A (3:14)

How would you like to hear from someone who has 25 years of clinical practice working with women around menopause and perimenopause? Well, I'd like to. You'd say, Dave, you appear to be a CIS white male. And I'm like, how dare you gender me? Okay, just kidding. But here's the deal. 51% of the population is women. And women who live long enough always go through perimenopause and through menopause. And I've seen women go through it in my work in the field of longevity. I've seen them go through it with flying colors where perimenopause is noticeable but not disabling, and where menopause is actually a new place of wisdom and power. And I think we need more of that in the world. That's why on the show you've seen dozens and dozens of experts who focus on the difference between men's hormones and women's hormones. And we all use the same hormones and we have different cycles on those hormones, and yet women have a lot more cycles, a lot bigger cycles than men. And I am terribly disturbed by the lack of testosterone in men and women, and it affects us very differently. And I'm maybe even more disturbed by the absolute shit show that is perimenopause today because it can wreck relationships and marriages and careers and lives. And there's no reason for it to happen except for a lack of knowledge. So that's why you get to have an amazing episode with Cynthia Thurlow, who's going to just break it down from her new book, which is called the Menopause Gut.

B (4:52)

Thanks, Dave. So good to be here.

A (4:54)

Happy you Come to Austin and do this live. It's way more fun than doing it on Zoom.

B (4:58)

Absolutely. And I have to tell you, one of the things my community said to me is I have never heard you laugh so much as you do when you record with Dave. So I'm hoping that we're going to have a great, like, vibrant, low key conversation about a very important time in a woman's life.

A (5:14)

I apologize in advance for my seventh grade sense of humor.

B (5:19)

Levity is important.

A (5:21)

So tell me with the menopause gut, how big of a gut does menopause cause?

B (5:26)

Well, I mean, we were talking before about how the title in and of itself is this double entendre.

A (5:32)

It's so fricking, actually.

B (5:32)

Yeah, it's like. So there's the one side. These body composition changes that women experience, most women experience, are deeply troubling, let's be completely honest.

A (5:42)

Oh yeah.

B (5:43)

And then on the other hand, how many clinicians are not talking to their patients about how the gut microbiome really governs every single symptom that women experience in middle age? And the better we can support the gut microbiome, the more likely we are to have patients that are going to be experiencing better relationships, better job satisfaction, better body composition, be able to navigate this transitional period in their life and have it not be such a big deal. Unfortunately, I think our modern day lifestyles contribute to why so many women suffer in perimenopause.

A (6:16)

It feels like sometimes you need a recipe to create a problem or to create a cake. It doesn't really matter. You gotta have enough ingredients mixed in about the right way. And if you were to create the perfect recipe for really rough perimenopause, it would be the world we live in today, right? What are the big ingredients in the things that cause painful perimenopause?

B (6:38)

I would say, number one is the lack of emphasis on high quality sleep. And I mean, you and I know how important sleep is so foundational to our health. But we encourage young mothers and women in general to be responsible for everyone else's needs and not our own. I mean, I was definitely that person in early perimenopause where I would get all the stuff done as soon as I got my kids to bed or my husband was traveling and I would stay up late to get laundry done or cleaning or what have you.

A (7:04)

Are you serious? You're an entrepreneur. You're doing your own laundry.

B (7:08)

I will admit something to you that I love doing laundry.

A (7:11)

Okay, I was gonna have to shame you for doing laundry for a Minute

B (7:14)

there someone cleans my house. But I do, I do. There's something therapeutic about it.

A (7:19)

I don't know why I always, when I'm giving this talk, especially to women entrepreneurs, like how many people wash their own socks? And I'm like, shame, shame. And I go, unless you're into it. Right. In which case I'm not gonna kink. Shame.

B (7:29)

Yeah, no, no. It is like my kids come home from college and I'm like, bring me all the laundry.

A (7:34)

So for you, it's like a nourishing, caring for others act. See, I love that.

B (7:38)

Yes, right.

A (7:39)

And you acknowledge that. And there are so many, especially people with families, men and women, where you're like stuck in the minutia. And if you're an entrepreneur, you just can't do that. Right. And even if you have a job, you probably can't do that. And just selectively saying these are the things that suck the most energy. I gotta get some help here. Because you only have so much energy every day. And what happens to energy production when perimenopause starts?

B (8:04)

Oh, I mean you get mitochondrial dysfunction. So you're absolutely dealing with a depletion of energy depending on where you are in a cycle, depending on how, how good your sleep quality is. And you know, in kind of dovetailing off that conversation, what is it about our modern day lifestyles? It's understanding that there is a sleep disruption piece that occurs with alterations in progesterone and estrogen and dysregulation of blood sugar. So there's a lot of things that, as we're heading into perimenopause, that if we're not being conscientious about our lifestyle, we'll actually worsen sleep quality. So number one is sleep. Number two is definitely stress management. We become way less stress resilient. And this is something that, for those of us that are type A and very conscientious, that becomes challenging to realize. Like you can't do everything. You have to start creating boundaries and saying no. Which is something that I know you and I both talk about, that's so critically important as grown ass adults.

A (9:02)

So the answer would be to just work out more. Right?

B (9:05)

Yeah. Oh, and that's. Yeah, that's it.

A (9:06)

Yeah. When you're tired, that works really well.

B (9:08)

Yep. What do you do? You go, you do more Orange theory fitness, you're gonna do more CrossFit, you have no recovery days.

A (9:13)

No. None at all. It's just the worst thing you could do.

B (9:15)

And then you're still eating a crappy standard American diet. And even with the change in the food guide pyramid, which that's great, most Americans are not eating nutrient dense whole food, they're eating ultra processed food. Cause it's quick and it' easy and I get it. And sometimes it's a lot less expensive. And so lots of things contribute to why we have this perfect storm of shitty sleep in perimenopause that extends into menopause. And I can tell you from taking care of tens of thousands of patients, lots of women just accept that sleep quality becomes problematic and they don't do anything about it because they think that there's nothing they can do.

A (9:53)

When does perimenopause really start?

B (9:56)

I mean, it depends on the woman. I mean, if you look at PCOS patients. So let's look at them. Number one, endocrine disorder that's out there for women, they're going to hit perimenopause likely earlier because they just have less circulating progesterone. So mid-30s, late-30s. And I think a lot of women chalk it up to I've got kids, I'm tired, I'm working a lot, I've got a lot of responsibilities. We're on that sandwich generation. Do I think that people that take really good care of themselves might be early 40s? Sure.

A (10:26)

Okay.

B (10:26)

But I think most of us, it's late 30s when we start feeling the effects of less progesterone and how that impacts sleep quality, mood disorders, you know, just overall irritability.

A (10:38)

I've often said that perimenopause starts at 35 for almost all women. And you might not have any symptoms for five or 10 years, but it's around 35. When your body makes less DHEA and pregnenolone, which are countering your stress hormones, they're giving you the stress resilience. So what would happen if women started managing their hormones at 35?

B (11:02)

I think they could feel a whole lot better. I mean, I think about what are the things that accelerate the aging of our ovaries, which are the most mitochondrial dense organ in a woman's body? What are the things that accelerate it? Toxins. So smoking, alcohol, you know, certainly chronic stress. We can unpack, you know, high ACE scores. We're starting to see emerging research on the impact of trauma and earlier ovarian aging, not to mention other types of toxins that we experience or autoimmune conditions. So what do I think would happen if women were able to start oral progesterone, oral micronized progesterone in their 30s, maybe 50 milligrams. They might not even need much the week before their menstrual cycle. Life changing.

