body? Our ovaries. The decline in ovarian function is the hallmark of that perimenopause to menopause transition. And I think for a lot of people, they don't know that the health of our gut microbiome is connected to the ovaries. There's a gut ovarian access, just like there's a gut-brain access, but the gut ovarian access, there are specific things that women do in their lifetime that can accelerate the aging of their ovaries vis-à-vis also accelerating their cycling into menopause.
So things like smoking, trauma, chronic stress, certain toxicants in our lifestyles, you know, the things that we're told cumulatively over time don't matter, you know, exposure to plastic and estrogen-mimicking chemicals, smoking decreases blood circulation to the ovaries, chronic stress imprints the body and also imprints the ovaries. And, and those are the things that I kind of started from and then moved on to aging of the immune system, which is. Immunosenescence, that's the big fancy word, but the aging of the immune system also accelerates aging. And so it really kind of walks you through, you know, these kind of key players and the immune system is super complicated. I'm the first person to say I'm not an immunologist, but I had a big whiteboard out so that I could be able to talk about the key players in the immune system and make the information still accessible. So I use a lot of analogies in the book. And then we kind of move on to, you know, the gut-bone axis. I think a lot of people don't know that the health of our bones is largely dependent on the health of our gut. And then we move through hormones and then, you know, we kind of move through different stages in the book.
But to me, it's what made sense to unpack, you know, the story, the aging in our bodies, how the microbiome ages, what drives aging, just giving people like really salient details so that they could better understand their physiology. Because I think the biggest takeaway for women is that you have to change your lifestyle to match your physiology in middle age. So what we can get away with in our teens, 20s, and 30s no longer works in our 40s, 50s, and beyond. And that isn't to suggest that in the health and wellness space, you and I obviously know lots of people who are the magical unicorns. They're the outliers, but that's not just accessible to those of us in this space, it's accessible to everyone if they're willing to learn and understand what are the things you need to change about your lifestyle that impact either accelerating or slowing the aging process. And the way that the book is also structured is that we start with foundational elements. We start with sleep, we start with stress management, we start with nutrition and exercise before we even talk about hormones, before we talk about supplements. And I think the biggest takeaway, Dylan, that I wanted listeners to your podcast as well as others to take away is that there's no magic pill.
There is no magic pill. It's not an, it's not a peptide. It's not just taking a hormone. You still have to still do the work. And so if you think you can live like you were 18 when you're 45, that's not going to work for you. As sad as that is, I have people tell me all the time, I don't want to hear that. I want to still like eat pizza at 3 o'clock in the morning. And I'm like, no. You really don't. You really do need to alter your lifestyle to match your physiology. And that happens for men too, although it's not nearly as dramatic. You know, women kind of get shoved off a cliff and then there's a gradual decline in testosterone, but it's not nearly as dramatic as what women go through.
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And that's the thing that people don't understand. They think they're getting away with something, but in reality, they're not. Yeah, actually they're causing accumulation of issues that are gonna hit 'em later on down the road. And yeah, I think that bringing awareness to people younger is imperative too. And I think that this book should resonate with more than people that are just midlife. This should be an eye-opening experience and understanding for people younger to prepare for what's coming and to understand what happens and how to prevent these things from happening. And I think that that is an audience that I really hope listens and really takes note of this. And I really want to draw awareness to people of all ages because one of the things I've personally learned especially is thinking long-term and developing that thought process and starting young on all of this. See, this is part of the problem, and I'm curious what you think about this before we get into some of these topics. There's so many things that we're told, like you don't need to worry about this because you're this age. You don't need to do that until you get a little bit older.
My thought is we start this a hell of a lot younger with the education, the, the changing of habits, everything. And that way we can have a healthier aging process and we don't have to worry about a lot of these things being inevitable because we've already started the process of taking care of it.
Yeah. And I mean, I was telling someone the other day, I recall when my I have adult sons now, they're 18 and 20, which is hard for me to wrap my head around cuz it's, it's gone by so fast. But I recall when they were probably just the same as it was for you and I, fourth grade-ish is when you have sex ed. They separate the girls, they separate the boys. I think there needs to be mandatory, compulsory, equal information that the GYN or the internist is required to kind of start preparing people way before we get to 35 or 40 so that men and women, well, especially women because it's a little more dramatic for us, but just basic information. Because if I think if women could plan and know ahead of time, they would probably make better decisions. I think that for so many of us, like when I look at men, I mean, male factor infertility is increasingly on the rise. Largely a byproduct of insulin resistance, poor metabolic health, and exposure to estrogen mimicking chemicals. But we have escalating rates of infertility in both men and women. And I was just interviewing a fertility specialist and we were talking about this and I just said, our modern day lifestyles are not superimposed with our physiology.
And I think there just needs to be greater awareness because I think most people don't want to have trouble with infertility if they want to have children. I think most people don't want to be dealing with poor metabolic health issues as young people. I think most people do genuinely want to make good choices lifestyle-wise. They've just never been given the information. And if the parents don't embed that in their children, then you have another kind of lost generation. I'll use an example. So my older son is a sophomore in college and he has food allergies, so he has to be somewhat conscientious about what he's eating and We were having a conversation that, you know, he plays college lacrosse, he's in a frat, he's an engineering student, he's living his best life. And we were having a conversation about one night, you know, the, the guys ate pizza really late at night after a frat party. And he just said, mom, I felt so bad, like so bad physically that he was like, it just isn't worth it. He's like, I'm just starting to make these connections. And certainly like living at home. My husband and I cook real nutrient-dense foods.
My kids have an abundance of protein options. They're both very athletic, very fit, so they can tolerate a good amount of rice or pasta. And the joke in our house is that they eat like a pound of meat along with, you know, an equal amount of rice because they're trying to build muscle. So they're spiking their insulin. But the point of why I'm sharing this is if we're not helping our children learn how to cook, If we're not talking to them about protein and carbohydrates and unprocessed foods and hydration and being mindful of the other, you know, the exercise, strength training, all these things, then we're not setting a good example for them. And I think it really becomes this domino effect. So I look at my kids who are both very lean, very athletic, very healthy. And I always say to my husband, like, I know we did a great job with them because everything that we talk about and we embrace and we prioritize has really been embedded in them. And the irony is my older son lives in a dorm— not in a dorm, he lives in an apartment with 4, 3 friends.
So there's 4 guys, all 4 of these guys, their moms taught them how to cook, which I love. I was like, this is fantastic. I mean, this is like a lost art because we have generations that are taught that they don't know how to cook. And so if they don't know how to cook, then they need to buy food outside the house all the time. They need fast food. They need the processed stuff. And you and I were talking before we started recording that when you travel, you don't even go to True Food Kitchen. You're like, oh, forget it. I buy my own pots and pans and I cook for myself everywhere I go. And you just start to understand that, you know, those habits have been embedded in you and they probably make a big difference over time being able to cook yourself as opposed to having someone else cook for you. I think I just got off on a tangent, but it was not—
Oh, the tangents are the best information. That's the best part. Here's my problem with some things, and I'm curious as to what you think about this. Well, one of my big issues that I've always said is when we're going through schooling, we don't really get taught the things that we need to know how to live. They don't teach you about credit, how to balance checkbooks, how to do accounting, and the importance of having credit. And they certainly don't teach us about what you just said about the importance of nutrition. The different types of foods, the different micro and macronutrients, which we should learn all about. They don't teach you how to read food labels. There's nothing. There's absolutely nothing. And the other thing that bothers me a ton is when I, I would always, and I stopped taking personal clients now because I don't have time, but one of the big things I would always get with parents, well, you know, I have to, my diet, because I have to feed the kids pizza or macaroni cheese. And, and my response was always, No, I don't know. Why are you feeding them that?
