← BETTER! with Dr. Stephanie Estima | Strength, Body Composition & Perimenopause
BETTER! with Dr. Stephanie Estima | Strength, Body Composition & Perimenopause
Childhood Trauma, Birth Control & Your Gut: The Perimenopause Reckoning with Cynthia Thurlow
01:13:10
Weight changes, mood swings, and digestive issues? Let's stop framing aging as a failure! Cynthia Thurlow explores how these changes during menopause can actually transform your health journey.
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- [00:01]
A
Imagine if we said that to men. Like, imagine if we were like, you know, why you can't get erect? Like, maybe you should, like, join a running club.
- [00:09]
B
Meditate. You need to meditate on your way to an erection.
- [00:12]
A
Yeah, exactly.
- [00:14]
B
I was reflecting recently. How old was I the first time someone made a comment about my weight? Ooh, I was 12 years old.
- [00:23]
A
Yeah, I remember my nickname when I was in. I guess I was grade nine. Grade ten was caboose. Oh, here comes the caboose.
- [00:30]
B
Whether that's neglect or abuse or a family member had an addiction, the imprinting that we get as children from those experiences. You take that quiz, you get a number. If your number is high, and I think of high as anything over three or four.
- [00:46]
A
Seven, right. Seven, right. Over here. Yep.
- [00:49]
B
We know, based on research, that it puts you at risk for quite a few things, not just autoimmune conditions. If you think perimenopause and menopause is just about slapping on an estrogen patch, you're wrong. You want to understand how the gut interfaces with these changes in hormones and neurotransmitters, because it is oftentimes the missing link for why you're not feeling better.
- [01:18]
A
Hello, my friends. Welcome to another episode of better with Dr. Stephanie. It's me, your host, Dr. Stephanie Estima. Have you ever been told that you're gaining weight? Or you go into a doctor's office, you tell them that you're feeling sluggish, your mood is not exactly the way that it has been, you're noticing some changes, and it's framed as a failure for you, or you've been told, well, it's just. It's just aging, you know, suck it up, buttercup. If so, my conversation with Cynthia Thurlow is one that you are definitely going to want to turn into. We are talking about all of the changes that happen in perimenopause and menopause, and specifically, what are some of the changes in the digestive system that leak into things like our bone health, our muscle health, our mood and our affect, and the way that we show up and perform with our energy? If you don't know, Cynthia, she is a very familiar face on the show. But in case you've never heard one of our conversations in the past, she's a nurse practitioner. She's the host of the Everyday Wellness Podcast, Herself an author, an international speaker, she has over 15 million views on her second TED talk called Intermittent Fasting A Transformational Technique. Cynthia has over 25 years of experience in health and wellness, and She's a globally recognized expert in perimenopause and menopause and intermittent fasting. And what we talk about today is going to blow your mind. So we start off talking about her first foray into what might be perimenopause all those years ago and what her experience was when she was on this beautiful romantic trip with her husband. And. And then we move into some of the mechanistic changes that happen in the body through perimenopause, specifically how we metabolize estrogen and hormones in our gut and how we can start to support our bodies as we are moving through this transition, through nutrition, through sleep, through activity, and through stress management. This is a phenomenal episode for you. And maybe you wanna listen to this with a friend and have a little discussion afterwards in terms of any of the changes that maybe you yourself, yourself have noticed. I was telling Cynthia some of the changes that I have noticed myself as a 48 year old woman making this transition alongside with you and without further delay. Please enjoy my conversation with Cynthia Thurlow. All right, friends, there are a few major verticals that you should be investing in for better skin. First, a gym membership. We all know that training and cardio is great for your skin. Orgasms. Hello, obviously. And a great skincare line that makes your skin look and perform like younger skin. Now, when it comes to your face, specifically, as you age, skin tends to become thinner, it produces less collagen, the proliferation and turnover goes at a slower rate, and it accumulates more damage with time. Now, in the world of dupe culture, this is where I firmly believe in investing in the right technology and the right brands. And One Skin is the first peptide proven to reverse skin's biological age. The scientists there analyzed key aging biomarkers in human skin samples before and after treatment in the lab. And they found that the OS1 face cream that has that OS1 peptide increases epidermal thickness, supports collagen biosynthesis pathways. So for my nerds out there, this is the COL1A1 pathway, and it promoted cellular proliferation or that skin turnover. And when it comes to your eyes, which are typically five times thinner than the rest of your body, using their OS1 eye cream, which is formulated with the highest concentration of that OS1 peptide, this is going to help target the accelerated eye aging that many of us see at the molecular level. There was a recent 12 week clinical study on the OS1 eye cream, and it was recently published in the International Journal of Cosmetic Science. And the researchers there found significant improvements in appearance in hydration, in under eye elasticity, firmness, and skin barrier function. And they also noted decreases in fine lines and wrinkles under eye puffiness and dark circles. This has been a skincare line that I have been using for the better part of two years, and I swear by it for you. If you want skin that looks and behaves younger, I want you to head over to OneSkin Co better and and use code better for 15% off your first purchase. All right. And we are live. Cynthia, my friend, welcome back to the show. What is this, number three?
- [06:03]
B
I think so. I think so. We've had many, many wonderful conversations on my podcast as well as yours.
- [06:09]
A
I want to start, I want to set the scene for our Bettys. We are in this beautiful, exotic. We're in Morocco. We're on a beautiful, romantic trip with our husband. We're having a beautiful meal, and then tell us what happens.
- [06:27]
B
So, yes, for our 15th wedding anniversary, I had planned this incredibly romantic trip to Morocco and southern Spain. And my husband and I ate the same food when we were in Morocco, and one of us got sick and the other one did not. And so when I reflect on my time in Morocco, it is, you know, they're just the exotic sights, sounds, smells. I mean, Morocco is just such an enchanting place, incredibly romantic. And our last night we were in Morocco, we were in Casablanca because we were going to fly to southern Spain the following day. And I think that's probably where I got the food poisoning. But My entire next 24 hours were spent in such a state that I kept saying to my husband, how is it possible that I'm the only one that is getting sick and you are not? And what I did not realize was the friend that I picked up in Morocco, which was giardia, stayed with me for a few months and actually, you know, culminated in a lengthy hospitalization. But what is most relevant was nothing had prepared me for understanding what is transpiring in our bodies as we are navigating a decline in hormones and how that impacts not only our immune system but opportunistic infections. And so I think for a lot of women, they might be surprised to know that in conjunction with impact on bone health and heart health and cognitive health, that there's a whole reckoning going on in our microbiome that is interfacing with our immune system and makes us much more susceptible to opportunistic infections like the one that I picked up in Morocco. I always say, like, I have such wonderful memories minus getting so violently sick, but stayed with me for many months to come. And it's kind of the working hypothesis for why I ended up in the hospital in early 2019.
- [08:20]
A
And of course, we can't resist quoting the famous Casablanca movies. Like, out of all the restaurants and all the places, Gardia, you had to walk into my intestines and create havoc. Yes, I think. Well, I think what your story really illustrates is that women are. We have a different immune system. We are much more susceptible to potentially infection than maybe our male counterparts. And I think what was really interesting about the story that you outlined in your book is that this was sort of where you realized that maybe you were in perimenopause. Right. So some of those changes that make you a little bit more susceptible to, you know, a, A chronic or a. A. A severe infection because you and your husband, like, it's the same environment, it's the same stimulus, like you're eating off of the same plate. But you are the one who is hospitalized, not him.
- [09:06]
B
Absolutely. And I think for a lot of people, we think about what's changing in our bodies in the context of things that are very identifiable. Bones, heart, et cetera. Because the immune system is not something that we can necessarily see per se. I think a lot of us are probably. It's not on our radar. We don't even think about it. And yet, if you look at the statistics on what's changing in the immune system with women and our increased risk of, like, autoimmune conditions and other things that happen in this perimenopause to menopause transition, it suddenly starts making a great deal of sense. And, Stephanie, you're absolutely correct. I probably, in my mind was not thinking that I was in perimenopause, but I recall being in Morocco, and Morocco is incredibly hot. It might be the most warm climate I've ever been to. And I remember saying to my husband, I can't acclimate. Like, my temperature. I was getting. I was having hot flashes in the sense of also in 104, 105 degree heat. And I was like, how is that even physiologically possible? So all these things were happening, but I think I was in tremendous denial. Like, when I think about it now, I'm like, you were completely the right age for that to have happened, but yet you weren't processing what was happening with your body. Because in your mind, like, I think for most of us, we don't necessarily feel our chronologic age, so we don't even think about it in terms of this might be what's actually happening. Transpiring right now underneath my nose.