A (11:45)

Oral, not topical. Why would you put progesterone in your mouth, not on your skin?

B (11:49)

I like the fact that you get a first pass effect in the liver and you get this metabolite called allopregnanolone, which can be sedating, upregulated, regulates GABA for most women. There's certainly women that are a little bit more sensitive to progesterone. And so there's emerging research that even intravaginal or intrarectal progesterone can be helpful for those kinds of patients. But most of my patients like oral progesterone.

A (12:14)

And the good news is you can get a test of your progesterone levels for very cheap from home. Lots of companies do that. Axo Health, one of my companies does that. But I mean, there's hundreds of companies for at home testing now. And you can buy progesterone that you can take orally on any website that sells that kind of stuff. You don't need a prescription, right?

B (12:35)

Well, it depends. I mean, if you want the oral micronized progesterone that's made by a pharmaceutical industry. Yes, but it's very inexpensive. You know, five, nine dollars, five to

A (12:44)

nine dollars a month, plus $200 for the doctor's appointment to get the prescription. I know they won't refill.

B (12:49)

I know, I know it's frustrating. Or, you know, some people want compounded progesterone because if you have a peanut allergy, that oral micronized progesterone is not a good, not a good option. You know, compounded options can be a little bit more expensive. Now, people will always ask, why not transdermal? I just don't see that. There's a ton of benefit to try if you're really looking to buffer those hormonal fluctuations. For a lot of women, they need the oral dose or plus or minus those who can't tolerate it. Interrectal, intravaginal are two other options.

A (13:18)

I, I love that. And I would encourage you see a functional medicine doctor. Yes, they should see you.

B (13:23)

Yeah.

A (13:23)

And if you're 35 and you have no money, you can do your own labs and you can get progesterone that's suspended in oil and take drops of it on Amazon. That's what I do when I want to raise my progesterone before bed.

B (13:35)

I love that.

A (13:35)

I just put a few drops underneath my tongue and it works just fine. And progesterone is important for men, too, but just not the same doses.

B (13:40)

Well, I was going to say that's the one thing that there's started to be this emerging research that's suggesting progesterone is important for men. Again, as you astutely stated, much lower doses, just like testosterone for women, we need about a tenth of what men make, but equally potent and important.

A (13:56)

One of the conversations I've had over and over, especially with clients in Unlimited Life, which is the concierge life extension medical practice I'm a part of, is once they're at the late stages of perimenopause, when women get on testosterone, appropriate amounts, they're like, oh, yeah, my libido, whatever. But I got my brain back.

B (14:18)

Yep.

A (14:18)

So what is testosterone doing for women's brains?

B (14:21)

Yeah, it's important for people to understand that it's more than just this bikini medicine hormone. It's important for executive function. So it's important for, you know, our ability to make decisions, to be thoughtful. I think a lot of people think of estrogen as the word finding thoughtful hormone. But I'd be the first person to say that, get off the couch and get your ass moving. Hormone is testosterone. And so I can tell you from personal experience, I had a period of time where I was working with one provider, and his thought methodologies were not aligned with mine. And so I took a little bit of a washout. The testosterone is what I felt the effects of first. That, holy cow. I was like, I want to go to the gym, but I don't want to go to the gym. I want to get off the couch, but I can't get off the couch. And so testosterone is this incredible intrinsic motivator. And I think for a lot of women, they don't realize executive function, being able to make decisions, being decisive. Think about how, you know, men can sometimes be decisive. Decision making, take the emotion out of it, get shit done. And so testosterone is so, so important for that. I think the other thing that a lot of people don't talk about is testosterone is also important for body composition.

A (15:26)

Yes.

B (15:27)

And so when we're talking about the menopause gut, we're really speaking to alterations in these hormones. And testosterone for a lot of women is what impacts that body composition piece quite substantially.

A (15:38)

So their workouts start working again because they have enough testosterone like they did in their 20s or 30s.

B (15:44)

Yep.

A (15:45)

Right. And I describe testosterone as something that raises dopamine, and it's the thing that motivates you to do things that matter in the world.

B (15:55)

Yeah.

A (15:56)

And I mean, you're an entrepreneur. You have all the business stuff that matters and parenting matters more than your business. Right. And you, I see this over and over in men and women, but more in women. It's like a sense of shame that, like, I should want to do that, but I don't want to do that because I'm so freaking tired. And it's testosterone behind all that and maybe thyroid.

B (16:16)

Yeah. Well, think about how many people have suboptimal thyroid. They're not, you know, they don't meet the, you know, the bell shaped curve distribution in a traditional allopathic model. And yet how many people, men and women, suffer needlessly?

A (16:30)

I've gone so far as to say if you're over 50, an eighth to a quarter grain of thyroid, which is a very low dose, is just a longevity compound and studies back it up. So almost everyone listening, unless you're hyperthyroid, if you were to do that with your doctor's support, ideally, then you're probably going to live longer and if nothing else, just have more energy, even if you don't live longer.

B (16:53)

Well, it's interesting. My husband in the past two years had a sub optimal free T3 and free T4. And I kept saying, you're telling me you don't feel any different, but I think you really need some thyroid medicine. And when he got started on, he said, oh, I just didn't realize it becomes this very subtle decline. And so I think for a lot of individuals, they think it has to be this, like, you can't, you're so tired, your hair is falling out, you're constipated, your skin is dry. It doesn't have to ever get that extreme. I think for a lot of individuals, they really have this suboptimal levels. And we don't want to be, you know, when we talk about suboptimal levels, we want to be an ideal range. We don't want to be in that kind of traditional, very wide range.

A (17:29)

Yeah. And the traditional wide range, you could be 1% away from low thyroid. Like, you're fine. And the simple test for this is, are you cold all the time? And if so, get your levels tested with a functional doctor like Cynthia, where they're going to look at all the four or five, if you want to be technical, different things that are part of advanced thyroid function. And you can also order that at home. That's one of the things we do at exo and it's life changing. And this is kind of Personal for me. When I was 26, I was in really bad shape. I'd weighed up to £300 and gone up and down, and I was cold all the time. I was really fat. I couldn't focus on anything. And I went to the first longevity doctor in the Bay Area because I'd sent my parents there. And he calls me up, he goes, dave, your thyroid levels are almost undetectable, and your testosterone is lower than your mom's.

B (18:25)

Wow.

A (18:26)

And when I went on thyroid, I remember it was like I felt a tingling in my brain. I'm like, this is how I'm supposed to feel. Because all the time before that, the amount of anxiety that you feel when I have the accelerator all the way to the floor and the car's slowing down, I can push harder. I got nothing left to push. And you just kind of feel helpless and stuck and is a gross feeling.

B (18:49)

I can imagine.

A (18:50)

And this is happening in perimenopause and menopause to millions of women. And it's cheap to fix, right?

B (18:57)

It is. I mean, although the thing I find is a source of frustration is that there are still women out there who need good care and can't get it. Number one, there are still people like, I just took the North American Menopause Society exam just to say I'd done it. And when I took the exam and I finished, I was like, that literally tested me on nothing about prescribing hormones for women. Like, little to nothing. And yet we have these organizations which are trying to do a really good job to educate more providers. But there are women suffering at a level that is so unacceptable. Like, I. We get. And I'm sure you hear it from your constituents, too. But like on social media and the inbox or the podcast, women are like, I can't find someone in my area who takes insurance. I can't find someone in my area who's willing to prescribe hormones because I'm more than five years out of menopause. And I'm like, wait a minute. You know, if you're 10 years out of menopause, 15 years, I mean, what you need is really good risk stratification, and you need some diagnostics, and then you need to have shared decision making, and then you and that provider make a decision about what's best for you, and that's what's not happening.

