← The Thyroid (and Hormone) Fixer Podcast: Thyropause, Menopause, Metabolism and How to Fix It
The Thyroid (and Hormone) Fixer Podcast: Thyropause, Menopause, Metabolism and How to Fix It
625. The Menopause Gut: Why Hormones, Weight, and Digestion Change After 40 with Cynthia Thurlow
01:06:13
Loading summary
Transcript46 lines
- [00:00]
A
The health of our gut microbiome has everything to do with not just how we transition from perimenopause into menopause, but it impacts longevity, it impacts our bone health, it impacts brain health. Literally. There is a gut axis with every single organ system in the body.
- [00:16]
B
Welcome to the Thyroid and Hormone Fixer Podcast. If you've been told everything is fine, but you're gaining weight despite doing all the right things, struggling with brain fog, mood swings, low libido, or feeling like a stranger in your own body, you're in the right place. I'm Dr. Amy the Thyroid Fixer and I want you to know right now, I see you, I believe you, and you don't have to figure this out alone anymore. We're going to do this together. But I'm also not here to play nice with bad medicine or empty promises. This show is meant to disrupt the entire health space. We're going to challenge the status quo, connect all the dots other providers miss and give you real, practical, science backed tools you can use. Today, you're not going to get any more recycled biohacking advice, just truth, strategy and hope. Let's get you back to feeling like the badass human you're meant to be. If you've ever walked out of a doctor's office being told your labs are normal, but you're exhausted, gaining weight, foggy, frustrated, then this is for you. Being told you're normal doesn't mean you're optimal, and it definitely doesn't explain why you still feel like something is wrong and feel like garbage. That's exactly why we created the Fixer Lab Test plus Consult. It's affordable, often less than ordering labs on your own from places like LabCorp or Ulta. And it includes comprehensive thyroid and hormone testing plus a full hour long consultation with one of my highly trained team members. We walk you through your results line by line and explain exactly what they mean for you so you can finally understand what's going on in your body and what your next step should be. So if you're done being told that you're fine and you're ready for real answers, then go to fixerpowerlab.com that's F I X E R P O-W-E-R-L-A-B.com and get some help that you need. I need to talk to every woman who's been told that your labs are normal while your body is screaming at you and rebelling against you. Fatigue, brain fog, the weight that will not come off, mood swings, hair loss, Feeling dismissed, frustrated and confused. I get it. And that is exactly why I wrote my new book, the Thyroid Fix. The no nonsense guide to Fix Fatigue, Fogginess and fat that won't budge. That just says it all. And it is now available for pre sale. So I need your help to spread the message. I am giving you an ask as my listener and a promise at the same time, if you pre order the thyroid fix, my promise to you is to continue delivering all kinds of free advice, information, content, education, empowerment. Because that's what I love to do. Whether it's here in the just fix your thyroid Facebook group or I'm on live. I will give you everything I possibly can if you do me one favor, which will be a favor for yourself as well and pre order the thyroid fix. Now, this book is not another list of supplements, vague advice. It's not a diet plan. It's not filled with recipes. It is a clear, honest guide. It is the Thyroid Bible. It is the last thyroid book that you will ever need because it teaches you how to read your own labs. No other book has done that. It teaches you what medication and dose you need. No other book has ever done that. It will help you to understand why you are being misdiagnosed, why you're being under treated, and why you can't talk about hormones, weight loss or menopause without talking about the thyroid. I called it Thyroid Bible because like I said, this is going to be the thyroid book of the next few decades. When you pre order, you're not just supporting me, you're telling the publisher. This message matters and it needs to get out to the world and it needs to get into the hands of women who have been ignored for far too long. So will you go to thyroid fix book.com and pre order a copy of yours today? It'll be shipped to you on May 12th and you will get free entry to our all day live event where I will be there answering your questions live, teaching live, and bringing in amazing guests for you to also connect with and ask your questions too. So thyroidfixbook.com pre order yours today. Today's guest is someone that you know and love. I know and love her. She's a friend, she's a colleague. She's been on the podcast Cynthia Thurlow. But we're talking about something different today and as I was saying to her off air, we have over 600 episodes of the Thyroid Fixer podcast and we have never. I can't believe this. We have never gone deep into your gut and how it relates to estrogen and hormones and you being in menopause and the whole gut microbiome and how that affects hormonal balance and your symptoms. We just haven't done it. But today we're going to. So that's why I'm bringing Cynthia on, because she has gone deep. She's wrote a book. We're going to talk about that today, on how your gut environment literally affects your entire body, especially in menopause. So, Cynthia, it's so great to have you back.