Why?
And, and if you are gonna feed them that, why do you have to eat that? So there's a problem there. One is you shouldn't be feeding them that crap. You should be teaching them how to eat properly when they're young. I'm not saying, you know, run a boot camp and never let them have anything. That's not ideal or smart either, cuz then that'll help actually develop bad habits later. But I'm saying teach them young and you certainly don't have to just eat that or do that. See, I don't, I don't fall in line or, or understand or grasp that whole mindset. So I'm wondering about, you know, especially since you have kids and everything, your thoughts on that.
Yeah, no, it's funny. I recall, you know, my kids have traveled quite a bit internationally and, you know, they've been to over 20-some-odd countries. And so people would always remark, oh, your kids don't want like the kids' plate? I'm like, no. First of all, they're boys. They eat a lot of food. So the kids' plate stopped working when they were probably 4 or 5, but You know, I think that I never cooked two separate meals. I made it very clear, like, we make one meal. Now, this isn't to suggest that my kids hated a vegetable, I forced them to eat it, but in my house, there's no, someone gets one set of food and someone gets another. And I saw a lot of my friends who were just incredibly accommodating of quirky things. And I would say, you know, you're not instilling in your kids that You know, it's not adult food and kid food, it's food. And that's kind of the, what should be conveyed. Like my kids have, when they've traveled the world, they've had all different kinds of foods. And I think they've been really open-minded and I'm proud of that because I think that life is far more interesting when our kids eat more than chicken fingers and french fries.
Now I'm sure Dylan, honestly, if my husband bought a bag of chicken Fingers right now, it would be gone and it'd be gone immediately because that would be a treat. But with that being said, I think that in many ways we facilitate kids being really picky and only choosing to have 3 foods or 5 foods or 2 foods that they refuse to eat. I, I've had friends say, you know, my kid will only eat the chicken fingers and french fries. And I was like, well, when your kid gets hungry enough, they'll eat more than that.
Exactly.
And you are the parent. And I say this lovingly, you are the parent. Just remember that, like, yes, your kids can be willful. I have a second child who's super willful. Older son, a little less willful. One is a little more food adventurous than the other, but we didn't accommodate much. Like, I have one child who prefers raw fish, not cooked fish, and I don't make a big deal about that. I'm just like, Fine. Preferences over vegetables. Fine. You know, I'd give them a couple options. I say, what would you like tonight? Here's 3 options. Pick one. You're going to have one on your plate. It's not a, it's not a question of if it's, it's a question of pick one or I will pick it for you. So that seemed to work out really well. But I, but I think even down to when I, I worked part-time as an NP when the boys were young and the wonderful woman who took care of them in my absence made whole cooked food. Like she didn't skimp. There was no junky stuff. She didn't cook hot dogs and beans. And for anyone who loves hot dogs, I'm just using that as an example, but she would make real food for them.
And so like the reinforcement consistently was we eat real food. We eat the same food as mom and dad. We don't get special food. And occasionally you might have a chicken nugget, but that's like a rarity. But when we would go out to eat, my kids generally did not eat off the kids menu. They would eat off the regular menu. They'd have the steak, they'd have the chicken, they'd piece of fish. Maybe not the kid who doesn't like the cooked fish, but the point being they were fairly food adventurous because we set that expectation.
Once you set like routines of eating good and then you get used to it, you can't live without the food you're eating. And I am a perfect testament to that because I, I, the foods that I eat now, I can't go without. I would, I would've told you before I wouldn't touch or I didn't like without even trying them. You know, and it's like the whole list of my top 5 foods that I can't live without, even just a few years ago, I wouldn't even touch them. And it's, it's all about developing the habit. And of course, one, you're the parent, you know, so the kid shouldn't be running the house, but two, if that's all you're giving them, of course, that's all they're going to want. Why wouldn't they? The problem is, as you know, and as you age, especially those foods, they sound great. They smell great. But as soon as you eat them within 5 or 10 minutes, you're, it's like the night after you drank, oh, I wish I wouldn't have done that. You know what I mean, and the same with the meal. You wish you wouldn't have done it cuz you feel horrible.
Well, and not to mention the fact, I mean, the ultra-processed foods trick your brain into thinking you haven't eaten as much as you have, you know, anywhere from 500 to 1,000 additional calories you're consuming per day.
Right.
So, you know, you wonder how we end up having poor metabolic health. It's not helped by, you know, making food choices. And it's not to suggest, like when I travel generally, I'll either fast or I can make a, jokingly, I can put together a makeshift meal of, you know, beef jerky, salted macadamia nuts or salted pistachios. And maybe one other thing like a boil, like a hard-boiled egg or a piece of cheese. I mean, I can make a makeshift I'm starving meal, but it's not, it's not glamorous, but I can do it. But I think for a lot of people it's easier to say it's too hard. So I'll just eat the burger, like the, you know, the burger with 95 pieces of bread on it and crappy American cheese and everything else.
It's just about having the desire to take care of yourself. You know, I, I don't think I told you this, but every single event I go to, I have a set time and it's normally about 2 o'clock where I don't take anything from 2 to at least 3 because I'm leaving and I'm going home to cook and then I'm coming back.
And that's just—
yeah, I block it off. And I, that's just, that's the way it's going to be. And I don't care where I'm at or what I'm doing, but you know, you have to, you have to have that within you and the want. And to me, it's like, that is a priority, you know? And I think priority number one, well, for me is always God, but then it should be your health and taking care of yourself. So what you're eating, what you're doing, if you're moving, I don't care if you're traveling or not, get up earlier and go walk. Doesn't matter. I don't like excuses because I know You know, through things that I've encountered and been through in my life, you can do whatever the hell you want if it's a priority.
Absolutely. Absolutely. I was saying to an earlier podcast guest that I could choose to stand while I'm podcasting virtually, but I actually sit because it allows me to stay really focused. But when I'm done podcasting, what do I do? I said, in my part of my state, there are not many basements, so everyone builds up. So we have a 3-story house that goes up. Very tall, and I said, I'll walk up and down the stairs a few times just to kind of, you know, clear my head. Take the one of, I have 3 dogs, take one of the dogs for a walk. It's really important to not just put those blinders on and convince yourself that movement's not important. It's important for so many things, not just digestion, not just skeletal muscle movement, brain health. And I think people make things far too complicated. If I'm traveling, Dylan, and I can't get it like a regular workout in. I'll just walk around outside. Like I'm that person. I'll put my shoes on and I'll have my exercise clothes on. And I just, you know, that's why that one hotel in LA is perfect because there's a mall around the corner.