C (20:04)

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A (21:04)

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C (21:27)

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A (21:28)

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C (21:47)

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A (21:48)

Go to try joy mode.comdave for 20% off. Joy Mode, the electrolyte packet for great sex. One thing that it was one of the most memorable things that's happened in my life in the last 15 years was in November, I got invited to Washington, D.C. to interview the commissioner of the FDA. Now, if you'd have said, dave, what's the least likely thing to ever happen? It would have been that. Followed by being in a magazine with my shirt off or on a book cover, in case my last one. Both those so far from the reality that most of my life has been. But that's the one, because I've been just, you know, vocally critical of them for a long time, to the point that I got shut down during, you know, Covid and all that. And I went in my first question, Marty, what big pharma company are you going to go to work for when you're done here at the FDA in front of 500 people?

B (22:46)

I think that's awesome.

A (22:47)

And he just looked. He laughed. He goes, I'm a surgeon. I'm an author. I've never worked for Big Pharma, and I took an oath that I won't. And then we spent much of the rest of the interview talking about how he just changed bioidentical hormone replacement to be the standard of care for women at perimenopause and in menopause. And he said, this is going to help 50 million people. 23 years ago, the previous regime at the FDA made a mistake based on unvalidated data and a press release, and we've harmed women greatly. And it's time to set her. And I almost had tears in my eyes.

B (23:21)

I have chills as you're talking about it.

A (23:23)

Man. We finally got someone in charge of the organization who understands. And it takes years to change organizational behavior, but I see the effect on women and on the people around the women when they're doing their very best and they're feeling all this shame. Like, I know I'm not this way, but I'm feeling this way. And it's just caused by these basic hormone things.

B (23:48)

It's so important. And Marty's a good guy. He's a Hopkins guy. I didn't know him while I was there, but he's a good guy. I mean. And I think that some of the changes that are being put in motion are going to have a tremendous impact. But I agree with you. If you look at the statistics that 70% of divorces are initiated by women, how many women really don't want to be divorced? Like, let's take the bad people out of it. There's some bad players that need to

A (24:10)

go on both sides.

B (24:11)

Yeah. But I think that in most instances, they don't want to initiate the divorce. But if they're struggling with anxiety and depression and irritability and no one is looking out for them from the perspective of replenishing hormones, not just estrogen, progesterone, testosterone, thyroid. But really thinking thoughtfully, I mean, how many women wouldn't have gone through a divorce had they not been a position where their hormones were optimized? Really, the word optimization is really key because it's not a whiff. We need a little bit more than that.

A (24:43)

Yeah. And we want to look at it. And it's different for each woman, which makes it a little bit. A little bit difficult. Some women will make toxic estrogen byproducts, some won't. And it's complex, but not that complex. It's something that you can teach, what, in a weekend?

B (24:59)

Yeah.

A (24:59)

To a Doctor Right.

B (25:00)

Well, and I think the biggest thing when I'm talking to women is helping them understand your perimenopause to menopause journey is as individual as you are. Yeah, and that's the issue. I mean there's a hundred plus symptoms women can experience and you could put 10 women in a room and they all might experience it dramatically differently. And to your point, everyone needs a customization to whatever they need. Not everyone needs testosterone in menopause or perimenopause. Most do. Not every woman necessarily needs thyroid replacement, but most do. I think the other piece is really, you know, looking at these GLP1 drugs that for many, many women not necessarily being utilized for weight loss, but shifts in body composition, reduction in inflammation, I think are really exciting because the research definitely supports HRT plus GLP1s. Life changing.

A (25:48)

I'm so happy you said that. There's so much I didn't actually understand it. People are like, oh, GLP1s are cheating. Yep. As a former 300 pound guy, I would have done anything. And I did do everything I could think of. And they say, oh, but there's risks. You know what the risk of being obese is? It's much higher than all the other risks combined. And so we have this weird moralistic thing that cheating is bad, but the same people who are yelling about cheating, they're driving instead of walking. Driving is cheating, guys. And they're eating a bag of chips which they didn't farm themselves, which is also cheating. So that cheating is okay, but using a peptide that changes your metabolism is somehow morally wrong. So those people are, are sick. Like they need therapists.

B (26:38)

Well, it's interesting because I feel like it's typically a certain demographic, a certain gender demographic, the young, sorry guys, young personal trainers that are males, it seems to be those are the ones that are screaming it from the interesting. Yes, at least in my world, those are the people that will say. They'll, they'll say, well, first of all, calories are, are, are completely the only reason why people have trouble gaining those

A (26:58)

guys, the biolanes of the world, the

B (27:00)

cecos of the world, they're the ones that will say to me, oh, your patients are cheating. And I was like, you know, there's enough shame and blame in this world. We don't need, we don't need comments from the peanut gallery, if you will. And I think for a lot of individuals, what I find interesting is microdosing of these drugs. Patients with autoimmune conditions, people are dealing with inflammatory responses. They don't necessarily be at a super high therapeutic level. They get benefits at microd that they can take long term. And so I think that we need to accept the fact that we are in a day and an age where appropriately dosed peptide therapies can be life changing for so many men and women. And why do we have to pass judgment? It's almost like you're the body composition police, like who decided that you are able to orchestrate and demonstrate that you are of such high moral character that you get to judge everybody else because maybe those people are genetically gifted and they will never experience.

A (28:00)

They're also poor metabolic, mostly like 25.

B (28:02)

Correct.

A (28:03)

And you can get away with a lot when you're in 25. And it's sort of like the 24 year old vegans and by the time they're 28 they're just wrecked and like, oh my God, I eat meat again. I'm crying and I feel so good. Like it's predictable. But one of my favorite observations here was there's a guy, Spencer Nadovsky or

B (28:22)

something I do know Sue Spencer is

A (28:25)

and so one of the biggest health trolls out there. And he's like, well, I've been doing this, calories in, calories out with my clients forever. He goes, but you know, some of them elected to use GLP1s because it was so painful and difficult for them to stick with my recommendations. I'm like, dude, your recommendations are shit. That's why like any sustainable weight loss or weight maintenance program needs to be sustainable in its nature. And you can do this with food for a lot of people. And I'm 100% aligned with you for longevity, microdosing, GLP1s. There's great evidence, I've done whole episodes like three or four of them on that. And so let's just remove any shame or judgment from that. Unless you're also going to sew your own clothes, walk everywhere. Right? Like this is insane. It's just a tool like any other tool. And what isn't okay is that if there is anything on the planet that's going to give you your brain back, give your body back, give you your relationship back and your vibrance back, we should be pulling out all the stops for every single woman in order to provide these to them with no judgment. I don't care what it is. I mean, if you need to hang upside down by one ankle from a pine tree, dude, all right, let's grow some pine trees. It doesn't matter. Will it work, by the way?

B (29:41)

Yeah, that might be uncomfortable.

A (29:43)

Yeah. But probably like the terpenes from the pine. Let's make up some science.

B (29:46)

Yep, yep. From the pines will be therapeutic. And yeah, they'll, they'll, you know, create epigenetic signaling that will drive, drive down inflammation. But, but I think, I think for so many people it's this kind of shame piece. So women navigate aging and let's be honest, men don't have the same judgment of their bodies, the way they look.