- [06:09]
A
Thanks so much for having my friend. I've been looking forward to this conversation.
- [06:13]
B
Well, and. And I have to thank you for writing this book. There's nothing out there like it, and it's really going to open a lot of women's eyes because, you know, I don't know about you, but in my community, I see the gut kind of being pushed aside, like, yeah, yeah, yeah. I don't have bloating. I don't have acid reflux, so I don't have to pay attention to my gut. Can you unpack that for the listener and kind of like, shed some light on why she needs to be paying attention to her gut a little bit?
- [06:44]
A
Yeah, it's amazing. You know, I think much like I'm sure you do, you interview all these experts, you learn so much from your guests. And for me, it was really this constellation of different conversations that made me realize, like, what are we not talking enough about? And yet the health of our gut microbiome has everything to do with not just how we transition from perimenopause into menopause, but it impacts longevity, it impacts our bone health, it impacts brain health. Literally. There is a gut axis with every single organ system in the body. So if a woman says to me, I'm not experiencing any gastrointestinal symptoms, no bloating, no constipation, no diarrhea, no dyspepsia or reflux or anything like that. That's probably pretty unusual because one of the most common symptoms that my patients and clients complain about is bloating. And what I find even more interesting is that when I started looking at the research, what is going on at a cellular level as we are navigating this transitional period in our lives and things like the gut microbiome, which encompasses 40 trillion microbes, viruses, bacteria, fungi, protozoa, you name it, the diversity of this microbiome changes dramatically in this transitional period vis a vis all these hormonal changes. So it is not just sex hormone changes. It is estrogen progesterone testosterone, insulin sensitivity, they are all impacted by this transition. So we get changes in microbial diversity. We are more likely to see more inflammation, more insulin resistance, more oxidative stress, more leaky gut, more autoimmune conditions. We get changes in the estrobolome, which is this goofy word that talks about how our bodies break down and process estrogen, probably something most of us never even thought about. We get changes in short chain fatty acid production, and we'll talk about why that's so significant and why fiber really becomes your friend, not grandma's metamucil, but fiber really becomes our friend as we are navigating this transitional time in our lives and why we need to do things a little differently. Like, it's something that I never learned in my medical training and really it's been the last maybe five years, this explosion of information. And last but not least, I think about the interrelationship. There's this amazing nerve that runs from our brains to our guts called the vagus nerve. It's a cranial nerve, longest nerve in our bodies. And it's like a super highway for information back and forth. So women explain to me that they're experiencing brain fog or more anxiety, more depression. And I help them understand the bulk of our neurotransmitters are made in the gut. And as these hormones are declining, that directly impacts these neurotransmitters production. And that can show up as neurocognitive changes that can show up as anxiety, depression, trouble sleeping, and they all interplay with one another. There's not one hormone or neurotransmitter or organ in our body that is often a silo. They all play with one another. And so as an example, as our estrogen declines, so does our serotonin. And if serotonin declines, so does our melatonin. And so it becomes this domino effect. And when you really think about it from a, you know, 30,000 foot perspective, you understand that there's far more to what's going on than meets our eye. And I think the last thing that I would say about that is I bet most listeners don't know that the health of our gut impacts the health of our ovaries. And our ovaries set the pacemaker of aging in our bodies. I'm going to say this again. Our ovaries set the pacemaker of aging in our bodies. And if our gut isn't healthy, guess what isn't also healthy? Those ovaries. And I think a lot of women perhaps don't realize that we are born with a finite amount of eggs. And you know, once we hit puberty, possibly once a month, we might release one egg with the hope of, you know, certainly not at the beginning of puberty, but when we're older, the hope of ovulation and then potentially fertilization and a pregnancy. But helping people understand that over the course of our lifetime we lose quite a bit of eggs. And as we get closer and closer to menopause, we obviously have less and less we go into menopause of that 3 to 400. So we still have some eggs, they're just not particularly viable. But the health of our ovaries is directly proportional to the health of the gut. And in our modern day lifestyles, I think a lot of women, myself included, until I really started diving into the research, I had no idea the impact of the health of our gut microbiome does on our bodies systemically.