And I, I'm not at a, it's an outside mall 'cause it's California, but I'll just do a couple loops inside there. I can get a couple miles in just walking around and I'm like, okay, I'm outside in the sunshine. I'm not doing any shopping. I'm admiring all the crazy things I see. I just put my sunglasses on. And I'm moving my body, which I think we sometimes forget that just something as simple as movement in general is really important for our health.
You know what my problem is, is I go on these trips and I have to, those normally, cause I don't really rest very much. I kind of overtrain a little bit. So those days I just get up and go walk. Well, the other day we were in, we were in Pasadena and I started walking and I had to be home at a certain time. Queenie's like, where are you? And I'm like, shit, I don't know. I'm lost. You know, cause I just started walking and I was talking to my mom on the phone and then I started to do some prayers and before I knew it, I was like looking around and I thought, okay, that's not the right street. That's not the right street. And just like, oh shit, you know, and started to run home. But okay. So, you know, you and I have interviewed a lot of similar people. You've interviewed far more than I have, but we have had some similar people. And you brought up a couple things earlier that I want to touch on that are in your book that I just kind of learned about. And, and I'm going to throw a couple names out and you're probably going to smile and say, yes, yes.
But Dr. William Li, uh, Dr. Jeffrey Bland, uh, Colleen Cutcliffe, these three I just spoke with recently. And so these three to me were the ones that made the most sense that actually got deep into the gut, the microbiome, where they actually explained things that didn't just tell me, oh, the gut is important and it it, it controls everything, or this. They actually broke it down for me. And one of the things that you said that you wrote about that I wasn't versed on was about the immune system. And I really gained a lot from those three individuals. And that's where I, I got the more intricate side of, of understanding the importance of microbiome and the relation it had to our overall health in terms of why are we getting sick so easy, you know, and, and why do we not recover well from illness or sickness? Why is this lingering? So could you touch on that? Because I know it's a big part of your book and I'd really love to get some insight from you on that.
Yeah, those are 3 great guests. Uh, Colleen and I were both at Hopkins at the same time, although we did not know each other. And William is brilliant, as is Jeff, and just such nice down-to-earth clinicians and researchers. So the immune system, as I mentioned, ages right along with us. But what's interesting is that with this decline in estrogen, we start seeing immune system devolution, if you will. So I mentioned that the immune system, immunosenescence, inflammaging, all kind of correlates with this decline in hormones. And estrogen and the immune system are intricately intertwined with one another. As estrogen declines, and I think everyone acknowledges that estrogen's an important hormone actually for men and for women, we start seeing more leaky gut. If you think about the small intestinal lining, it's one cell layer thick. And if you think about a brick and mortar analogy, estrogen is the mortar and the bricks. And as estrogen's declining, we start seeing more tight junction opening and we will leak food particles into the bloodstream, will trigger an immune response. So this is when women will say, gosh, foods I used to eat just don't land the same way with me.
I'm suddenly sensitive to dairy. Or they get provocation of histamine responses and they suddenly start developing rashes or even allergic reactions to foods that had otherwise always been tolerated. There's something called the thymus gland, and it's kind of, by the time we get to be adults, it's kind of a fatty blob of tissue. But what's interesting is in the immune system, we have these T helper cells. We have a T helper 1 and T helper 2. And what happens to women in the setting of a decline in estrogen in particular, we start seeing more opportunistic infection. We have less of a reaction to vaccines. So when you go to CVS and they offer you a shingles vaccine, a flu vaccine, and a pneumonia vaccine, Number one, they're acknowledging that as you are aging, you are more susceptible to these things, but it's also acknowledging that we just have an immune system as women that is more provoked. Women, women are 4 to 5 times more likely to develop autoimmune conditions in middle age. So things like celiac, rheumatoid, Hashimoto's. When I finished my medical training, I was talking to a colleague recently. I said, what were there, like 20, 30 diagnoses?
That's what we knew of. Now there's over 100, including things like long-haul COVID and chronic Lyme. So autoimmune conditions in women will start seeing an uptick. And I remind women all the time that once you have one autoimmune condition, you're likely to have more. And so the immune system is there to protect us. We have kind of a basic immune system, you know, the barriers like cilia in our nose, our skin is designed to be a barrier. And then there's a more targeted immune system that develops antibodies, is more sophisticated. Both of them start to change as we are navigating this decline in hormones. Women may see things like the autoimmune condition leaky gut as their microbiome in their vagina, vag— they may have more urinary tract infections. They may have painful sex, pelvic floor issues. They may be getting up at night more often to pee. Not a fun thing. That can also happen to men, but obviously it can be from an enlarged prostate, but it becomes this kind of domino effect. The immune system's there to protect us. It starts working a bit less effectively. We can't mount the same immune response than we did when we were younger.
We become less responsive to vaccines. We start seeing more autoimmune conditions. As I mentioned, not an exhaustive list, but there are quite a few. And what I find for a lot of women, the first sign that something is changing in their digestive system is the bloating, the alterations in bowel habits. The feeling like they have more reflux, more heartburn, and that can all be a sign of alterations in the immune system along with some other changes that happen with what I refer to as digestive fire. And I'm sure we'll probably talk about what that is.
Yeah. I mean, there's a lot there that goes on. How prevalent of a problem do you think this is for women at this stage of life? And then just women or men in general, but specifically at this stage of life, because as time has gone on, we've actually accumulated in and develop this into a much bigger problem. And if it's not addressed, then it turns into a full-blown disaster.
Yeah. I mean, I, I think there's many things I always say perimenopause is a litmus test for how well we take care of ourselves. Because irrespective of how we grow up, we get away with a lot in our teens, twenties, and thirties. As hormones start declining, neurotransmitters start shifting, our coping skills that were at one point adaptive can become maladaptive, meaning You know, the not enough sleep, the overexercising, the too low carbohydrate or, you know, food restriction or those things can start to backfire. In fact, oftentimes I'm telling women do less, do less, not more, because our standard kind of prevailing thought is if I start gaining weight in middle age, I just need to eat less and exercise more. I just need to fast more and eat less carbohydrate because carbohydrates must be the problem. And it's helping them understand that as our physiology is changing, less skeletal muscle mass, decline in estrogen, decline in progesterone, decline in testosterone. Not in every person. Some women, about 25%, still make enough testosterone. But with those alterations, changes in the immune system, more susceptibility to stress. Like one thing about women in middle age is that what you can get away with in terms of hormetic stress or just stress of life.
Starts to shift. So you don't cope quite as well when you're not sleeping 7, 8 hours a night.
Right.
You don't cope quite as well with this really intense exercise. So I usually use the example of Orange Theory Fitness or CrossFit. If you think you can do that 6 days a week with no recovery, you're gonna crash and burn in middle age.
Right.
I think for a lot of women, maybe they were doing a little bit of intermittent fasting at certain times during their cycle. All of a sudden, like compressing their feeding window means they can't get enough protein in. Can't get it, if they can't get enough protein in and they're not lifting regularly, they're going to get this unwinding of skeletal muscle. And so sarcopenia is a real issue that also makes us lose insulin sensitivity. So metabolic health piece, this weight loss resistance piece is never just one issue. It is generally multiple issues that are contributing. Not to mention the fact, as we're getting older, we produce less stomach acid. Stomach acid is what helps break protein down into amino acids so it can be absorbed. We generally also have less digestive enzymes, so we're not breaking down protein, fat, carbs, so not able to absorb as much across that small intestinal lining. And then as estrogen's declining, this is kind of one of those nerdy things, as estrogen Uh-huh. Down and emulsify fats and it with multiple angles of what can impact digestion and how they feel. And there's certainly lots of, you know, tips and tricks that I talk about in The Menopause Gut, but I think for a lot of individuals they're surprised.