A (30:08)

You're looking at a guy who had a facial circumcision.

B (30:10)

Oh, you did?

A (30:11)

Yeah. I had literally a passport cover sized piece of skin from when I was obese on each side of my face taken off because like this is not aging skin. This is, I have extra, I have like a beach towels or half a beach towels worth of skin all over my body from being obese. I'm like, I'm going to take this stuff off my face. I cut my toenails too. And so I'm real public about it because I think it's kind of funny.

B (30:30)

Well, you look great.

A (30:31)

Well, thank you. But like guys don't want to age either. And there's whole brands for that. And we're maybe less sensitive, but we're getting more sensitive about it probably because of social media.

B (30:39)

Yeah.

A (30:40)

So everybody wants to look good and you want to recognize yourself in the mirror. And this loss of body autonomy, nobody likes it in aging, but men, it's a slow decline. Yeah.

B (30:50)

And with women, drop off a cliff,

A (30:51)

you hit a wall or fall off a cliff. And so that's when it's really scary because I kind of know my body and I know how to run things and all of a sudden nothing works. And I want to know what are the lab tests? The first lab test that went on, I was like, okay, some went weird. What do I look at first?

B (31:11)

I would say, you know, I want to look at metabolic health parameters. So I want to look at fasting insulin. I want to look at an A1C. I want to look at lipids, specifically APOB, APO, lipoprotein B, Lp because everyone thinks about the traditional cholesterol panels. And I'm like, I want to see your triglycerides and your hdl because that tells me if we're thinking about you being insulin resistant and then moving on to a full thyroid panel, that is not just a tsh. That doesn't tell us much. Really looking thoughtfully at like leptin, looking at ghrelin, looking at estradiol, looking at free and total testosterone. Looking at progesterone, thinking thoughtfully about, you know, inflammatory markers like high sensitivity crp, looking at ferritin, which is iron stores. How many people have, you know, they're convinced they're, they're hypothyroid because their hair is falling out. It's because their iron levels are suboptimal.

A (32:01)

How many women in perimenopause are low iron?

B (32:04)

A lot of them, because they have this relative estrogen dominance and their menstrual cycles are really heavy.

A (32:10)

So high estrogen equals low iron if

B (32:12)

they're having a lot of blood loss. So if they're having very heavy menstrual cycles. So, you know, a normal blood loss during the course of a menstrual cycle in perimenopause can be twice what it was when they were younger. So you start to think about if they're not able to replenish those stores of iron over time. And this is why a lot of women end up getting either uterine ablations or hysterectomies because they're like, I can't tolerate this bleeding. And so serum ferritin, I think, is really important as a really good marker of iron. And beyond that, it's really getting customized. That's when I start looking at food sensitivity testing. I look at gut health. I want to look at stool testing. I think stool testing should be routine. It should not be, oh, we think you have ova and parasites. So we're going to do, you came back from Mexico and you have traveler's diarrhea, and you go to your traditional allopathic document. They check that and then it doesn't really give us a sense of anything else. So looking at these integrative medicine tests, you know, thinking thoughtfully about, you know, this microbiome tests and, you know, what else could be going on in the gut. That's a starting point.

A (33:13)

That's like $5,000 worth of tests.

B (33:16)

Maybe not, maybe not 2,000. Well, I would say, you know, those integrative tests, if we're looking at a stool test, couple hundred dollars, we're looking at food sensitivity testing. Because so many of my female patients start developing new food sensitivities. They're getting rashes, they've got eczema, they're like, I have, you know, high histamine. I'm breaking out in hives. What is going on? I would say I'm pretty conservative. I mean, there's other tests that we can look at, like saliva based testing to look at. That's where I like to look at cortisol, like what's going on over 24 something Dutch or just looking at a traditional 24 hour distribution of of cortisol. I think that can be helpful to see like, you know, what is cortisol distribution should. It's like a circadian rhythm. So it should be highest in the morning, ebbs and flows throughout the day and drops in the, in the afternoon, evening.

A (33:59)

And you talk about this in the menopause guide.

B (34:01)

I do. I do talk about this.

A (34:02)

So if you're listening, scribbling notes right now, number one, there's notes on the website.

B (34:08)

There's lots of good stuff.

A (34:08)

So I'll throw this down. Yeah. And they're on. The notes for this episode will be on my website. Cynthia. Your website?

B (34:13)

Yep.

A (34:14)

What is it?

B (34:14)

Www.cynthiathurlow.com.

A (34:17)

now I gotta tell you this, as a tech guy, you don't have to say www anymore.

B (34:21)

I just like, sorry. I think it's like it's just ingrained in my brain now.

A (34:25)

If you're like 10 years older, you'd be saying HTTP colon. I'm just teasing. Yeah. Cynthia.com.

B (34:33)

yeah, thankfully I don't do that.

A (34:36)

I still cast myself sometime sometimes. So I'm totally teasing. But cynthia thurlow.com and so you've got tons of good info on there. So rough budget. Thousand bucks.

B (34:49)

I mean out of pocket if you're looking at two or three integrative medicine tests and then the rest can be covered by insurance. Although now I think a lot of people, there's companies that are out there where you can get your labs drawn relatively inexpensively on your own. The question is, what do you then do with the data? Like we have people in unpaid groups that will say, oh, I got all these labs done. What do I do? And I'm like, I can't review your labs for you.

A (35:10)

So Grok has this thing called Not a doctor. How not of a doctor is it?

B (35:14)

I don't know. I don't know.

A (35:16)

I have found with appropriate programming that actually chatgpt even is profoundly good 90% of the time. The other 10% is just bullshit.

B (35:28)

Yeah. When I'm like onboarding new people onto the clinical team, I'll actually have it create fake patients so I don't have to worry about taking information out. I'm like, create this about this patient. That's a great job. I'm like, this wasn't around when I was a student. That would have been so much easier.

A (35:43)

I was working with a pro athlete who sent me 40 labs. And I'm not a doctor, but I partner with doctors, and we do things at unlimited life at the very high end. So I'm like, all right, anonymize and all the things. And then I have a hypothesis without saying a word. And I've programmed thousands of lines of how to think like me. And sure enough, it matched what I came up with. I'm like, this is pretty crazy.

B (36:11)

That's awesome.

A (36:12)

Right? And so for people listening, you should go see Cynthia. Or a functional medicine doctor who understands hormones and thyroid and menopause and perimenopause, or maybe one who isn't a specialist in that, but at least understands longevity in women. Right. And this is preferred. And I just want to recognize there's a lot of financial stress in the country right now. So this is something. If I am on my last legs here, and that's just not going to happen, my insurance will cover it. Order the cheapest labs you can. Do your best with AI and you'll probably get most of it, but not all of it. Enough that the wheels are back on the bus, the lights are back on, and maybe they flicker a little every so often, but you'll be back in the driver's seat. Like, that is precious.

B (36:51)

Yeah, it is. Well, and I think we're at a time and an age where people have endless amounts of access to information. And so I used to say all the time, I was never a clinician that was offended if a patient came in with questions or research or something they wanted to discuss with me. And I think if there's a clinician listening who gets offended when their patients do that, they have to understand, like, times are changing. We have patients that are much more educated, they are much more aware. They have access to information that is infinite. And so we have to meet them where they are.