- [10:30]
A
Yeah. And I think for a lot of women, too, just the idea. I mean, maybe the word perimenopause or aging, this is a very scary topic. Right. It forces us to come to terms with our mortality. Like, we associate aging with wrinkles and losing who we were. And so I think that there's a little bit of at least my. My experience and just having conversations with the women in my community, like, we don't like the word aging. So even just thinking, like, oh, maybe this is perimenopause, like, no, no, no, no, no. You know, it's like the same. It's, you know, when women. There's some women I've seen, like, they don't like to be called grandma. Right. Or they don't like. They don't like that because it sort of ages them in a way. I think that there may be something that's similar. Not that you have that. I'm just making a comment that I think a lot of women are resistant to this idea of aging.
- [11:14]
B
No, I agree with you. And it's interesting because in 2018, like, towards the latter part of the year, I did my first TED Talk. And I recall what I had pitched to the TEDx organizers was a talk on perimenopause. And do you know in 2018 how many Ted talks there were on perimenopause or menopause?
- [11:31]
A
Probably this many.
- [11:32]
B
Four on menopause. Therefore, they were like green light, the perimenopause conversation. But I remember when I stood on that stage in Toronto, I was embarrassed to talk about perimenopause. This makes me laugh. I mean, this might be the first time I've admitted this publicly, but I remember feeling a sense of shame about acknowledging that I was old enough to be in perimenopause. And yet now I think about it, that's so silly. Like, how could I have ever thought that? That's so silly. But I think that's a shared feeling that many women experience. They're like, oh, we're really talking about the end of my fertility. And even though we are very happy, or at least I was at, you know, the age that I was.
- [12:12]
A
I was very happy to put that down.
- [12:14]
B
Yes, I was like, I love my boys, but I was ready to not be having pregnancies and babies anymore.
- [12:19]
A
Yeah.
- [12:19]
B
But it's. It's like you. You kind of start to have to cut. It's a little bit of a reckoning with yourself mentally, of, yes, you are Indeed old enough to be going into perimenopause, but then your brain has to kind of catch up with you. And that was a really interesting dynamic that I had to kind of interface with when I did that first talk.
- [12:38]
A
Yeah. Yeah. Well, I mean, thank you for sharing that. I know that there's going to be so many women that are like, yeah, I hate the concept of aging. You know, it's like you have a love hate relationship with it. Right. You're like, on the one hand, it's a super. Like, what's the alternative? You know, it's like, the alternative is that I'm not here, right? So of course I want to age, I want to see my children grow up, and I want to meet my grandchildren. But then the, you know, the alternative to that is sort of what we've been sold through culture is that once you, like, as you said, once you lose that fertility status, that somehow you are over the hill or you're, you know, past your prime. So I think that that's a shared view that I think we have to all unlearn. And you've certainly done that. And I. I think. Thank you. Like, thank you for sharing that. I think that's gonna touch a lot of women and maybe speak to their hearts a little bit and ask them to really ask, you know, to. To question themselves. Like, why do I have such a weird relationship with aging? Is it because of this? You know, maybe we're getting off topic here. But a little, you know, it's this patriarchal society that just values youth over everything. And part of that, if I may just be so bold, is to say that, you know, a woman who knows who she is is much harder to control, you know? Absolutely. Right.
- [13:43]
B
So, I mean, Steph, this might be relevant. I. I just spoke at south by Southwest, and one of the questions I was asked on a panel was, would you in 2018, have imagined the reckoning that is coming for perimenopause and menopause? And I was like. I was like, no, and here's why. And I kind of tied that story in, but really was saying, like, I'm so thrilled that women are getting the attention and focus that they deserve to have. But, no, I would not have anticipated because 2018, no one was talking about or not anyone that I knew was talking about it.
- [14:16]
A
Yeah. And I think the whole. I mean, this is a. This is a really large conversation around women being. When you sort of come into your own and you feel comfortable in your own skin, I think that you become much Harder to control. I think you have your own opinion on things, you have something to say, you are done giving to others and you can finally start to give to yourself the things that maybe you haven't for many years, possibly decades. And so I think that there, there's a reason why there's a perseveration on youth, because usually the youth, you know, are beautiful young daughters that are going to be listening to this conversation, certainly, and their mothers. When you're younger, you're much easier to manipulate. It's much easier to infect your thinking with, you know, whatever mind virus du jour that there is. And there are many of them. But I think that as you age and like when you were talking about your, you know, when you were talking about your perimenopause, when you were talking about perimenopause on your TED talk, four, like four talks on menopause is in, in 2026 is literally ridiculous. Like there are probably four talks every couple of days now.
- [15:24]
B
Yeah.
- [15:24]
A
On perimenopause and menopause. So, you know, I think that you've been really instrumental in changing that conversation as well.
- [15:29]
B
Oh, well, thank you. Thank you. Likewise.
- [15:32]
A
Okay, so you said earlier on that when you first did your TED talk on perimenopause and menopause, there was like four other talks on it. And now, of course we know that they're flooded. You know, like every, every, everyone and their mother now is talking about perimenopause to some capacity. I mean, we still have work to do. But how many books do you think are there currently right now on the digestive system and the changes that happen in perimenopause? And my feeling, before you answer it, is that you're. This is probably a redo of 2018, where you're probably one of the first people to really put this in a comprehensive package. But in your research, are there other people talking about specifically digestive changes and perimenopause and menopause?
- [16:16]
B
Absolutely not. Which is why I think this is a really unique and fresh perspective. I mean, there's obviously people talking about the microbiome, but no one is myopically talking about it through the lens of perimenopause and menopause. So this is unique. This is the zeitgeist. We're way ahead of that proverbial curve. So in 2018, when I was talking about perimenopause, I didn't realize I was way ahead of the curve. And so I think this is going to be one of those Kind of sentinel books that is going to be incredibly influential, not just for clinicians, but also for the lay public in a way that's really valuable. Like it's designed to be valuable. Like you have me in your pocket, that you have actionable items and actionable information as well as recipes and other action items that'll make it even more solidified in terms of content.
- [17:03]
A
Yeah. And we have a lot of doctors, a lot of clinicians who listen to the show. So that's also really great for a clinician to know as well that maybe they want to pick that up as a way to further and deepen their connection and their conversations that they're having with their patients too.
- [17:14]
B
What it speaks to is that this generation of women is coming into their own. They are demanding better than what was offered to their mothers and they are loud and proud about it. They're not only demanding more care, they're demanding better options. They're demanding a higher level of accuracy. They're requiring more of their healthcare practitioners as well as themselves. And I think that's a good thing, that consumers are waking up to the fact that they are an integral part of this entire trajectory of women's health.
- [17:46]
A
Yeah. It's like, do no harm, but take no shit. You know, that's sort of what I feel. Bravo.
- [17:52]
B
That is exactly how I feel. My husband said to me last night, he said, the one thing I've learned about you is you don't like anyone telling you what to do.
- [18:00]
A
Yeah.
- [18:00]
B
And I said, how did I ever function in a traditional allopathic model of care? Like, how did I function? I was so affable. Like, it was in all of my. Yeah, all of my reviews. She's so affable. We wish we could clone her. Said by the grumpy cardiologists I used to work with. I'm like, why was that? Because I was so agreeable.
- [18:20]
A
I have been. I mean, I. You know, being a chiropractor, you take a little bit of a different route because you're sort of always for better or for worse, right or wrong. You're almost like a second class citizen a little bit in the healthcare community. You're always sort of forgotten. Like, you're like, oh, are you a physio? It's like, no, I'm a chiropractor.
- [18:36]
B
There's.