They're like, perimenopause snuck up on me and no one told me that bloating was normal. Like, I think that might've been my first symptom. And I was like, what is this? You know, I wake up with a flat stomach and I go to bed looking 6 months pregnant. And there's no woman out there who wants to look 6 months pregnant. No. When they're not pregnant. Like, let's be very clear. You know, it's like, what is going on with my body? So I think in a lot of different ways, women start to feel like their body's working against them and not for them.
You said something there, and it's very natural to assume to just start training when you see anything wrong, especially somebody like me. And there's a lot of people out there like that, that that's just the first answer. And you brought up overtraining. So I would, I would love to get into the dangers of overtraining, what, what problems that can cause and how that can have an adverse effect on what you're actually hoping for.
Yeah. I mean, I, I think it is human nature that the solution to the problem is more work, right? I mean, I think that's human nature. I certainly was guilty of this in perimenopause. I was like, I'm weight loss resistant. I just have to work out harder.
Right.
What people need to understand is that exercise is one of many types of hormetic stress, beneficial stress in the right amount at the right time. So for these women in perimenopause in particular, you know, they start gaining weight, you know, they're frustrated. They're like, okay, I just need to get up earlier for the gym and work out twice as hard as I did before. And then I'm going to intermittent fast and not eat for 6 hours after I finished exercising. And then by the time I get home, I can't settle down. So I'm not getting enough sleep. It's really important to understand that exercise is a hormetic stress. So if you are really tired after exercise, that's a sign you might be overtraining. If you don't recover from an injury, that might be a sign you're not training. If you're still getting a menstrual cycle and you stop getting a menstrual cycle, that might be a sign you're not— you're overtraining. Mm-hmm. I think, you know, persistent soreness, especially persistent fatigue. It could also be signs of other things, but one tough workout is one thing. One tough workout that you never seem to recover from, you're getting sick more often.
But we know if you're overtaxing your immune system, that's always my tell. Yeah. Throughout this book launch timeline, that was always my tell. I would tell my team, oh my God, I'm losing my voice again. And they're like, oh, you need to make sure that you do more self-care and get to bed earlier. But I think for a lot of women, we've been conditioned to believe that when we don't have the output that we want, and generally that's changes in body composition or weight loss. The solution is to work harder. And I'm here to tell you, oftentimes it's to do less, less fasting, less exercise, more sleep, more recovery. And that can be a little bit of a mind screw for women because that is not what we've been conditioned to believe.
Mm-hmm.
And I think there's a very fine line between relative energy deficiency or RED-S, which I think there are a lot of women out there that never properly fuel their bodies. So you're not gonna get the recovery that. Someone else is getting because they're eating the proper macros. They're being conscientious about their protein. They're being conscientious about their fiber. They're being conscientious about their carbohydrate intake versus someone that's like, oh, I've got a 4-hour feeding window and I just had really, really intense exercise the last 3 days and I'm going to eat in this super compressed feeding window. So maybe I'll eat one meal and that'll be my recovery. That doesn't work.
No.
And so more often than not, I'm encouraging women to stop overtraining. To listen to their bodies. Like the me from 10 years ago, maybe 12 years ago, I was up at 4 o'clock in the morning. I would take really intense conditioning classes. I would shower at the gym, race home to get my kids on the bus, get them ready, get them on the bus. Then I would go to the hospital. And that was my life for a long time. I can't think of something I'd want to do less now. I would love to go back and be mom for little kids for a couple days, but The point of what I'm making is I got up at 4 o'clock in the morning. It didn't matter what time I went to bed. It didn't matter if I slept well or not. I was still waking up. And so oftentimes the things I tell women that they need to stop are things I had done myself. So I understand what it's like to hear someone say, I think you need to do less.
It's nice to hear. It's hard to comprehend. And as, especially as you get older, a lot of times less is more. It's more the quality. Of how you do it and what you do it and the way that you do it. It's, it's just like anything else, man. It's like the athlete that they have to train smarter. They gotta play smarter. You gotta lift smarter. I run into this all the time where, oh, you've gotta lift heavy weights all the time. And I always tell people, what's the point in lifting heavy weights all the time? But you're always injured cuz you're gonna get injured as you get older. It's inevitable.
Yeah.
I would rather lift consistently and, you know, I'd say, you know, good hard workout, not crazy or anything, but be able to do it. I mean, hey, I lifted so heavy today and now I'm screwed up for 3 weeks. I mean, you know, it kind of defeats the purpose. So it's, it's just, I think a lot of it is so much up here in all of us, even us that do this or talk about it. It's not easy. You know this about me is my background is a lot in hormones and so I really have a knack for understanding what women go through, but also don't understand. And I think that women are always gonna be a little bit more in tune with their bodies than men because they go through so much more. So you kind of have to be, it's not, it's just, it's just the way it is. And not that men aren't thoroughly in tune because we are, but you guys have, it's like quadruple the amount of stuff. And especially as you get older. So here's my, my wonder and my question to you, because as I've really gotten more versed in this and talked with more experts and experienced more, the, the whole testosterone aspect with women is becoming more widely recognized as like one of the biggest issues during menopause.
And of course progesterone and estrogen balance is there, but I think part of it is a lack of understanding why you need it or what it is. 'Cause it's fair. Everybody just thinks it's a male thing. Just like men don't often understand unless they're bodybuilders, the importance of estrogen.
Yeah.
But I think too that women are kind of scared of it. I'm fairly sure of that because they have a one-track thought of, well, that's gonna make me big or give me, make me talk like a man or, you know, whatever. But could you speak on, one, why that it hits women so hard and two, how big of a problem this is and, and why aren't more women either in tune with it or checking it?
Yeah, I, I mean, I think there's, there's a twofold issue. Number one, there's this misconception that women are going to get masculinized with testosterone and women make 1/10 of the amount of testosterone as men. So it's a very potent hormone in women. But with that being said, in, you know, the proper range, you're not gonna get masculinized. I mean, you would have to be taking, you'd have to be hitting doses of where men would be on a normal kind of distribution curve. I think a lot of clinicians, because technically testosterone is not FDA approved, which is complete BS because women make it, 75% of us make it up until menopause, and then most of us benefit from replenishment. But a lot of clinicians are never trained, you know, they're not trained to check hormones. You know, looking at a free and total testosterone as a starting point. I think that people tend to think about testosterone in a very myopic way. It's just about libido. No, it's your executive function hormone. It's the get off your ass and go to the gym. It's the get things done hormone. It also impacts body composition. And so I think for a lot of women that get fixated on, oh, it must be 'cause my cortisol's high or my estrogen's not optimal.
