Podcast Summary

Podcast: BETTER! Muscle, Mobility, Metabolism & (Peri)Menopause with Dr. Stephanie
Episode: Why Gut Changes Can Destroy Your Muscles in Perimenopause with Dr. Christine Maren
Date: November 17, 2025
Host: Dr. Stephanie Estima
Guest: Dr. Christine Maren

Episode Overview

This episode dives deep into the intricate links between gut health, hormonal changes, and overall well-being for women in perimenopause and menopause. Dr. Stephanie Estima and Dr. Christine Maren explore how gut dysfunction, hormonal declines (especially estrogen and progesterone), and lifestyle factors interplay to impact issues like muscle loss, thyroid function, immune changes, food sensitivities, and weight management. Their goal: to connect the science with actionable strategies for improving health and resilience during this transformative phase.

Key Discussion Points & Insights

1. The Gut-Hormone Connection in Perimenopause

• Gut Diversity Declines in Women:

  • Recent studies show the female gut microbiome diversity drops as women age, notably around age 40, plateauing in menopause. This decline is more marked in women than men (sexual dimorphism), affecting not only digestive symptoms but immune function and thyroid health.
  • (06:29–08:06)

    "When we're looking at the microbiome, we can see that the female microbiome starts to decline in diversity as we age...the male and female microbiome are really different. That's called sexual dimorphism."
    — Dr. Marin

• Estrogen as the Primary Driver:

  • The fall in estradiol is identified as the prime driver of decreased gut diversity, with downstream effects on motility (linked to progesterone), immunity, and sensitivity to foods.
  • (08:23–08:56)

    "I think the number one is estradiol. I think as we experience less estrogen, less estradiol specifically, we have less diversity in our gut microbiome."
    — Dr. Marin

2. Food Sensitivities, Gut Permeability, and Immune Changes

• New Food Sensitivities Explained:

  • Increased gut permeability (leaky gut) in perimenopause lets immune cells encounter more food particles, leading to new sensitivities. Loss of estrogen weakens tight junctions in the gut wall, while dysbiosis increases infection risk (H. pylori, candida, etc.).
  • (10:20–12:36)

    "Estradiol influences the tight junctions in our gut and plays a direct role in intestinal permeability...we get more food sensitivities."
    — Dr. Marin

• Immune Shifts & Autoimmunity:

  • Loss of progesterone destabilizes mast cells (which release histamine), amplifying histamine-mediated symptoms—itchy skin, runny nose, migraines, and more pronounced food/alcohol/caffeine intolerance.
  • (13:27–16:55)

    "Loss of progesterone stabilizes mast cells which release histamine. Loss of progesterone is going to do that double whammy, especially if you have underlying issues with your gut."
    — Dr. Marin

3. Histamine Issues—How to Spot Them

• Symptoms Beyond Allergies:
  • Obvious: runny nose after eating certain foods, itchy skin, hives, rashes, allergy-like discomfort.
  • Less obvious: palpitations, headaches/migraines, brain fog, abdominal pain, and visceral sensitivity.
  • Histamine "bucket": flare-ups can be hormonally triggered (especially with ovulation or before menstruation).
  • (16:55–18:48)

    "Itchy skin is actually a really common symptom for women in perimenopause, which can be very much histamine related."
    — Dr. Marin

4. Detoxification Changes & The Role of the Estrobolome

• Liver Detoxification Stages:

  • Three phases—Phase 1 (CYP enzymes), Phase 2 (methylation), Phase 3 (gut excretion). All are influenced by nutrients (B vitamins, magnesium), hormonal changes, and gut function.
  • (19:54–22:02)

• Beta-Glucuronidase & The Estrobolome:

  • A subset of gut bacteria (the "estrobolome") produces beta-glucuronidase, which can re-release estrogen marked for excretion back into circulation.
  • Sometimes, this recycling is beneficial (e.g., when estrogen is low in perimenopause/menopause), acting as a protective mechanism.
  • Overactivity is often a sign of gut dysbiosis and can exacerbate estrogen-dominant symptoms when not needed.
  • (23:24–25:19)

    "Our body has this mechanism...Let's say in menopause, our gut microbiome is healthy, our body might say, hey, you know what? We've got low estrogen levels. Let's reabsorb some of that to protect you."
    — Dr. Marin

5. Strength Training & Exercise – Impact on Gut & Muscle

• Exercise Enhances Gut Health, But Balance is Key:

  • Moderate exercise (especially strength training) positively shifts the gut microbiome, supporting diversity and motility. Too much or too little exercise can worsen gut permeability or "leaky gut."
  • (32:31–33:57)

    "Exercise in and of itself is really good for your gut microbiome. So do more of it."
    — Dr. Marin

• Muscle Resilience & Motivation:

  • Strength training builds not just muscle but also emotional resilience, confidence, and is protective against autoimmune disease, cancer recurrence, and metabolic dysfunction.
  • (66:34–67:28)

    "There's a side effect and it's your confidence. It gives you so much more emotional strength."
    — Dr. Marin

6. The Microbiome-Thyroid-Carbohydrate Triad

• Low-Carb Dangers for Thyroid in Midlife:
  • Consistently low carbohydrate intake (without medical need) dampens T4-to-T3 thyroid conversion, sends "danger" signals to the nervous system, and impairs metabolism and resilience.
  • Controlled, temporary carb restriction may assist initial weight/fat loss for some, but chronic restriction can backfire, especially in active or already-lean women.
  • (49:51–53:51)