- [18:36]
A
There's a difference between them. So I was always like a little bit of an outsider, but I always knew I was completely unemployable. Like, I could never work for a big conglomerate. I could never work in a hospital setting the way you did. I had to always set my own rules, even if I was totally shooting myself in the foot. That's sort of how I've always operated. But I think that there are individuals that I've had the pleasure of becoming friends with, such as yourselves, who also see the truth, who've also, you know, drunk the Kool Aid if you. If you want. Who have our sparkly conspiracy tinfoil hats on where we bajor, we, you know, bejewel them with our fun little diamonds and crystals and things where we're able to sort of share some of these ideas and make progress and give women an alternative. Because I think that the alternative that they've been given up until this point without having conversations like this is, well, just suck it up, buttercup. You know, you're getting old. You're past your prime. Like, this is, you know, take an antidepressant. Here's the. This is the three or four tools that we have to. To treat you, right? Like, you don't get hormone therapy, because that's dangerous. That causes breast cancer. You, like, take an antidepressant. Take a pottery class. You know, it's like, you know, why don't you take up knitting? Yeah. I mean, can you imagine if we gave men the same advice? Like, there would literally be a revolt. Like, imagine if you have a patient, male patient, that's like, hey, I'm 40. I'm 50. I'm having, like, erectile dysfunction issues. And the doctor was like, well, honey, it's because you're old. Like, why don't you join a run club?
- [20:01]
B
Or. Or even better, why don't you meditate your way to an erection?
- [20:05]
A
Yeah. Yeah. Like, it's so ridiculous. So I think that, you know, if we think about villains, if you will, the villain has really been not really any interest in women's health for a long time. And this is why your TED Talk back in 2018 and your podcast and your book, all of these things are such important game changers, because they give women safe spaces to start talking about some of the changes that are happening, and they're not construed as abnormal. So we're not like, oh, well, these changes in your digestion that you're feel like, you know, here's just. Here's an antacid. Right? We're starting to really understand the female specific changes in her digestive system. Right. Which is some of the things that I think I'd love to explore with you today If. If you, if you're willing to.
- [20:54]
B
Of course, always. But you know, it's, it's interesting. Over the past eight years, I think that women are kind of waking up, they're realizing that the system, and we'll say the system in air quotes, the system as it is is not designed to be adaptive to a middle aged woman.
- [21:14]
A
Right.
- [21:15]
B
For so long we have been told that we need to shut up, accept the fact that we're tired, accept the fact we aren't sleeping well, accept the fact that we've gained 5, 10, 15, 20 pound and just sit with it. And so I think that, you know, our generation is saying, you know, I want to better understand my physiology, I want options. And no, it's not acceptable. Like I recall, this is probably 12 years ago, I was seeing my GYN for an annual appointment and I comment about my, my cycle being heavy and she said, okay, well we've got four options for you. Number one, we can put you on the pill. Number two, we'll give you an iud. Number three, we'll do an ablation. Number four, we'll just take your uterus out because you told me you're done having kids. And I was like, no, no, no
- [22:01]
A
and no 4 nos. What else you got?
- [22:05]
B
Yeah, exactly. I was like, I want none of the above. And then she said, and oh, by the way, you've gained five pounds since your last office visit. I just want to let you know this is just normal. And I walked out of there so defeated, I was like, you're fired and I need to move on.
- [22:19]
A
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- [25:37]
B
Yeah, well that was the same context of the conversation with this gyn, female GYN who probably was my age or very close to it, and she was trying to female splain me what was going on with my ovaries. And I remember I was like, I kind Of I'm sitting on an exam table, I'm in a paper gown. I'm naked underneath the paper gown. And she's trying to female splain to me what's happening to my bodies. And I. And I'm thinking, yeah, yeah, I know my ovaries are, like, past their prime. Like, you don't have to reaffirm that for me. I already understand it, but I recall feeling so defeated and frustrated because this is a comment and this is a conversation that this woman was having probably daily, and yet it was such a missed opportunity to talk to women about their bodies and their physiology, but yet they. It's all this kind of shaming, like, you, you, you, you, you. You're getting older, your ovaries are older, and this is just the way things are. Like, I don't care that your sleep isn't good. I don't care that you can't manage your stress. I don't care that you gain weight. Just accept it, because this is the stage of life that you're in.
- [26:43]
A
So it's framed like a failure. Like, oh, your ovaries are not as vibrant. It's like, well, what do you expect? I'm 48, you know, like, they're not meant to produce viable eggs forever. Like, that's not who I am. That's not my biology. I'm not supposed to do that. Yes.
- [27:00]
B
And I think that the larger issue that I think a lot of women face is that there's a lot of focus on women's health, appropriately so, on contraception and pregnancy prevention and pregnancy and postpartum period, and then, you know, this kind of nebulous period in between before women go into menopause. And I would argue, Stephanie, did you have any education about pregnancy or menopause and your education. The banana talk.
- [27:28]
A
I had the banana talk in sex ed. It was like, here's a banana. Here's how you put the condom on. I'm sure that they slapped up some, if anybody remembers, slapped up, like, on them overhead, there was some, like, plastic thing, like a laminated thing, where they're like, this is the menstrual cycle. You know, this is how. This is, you know, the fertilization of the eggs, the zygotes and that. Like, you get that. And then the banana. And that's about it.
- [27:50]
B
Yeah, I. I recall.
- [27:51]
A
And it's by. It's done by the gym teacher who doesn't want to talk about it. Yep.
- [27:54]
B
We had about the same. And then I think even in my nursing education, in my in my nurse practitioner education, there was, like, little to no conversation about anything around female aging. There was no discussion on perimenopause and the word menopause might have been used. Once I actually pulled my pathophysiology text, which I still own because I'm a gigantic nerd. I pulled them the other day just to see what was discussed about menopause, and it was little to nothing. So clinicians aren't learning much, and then they're expected to treat women for the trajectory of their lifetime. Is it any wonder that women have just been expected? And maybe that's part of the patriarchy that women have expected to suffer through every stage of their lives, whether it's painful menstruation, whether it's the issues around contraception access, whether it's postpartum period when many women are suffering, or even that perimenopause to menopause transition that women are just told and gaslit. Too bad you're gaining weight. Too bad you can't sleep. Too bad you can't manage your stress. This is all normal. Just accept it and move on. Like, shut up and put up. And that's kind of been this prevailing theme, I think, for far too long. I remember I interviewed a guest on the podcast and he said, if men. This is Avrim Bluming, who's a medical oncologist, and he said, cynthia, men would never tolerate, but women have been expected to deal with for the entire trajectory of time.
- [29:26]
A
Well, the other thing that you said that I thought was really interesting was your, your ob GYN said you, you gained five pounds and that's normal. But she didn't actually quantify what kind of weight that is. Because if it's five pounds of muscle, that's not just normal, that's ideal, right? But if it's five pounds of adipose tissue, con combined with a loss of mass in bone, let's say, or muscle, then that's a problem. So I don't like this, like, almost. I don't know what the word is, but just washing of all is the same. Like, I want to gain five pounds of muscle. I don't want to gain five pounds of adipose tissue, right? Because we know that that excess adipose tissue is an endocrine organ, it's inflammatory, et cetera, et cetera, et cetera. So I think that that's also. I don't like. It's a failure. It's a failure. It is. It's a disservice to you because now you have no idea what kind of weight you've gained. You just know that it's. It's air quotes, normal. You don't know if it's muscle. You don't know if it's connective tissue or bone or organ weight. You don't know if it's adipose. You don't know what it is. It's just, okay, I'm five pounds heavier. Like, it's meaningless.
- [30:32]
B
I can tell you at 42, it was most definitely subcutaneous body fat, because, you know, I was also hypothyroid, but they didn't even want to do labs. And, I mean, how many women are navigating that transitional period in their lives? And to your point about body composition changes, obviously, if it's muscle, yay, the weight goes up. If. If your weight goes up and it's due to adipose tissue, that's a negative. But traditional allopathic medicine is not even looking at it from that perspective. They have one metric. You step on the scale, you're lucky if they let you take your shoes off. They don't take. You know, you've got five pounds of clothing on, but they don't care. They step on the scale, and then they stick you in a room. And so I think for a lot of women, it is not just the. The number on the scale. It's what it does to them mentally. I think for so many women. I was reflecting recently, how old was I the first time someone made a comment about my weight? Ooh, I was 12 years old.