It very likely is that your testosterone's not optimized either. And so I think on a lot of different levels, like as the black box warning was removed from estrogen and Marty Makary's working diligently to kind of speed things through the FDA or make changes, and this is not a political statement, I'm just saying, I think that it's good that, you know, he seems to be doing a mea culpa for the Women's Health Initiative that came out in 2002. But I think for a lot of individuals, It's helping them understand that number one, you deserve to have testosterone replacement therapy if your testosterone levels are not optimal.
Yes.
And, and full stop. This is for men and for women. And I think that, you know, I, I'm doing an N of 1 experiment. Uh, for a long time I've been taking compounded testosterone. I just got tired of rubbing compounded creams on my body because they're ridiculously expensive. Let's be transparent. So I said to my primary, I was like, can you just gimme some Androgel and I'll just squirt out a pea-sized amount. I'll try that and see how I do. It is super cost-effective. It's like $5 for a big bag. It, I mean, the last bag I received from CVS, I've had it since October.
Yeah.
This is almost 6 months. $5. That's how it should be.
Right. Well, and, and women, so for men when they use Androgel, it requires so much more, especially if they're severely hypergonadal and it's not very effective. But for women, it's like a dream. Because it doesn't take much at all and it's so good in terms of how it'll work for you. And it's like, it's perfectly suited for you. 'Cause let me tell you something, it does get old injecting. 'Cause I, I put myself on it like a fool and that's a whole nother story, like too young because of the, the work that I was doing in the environment I was in. And I teach people to not do that and it sucks. But for women, you guys could make it severely easy, like, like you just said, and it'll cost you nothing. And it takes like a pea size to actually work. So in that regard, I think more it's, it's, we need to be reliant on people like you to deliver the message of the importance of, because it's one thing to hear it from a guy, but it's a whole nother thing to hear it from a woman that is, you know, looked upon as an expert or really respected explaining this to them because you can relate more with a female going through it.
And I, and I understand. How it, it, it can be in your head, oh, it's gonna do this and that. But factually it is so, so, so important because without that balance, it, that is the lowest quality of life possible to have that testosterone gone, even for women.
Yeah. Well, and I think for a lot of people it precipitates mood disorders. I think so much of it is thought it's just, you know, progesterone and estrogen, but I, I really do think of hormones as a symphony. And for each one of us, like this very much this bio-individual approach that for each one of us, that symphony might sound a little different because that is as unique as our bodies are. So, you know, my hope and my intent is that we'll start seeing testosterone being properly evaluated for each patient and not being told, like, there are some people in the menopause space that they want the lowest Lowest dose available for hormones, not optimization, just baseline replenishment. And I think that, you know, patients will sometimes say to me, I feel really good when my free testosterone is X. I feel really good when my total testosterone is Y. And I really think that that speaks to this very much, this bioindividual approach. Like there should be a range, you know, there should be an optimal range. Now I will be totally transparent and tell you that. I've interviewed enough experts on the podcast, some of whom do pellets, most of them don't, because of the super physiologic dosing that comes with pellet therapy.
Yeah.
And I've had women say to me, I feel like I was chasing a high over and over and over again. Like the first high I got from testosterone, I never felt that good again. And so I always say, unfortunately, that is because you got a super physiologic dose. They keep it really high because you're, you're getting a, a pellet placed every 3 to 4 months. And if they overdose you or put you too high, you're stuck. Like they can't remove it. And so I think that, you know, there, there's kind of a graduated approach, you know, transdermal approaches for women, then maybe subcutaneous, then, you know, maybe IM, but that's probably not my favorite either. And then the other thing transparently is there's a lot of people in the health and wellness space that are women that are using anabolics and you can tell.
Yeah. I, I've I've seen it all and I've been through it all, and I will tell you in my experiences, and I say this as somebody that has been in the trenches for 15 years, there are so many doctors and people that go to their books or go to something that have no clue about understanding ester chains that are attached to testosterone and the highs and lows. The peaks and troughs and they don't grasp and they put people on different methods. Like you said, with the pellets, which I would never be in agreement with for anyone.
There's too many other options and there is, and every time I say that, I get a message from someone saying it's awesome. And then, you know, a couple months later they'll say, oh, you're so right. I feel terrible now. So I think that I know they're very profitable and I know the people that are doing them. I think that they, they believe that they're giving women what they're asking for, but I, I like predictability when it comes to replenishing, replacing hormones. And so I, I just think there's better options. And I'll share with you transparently, when I first started HRT, there was a provider who's never been a podcast guest. So I'll just put it to my, your community that way. Cause people then always want to know where are they in Texas? They've never been a podcast guest, but I think it's important and significant to say that this individual convinced me that IM administration of estrogen and testosterone was the way to go.
Always.
Well, for me it wasn't.
Yeah.
And I mean, it, it was a little bit of a disaster. And so I said, I think some of us are really sensitive to replacing hormones. And so this individual was, because I was not fitting the way that he wanted me to fit within his kind of practice paradigm, we had to part ways. But for me, I don't need to have super physiologic dosing to feel good. Mm-hmm. And so I think if, if anyone's listening and they haven't yet met the right provider, I promise you they're out there. It took me a little bit of fits and starts to get to the right people. But I, I, I think you'll know when your hormones are optimized within the range that you want them to be in, cuz you'll, your brain will work. And, and I think Dylan, and, and I'm sure you would agree with this, when you're a podcast host and you're speaking on stages, I have to feel like all my cylinders are firing and then some. So if my hormones are not optimized, I'm going to know. That's exactly right. We're going to know. The, my one tell, and this is funny, I did a, I did a little Insta story about this.
I was sitting in the airport and I was irritated. I was irritated by someone who was chewing their gum like a cow and I made a comment. So I like put, and I was like, clearly my estrogen patch needs to be changed tomorrow because I'm so irritable. And sure enough, then when all these people were commenting, they're like, oh my God, same with me. That's exactly what happened to me the day before I changed my patch. And I was like, otherwise I'm like, whatever, you know, when I'm traveling, it's like, go with the flow. But this woman was chewing like a cow with her gum, like popping and snacking. I was like, I kept looking at her like, do you realize you're disturbing all of us?
I don't care how balanced I am. I would've been annoyed. I don't even care. No, I will say this, and this is how you know when you're dealing with somebody quite smart or somebody that you were dealing with that is not. The, the best way to get it into your system and to absorb it without a shadow of a doubt is I Am. However, that does not make it suitable for everybody, and every single person is different on what they need and can handle. And just because that's the most efficient way doesn't mean it's the most effective way.
No, I think I had this massive peak and then I would have this massive trough. And so for listeners, peak is when you have the highest level and trough is generally your lowest level. And for me, I just, I mean, within 2 weeks I was like, holy cow. I just, I, it was not a good feeling. So for me personally, not the right decision for me. I know that other people have done well with subcutaneous or even IM injections, but that wasn't the right one for me.
My question would be too, and this is probably his ignorance. Is it depends too on the ester chain and when you're doing it. So for instance, test cypionate has the perfect half-life for TRT given the half-life. However, a lot of people like to take it once a week. The problem is, is you take it at the start of the week and by the time the end of the week hits, if you look at a level on somebody, they were at 700, 800 here and then it's down to 1. See, I've always, always said that you need to do it twice a week. You hit it right in the middle and you take your Like I take 75 milligrams Monday and Friday. Yeah. And I'm always in a straight line where I need to be, where it's perfect. Right. Yeah. But people don't understand esters and the release and how it works and, you know, misguided information is everywhere, unfortunately.