A (37:21)

We do. And we also need to back off with the insurance companies, this whole standard of care nonsense. Because I asked a doctor once, I was on some kind of new pharmaceuticals years ago, I said, you know, given that I read the side effects on this, I'm thinking about taking a little extra vitamin C to help support a process in my liver. He goes, oh, I wouldn't recommend it. I'm like, why? Because, well, there's no studies of that. And I just stopped and I said, there's no studies of lotion and this drug, but you recommend lotion, Right? And he goes, good point. I would take the vitamin C. I'm like, thank you. But he didn't feel safe to tell me that because there's not a study. And the reality is 99% of things in the world don't have studies, nor should they.

B (37:58)

Well, and I think, here's the thing is that what kind of gets people thinking that a particular intervention might be helpful is they start doing anecdotally, like, I'll say sometimes online, like, I don't have a research article to support this, but I can tell you clinically what I have seen. That is the start of, you know, heading in the direction of maybe doing some research. And I think that, you know, just because there isn't a randomized controlled trial available, that does not then mean that that intervention is not beneficial.

A (38:25)

In fact, clinical evidence is the font of knowledge. This is why doctors who are experienced train new doctors because of clinical evidence. And to say clinical evidence doesn't count because you're an angry health troll or you're a big pharma company, either one of those is ignoring the power of doctors and healers. And then what's even more important, a big pharma study can come out that says this works. And when clinically, you see that it doesn't work, that is the most valid evidence of all, because there's a lot less corruption in frontline healthcare workers than there is in big pharma.

B (39:00)

Yeah.

C (39:02)

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A (40:00)

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B (40:10)

Hey, everyone, check out this guy and his bird. What is this, your first date?

A (40:13)

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C (40:16)

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A (40:17)

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B (40:20)

Yeah, the bird looks out of your league.

A (40:22)

Anyways, get a'@libertymutual.com or with your local agent.

B (40:25)

Liberty. Liberty. Liberty. Liberty. Well, I. I can tell you, in 2016, when I was still in traditional allopathic medicine in cardiology, the Jupiter study came out. Want to talk about a big study? And what came out of this study was that women that are taking statins are at increased risk of developing diabetes. And I remember I went directly to my supervising cardiologist that I work with, and I said, how would you like me to address this? Because inevitably the patients will be asking me and they're gonna wanna know, and I wanna be honest with them. And I was told to shut my mouth. Essentially, they're like, you can discuss the study, but tell them we're gonna monitor their blood glucose and we're gonna make sure they don't develop diabetes. And I was like, but mechanistically, they will develop diabetes. It's not a question of if, but when while on a statin. And so when I think about like, that is one example, and if anyone is taking a statin, do not stop your statin. I'm not telling you to stop your statin. I'm just saying, have the conversation with your provider. Because, you know, you think about metabolic health and you think about statin therapy was being this huge. I mean, it was a huge part of what I did for years and years and years.

A (41:34)

And I want to catch that. I am telling you to stop your statin. I think you should tell your doctor that you're going to stop your statin. But I think you should stop your statin and you should come up with a plan to taper off or whatever the heck you do, because statins are generally bad for you, unless you're in the 1% who actually need it. Because for every hundred people who take statins, one person may get benefit. And that's what the science shows. It's just a terrible scam. So let's test people to see if you're the 1%. Otherwise, we should be taking our statins and literally sending them back to the manufacturer, hopefully with napalm or something, because we need to stop this.

B (42:07)

Did I ever tell you the story about my dad? No. So both my parents were on statins, and when I talked to my mom, my mom decided in conjunction with her doctor, I'm gonna stop and we're gonna find an alternative. My dad steadfastly did not listen. And my dad developed every sequelae that you can develop from taking long term statins, including significant muscle loss, neurocognitive changes. And my dad had a series of falls and died in 2024. And no, but it's one of those things where I was like, he is the perfect example of someone who really believed what his provider was telling him. And even though I was trying to give him evidence, I was like, hey, dad, you should probably look at this. Didn't want to make any changes. And so I always think about my dad when people say, oh, statins are benign. I'm like, no, not really. And that's why you need to have that ongoing discussion with your provider about, is this really the appropriate drug therapy?

A (42:59)

For me, our ability to believe things despite new evidence seems like a design flaw in humanity.

B (43:06)

Oh, it's a degree. I think it's cognitive dissonance. And it is pervasive, as we know.

A (43:11)

There's this entire story around medicine that was just built in the last 80 or so years, backed by Rockefeller for the most partner report. And it's not real. It's a way of working with people. And I have just the utmost respect for what you've done because you were well indoctrinated as a cardiologist in that system. And one day you said, I'm gonna serve my patients. And it's incredibly risky for your career to make that change.

B (43:41)

My dad thought I lost my mind. He was like, are you having a midlife crisis? Like, literally was like, I'm worried about you. Are you having a midlife crisis? And I said, no, I cannot write another prescription. Like, I felt that strongly that lifestyle medicine really needed to be the focus of what I was doing as opposed to prescription writing. And I still love my allopathic friends and colleagues, and there's a place, but

A (44:05)

everyone should have a few allopathic friends. Incredibly useful. Hospitals are great when you've been in a car accident, and if you have a chronic condition, not so much. I think you've helped hundreds of thousands of women because you made that decision. So thanks for taking that step because it is a big one.

B (44:22)

It'll be 10 years on April 1st. 10 years. It's hard to believe because at the time everyone thought I was having a midlife crisis.

A (44:29)

Well, especially you made the decision on April 1st that they think you were punking them.

B (44:33)

Well, I had decided in February, but I was like, that was my last day. And it was hard. It was bittersweet because I Love everything about the heart, but I was like, I can't continue in this. For me, it wasn't the right decision. And again, I respect and love my peers, but that was a hard decision to make.

A (44:50)

And there's validity to both. You know, if I had a bunch of calcified arteries in my heart and was having a heart attack, I'm grateful that we have the ability to do interventions.

B (45:00)

Exactly.

A (45:01)

And at the same time, I not going to go there.

B (45:03)

Yeah, yeah, well. And I think we know so much more now for sure.

A (45:08)

You're talking about some things in the menopause and perimenopause world that few other doctors are talking about. It's the direct effect of the gut, not just hormones, on perimenopause. What's going on in the gut that's affecting menopause?

B (45:23)

Yeah, I would say so. The gut microbiome is 40 trillion bacteria, viruses, fungi, protozoa, and there are more of them than there are cells in our body. So just give everyone some perspective. And when we talk about the gut microbiome, we're talking about an area of the large intestine, the colon. A lot of people are like, I can't see it, so it doesn't exist. And I remind people it's really been the last five to 10 years. We've learned it more and more. But what I think is endlessly fascinating about the gut microbiome is every single body system is connected to the microbiome. There's a gut bone axis, there's a gut brain axis, there's a gut lung axis. You name it, it exists. And so this crosstalk communication, gut, ovarian access, every organ system intersects with the gut. So when we think that what we eat is important and the amount of stress we get, or over exercising or even the stress management piece, if we think that that's not impacting our bodies, that gut microbiome is talking constantly. And the influence, what I find really interesting is from the time that young men and young women are born up until puberty, our gut microbiomes are pretty similar. And it's the three Ps, it's puberty, pregnancy, perimenopause, where we get these dynamic shifts in response to estrogen, progesterone, testosterone. And so I remind people that life comes full circle because in menopause we get alterations in microbial diversity, we get changes in inflammation, we have a reduction in things like short chain fatty acids, which is not a sexy topic, but is an important one. And so our microbiomes start to resemble men's again. So it's like life comes full circle. But I remind people there's nothing that goes on in that perimenopause transition that is not impacted by the gut. I'll give you an example. You know, people talk about hot flashes or vasomotor symptoms, which are incredibly bothersome. If you've ever had a hot flash and you're listening, you know what I'm talking about. They're really bothersome. But do you know that there's a connection between the worsening of symptoms and the health of that microbiome? So if you have significant blood sugar dysregulation, you're insulin resistant, you have more inflammation, you are more likely to experience more of these vasomotor symptoms. And although we don't 100% understand why we have them, we think that it could be alterations in chemical signaling in the brain with the hypothalamus and the thermostat internally, and estrogen. But we know that there's also this contributory piece that comes from the microbiome itself. And so I remind people we can put on an estrogen patch and we can take oral progesterone, and maybe we're taking transdermal testosterone. But if you're not thinking that there's something else going on, if you think that's just gonna simply fix a woman symptoms, you gotta work on the gut because it impacts everything.