- [31:35]
A
Yeah, I was gonna say I was. I think I was like, 8, 9 or 10.
- [31:38]
B
Yeah, I was 12.
- [31:40]
A
I think someone said, like, my thighs. Like, it was a comment about my thighs being really big or my butt. Like, I remember my nickname when I was in. Oh, how. I guess I was grade nine. Grade ten was caboose. Oh, here comes the caboose. Here's. Here comes the wide loads coming through. Because they were talking about my butt, right? Which is, like, at the time, very unfashionable. You know, to be curvy was like, not. That's not the. That wasn't the body type du jour or whatever. I remember the girl who used to call. I remember her name, too. Yeah, like, it's that. That stuff really sticks with you. Yeah, yeah.
- [32:08]
B
I remember it was one of my aunts, and she made a comment. My parents were divorced, and she. This is my father's sister. And she said, you're starting to look more like your mom. And my mom had a very much an apple shape. And so she was making this comment, and I was in the throes of.
- [32:23]
A
And you knew what that meant.
- [32:24]
B
And I knew it was not a flattering comment. And so I remember that was the first time I remember, like, whoa. I've never thought about my body in terms of good or bad. But now that message was not a good message. Like, I acknowledge that. And it's interesting how we as women, we kind of.
- [32:42]
A
It.
- [32:42]
B
Some comments are made fairly innocently, not done to be malicious, I think, in most instances. But it imprints us and it stays with us because it's like, then the next time someone makes a comment, you're like, oh, I'm not as small as this person. Okay, what does that mean? And it's so. It's this kind of constant interplay that women get imprinted, I think, at a very young age about their bodies, whether it's positive or negative.
- [33:05]
A
This. This is a wonderful opportunity, actually, to talk. This is something that you talk about that I want you to expand on. I think my Betties need to hear this, which is this idea of these early childhood experiences, these negative, potentially traumatic. So little T, big T. And we can define what that means. Trauma that tends to leave an imprint and residue not only in the nervous system, but certainly in the gut of the things that I. I have seen in practice. I know you have seen this as well. Is that this clustering of, like, from age 44 to, like, 54, autoimmunity, everyone's like, it's a Hashimoto's, it's a multiple sclerosis, It's a rheumatoid arthritis. There's some autoimmune diagnosis that's usually levied on a woman in that time. But before we get to that, you know, diagn. Before we get to when she's 44, let's talk about how the adverse childhood experiences, these aces. Can impact the digestive system, can impact the nervous system, and how that can sort of follow us and leave this, like, residue maybe of, like, subclinical chronic inflammation potentially, and how that. How that affects our gut and our digestive system as we age.
- [34:18]
B
Yeah, it's such an important conversation, Stephanie. So when we're talking about adverse childhood events, we're talking about research that was done as a joint venture between Kaiser Permanente and the cdc. And anyone that's listening can get online and you can get access to this short quiz. And they're talking about both big T trauma, rape, suicide, et cetera, and little T trauma, which we're just starting to recognize, finally, is equally pervasive and caustic. And so whether that's neglect or abuse or, you know, a family member had an addiction. So the imprinting that we get as children from those experiences. You take that quiz, you get a number. If your number is high, and I think of high as anything over three or four, you can.
- [35:03]
A
Seven, right? Seven, right. Over here. Yep.
- [35:06]
B
And if you have a high enough score, we know based on research that it puts you at risk for quite a few things. Not just autoimmune conditions, poor metabolic health disorder, relationships with food. Not to mention the fact that it completely clouds your perspective on what is normal. Because whatever we grew up with then is what we perceive as normal. And I don't think it was until I went off to college that I started to realize that what my normal is, was not normal. It was very abnormal. But we have a degree of shame and secrecy about the way that we grow up, if we've grown up like that. So I start to think about what are the things that I see in patients and what's happening physiologically. We know in individuals that have experienced quite a bit of high ACE score situations that their nervous system gets reregulated differently than a child who grew up in a loving, respectful, non addict, non trauma home. So the nervous system gets reregulated, and that means that that individual is in more of a sympathetic dominant state. I know traditional allopathic medicine hates that, but let's talk about the autonomic nervous system. It's designed to have sympathetic. You know, this is when you are fight, flight, flee, or fawn versus parasympathetic rest and digest, rest and repose. It's designed to be balanced, just like everything else in the body. But for people that grew up with quite a bit of trauma, their nervous system gets hardwired to be sympathetic dominant. So they're going to experience alterations in cortisol that do not mimic those of their conventional counterparts. So these are individuals that are more likely to have alterations in the gut microbiome because cortisol is not a bad hormone. But cortisone. Cortisol, when it's elevated over time, can lead to muscle breakdown. So you get catabolic, you are more likely to have autoimmune conditions. Your immune system is more susceptible to opportunistic infections, and the immune system can be highly inflammatory. And then we have this kind of reintegration of the microbiome. So when I'm looking at these patients and talking to them, if we're identifying them with high ACE scores. I know already that they are going to be more likely to develop autoimmune conditions in their teens, 20s and 30s. Once you have one autoimmune condition, and these are there's over a hundred diagnoses now, including things like long haul Covid and chronic Lyme, but other more recognizable celiac rheumatoid Hashimoto's, they're more likely to have at least one autoimmune condition, and once you have one, you're more likely to have others. Number two, they are much more likely to be dealing with alterations in the gut microbiome. And when I speak to this, I'm really speaking to they get changes in the diversity of bacteria, they have more inflammation, they are more likely to be metabolically unhealthy, meaning they're more likely to be insulin resistant. They are more likely to have poor metabolic health. And it goes on and on and on. It doesn't mean that every person is necessarily going to have all these things happen. But what I see most often, Stephanie, are women that have disordered relationships with food. And that runs the gamut. It runs the gamut from binge eating to anorexia and everything in between. And so my hope and intent is by bringing greater awareness to this, that women will better understand themselves. Like, when I think back, I had my first autoimmune condition diagnosed in my 20s. I now have four. They're all in remission. But it's something that most of these patients are going to have to work diligently for towards their entire length of their lifetime, because by the time they get to perimenopause and menopause, when we have all this hormone chaos, women are four to five times more likely to. We are 80% of the autoimmune cases. And at this important juncture in our lives, we are four to five times more likely to be diagnosed. So maybe you weren't diagnosed with your first autoimmune condition when you were younger, but what I see is an explosion of Hashimoto's diagnoses for women in perimenopause and menopause. And I think a great deal has to do with, you know, changes in the immune system. But also for those that were already susceptible, they are much more likely to get their first or subsequent autoimmune diagnoses. And for anyone that thinks that's not a big deal. I want everyone to think about the fact that if we've already had an immune system that's been imprinted just like that nervous System gets imprinted. The world is not safe. The world is not safe. And it just sets us up. It rewires our bodies to make us more likely to be provoked more easily. And I say this in the most loving way possible as someone that has navigated, you know, 54 years on this planet with a lot of therapy and a lot of interventions to get me in the right mindset. But how many of my patients come to me and they'll say, oh my gosh. It wasn't until perimenopause that I started talking about the way that I grew up and started addressing it through therapy or other types of therapeutic modalities. So there's a lot that we can do. But the impact of chronic stress and how it imprints our bodies, including our ovaries, is something that not enough people are talking about.