Yeah. I mean, I, I recall him saying to me, yeah, your levels look great now. And I'm like, I don't feel great.
Yeah. That's a problem.
I was like, I'm not, you know, So for women to have a sense, like your estradiol levels, which is our predominant form of estrogen our body makes until menopause, there's probably 2 or 3 days where your estrogen level's like 300. Yeah. He had me climb, like I was there for weeks and I kept saying I felt terrible and he was not listening. And I just said, this is not sustainable. I'm, I'm developing fluff and no woman out there wants to feel fluffy. That's not a good feel. Like we like our pancakes. Fluffy if we ain't talking about it.
Yeah, he had you on too much for sure. So, you know, one of the other things that you talked about was circadian rhythm. And I have really stressed, I don't know, the past 6 months, especially the importance of sleep. And, and I've caught a greater understanding and value as I've gotten older, especially that doing the 5 and 6 hour thing doesn't, it's not something to brag about. It's, it's, it's degrading your life. Would you talk about the importance of that in general, the sleep, and also how do we develop and fix circadian rhythm when it's kind of off and we're having trouble sleeping? What are some of your tips?
Yeah, so number one, I think of sleep as being foundational. So if you're not sleeping through the night, that's the first thing we have to work on. Not to mention the fact that if you look at the microbiome research, we have circadian clocks throughout our digestive system. You know, people always talk about the suprachiasmatic nucleus in our brain and I'm like, yes. That is the master clock. However, if you eat a large bolus of pizza at 2 o'clock in the morning, guess what happens? You are disrupting secretion of melatonin. You are disrupting circadian rhythms. You are not as insulin sensitive in the evening. There's so many things that happen, but when we're talking about circadian biology in a 101, it's really, we are awake when it's light outside and we go to sleep when it's dark outside. We eat earlier in the day when we are more insulin sensitive and our bodies are primed for food as opposed to not eating 2 to 3 hours before bedtime. So a lot of the things, you know, light exposure, meal timing, sleep awareness are all in alignment with the circadian rhythm. Now the circadian rhythm gets off due to meal timing, travel.
I mean, that's one of the big ones. You are on PST and I'm on EST. When I travel to the West Coast, I stay on the East Coast time and I'll be out there next week, and I will stay on East Coast time the entire time I'm out there. And I look like a loon and I'm in bed early, but I do so much better. But having said that, I think for anyone that's listening, things that disrupt circadian biology impact our health in very profound ways. We talk about shift workers. Shift workers are at greater risk for cardiovascular disease, poor metabolic health, certain types of cancers, all from the disruption of the circadian rhythm and alignment. Alignment. So when we're out of alignment due to jet lag or travel or stress or shift work, there are things that we have to do to kind of bring things back into alignment. You know, some of my patients, I had them get off a night shift. That was like the first thing that we did, because it was wrecking their metabolic health. It was wrecking everything about their lives. So the microbiome actually adjusts to sleep. So when you're not getting enough sleep, your microbiome shifts.
Sometimes it shifts in a way that you'll extract more calories from food. Sometimes you have more inflammatory bacteria. Sometimes it can interrupt the estrobolone, which is the estrogen processing center of the microbiome. But when I think about very tangible things that everyone can do that don't require any gadgets, light exposure in the morning can help with circadian realignment, meal timing. So eating earlier in the day, not later in the day, getting exercise, wearing blue blockers. So technically right now, cuz it's starting to, the sun's starting to go down. I should be wearing blue blockers cuz I'm under very bright lights right now, which is very stimulating, suppresses melatonin, increases cortisol to keep me alert. I also think about hydration. You know, for a lot of people we underestimate the value of hydration, but dehydration can exacerbate just about anything. I also think thoughtfully about the meal timing piece, not eating 3 to 4 hours before bed. And then we start layering in other things. If you are a perimenopausal woman, you may benefit from oral micronized progesterone. 1 to 2 weeks prior to your menstrual cycle. If you're later into perimenopause, you may benefit from estrogen therapy because progesterone helps us fall asleep and also upregulates GABA, which is this inhibitory neurotransmitter.
From progesterone, our body will make allopregnenolone, which has a sedating effect, and then estrogen can help with sleep. So I start thinking about modulating hormones. I also think a great deal about supportive supplements. So things like adaptogenic herbs, remora, ashwagandha, rhodiola. I think about supplementing with magnesium. I think about B vitamins, although usually we dose them in the morning. I think a great deal about myo-inositol, which for me is like the game changer nutrient that most of us need more of anyway. And I kind of titrate that depending on what I'm doing. Then we move on to like Vagal training, things that get us out of fight or flight. So whether it's humming, singing, putting legs up a wall, breathwork, reading a physical book, those are all things before we ever talk about gadgets, because inevitably what people do is they're not sleeping. They're like, oh, I need the Oura Ring. And I'm, I don't mean to pick on Oura Ring. I love my Oura Ring. I'm wearing one right now. But I think for a lot of people, they get focused on the Whoop Band, the Oura Ring, the vagal devices, which are great and awesome.
But I always say, don't add the devices until you've dialed in on The lifestyle measures that really make the biggest impact. And here's the thing, Dylan, when someone's doing everything and they're still not sleeping, I'm like, it's gut health. It's unresolved trauma. It's chronic stress. Show me a woman who doesn't sleep well and show me a woman who doesn't manage her stress. Full stop. It is never an exception to that. And I think for a lot of women, they think they're managing their stress. But they're actually not, you know, whatever you need to do to manage your stress, be, do something that you like and do it often. So for me, I can do breathwork anywhere and that's usually my go-to. That's how I, you know, I can slow my heart rate down. I stimulate my vagus nerve. I'll get myself out of fight or flight. I do things before bedtime. Once you've mastered all the basics, then you can layer in other things. But I think for a lot of women, it's diagnostic stool testing, really looking at what's going on. Far too many women have a lot of issues in the gut that are driving a lot of the symptoms they experience.
You know, the vasomotor symptoms, the night sweats, which are really unpleasant for women to experience, plus or minus the underlying trauma that many of us don't deal with. And I always feel like perimenopause is the litmus test. That's when the wheels fall off the bus. That's when women suddenly, all those adaptive strategies they've used their entire lives become incredibly maladaptive. So. You have to deal with your stuff. And the research demonstrates if you have adverse childhood events scores, you know, anyone listening, there was a joint venture between Kaiser Permanente and the CDC. You can go online, very quick quiz. If you have a high ACE score, you are more likely to have poor metabolic health, disordered relationships with food, higher risk for cancer, earlier menopause, more likely to have autoimmune conditions. So for a lot of women, and I'm one of them. My ACE score is quite high. I think perimenopause was far harder. And I say that lovingly and respectfully. My parents did the best they could, but when you grew up with a lot of neglect and abuse and addiction and, you know, physical and verbal abuse, that imprints your nervous system. My nervous system tends to run hot, meaning it's much more reactive.