A (48:07)

One of the areas that I've worked with clients on that's really interesting is the symptoms of a hot flash. And the symptoms of getting a dose of histamine are very, very similar. And what happens when you have a change in estrogen to your mast cell sensitivity?

B (48:25)

Oh, it provokes them. So you get histamine response, you get mast cell degranulation. And for a lot of people, this is when they start developing hives. They'll say, I've never had hives.

A (48:34)

Yes.

B (48:35)

Or they start becoming anaphylactic, meaning severe manifestation of food allergies, high estrogen. Correct. In this setting. And so people will say, but I don't understand. If my estrogen's low in my body, why is that happening? And then you have to talk about exogenous estrogen sources. So personal care products, environment, and food are hugely influential. And if you think that you exist in a vacuum, you don't.

A (48:59)

So you might eat some soy sauce, you might eat some leftovers, you might eat some fermented whatever. And that something you could have tolerated just fine at 35, and now you're in perimenopause and you eat it and get a huge hot flash. What was it a hot flash or was it a histamine reaction?

B (49:17)

It's dramatic.

A (49:18)

So sometimes the things that work for mast cells, like Claritin. Right. Could have an effect even on perimenopause.

B (49:25)

Yeah. H1, H2 blockers.

A (49:26)

What's your take on Claritin? Pepsid. There you go. That's my COVID protocol for most people to start anyway and for toxic mold and all that. So how much of perimenopause is actually allergies happening?

B (49:40)

I mean, I think it's just, we have this tipping point. We're just more. It's more easily provoked and it doesn't necessarily happen for every woman. But I've also had women in menopause who have those same symptoms and they'll say what is going on?

A (49:52)

And that's a different thing then.

B (49:54)

Well, well, yes and no. I mean it can kind of. You can have these 20 to 30% higher estradiol levels in perimenopause, which is what provokes a lot of those symptoms that women find so bothersome. Breast tenderness, heavy cycles, brain fog, et cetera. But I've seen women in menopause also have those symptoms and it is a constellation of are they taking too much exogenous estrogen to replace what's there? That can be some of it. Are they just. Their toxin bucket has been progressively filled over 20 plus years. And they think that their personal care products, their plastic wrapped food, the microplastics in water, et cetera, they think that it's irrelevant because they can't see it.

A (50:32)

Yeah. Food delivery every day in plastic containers. Yeah, that's not gonna work out well.

B (50:36)

Yeah. So I think that for a lot of people it becomes this scary situation, especially if you are being told to carry an EpiPen. Wow. Like, oh, you're gonna have to carry an EpiPen. What's interesting is I'm also starting to see this interrelationship between there's something called alpha gallop, which probably so Lone star tick, which in Virginia, ironically enough, University of Virginia was doing some of the first research on alpha gall. But people who would develop mammalian meat allergies. And so when patients are starting to develop reactions to food, I start to think automatically, are we dealing with a tick borne illness? Like that has to be ruled out. And that's really important because we had patients who couldn't go to have surgery because they couldn't have animal products like porcine or bovine blood products in surgery. So it becomes a larger issue.

A (51:26)

So which is a better bioweapon, Covid or lyme disease? Just wondering.

B (51:31)

I'd like to take a pass on both. True. Truly. I mean, long haul Covid and long haul like lyme bad news. I mean those are they become autoimmune.

A (51:41)

They do. In my history, I was diagnosed with long standing Lyme disease and I was diagnosed by the normal western blot test. And then my former wife and I started a lab testing company that had a very precise way of testing white blood cell reactivity. I had active Lyme, but strangely, when I got rid of my toxic molds, a Lyme went away all by itself.

B (52:04)

Well, you know, that's what we're starting to learn is I have a. My 18 year old is in a moldy high school.

A (52:10)

Oh my God.

B (52:11)

And so he has Lyme and his functional med doc said, you're not gonna get rid of your lyme until you're out of the school. And he said, I've got six more months of high school. I'm not willing to leave. But sure enough, where did he get into for college? A very moldy state. And so we were like, okay, we're gonna have. But so for people that are, that are dealing with chronic Lyme or chronic tick borne illnesses, if you're also dealing with mold, you probably are not gonna get better until you are in a different environment.

A (52:38)

Well, shout out to the episode with super stratum, which is a company that I think has finally come up with a way to treat structures. And I'm, I'm so disgusted by the way we treat our schools for our kids, including our colleges, they don't maintain them. They're all moldy. And it's a causing adhd, it's causing behavior problems, nightmares, all kinds of health issues for the teachers and for the kids and got to do something about that. I wonder too how often when someone has really severe problems with perimenopause or menopause is environmental mold.

B (53:10)

I absolutely think it is. Yeah. We actually had our house evaluated last year pretty thoroughly, which was both terrifying because I was like, we have a brand new house. I'm hoping you don't find something both terrifying but also very satisfying because we realized that was not the vector for my son, but the high school was, which is unfortunate.

A (53:29)

Guys, go to daveasprey.com mold and there's a collection. There's the documentary I did on mold, there's episodes on mold and all this stuff that I know about Mold, because it's a big thing and it's huge. I feel kind of bad when someone's starting on their longevity thing. They're usually around 45 to 55, going, oh, you know, I don't look the same in the mirror. I gotta do something. And so they go out and they spend a lot of money and time and they're trying to optimize when they're floating in toxins in their home. And you gotta start with that toxin thing. So the people who come through unlimited life, we give them all a mycotoxin screen. And if they have high levels, then we do something about it. If they don't, we don't worry about it. And one person that I've worked with in their early 40s had very high levels of toxic mold. And the markers of Alzheimer's beginning, which are directly linked to. And you can catch that stuff in lab, in labs, if you know there's a connection. But I think mycotoxin screening should be just a requirement, as when you go to the doctor and they're doing, you know, let's do your annual physical, they should just what toxins are coming out of there. And if you got high levels, it's not that hard to get rid of most of the toxins if, you know.

B (54:46)

Yeah.

A (54:47)

And I think that can clean up a lot of the symptoms. My favorite mold toxin is directly tied to perimenopause, and it's one that I have intimate experience with. And it's 10,000 times stronger than human estrogen.

B (54:59)

Really?

A (55:00)

Yeah. And it's so powerful that pharmaceutical companies concentrate it into a little wax pellet and they stick it in a cow's ear so it'll melt into their bloodstream and then that cow will get fat on one third less calories.

B (55:13)

Wow.

A (55:13)

And we'll eat it. That's why I like grass fed.

B (55:16)

Wow.