- [40:33]
A
If you are overstressed and under recovered and you don't feel like training, you're probably not low on motivation, you're low on electrolytes. Stress burns through sodium and hard workouts also drain it. And if you're sweating, you're losing way more than just water. Most women are under salted and over caffeinated, which frankly is a terrible combination. If you want stable energy, sharp focus and a body that performs the way that you want to, this is where LMNT comes in. It is a science backed electrolyte mix. It's high sodium, no sugar, no nonsense. And how I usually use it is I don't even use a full packet. I will take one sachet and I will empty half of it in water and that's my electrolyte mix for the day. So it obviously means that my box lasts longer, but I still get what my body needs, right? So on high stress days and intense training or anytime I'm sweating like I mean it, I make sure that I'm getting the basics done and that they are done properly. And the best part about the company is if you try element and you hate it, they just give you your money back. You can literally try the whole box and they have a no questions asked refund policy. So for hydration that actually works, head over to drinklmnt.com better. That's drinklmnt.com better. When I think about trauma, I typically think about it in three buckets. It's like physical, chemical and then, you know, emotional, you know, and I, we've talked a little bit about Aces. I wanted to maybe introduce potentially controversially chemical trauma that I'm probably gonna get some blowback for. But please Listen, with an open mind and heart, and that is the idea of chemical trauma. So we've been talking about emotional trauma. What might be the impact, the long term impact of taking something like an oral contraceptive, which is chemical stress over a long period of time on the gut microbiome. Is there semi, is there permanent damage? Semi permanent damage. Is it totally reversible? Like what are some of the changes that we might see in someone who maybe started when she was 16 or 17 on the birth control pill and she's taken it until, you know, 35, until she wanted to start having children?
- [42:59]
B
Such a great question. I mean, what I can tell you is there's some research to suggest that early use of oral contraceptives, and I'm thinking predominantly about teenagers who have not yet laid down their peak bone mass, whether it's oral contraceptives or Depo Provera there. And Depo Provera has a black box warning for bone. Number one. I do think when women are kept in a low estrogen state, they are at risk for bone effects. And by that I mean if you look at where a young woman is not yet at peak bone and muscle mass and let's say they're 15 when they start to prevent pregnancy. And I totally get it. I was part of that generation. Everyone got put on an oral contraceptive, even if it wasn't for contraceptive purposes to fix wonky periods or painful periods. And they're kept on that for, let's say 10 years. They're kept in this low estrogen state. How is that any different than women that are in menopause that are not on hrt? They're kept in this low estradiol state. So number one, I think about bone, we know with Depo Provera, two years of Depo Provera use, that is reversible. We don't know enough about oral contraceptive use.
- [44:15]
A
Did you say reversible or irreversible?
- [44:17]
B
It's reversible for Depo Provera if you, if it's used within two years, and that's, that's the black box warning, it's reversible, but I don't think there's any long term effects to look at if you're on it for 10 years. And how many young women are on that? Because it's a set it and forget it. You know, you get a shot every couple of months. What I think is more provocative, and I was introduced to this concept by Dr. Felice Gersh, was that oral contraceptives in and of themselves are Endocrine mimicking chemicals. And for everyone that's listening to understand that what Stephanie and I are talking about, we're not telling women not to protect their decision about when and if to have children. That is not what this conversation is about. But it's a conversation about what are the long term effects of some of these medications that we think about pretty innocently, right? So when we talk about endocrine mimicking chemicals in the context of our endocrine system, we know that many of these chemicals are significantly more potent than the actual hormone itself, whether it's external exogenous sources or things that we're taking and through our mouth and through our digestive system. I also think about the fact that in a developing gut microbiome, so we know that the microbiome is heavily imprinted by whether or not we're a vaginal delivery or a C section, whether or not we're breastfed or we're formula fed. There's imprinting there. We get imprinting around puberty and then we get another big shift, plus or minus, if someone becomes pregnant. But I would imagine in a developing microbiome of someone that I still think is still a growing individual, even though they're, you know, teens, young adults, that there could be significant long term sequelae or long term effects of taking a synthetic hormone that is designed to block what is a normal process in the body. Ovulation, menstruation. Because for anyone, whether or not people realize this or not, when you're on oral contraceptives, you're not having a true menstrual cycle. It's breakthrough and bleeding, and it's very different. What's interesting is when I spoke to Felice and we had a lengthy conversation about this, it is an endocrine mimicking chemical, so it's not doing what the body has designed for it to do. There's not enough research, because I tried when I was writing the book, to really hone in on this. Is there enough to suggest that this is particularly disruptive? I think based on what I know, I do think that oral contraceptives have a significant net impact, especially on younger people's microbiomes, especially in the sense that they're not getting the normal hormonal regulation. And conversations, whether we're talking about susceptibility to leaky gut, whether we're talking about diversity, maybe we're talking about motility, whether we're talking about production of short chain fatty acids, any of the normal physiologic things that are occurring in A developing microbiome. So I think I would always say as a cautionary tale, we don't yet know, based on research definitively, but certainly presumptively based on what I know, I think that oral contraceptives are not nearly as benign as people would like to think that they are.
- [47:29]
A
Yeah, the estrogen conversation is really interesting as it relates to the microbiome. So you mentioned the impact that it has on bones. Certainly when we are in a low estrogen environment in those peak bone building years, which you cannot get back, by the way. So if you are in a low estrogen environment in those peak bone building years, like that's all you got. Like you don't get it. Which is why dieting for women, especially in their teenage years is so, so, so dangerous. Because you are really sacrificing now, you're sacrificing your future for potentially a smaller version of you now, which in my opinion both are undesirable. But I think as it relates to the microbiome as well, because my understanding of the microbiome, and especially for women, and I'd love for you to expand on this, is that there's this particular area of the gut, the estrobolome, that's involved only for the, the metabolism of estrogen. So how, if we are left in a low estrogen environment, does that affect a, the maturity of the microbiome as that diversity is, is, is populating or not? And the ability for the microbiome to deal with estrogen?
- [48:35]
B
I think it's a huge problem. So when we talk about the estrobolome, it is a specific place in the microbiome and neither Stephanie nor I named it. Everyone always says it's such an awkward name. Yes, it is, and there's nothing we can do about it. But it is the primary site for detoxification. So you know, the liver, there's two phases of detoxification in our liver and then it goes to the gut. So the liver's primary job is to break estrogen and metabolites down into water soluble compounds so that it can be packaged up like a present and pooped out of the body. Now that's an oversimplification, but it's important for people to understand that if it's not packaged up and pooped out of the body, it gets recirculated, it gets put into the enterohepatic circulation, which is a fancy way of saying through the gut, through the liver gets put back into circulation and can contribute to magnifying symptoms of breast Tenderness, weight loss, resistance, brain fog, joint pain, skin issues. I mean, it goes on and on and on. And if you think about it from the perspective of a younger person who has not yet had the ability to have the full effects of this regulation of hormones, I think it can make things so much worse. Like, are we setting women up? And I'm just. This just came to me, are we setting women up that have been on oral contraceptives for a long period of time? Are we setting them up for a rockier perimenopause to menopause transition? Because they've never had this fully optimized estrobolone. And I think a great deal about if you're already set up, like my generation, Stephanie, we got put on multiple courses of antibiotics. I mean, and my mother was a nurse and was very conscientious. I mean, I don't. I think I had, yeah, I had perfect attendance. I was never allowed to stay home. I was never sick. Right. But I'm sure I had cycles of antibiotics for one thing or another. And you just think about the insults one after another, not to mention kind of the epigenetic things that impact the health of our bodies just in general. So I think that there's a lot to be said about what will be the research that is forthcoming in later years, really looking at what are the things that set up, set our microbiome up for success versus what are the things that have the ability to set the microbiome up, that it's always a little less healthy. Like, you're a little more likely to develop an autoimmune condition, you're a little less likely to be able to process and package up your estrogen. Because I know for myself, I was on oral contraceptives from like 16 to 32. I got married at 32, went off the pill finally. And I remember saying to my husband that my gut never felt like right. And if you were to ask me 20 years ago how I felt about my gut, my digestion, just the things that we just take for granted, I'm probably one of many people that would be the first person to say my perimenopause experience was way more wild and unyielding than a lot of patients that I take care of. And I think there's a lot of little insults that I probably had throughout my lifetime. But just like many women, but I do think oral contraceptives can contribute to long term effects. And the other thing that I find interesting, I had an opportunity to connect with exercise physiologist Annie Galpin. And he said, cynthia, it's not actually the teen years that are so important for women. It's actually the, from the ages of 6 to 12 that are critically important for setting you up for the preteens health. Exactly. So that is the most important time. It is less about the teen years and more about the, you know, 6 to 12 years old. So if you have been a sedentary couch potato as a kid, plus or minus, you know, the use of oral contraceptives or whatever else, antibiotics, you might be in for a rockier kind of microbiome trajectory than someone who was a gymnast or someone that was outside playing. Like, I was never allowed to hang out my house. My mother kept me outside all day long. Like I was like a free roaming
- [52:31]
A
street light came out.