And there are a lot of women listening that we convince ourselves that what we grew up in was normal. And in many instances it's not. So just understand that if you're still struggling with sleep, the gut microbiome is part of the, is part of the equation. Addressing your underlying stress and trauma is part of the, the equation. It's not just about replenishing hormones. That estrogen patch is important, but it's not the only solution.
Right. Well said. So one more question for you. Um, I'm curious, this is more of a personal question, but a recommendation. So I'm curious to, if you have a protocol or certain supplements that you think are more, I don't wanna even say imperative, but helpful when you are going through these different stages of menopause that you really stand behind or that you personally use. Now, I always talked about creatine as one of those being very, very important. And you and I got into that last time quite a bit about you know, the right forms of creatine and the basic importance of it. But I, I'm very curious as to your thoughts on certain recommendations, and I wanna preface that by saying you made it very clear already, don't rely on these before. So people listening, she's not saying these are magic, these are extra added beneficial things after you've done everything else that, that she talks about in her book. And this is just an something extra.
Yeah, I would say the things that stand out that I think every woman needs to know, you need to know your vitamin D levels. You very likely need to replenish magnesium. There's over 400 enzymatic reactions in the body, and you need a red blood cell magnesium because that is actually more accurate than a standard magnesium level. And it's not an unusual test. I drew it all the time in cardiology, and I've been outta cardiology for 10 years, so I'll just put it to you that way. Magnesium is absolutely something that I think about adaptogenic herbs because we become less stress resilient. So I think more about B vitamins. I think about adrenal nutrients. The adrenal nutrients are the magnesium, the vitamin C, the B vitamins. There's a lot of nice formulations that are out there. Of course, creatine monohydrate, and there's more to creatine, like the research is evolving about the microbiome. There's another indication for helping with small intestinal permeability. There's so much about creatine monohydrate. It is a total game changer. Everyone listening should be taking creatine monohydrate and let me be very clear. You wanna make sure it is Kreapure or Kreavitalis.
Unfortunately, the darned German company now is forcing all of us in the Health of Mama space to use Kreavitalis. So it's a more expensive investment. Exactly. That's exactly what my— your facial expression was exactly mine. I was like, a what? Uh, so that's the highest quality. You're less likely to be reactive. You wanna be conscientious about sourcing it from reliable companies. It doesn't have to be my own. It can be, there many good companies that use that. I think the other things that I consider is really dependent on what you personally need. So, you know, I feel like a lot of my patients need stress support, so those adaptogenic herbs become more important. I think that, you know, we're learning a whole lot more about short-chain fatty acids, and I, we didn't even touch on these, but as our hormones are declining, we start making less short-chain fatty acids, and that's when fiber becomes important. But I would like people to get fiber from food, not fiber from a supplement. And I guess the last thing that I would say is magnesium soaks. I know this isn't gonna be sexy, but this is something I used to teach my patients.
So not only do you need oral magnesium, you need skin absorb transdermal magnesium. So this is my magnesium soak recipe. 2 cups of magnesium. So magnesium sulfate soaks, 2 cups of baking soda, 2 tablespoons of borax. That will help you absorb more. And notice borax, we're not talking about swallowing it. We're just saying we're gonna soak our feet in it, or we're gonna take a bath with it. And that will really help your body absorb the magnesium. Now, yes, it requires a couple steps, but I found that to be really effective because so many of my patients were dealing with palpitations. Irregular heartbeat after we'd ruled out really serious things. And that was a way that I got their magnesium levels replenished in a way that they were sustainable over time. It doesn't mean you need that every day, maybe once or twice a week. And we're heading into warmer weather where I am, and there's no way in heck I'm taking a hot bath in the middle of summer. So that's when I will sometimes sit at night with my husband and I'll just soak my feet.
Glad you brought that up cuz I'm having the same problem cuz I was taking Jardy and and the palpitations have been like frequent and it's not anything else. I've had every test under the sun and I know what it is and I can't seem to get it back properly no matter how much I take in.
It can also be hormones. I mean, that's one thing, like depending on, you know, where your variances are. I know for women, you know, that drop in estrogen and progesterone can provoke a lot of palpitations. Although traditional cardiology is just making sure you don't have an arrhythmia that's gonna kill you. It's like, we rule that out. Okay, so they're benign. So stay away from caffeine.
Yeah.
Stay hydrated. That, those, that Rose recommendations only go so far.
Right. So one more thing I'm gonna ask you, cuz you brought it up, the fiber. So I wanna just quickly just talk about the absolute importance of fiber and then maybe a few good sources of where people should be looking for it.
Yep. So fiber is important. I, I mentioned these signaling molecules, short-chain fatty acid production goes down. They're important for de-inflaming. They're important for endogenous GLP-1 regulation. They're signaling molecules. One of them, butyrate, crosses the blood-brain barrier. So they're really, really important. They help with the mucus lining of the digestive system. So fiber becomes more important in middle age. When we eat fiber, fiber goes through the digestive system, gets to large intestine or colon. There, the colonocytes ferment it, and when they ferment it, what comes out of that are short-chain fatty acids. These are really important. So I remind people, this is why, and when the carnivores insist that we don't eat fiber, I remind them the research now suggests that if you are not consuming fiber in the absence of me, of eating any carbohydrates, you're just eating meat, your body in a desperation will try to ferment the protein, which is a bad thing. Putrefaction is not a good thing. You know, protein is not designed to be fermented. Ideally, I think about really easy ways to get more fiber into your diet. Number one, track so that you know where you are. Average American diet is anywhere from 5 to 8 grams a day because processed foods are really devoid of fiber.
So track where you are first. Most recommendations are anywhere from 20 to 30 grams a day. So if you're currently eating 5, don't try to go to 30. You'll be very unhappy cuz your microbes need time to acclimate.
Mm-hmm.
So when I think about gentle things that we can do with cooked vegetables, lentils, soaked beans. If you feel like beans become problematic, maybe you start with a tablespoon. You don't have to start with 5 cups. The other thing that I really like is fresh ground flax and chia seeds. Really, really gentle and easy. I have it in a smoothie every day. Uh, I will tell you, it will give you gold star poop. So, you know, when we talk about Bristol stool chart and we're looking at, you know, the ideal is a number 4. For a lot of my women that are either constipated or they have diarrhea, adding a little bit of fiber into their diet will generally help normalize things. Jokingly, in my house, they call artichokes fartichokes, but anything that is going to be beneficial, you know, think about ferments, fermented vegetables, or, you know, kind of good option. We don't have to get complicated. I think people automatically think salads. Yeah. And I'm like, salads are fine, but we want at least 30 plant species per week. So sometimes a salad is a good idea if you're trying to get like 10 things in at once.
But thinking thoughtfully throughout the week, I go through, I go through stages where I like certain vegetables and certain protein more than others. And jokingly, I always say monogamy is good, but food monogamy we don't want. So you don't wanna be eating the same exact food every single day.
Yeah.
Because those microbes in the gut need variety. You know, those brightly pigmented fruits and vegetables, that's valuable information. There's polyphenols and other really important things. So start simple. Don't overthink it before you even think about psyllium husk or any of these other varieties. I know when I was writing the book, my editor kept saying like, we need to have some options. And I'm like, yes, but I still want people to genuinely eat the food. Like that is the goal to eat the food.