A (55:17)

And the drug is called Zero. And the substance, the toxin from mold is called zearolanone. And it is a very potent estrogen mimetic or a xenoestrogen. And man, if you're trying to navigate through perimenopause, I got 10,000 times equivalent human dose because it's on my pillow. You're not going to win until you deal with the mold.

B (55:37)

Well, I jokingly refer to dairy as the five pound dairy, because for a lot of individuals, especially in that perimenopause transition, dairy is hugely inflammatory. And it's not just, you know, a one versus a two versus sheep versus goat's milk. It is dairy in General, why do

A (55:53)

you think that is?

B (55:55)

I think it's. I think it's a constellation of different things. I. I think that, you know, we're more prone to leaky gut. And if we have that small intestinal hyperpermeability and we have. We provoke an immune response on the other side of that, leaking food particles into our bloodstream. I just think that we are at greater. I mean, just with all the constellation of things that are happening physiologically for women. I think it's driven by the fact that there's, you know, subsidies for dairy. So dairy is in everything. You have to, like, read labels copiously. I just think we are set up physiologically at that time where if we're not really careful about, and let's be clear, most of us have leaky gut.

A (56:36)

It is abundantly common. Isn't there a drug that fixes leaky gut?

B (56:41)

Do I think that there's a drug per se? I don't know if I 100 agree with that. If we're like, testing, are you looking at, like, zonulin levels to confirm that you've fixed, you know, the leaky gut?

A (56:51)

Trying to remember the name of it. One of the people I was chatting with was talking about a pharmaceutical that really helps to seal the leaky gut, but I'm forgetting what it is. There's probably some that help.

B (57:00)

Yeah.

A (57:01)

And I mean, there's all kinds of.

B (57:02)

Well, there's a lot of, like, gut protective. I mean, you know, the research. Sex, like L. Glutamine is helpful. There are peptides, you know, BPC157. I mean, there's definitely things that can be helpful. But ultimately, like, what really helps? You got to change your lifestyle.

A (57:15)

You want to hear a really scary story about Derry?

B (57:18)

Sure.

A (57:19)

Okay. Do you know who Lord Rothschild is?

B (57:22)

I don't.

A (57:23)

Well, he's a member of the Rothschild family, the leader of the family. And I don't know if that one is still alive, but he's one of the people who controls power. You know, some of the kings and queens, you know, they help to make all that stuff happen. I don't know. I've seen enough direct evidence that I believe that's true. And lots of people say good conspiracy theory, which is words made up or at least popularized by the CIA to make people who ask questions sound crazy. So there you go. I'm crazy, whatever. But this guy has only done two public edicts in his entire life. One of the two was after the first tests of pasteurized milk came out and they fed pasteurized milk to one set of rat pups, and they fed raw milk to the other. And pasteurized milk reduced fertility dramatically in those. And then his public edict was, thou shalt pasteurize thy milk. And have you seen the incredible aggressiveness of enforcement over raw milk? It doesn't make any sense.

B (58:23)

It's like, it's almost in code because I'm part of some natural food groups on Facebook and it's like code. Like they can't actually say raw milk. They have to be very careful about it.

A (58:35)

Fentanyl's okay, but not raw milk. Fertility is a sign of hormonal health and good aging when you're young and in your fertile years. And so if you're eating pasteurized milk that ruins fertility, it probably also is going to make perimenopause and menopause worse.

B (58:55)

I think it's almost like a litmus test for how well you take care of yourself. I mean, I tell everyone that, the women that'll say to me, I literally had little to no symptoms in perimenopause. I'm like, you are an outlier. And that's great. But more often than not, I think it's a litmus test of how well you take care of yourself. And so whether it's the quality of the food, how frequently you eat, what your sleep habits are like, do you manage your stress, do you have healthy relationships? We can unpack what trauma does to ovarian aging, plus or minus navigating the perimenopause shit. Show that it can be. You don't deal with your stuff, it'll find you.

A (59:33)

We haven't talked about that yet. So we're sitting here in Austin, very close to the new home of 40 years of Zen. I've got four people going through, let's see, three women and a male are going through. All of them are unpacking trauma. They're all high performing, amazing humans and going, oh my gosh, I never realized this. So what is the role of trauma in perimenopause?

B (59:55)

It's huge, Dave. I think this is what, while I was writing the book, was the thing that I found most humbling. So if we look at adverse childhood events, it was a joint venture research done between Kaiser Permanente and the cdc. And anyone listening can get access to the questions that are on that and you can quickly estimate, you know, what your childhood experiences were like.

A (60:13)

Okay, I want to be really clear. This was the pre Covid cdc back when there was any validity to that organization, just to be honest.

B (60:19)

And this has been around for a while.

A (60:20)

So, yeah, the old cdc.

B (60:21)

Yeah. So adverse childhood events. I have a trauma score of 9. So for anyone listening, that's pretty high. And so when I talk to patients, trauma's always a piece. I'm like, I'm not a trauma expert, but I can tell you when I talk to patients about what their childhood was like. Young adulthood, I think many of us were conditioned to believe. I certainly was. Trauma is big T trauma. Murder, rape, suicide, Little T trauma is insidious. Little T trauma is what is going to drive maladaption and problems if you do not deal with your stuff. And when I say deal with your stuff, deal with it in a proactive manner. You gotta acknowledge it, process it, move through it, and probably do something for the rest of your life. So when I see women in perimenopause that are dealing with neurotransmitter disruption, less dopamine, less serotonin, less gaba, less hormones, you know, the irritability they get from estrogen and progesterone loss. It's the perfect storm. So why do I see so many women in perimenopause that start questioning their relationships, questioning their life, wanting to make different determinations? That's part of it, but the other thing is what's happening internally to those ovaries with chronic cortisol activation over time? How many people that are super type A, super successful, that just stuff down those feelings for years and years and years, and then they're looking at, you know, we know it's considered to be normal if you go into menopause between the age of 45 and 55. 45 sounds pretty young to me. Average age in the United States is 51. Now these women are going into menopause at 47, 48, 46. And because they've had this chronic overactivation of the sympathetic nervous system. You know, Dr. Sarah Godfrey talks about the pine system, the psycho, immunology, neuroendocrine pathway, and how that chronic overactivation cortisol is not a bad hormone. But chronically elevated cortisol will catabolize muscle. It'll dysregulate your immune system. It can also age your ovaries. And so I think that's quite significant. That's something that not a lot of people are talking about is what is the net impact of high ACE scores, previous trauma, ongoing trauma, and then earlier menopause.

A (62:31)

This is such important stuff to talk about. And I didn't understand what trauma was. I would have said when I First started doing this work, you know, when I was about 30. Like, I don't have any trauma.

B (62:43)

Same.

A (62:44)

You know, I have all my limbs, whatever. You know, I was blessed to not have any essay in my life. So, like, I'm. I'm good. And when I really understood it, trauma is just any time that your body felt unsafe and your body took a snapshot of whatever was happening in the world around you. So anytime that I get that same snapshot, secrete stress hormones because it's probably unsafe again. And. And if you have lots of those, we'll call them micro traumas. It makes you feel better. You just have constant cortisol because the body's like, you know, you got in a fight in fifth grade, and the guy looked like that, and a guy walked in like that. Have some cortisol, and you have no idea unless you train yourself to feel it and then how to change it. And that's. And for me, I had PTSD around birth. I didn't know that was real.

B (63:30)

Wow.

A (63:30)

I was born with a cord wrapped around my neck.

B (63:32)

Oh.