- [52:32]
B
Yeah, I was like a free roaming kid.
- [52:34]
A
Yeah, that actually makes a lot of sense at 6 to 12. Makes a ton of sense even from just a biomechanical perspective. Right. Like when girls like girls and girls and boys, they sort of run the same way until like 7, 8, right? Then that estrogen starts to flourish and then their hips start getting wider, they get the breast buzz and now all of a sudden they feel really awkward when they're running in soccer or whatever sport they're playing. Now they can't run properly now they're starting to get injured, right? And then we have all of these different developmental things that happen. And it's in that 6 to 12 time period where we actually see those big, big, big changes in those secondary sex characteristics develop. So that actually makes a lot of sense. Also from biomechanics too. Okay, so, okay, so paint the picture for us now. So we have women, women who've been on oral contraceptives, maybe they've been on multiple courses of antibiotics like you were describing. They have some degree of bone loss because they watched America's Next Top Model like you and I probably did, and Tyra yelling at everyone. And we all have some degree of a little bit of body dysmorphia. Maybe we're scared of food. We don't have the bone density, we don't have the muscle that we should because we were scared of getting bulky, et cetera, et cetera. We land in our perimenopausal and menopausal years. How does this translate now to the way that we navigate perimenopause? And how does that maybe change with our digestion? How does that change with our sleep? And then most importantly, I'd love for you to talk about what we can do about it as well. You work really, really hard, whether it is building your career, managing your home, maybe both. If you are dedicated to building your dream life, you are probably spending a lot of time taking care of others and a very long to do list. And while you are being busy and crushing it, I think it's equally as important, dare I say delicious, to wrap your very limited downtime in little moments of luxury. For me, that means my downtime at home should feel effortless and honestly, just for me. And that's where Cozy Earth's robes and pajamas come in. I feel like a literal queen in their products. The robe, ugh, wraps me in this like softness. It's plush waffle material. And the pajamas are unbelievably soft and temperature regulating so they keep me cool overnight. I just feel like I have my life together when I remember to take care of myself. So let this Mother's Day be a reminder for you or a woman that you love, that you also or they also deserve care and a touch of Lux in your life too. Head to cozyearth.com and use my exclusive code better for 20% off. And if you see a post purchase survey, be sure to mention that you heard about Cozy Earth right here on the podcast.
- [55:30]
B
Let's start with like sleep because that's so foundational to our health. There is no other intervention that I can think of that has a larger net positive or negative impact on the body. Full stop. So when I think about the things that are critically important for women to help unwind for themselves in perimenopause, it's like sleep hygiene and figuring out the n of 1 what works well for you. So whether or not it is, you know, five sleep strategies that you have to do and beyond the cold dark room. And let's be clear, I'm not talking about a gadget. Before we even talk about gadgets, it's figuring out what you need to do. Do you need to take glycine before bed? Do you need to take magnesium? Do you need to take myo inositol? Are you, you know, a week or two out from your menstrual cycle? And you need oral micronized progesterone knowing that the net impact of sleep quality, how that imprints the microbiome because we have circadian clocks throughout our digestive system, which is why we encourage people not to eat three or four hours before bed because that disrupts melatonin secretion at the expense of processing a bolus of food. So the number One intervention that I would start with any patient, and it's the first intervention chapter in my book, is talking about sleep. And I think for a lot of individuals, Stephanie, and I'm not sure if you see this with your patients as well, a lot of people get focused on. I'm going to pick on a couple companies and it's not that they're not good companies. I'm just mentioning people are like, I'm going to buy my aura ring. And I'm like, well that's great. Or a whoop band or your Apple watch or whatever it is before they even even think about the low lying fruit. Are you getting off electronics? Are you wearing blue blockers? Are you doing some type of physical activity so that you're physically tired by the time you go to bed? Are you eating too close to bedtime? Are you fasting too much? And your body is undernourished and therefore you're waking up at night because your blood sugar drops because you're just not eating enough food. So it's like these little interventions that I think make a large impact. So understanding that sleep is intricately interwoven with the microbiome. The other thing that I think is really interesting is we get alterations in the microbiome with jet lag. So, you know, when you and I travel overseas and you know, we have all these tricks for getting ourselves rerouted when we're jet lagged. The microbiome shifts dynamically. It shifts in ways that, you know, it impacts insulin sensitivity, it impacts the way that the body is perceiving the stress of the jet lag. The next thing that I think about when we're talking about perimenopause is stress management. And I think for many people, they think this is lip service. They're like, yes, I do five minutes of meditation once a week. That's all I need to do. We become less stress resilient with these alterations in hormones. In particular, less progesterone is going to make us potentially more anxious, more depressed, more mood disorders, more alterations in gaba, which is this inhibitory neurotransmitter for a lot of women, they just feel less able to deal with stress. Then you add in plus or minus wherever estrogen is in your perimenopause journey. Some months it's 20 to 30% higher, some months it's much lower. Estrogen can make us really irritable if it's not in its Goldilocks effect. And by Goldilocks I mean for each one of us, I think as Someone that was on, you know, the pill for so many years. I was in a low estrogen state for a long time, which explains a lot, might have been why I was so irritable. But when I think about women in perimenopause and just how much more susceptible they can be to stress, overall, we understand that cortisol, although thought of as a really negative hormone, is a very important hormone. So if we're not properly regulating cortisol, and as I always say, show me a woman who doesn't manage her stress and show me a woman who doesn't sleep. Number one, cortisol. If it's elevated over time, it breaks down our muscles. Our muscle becomes so precious in perimenopause, it also weakens our immune system. It more makes us more likely to develop leaky gut. And so there's a lot about stress that has to be managed proactively. And I always say to women, find something that you like and do it often. So whether or not it's, you know, connection to nature, grounding, meditation, legs up a wall, it doesn't necessarily have to involve a gadget. Again, I'm going back to the gadgets thing because we as a society, and certainly the people I interact with love gadgets. And I'm like, gadgets are great. But ultimately that's something that it's like a. The very last thing you add is the consideration of a gadget when you've dialed in on all these other things. You know, next is like thinking about nutrition and certainly for perimenopause, helping women understand that, you know, maybe this is a time in your life where you haven't really thought about eating nutrient dense whole food. Maybe you've been eating a lot of ultra processed foods, but for a lot of these women, it's the additives, it's the preservatives, it's the artificial sugars that can become problematic, can impact digestion. And I think for many, many women, maybe it's the first time they've had a conversation around protein. Maybe they've never been told protein's important. Maybe they've been just eating whatever their body is kind of designed to gravitate towards depending on where they are in their cycle. And then the concept around fiber, which jokingly now is the new F word, depending on who I'm talking to. Some people like to hear about fiber and other people are reticent to hear about fiber. But I would make the argument that fiber is this kind of missing fourth macronutrient, that not enough People focus their attention in on, but becomes really important when we're looking at the changes that are happening in perimenopause and menopause. And that's just a starting point, Stephanie. And in terms of like looking at lifestyle interventions that I think have a large net impact, those are usually the first couple that we talk about. There's obviously more than that, but those are the things like the high level, I always say, major in the majors. Those are the three things that I think for most women become the biggest levers for success in terms of reducing symptoms and feeling better, like intrinsically feeling better.
- [61:21]
A
All right, so let's speak to the mothers who are listening here with daughters who may be those mothers themselves, us that we've talked about have had higher ACE scores. How can we help our daughters who are maybe going through some of those changes in that six, you know, that six, six to 12, as Andy was saying, and I was talking about the biomechanical changes and we were talking about some of the impacts that women are young girls are exposed to in that time. How can we specifically counsel the mothers who are listening, who have daughters to help prevent them from maybe going down the same path that they went through where they have potentially compromised their bone density and their bone health overall?