    "Adding carbs is like this signal to our nervous system. I also think strength training signals the nervous system like, hey, we're good here. Everything's good. Go ahead, do your thing...It's a safety signal."
    — Dr. Marin

7. Carbs, Fiber, and Modern Diet Myths

• Fiber for Flow & Microbiome Health:

  • Most women under-eat fiber and overeat fat. Adequate fiber (25–30g daily) from whole foods (oats, chia, flax, fruit, veggies) improves bowel regularity, glycemic balance, and supports gut motility and estrogen clearance.
  • (42:47–45:39)

• Carb Fear-Mongering Debunked:

  • Demonization of "healthy carbs" like oats is unfounded. When paired with protein and whole foods, complex carbs are beneficial for muscle fueling, metabolic health, and pleasure.
  • (44:52–45:39, 45:39–49:51)

• Best Carbs?

  • Oats (not oat milk), whole fruit (not juice), potatoes/yams (with skin), basmati rice, colorful vegetables, tubers—focus on fiber and color, not restriction.
  • Allow joyful flexibility—pleasure from occasional bread, celebratory food is part of resilience.
  • (59:56–64:10)

8. Birth Control Pill in Midlife: Why It's (Usually) the Wrong Tool

• Hormonal Contraceptives vs. Menopausal Symptoms:
  • Birth control pills are often inappropriately prescribed to regulate perimenopausal symptoms, but they actually shut down natural ovarian hormone cycling, reduce gut diversity, and increase clot/nutrient depletion risks.
  • Safer alternatives: IUDs, vasectomy, natural family planning, or (when indicated) bioidentical HRT.
  • (71:41–77:06)

    "It's not regulating your cycle, it's shutting your hormones off...Birth control decreases the diversity of your gut microbiome. HRT improves your gut microbiome."
    — Dr. Marin

9. Practical Action Items & Health Foundations

Dr. Marin's 5 Pillars of Foundational Health:
(78:01–82:14)

• 1. Protein-centric, high-fiber whole foods
• 2. Strength training & movement (for 'flow' & resilience)
• 3. Low-tox living (minimize toxins—filtered water/air, pragmatic 80-20 approach)
• 4. Sleep prioritization
• 5. Mindset shift (commit to showing up for yourself, not just others)

Getting Help:

• Seek comprehensive labs if symptoms persist (thyroid panel, gut testing), ideally with a functional/integrative provider.
• Remove gut infections (don’t just keep eliminating foods), then "replace" what’s missing (enzymes, acid, fiber, etc).
• Be wary of chronic or extreme dietary restriction; rebuild flexibility and trust in your body.

Notable Quotes & Memorable Moments

• "Our gut microbiome is like a rainforest. And as you kill off some of the good bacteria...it's just like this bonfire of things that then contributes to more dysbiosis, less beneficial bacteria, more bad bacteria, perhaps also more infections."
  — Dr. Marin (10:20–12:36)

• "If you can't sleep, it doesn't really matter what diet you're...doing at the gym. Like, if you can't sleep, you can't function properly."
  — Dr. Stephanie Estima (37:07)

• "It's an act of consistently showing up for me when I go to the gym. And then you get to this point where you're like, oh no, I show up for myself just like the way I've showed up for everybody else for the last 25 years. Now I show up for me."
  — Dr. Marin (69:50)

• "Eventually, performance, thyroid, body composition, the weight starts coming back in. And what do women do? They don't say, maybe the diet's not working for me anymore. They say, oh, I just got to do it more. I gotta, I gotta keto harder."
  — Dr. Estima (53:51–56:25)

• "Birth control pill is a huge under-service to women who are perimenopausal. It's not regulating your cycle, it's shutting your hormones off...There's not a great place for the birth control pill in perimenopause, in my opinion."
  — Dr. Marin (71:41–73:44)

Timestamps for Key Segments

• 00:47 – Episode Intro & Topics Overview
• 06:29 – Gut diversity changes with age & sex differences
• 08:23 – Role of hormones (esp. estrogen) in gut health
• 10:20 – Food sensitivities, leaky gut, & new symptoms in perimenopause
• 13:27 – Alcohol, caffeine, histamine, and immune changes
• 16:55 – Identifying histamine issues in midlife
• 19:54 – Detoxification, estrobolome, and beta-glucuronidase
• 32:31 – Exercise, flow, muscle, and gut integrity
• 42:47 – Fiber, carbs, and debunking food "villains"
• 49:51 – Carbohydrates & thyroid, dangers of chronic restriction
• 59:56 – Good vs. bad carbs; food joy & flexibility
• 71:41 – Birth control pills & menopause: risks and alternatives
• 78:01 – Action items, foundational health habits

Tone & Takeaways

Conversational, science-driven, and infused with compassion and realism. The hosts acknowledge the complex, multifactorial changes of midlife health and advocate for self-care that's rooted in agency, flexibility, and joy—not perfection or restriction.

Big Takeaway:
Women's midlife health isn't just about solving isolated symptoms. It's about recognizing how gut health, hormones, stress, and lifestyle are inextricably linked—then applying science-backed, self-compassionate strategies to thrive, not just survive.

For listeners:
Start with small shifts—more fiber, strength sessions, and sleep—then layer in advanced testing or practitioner guidance as needed. Make space for pleasure and flexibility in your approach. Your well-being is worth it.