A (63:33)

And so you come into the world thinking something's trying to kill you. Like, you might be a little bit combative as a teenager. You think, think, right. And I was able to resolve all that. And my most recent book was about, here's all the altered states you can go into to heal yourself at different pathways. And when people understand what trauma is, there's no judgment. I don't care how good your parents were. There's a time. And my favorite trauma, the one that happens over and over, especially for moms, you're nursing your baby, and you're like, okay, you have teeth. That is the last time you bite my nipple. Okay. And then you're like, hey, we're done. And the baby's like, ah, I want more milk. Okay. There's a trauma. Right?

B (64:10)

Right.

A (64:11)

Nobody did anything wrong. But if it left a mark in that one time, okay, it can. Until that's resolved, it's a pattern in the nervous system and the body and the ovaries, as you said, the most mitochondria. Mitochondria is sensing safety in the world around you. So if your body has enough programming that the world isn't safe, even though it is, it's not going to put energy into keeping her ovaries young, keeping your hormones. It's going to put them into keeping you safe and insidious and pernicious. And it's something you can heal. And we have so much technology and techniques and knowledge, we didn't have 10 years ago about trauma. It's one of the big themes on the show. It's like, if you want to be more conscious, how about run less of that programming? Right?

B (64:48)

Yeah.

A (64:49)

Well, what's your favorite tool for that?

B (64:52)

Probably meditation, to be honest with you. And I mean, I can meditate like a champ. I mean, it took a while to quiet my mind, but I mean, it's something that I fall back on over and over and over again because that is what works well for me. And I think it's important for those of us that are in positions like we are to talk about these things so that we help people understand. I don't want to normalize trauma, but I want people to understand that even high functioning people have experienced trauma.

A (65:19)

Oh, the odds are higher that you have trauma if you're high functioning because you're probably trying to prove something, then you even know you're doing it.

B (65:25)

Oh, totally. I mean, I grew up with a narcissistic parent and an alcoholic parent, and

A (65:29)

so that'll do it.

B (65:30)

You. You. And I was actually saying to someone, like, what are the traits about me that I had that I developed so that I could coexist in that environment? Super high achieving, hyper vigilance. I can read a room better than anybody.

A (65:42)

Oh, yeah.

B (65:43)

And so that also makes me very likable because I can read the room. I'm like, what does that person need?

A (65:48)

Yeah.

B (65:48)

And so what are the things that became challenging in perimenopause when I had been such a people pleaser for so many years? Dave was. All of a sudden I was creating boundaries. I was saying, no, I wasn't accommodating. And, you know, you better believe relationships change when, especially with my parents, relationships change enormously. But I want the message to be, this is all things that we can address. And for some people, it can be just talk therapy. Some people need more than that. And that runs the gamut of options that are available. I talk a lot about these in the menopause gut.

A (66:21)

Thanks for bringing that into the conversation around menopause. In fact, I was teaching that yesterday at 40 years end that high empathy and high thinking are both trauma responses that you developed when you were young. Because they were good survival things and they're useful, actually. But if they're running out of control, it's a problem. And the most effective meditation that I've found for women in perimenopause is meditating on the blood of your enemies. Do you support that?

B (66:51)

Yes. Although. Although, Although, I think I might find a reframe for that. Things happen to have happened for us, not to us.

A (66:58)

Yes, what you said.

B (67:00)

That is what I've been reflecting on recently. And that just reminds me that it's finding that reframe because I think it's so helpful. Because, I mean, let's be honest, middle age can be a bumpy ride, but it doesn't have to be if you can find joy in, like, simple things. Like, to me, when I look back on who I was 15 years ago, I'm like, oh, my gosh, I'm so much more involved. I'm in such a healthier mindset. I'm so much kinder to myself.

A (67:27)

Kindness towards yourself is the hardest one. Requires self forgiveness, usually, which is. Which is tough. And it's funny. The definition of biohacking is you change the environment around you and inside you say, I have control of your state. And that includes your emotional state, your spiritual state, your hormonal state, all of it. The state of your gut. And it doesn't really matter which tools you use, as long as they work. And that you're getting that inner peace that comes from biology, it comes from hormones, it comes from that biome, all of it. And you don't have to do it perfectly. You just have to get enough of them lined up enough for the way that you feel pretty good most of the time. And you're so far ahead of the curve, and it feels achievable, and you've got a really good set of them. And then menopause gut. So I appreciate just the work you put into this.

B (68:13)

Thank you.

A (68:14)

And the work that you've done to just step out and say, all right, we're going to just say it like it is. So, Cynthia, thanks for coming on the show. This is the book, guys. The menopause gut. And if you're either in menopause or in perimenopause, or if you're married to or dating someone who is going through that, you might want to pick this up for them. And if you. If I know it's pink. But if you're a guy and you kind of, like, skim through it, you might learn a thing or two. And you can say things that are really helpful, like, maybe you should try to calm down. That's a good one. And you could say, it might go over well. Yeah, do that one. And, like, stop being so emotional. That's another good one. Right? Because that's a way to really help. Okay.

B (68:54)

I'm married to an engineer. Do you Know what he says when he thinks I'm being illogical? We're not communicating.

A (68:59)

Oh, my gosh, that's so funny. As a former engineer, I kind of appreciate that. But one thing you can say if you understand what's going on is, honey, here's some thyroid hormone. Okay, maybe not.

B (69:14)

Maybe take some progesterone.

A (69:16)

There you go.

B (69:17)

Like, let me rub that progesterone on your back.

A (69:19)

One thing that also worked for me, my former wife is going to kill me for this is, you know how, like, when you, like, you're training cats to not jump on the counter, you have a spray bottle. I just put progesterone in there and I just. And then like. Okay, I never did that. Sorry, Lana, I'm just teasing, but the thought might have occurred to me once.

B (69:38)

I bet, I bet.

A (69:40)

So progesterone can be a good thing. And if you're listening to this and you're either laughing or saying, dave's a jerk, I respect that. But just knows that one thing. Progesterone can be relatively rapid acting. And if you're, like, really freaking out and you know your levels are low, it's a tool. And it's not. You're not freaking out because you're a bad person or because you're weak or because you don't try hard enough. You're freaking out because you don't have enough of progesterone. And, like, I have it in my purse and two drops and stuff goes away. Okay. Or two pills, whatever.

B (70:04)

Take it before bed. That's it. Makes me sleep.

A (70:06)

So, okay, so there you go. So there are tools and your book is just so full. So thank you.

B (70:10)

Thanks, Dave.

A (70:11)

See you next time on the Human Upgrade Podcast.

D (70:20)

The Human Upgrade, formerly Bulletproof Radio, was created and is hosted by Dave Aspen. The information contained in this podcast is provided for informational purposes only and is not intended for the purposes of diagnosing, treating, curing, or preventing any disease. Before using any products referenced on the podcast, consult with your healthcare provider carefully read all labels and heed all directions and cautions that accompany the products. Information found or received through the podcast should not be used in place of a consultation or advice from a healthcare provider. If you suspect you have a medical problem or should you have any healthcare questions, please promptly call or see your healthcare provider. This podcast, including Dave Asprey and the producers, disclaim responsibility for any possible adverse effects from the use of information contained herein. Opinions of guests are their own and this podcast does not endorse or accept responsibility for statements made by guests. This podcast does not make any representations or warranties about guest qualifications or credibility. This podcast may contain paid endorsements and advertisements for products or services. Individuals on this podcast may have a direct or indirect financial interest in product, products or services referred to herein. This podcast is owned by Bulletproof Media.