- [62:07]
B
I think there's two things that I would absolutely think about. Number one would be ensuring that your child between the ages of 6 and 12 is physically active. We know that being sedentary is directly impactful to long term bone effects. I think so many of us think about it as, oh, it's just a teenage, young adult thing. We actually start setting down or setting for success the bone health in that 6 to 12 year range. So even if your child's not particularly athletic, finding some activity that they enjoy doing that allows them to continue moving. Obviously gymnasts have the best bone density, but not every young woman needs to do that as an example. The other thing that I think is important is obviously we want our young, our teens and our young adults to have access to high quality contraception for a variety of different reasons. I think that part of that conversation also needs to be, if this is a long term choice, we need to be thinking about, you know, is there a period of time that we stop oral contraceptives or stop Depo Provera for other options that are available that have less net impact on bone health long term? I think that the concept of fully informed consent is not something that was ever discussed with me. I don't even think we even had these conversations in the 1980s and 1990s. And I'm not even, you know, I come at it from a very objective perspective. But I think when we're talking about long term effects of being kept in a low estrogen state in order to prevent pregnancy, we also have to be speaking about what the sequelae can be from that. So I would want to have an honest conversation about limiting long term use of those options and instead considering other options that have less net effect on bone health overall. The three things that I think are most important for women to focus in on in perimenopause and menopause. Number one is sleep quality. Number two is stress management. Number three is nutrition. And getting really granular about what that represents. So protein centric, fiber dense diet. The other thing that I would dovetail into there that is relevant to nutrition is meal frequency. It doesn't need to be that every woman is intermittent fasting because it's not the right strategy for everyone. But every single person listening can do 12 to 13 hours of digestive rest.
- [64:24]
A
Can you give us a little bit of maybe a sneak peek into how you integrate some of these things? So I think that this is awesome when you talk about sleep quality and stress and nutrition and protein centric and fiber centric. By the way, the only people who hate fiber are the carnivores.
- [64:38]
B
So I could tell you stories. Like one day we will unpack this book launch and I will tell you some of the stories I've had with people. I almost got booed off a keto stage recently because they were like. No, booed, booed. I mean they were just like, it was like a hush over the ground.
- [64:53]
A
Oh my Lord. All right. No. Fiber is your friend. People we can, we can remove. The reason why colorectal cancer is number three is cause people are not having enough fiber. There's a lot of data, you know, Mendelian rent, like there is just good evidence for fiber, despite what your local carnivore enthusiasts might say. But what are some of the things that you do? I would love for people to say, okay, like these are all great, but tell me what Cynthia does right? Like how are you managing your sleep quality? What are some of the things that you do specifically for your stress and how do you eat now? What are some of the things that you. What are the pearls that you like to integrate every day?
- [65:29]
B
Yeah.
- [65:30]
A
Or maybe not every day. You're not perfect. We get it.
- [65:32]
B
But I mean, I would say sleep is something I think about when I get up in the morning. And so When I say to people get sunlight exposure in the morning, I walk my dogs with my husband for 15 to 30 minutes depending on how busy the morning is. So getting early sunlight exposure is absolutely part of my kind of sleep preparation mode. I think. You know, the other things that I think about is just being really conscientious about stress management early in the evening. So before I'm even getting into bed, whether it's box breathing, whether it's meditation and, and these aren't even, these aren't necessarily using gadgets. It's just I know how what I need to do to kind of regulate my nervous system. Exercising during the day for me is huge for stress management. You better believe while I was writing this book, before I even sat down to write every day I was exercising and doing self care. And for me that could be strength training, that could be zone two training, it could be yoga, although I probably need to do more of that. But in terms of supplements that I take prior to bedtime before I even get to oral progesterone, for me, the, the absolute non negotiables, magnesium lyanositol. For me personally that has been a game changer. Some type of an adaptogen. Depending on whether or not I feel wired or if I feel like I just want something to tonify. And adaptogens are plant based compounds that can be very tonifying to cortisol, so very nourishing to the adrenal glands. Some days I need more vitamin C. I know that sounds silly, but I think the magnesium, vitamin C, B vitamins depending on where my stress level is. And then, you know, I, before I go to bed, I have a red light that I turn on in my bedroom and I have that on for about 30 minutes. I'm usually reading a physical book that will help me fall asleep really fast. Transparently if I try to read something on a device I will never fall asleep quite as quickly. But I think it's this kind of gestalt. These are the things I can do generally from anywhere I am that make a big difference in my sleep. It's also not checking my phone before I go to bed. I've gotten to a point now where the only phone calls that will come through on my phone at any time of the day are my children and my husband. And my husband's usually in bed with me. And at least one of my two kids still lives at home. So I generally know where they are. When it comes to stress management, I say do whatever makes you feel good, whatever you can do. Consistently vagal nerve maneuvers. So things that like humming, singing, gargling, which generally speaking, depending on where I am, I can or can't do, but box breathing comes back to that. I've now integrated one vagal device that I will use episodically that has improved my heart rate variability. But finding things that bring me joy and learning the value of boundaries. I think one thing that many women will say to me is they finally learned how to say no in middle age. And that for me, as a former reform people pleaser, has been life changing for me in many, many ways. When it comes to food, I don't intermittent fast like I used to. I know that I'm known for that. But I like to share that 12 to 13 hours of digestive rest is what works for me because I'm really trying to get three boluses of protein in. And for anyone that's listening, we want to maintain muscle mass. So the strength training that I know Stephanie speaks to so frequently, I think the other side of that is just making sure you're maintaining your muscle mass, so getting enough protein in and just being strategic about fiber. I know that for everyone listening, there's an n of 1 I always suggest tracking so that you have a sense of where you are. But for me personally, I'm probably eating anywhere from 10 to 15 grams of fiber with each meal. That's what I tolerate. And that's generally coming from a variety of sources. 12 to 13 hours of digestive rest. And then those are the things that I try to focus on. Hydration. I'm someone that has mild dysautonomia, and so I generally have to drink more water and have more electrolytes, especially if I'm stressed or traveling. But those are like three kind of high point things that I aim to do every day. I am not perfect.
- [69:22]
A
Yeah. And there's other. There's a couple things I was writing down as you were saying this. There's iPhone settings like you can create iPhone settings like do not disturb where you only get, you know, if there's only one person, maybe it's your son or your husband or whoever that can kind of get through to you when those iPhone settings are on. So you're not tempted by every notification on Instagram or Facebook or whatever it is that you're. That you're perusing. So iPhone settings can be really great. And I love the. I love the red light. And for me, I also, like, as someone who just got back from vacation, definitely noticed the changes in my digestion I mean of course I was like feasting on foods that I don't normally feast on here. So I was in France. So it's like all the butter, all the bread, all the croissants, all the pastries are very, very rich. And so my digestive system goes like, what the hell? And I always know that, and maybe this is tmi, but when I finally have a bowel movement, I'm like, okay, now I'm settled, right? Because when I first fly somewhere it is like, like my digestive system like shuts down for a couple of days because it's, I almost, I almost joke and say like I'm scared. Like my digestive system.
- [70:33]
B
You're the non public pooper.
- [70:34]
A
Yep, I'm the non public pooper. But when I, but when I travel it like it goes like to the nth degree. Like it's like, no, we are not doing any, it doesn't matter how much food you eat. We are not releasing any of this until we feel safe. That's basically what happens to me when I travel.
- [70:48]
B
Well, there's, I mean it's very common to get constipation with travel. I mean think about it. If your body's six hours ahead, your body's like, normally I'm asleep and you're me now to poop. This is not the way things are meant to work.
- [70:58]
A
It's 2 in the morning.
- [70:59]
B
Yeah, it's not going to happen. But I'm glad that when you're traveling you enjoy that. That's one thing that I would encourage everyone. Like when we travel, I will have the gluten free bread, I will have the dessert. I will enjoy all of it. Because life is meant to be enjoyed. And it's like very much an 8020. Like I'm not perfect. I, I, although I think I probably eat pretty boring. If people were to probably look at how you and I eat, they might be like, that looks boring. But I love consistency. And for me like consistency is my happy space right now.
- [71:29]
A
Same. I need frameworks. I need a system within to. I thrive with systems. Like, I have the same breakfast pretty much every morning. I have pretty much the same like lunch and like I rotate obviously. But there's like, you know, a couple like favorites that I kind of always come back to. And yeah, I'm very boring except when I'm in Paris where I'm having rose macarons and all the things.