Yes. I can't, as a nutritionist for so long, and as somebody that really has studied food as long as I have, I will never be able to get behind the, we don't need fiber thing. I just can't, I can't get there. And I've got some people that I really respect trying to tell me that, and I just, I cannot, I, I'll never get there. I just, I just don't grasp that one. So I'm glad you talked about that and brought up and different options too, cuz a lot of people, they do, they just think psyllium husk or they just think oatmeal or something. And that is just not, it's just, there's so many options. You just have to, A, understand and B, be creative, you know?
Absolutely. And I think, you know, when someone says to me, I don't tolerate anything other than meat, I'm like, something's going on in the microbiome. Like, I was hospitalized in 2019 and I talk about that in the book, and I went 9 months with eating boiled meat, which I did not enjoy, just eating meat. But that was all my digestive system could tolerate because my gut microbiome had been decimated after 6 weeks of antibiotics. So, you know, slowly over time. And it has taken time to build that back up. When someone tells me they do not tolerate fiber, sometimes it's quantity. Like I said, don't eat 5 cups of beans. If I ate 5 cups of beans, I would be really gassy. But yeah, you start with a tablespoon. Like sometimes it's quantity, sometimes it's the quality. You know, don't start with the supplements, start with the food because your body knows what to do with that.
Yeah.
And so people get caught up as soluble, insoluble, resistant starch. I'm like, just eat more fiber. Stop getting so caught up in the nuance. Like, just think high level. And again, the health of your microbiome to me can demonstrate whether or not you're tolerating much fiber. So trust me, in 2019, my gut was a disaster. I am now in, you know, 2026 and my gut is doing a whole lot better, but it has taken time. Sometimes it, what you need is a tincture of time. We talk about that in medicine. Sometimes you just need time. And, you know, we are a society that's instant gratification, doesn't like to wait, doesn't like to be patient. And sometimes I have to tell people, you need to be more patient.
Yeah.
Give it some time.
No, it's perfectly said. I swear to you, I could, I would, I think you and I could write a book together on stuff right now because I could just keep going. I know I said that I would be mindful of time and I just looked and I'm like, oh shit. Well, you know, I, I cannot tell you, Cynthia, and I express this wholeheartedly how much I enjoy talking with you. I think it's always so fun and nice every time I see you or anytime we get to encounter each other. It's always great. And I feel like we, we convey a lot of great information. So before I have you talk about your book or anything, just thank you. 'Cause I, I love this. I really do.
Thank you, Dylan. It's, it's an honor and thank you for being so gracious for Dylan's community to let everyone know that Dylan is just doing in-person podcasts right now. And, and my schedule has gotten so compressed that very graciously Dylan said, I will make an exception for you. So I'm truly very grateful and appreciative that you were willing to, to give me a little bit of a grace for that. And, and we'll obviously have to do an in-person podcast at some time.
Yeah, you're, I want you to be my most frequented guest, so you, anytime you want, you just tell me. So, Everybody, you have to get this book. And more than that, it's not just to go buy the book, it's to educate yourself and it's to change your life and to, to listen to the, the interviews that Cynthia gives and the people she has on and what we can extrapolate from all of these people and the conversations and the questions she asks. It's absolutely phenomenal. So if you would, A, publishing date, when can we buy this? B, where do we get it? And then where does everybody follow you? And everything will be in the description.
Thank you, Dylan. So it's The Menopause Gut, will be officially published on April 28th. Sold where all fine books are sold, Amazon, Barnes Noble, Target, Books-A-Million, your local bookstore. You definitely wanna check it out. And this is the kind of book you actually want the physical copy cuz there's so much information. I've been encouraging people, I'm like, buy one for yourself and buy a couple for your friends. This is a book that I think will end up being, um, a groundbreaking book. That's one of the things I've been hearing from the physicians I've been engaging with over the podcast are like, no one else is talking about this. This is so needed. And so you can find me all across social media. I'm probably most likely to be on Instagram, or I have a private Facebook group called the Midlife Pause backslash my name. Hint, that was the original working title of the book when I submitted my book proposal. Um, but it became evident that we needed to make the title very descriptive about what was contained in the book. And my podcast is Everyday Wellness. It's probably one of my favorite things I do in my wellness, in my business.
But if you go to my website, www.cynthiathurlow.com, there's a big banner at the top. You can click on that. It'll take you directly to pick the vendor of your choice to pick up a copy of The Menopause Gut.
Well, all I ask of you is a signed copy of the book and your friendship. That's all I want. So thank you so much for the time. It's gonna be cool to go back and watch the difference and how we interview and do stuff now when I go back and compare, which I'm certainly going to do. But I really enjoyed this. You know, it's, it's even a non-recording day for me and this was just fun. I just had a good time. It does not work at all. It's just fun. So thank you, Cynthia, for all that you do, all of the information, all the time you spend away from your family. Cause I know, I understand, I see it. So thank you. It's been a pleasure and an honor and hopefully we'll do this again soon.
Thanks, Dylan.
Awesome. All right, everybody. Well, get out and get this book. Follow along, follow Cynthia, and stay tuned for plenty more to come. Dylan Gemelli and Cynthia Thurlow signing off.
Episode #116 Featuring Cynthia Thurlow PART 2! THE MENOPAUSE GUT: Balance Your Microbiome to Reclaim Your Health in Midlife and Beyond
My DEAR FRIEND and Colleague Cynthia Thurlow makes her SECOND appearance on my podcast EXACTLY ONE YEAR to the date we recorded this episode together! God always has his way of working! Cynthia is far beyond brilliant... She is passionate and caring along with a deep drive and motivation to make a REAL difference. She is the epitome of compassion and care! Her drive to travel all over the world to make a difference, going non stop and still having a large family shows her willingness to do whatever it takes to spread her message. I am honored and privileged to call her a close friend of me and my wife and it is my honor to showcase her to the world and bring her new book to light for everyone!
This episode is not just meant to promote her new book, but to give deep insight into her work and passion behind it. We start with the discussion of the work and effort it took to create her new book, what inspired her and why she felt the topic of the gut was imperative to change the lives of everyone! We take a deep dive into menopause and how the gut plays a key role in how women make it or break it during this stage of life. Cynthia shows deep compassion for women that are suffering and has made it her life's work to help women overcome one of their biggest struggles in life. We then take a turn into eating habits, specifically as it relates to our children. There is a discussion on how there is a significant need to make it a priority to instill proper eating habits into our children's lives but to also set the examples ourselves for them as parents and role models. We then talk about the role the immune system plays in our gut health. This section of the discussion may be one of the most impactful because many are unaware of how imperative of a role the immune system plays. We then shift into the topic of overtraining and how truly detrimental it is for our health, short and long term. Then we get to the topic of testosterone specifically to women and how important it is to check and regulate, ESPECIALLY during menopause. We then cover hormone replacement therapy and how the polarization needs to stop! Then we shift to the huge importance of sleep and circadian rhythm, followed by a discussion on supplements, specifically the recommended or ideal ones to use during menopause. We end the conversation with a long conversation on the role of fiber in health!
Cynthia's knowledge and passion are showcased in this interview and once again, I want to reiterate the honor and pleasure of not only interviewing but calling her a true friend! DO NOT MISS THIS EPISODE!!
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