- [71:51]
B
So good.
- [71:52]
A
There's this funny meme where it's like the only pain I want in My life is a pain au chocolat. And it's like, yes, that's exactly it. I just want that pain au chocolat when I'm in France. Okay, so imagine someone. I want to imagine someone. You're walking down the street, you get into an elevator, and poof, it's Cynthia Thurlow right beside you. Okay, you. You have. You're going up to the fifth floor or whatever floor, and she's. That person is talking to you. What would you say to her? Like, if you're like, hey, you need to get my book, the Menopause Gut, which is the name of book, how would you pitch it? What would be your elevator pitch for everyone? Why should someone pick up this book?
- [72:30]
B
My standard response to that question is, if you think perimenopause and menopause is just about slapping on an estrogen patch, you're wrong. You want to read my book to understand how the gut interfaces with these changes in hormones and neurotransmitters, because it is oftentimes the missing link for why you're not feeling better.
- [72:52]
A
I mean, and then, ding.
- [72:54]
B
I told you.
- [72:55]
A
Thank you so much. I'm going to Barnes and Noble.
- [72:58]
B
I told you. I've been working on my little pitches.
- [73:00]
A
Yes, that is fantastic. No, I mean, that is a really good. Like, that is one of the things I have noticed that has been one of the changes for me is my digestive system. Like, I take my probiotics. I do my walks. I like to walk after meals now because if I don't, I just feel heavy and bloated and gross. Okay, so tell me about the title of the book, the Menopause Gut, and tell me where people can find it as well.
- [73:23]
B
It's a double entendre. I wasn't initially thrilled with the name because I was like, the Menopause Gut, when I first thought of it, was like, what do women talk about that they find frustrating? And it's the physicality of the changes. But then I realized we're really speaking specifically about what is changing in the gut in perimenopause and menopause. So the Menopause Gut is the name of the book. It's available where all fine books are.
- [73:44]
A
Are.
- [73:45]
B
Are available. If you go to my website, www.cynthia thurlow.com, at the top, there's a banner, and it can take you to any number of bookstores. You can pick the one that is most in alignment with where you feel like you want to spend your money. Nowadays, I know some retailers are less popular than others. I'll just put it to you that way. But I feel like this is the work that I was really meant to do. You know, when I reflect back on the last 10 years and being able to be of service to women, this is a book that's incredibly unique and also dovetails really nicely into the existing kind of perimenopause and menopause milieu, but from a very unique lens. And I'll say it again, if you think that perimenopause and menopause is just about slapping on an estrogen patch or taking oral progesterone, there's so much more to the conversation, and that's really what we're speaking to in the menopause gut.
- [74:36]
A
Yeah. Well done, Cynthia. Congrats on the book. I've read through it. It's fantastic. I think you do a really good job of telling stories, which I think a lot of people, I, too, appreciate reading your personal, like the Morocco story, I think was really great. The, you know, your ovaries are not as vibrant. You know, it's really like, it's so personable. Right? It's like, oh, like, okay. Also, Cynthia, you know, someone who's so well established and knows her stuff, she's also dealing with this, we'll call it the, you know, the patriarchy generally, but just this mistreatment and malalignment with women's health. So I think it humanizes you in a way, and I think you give a lot of really great, there's a lot of really great action items. I think that women are going to walk away from that knowing and understanding how to predict better their digestive system and changes that happen there and then maybe most importantly, like, what to do about it. So congrats on the book and shop local if you can. We'll have all the links in the, in the show notes. As always, Cynthia, this has been just a delight.
- [75:34]
B
Thanks, my friend. Always good to connect with you.
- [75:40]
A
All right, friends, welcome to the after party, where I let you know what I really thought of the show. And as a reminder for those of you don't know why we call this the after party. Everybody wants to get invited to the afterparty. It's the party after the party, AKA menopause. So we all are very, very excited to lay down our fertility and go into the land of menopause. Landia. Okay. So Cynthia, as you know, is a dear friend of mine. I've known her for years. She's been on the show multiple, multiple times through our. She Said, she said episodes and otherwise. And there was a couple of really big takeaways from this conversation and a couple highlights for you and I. I'm actually very curious to hear what you thought were some of the highlights. But a couple highlights for me was when she said, you know, that we don't. For men, we would just absolutely never expect. If someone went into the office and said, hey, I'm having some erectile dysfunction, for them to be told, well, just medit. You can just meditate your way out of it of, you know, not being able to get erect. I think that that is just so ridiculous to even say out loud, but it is something that women are subject to every single day, right? You have a woman who's going in, she's not feeling like herself, she's anxious, she's not sleeping, and she. Maybe she is having a little bit of mood disorder, and she's given. You know, she's told, maybe you need to pick a pottery class or. This is just aging. You know, just suck it up, buttercup. This is how. This is how it is. So loved that we would all. And the other thing that I didn't actually get to say to her when we were talking about this is the solution so often for women's health, is that we will just medicate her or cut it out, right? It's like, oh, you have a problem. Let's just take out your ovaries, let's take out your uterus, let's lob off your breast. And that's not to say that there's never any justification for those surgical interventions, but they are. We would never say to a guy, well, we're just gonna lob off your ball sack. You know, you can't get. You can't get hard anymore. So, I mean, right? So I think that the comparison there. There's a little bit of. It's a bit disingenuous. Like, it's not exactly the same thing, yet women are tolerating it all the time. A couple of other things I thought was really impactful, at least for me, was the age at which which you, as a woman, probably first heard a comment on your body. Very, very young, probably too young. If I had. If I was a betting woman, I'd say too young. And these things leave residue. They leave residue in your nervous system, and they certainly leave residents in your resident residue in your digestion. And you know, how that shows up? 10, 20, 30 years, we don't know. But it is certainly far more common for a young girl to be Told that she looks like her mother or her thighs are getting bigger or maybe she's gained a little bit of weight, maybe she shouldn't have that extra slice of cake because she's looking a little chunky. Things of that nature, we are told ad nauseam. And kind of playing into that was this idea that this age range of 6 to 12 is really where we should be focusing a lot of our efforts. Not only from a biomechanical perspective, where I can, can certainly comment and provide some intervention and advice, but also just from a trauma, big T, little T trauma. If we're being told when we're 6, 7, 8, 9, 10, 11, 12, that our bodies are not adhering to a certain standard that is going to affect us over the long term if we go on a diet. I think that the average age in the United States for a girl to first go on a diet is eight. Eight freaking years old. So what does that do to her bone density? What does that do to her muscle, her capacity, her digestive, her, you know, biodiversity in the gut? All of these different things. They start with our beautiful young daughters, which we must protect. Fiber is the new effort. I love that from her. I think certainly, you know, I sort of made a little dig at if you're a carnivore, I still love you. I obviously still love you if you're carnivore. But, you know, fiber is really good for you. It's very, you know, very much an established. I don't use the word proof often, but proof fiber helps a lot. And then I think the other big thing was the imprints that we have when we are younger. And we often think about these as developing into autoimmunity like we discussed. But this idea that there's this perversion in what we accept as normal and what we think is normal and what we are worthy of, I think that those are other ways that we are imprinted when we are imprinted upon when we are young and developing and we are told that we need to adhere to a certain standard or we are not. So those were some of the things that really impacted me. I'm interested for you. What were some of the big aha moments that you had from this conversation? Make sure that you leave it in a comment or review on Spotify, on Apple, wherever you listen to this show. And if you feel like we're worthy of five stars, we would love, love to receive that from you. So until next time, I bid you adieu and we'll see you then. I hope you enjoyed today's episode. And now I must give you the obligatory legal and medical disclaimer. This podcast, Better with Dr. Stephanie, is for general information only. The advice and recommendations we discuss do not replace medical, chiropractic, or any other primary healthcare provider's advice, treatment or care in the consumption of this podcast. There is no doctor patient relationship and the use and implementation of the information discussed are at the sole discretion of the listener. Please take this information to your primary healthcare provider to make the best choice for you. Remember, I am a doctor, but I am not your doctor, and these episodes are meant for educational purposes only.