- [11:06]
B
No, I didn't either. And that's why your, your book is so eye opening and enlightening needed right now. Because it just, it provides another layer of answers to this huge question of menopause that really we are still researching and uncovering. Now I want you to unpack this because as you were talking, I'm thinking in my head, okay, which came first, chicken or the egg? What came first? Is it the decline in estrogen that's producing some type of dysregulation of the gut microbiome? Or is it the destruction over decades that we've done to our gut that is then affecting our hormone levels, Maybe sending women into early menopause, making menopause worse? Which is it? Or is it both?
- [11:56]
A
I think it can be both. I think we love the term multifactorial, which just means multiple reasons. I think you can have people that have lived a fairly clean, pristine lifestyle that might experience less symptoms making that transition. But typically here in the United states, you know, 70% of us are eating an ultra processed diet. We're on synthetic hormonal birth control. No judgment. I was too. And we can talk about what hormonal birth control and things like Depo Provera can do to our bones and other things. I think about the chronic stress, we're overstimulated. I mean, think about it. We can get anything at any time. We can literally not leave our homes. And we can order Uber Eats or you get on Amazon get the same day shipping. I mean, we live in an instant gratification culture. And so I think it is multi layered. I think it's the food. I think it's our toxic environment that we live in. I think, you know, certainly in our generation, probably less people were smoking than our parents generation. But you know, things like the toxins we're exposed to, whether it's tobacco, whether it is illicit drugs, whether it's alcohol, whether it's the synthetic hormones that we take to prevent pregnancy, and there's no judgment there. I want to be really clear because I was on the pill for years for crazy periods, not realizing what it was doing to the health of my microbiome. And then just other toxins, you know, things that microplastics and things that have solid research behind them. I'm not just, you know, conspiracy theorists, but it's like you start to look at this multi layer and then you layer in things like adverse childhood events, you know, people that have experienced significant childhood trauma or even young adult trauma. We know that can age the ovaries and impact our gut microbiome. So I think that it really depends on the individual. I would say bio individuality rules, so the power of the n of 1. But I think the more that we understand, you know, we're living longer, is our quality of life better? You know, when I reflect on the fact that a hundred years ago people maybe lived into their 50s, early 60s, and now we have pushed that to 80s, 90s, and there are centenarians that are out there, you really start to think about what are the things that impact our quality of life substantially. And it's a lot of the lifestyle pieces that aren't sexy much are very impactful. And I would, in fact, I would argue that we really have to look at it as a whole. It can't just be one thing. It's not just replenishing hormones when we make that transition into menopause. It is so much more than that. And how we take care of ourselves in our 20s and 30s definitely impacts in middle age and beyond. And let me be very clear, the message is not if you took really crappy care of yourself as a young person, that doesn't mean that you can't turn things around. The gut microbiome is incredibly malleable and can be very responsive in a short amount of time to interventions that we lead to that ultimately are going to be of benefit and aren't per se going to extremes. Because I think that, you know, you and I exist in a space where there's all sorts of gadgets and fun things, and those things are fun. But I always say major in the majors, like don't major in the minors. Like, get all the lifestyle stuff dialed in. And then if you want a gadget, I think that's great. But, like, don't go buy. I'm just gonna pick on the oura ring. Don't buy an aura ring and then neglect your sleep and the quality of the food that you eat. And don't not exercise. Like, that shouldn't be the message. So major in the majors.
- [15:13]
B
Oh, I love that. We all biohack our way out of the foundational premises. You know, we think that red light, hbot, oura rings, all the things are gonna heal us, and we forget the basis. So let's actually rewind. You had mentioned women in their 20s, 30s. Let's go 40s. Let's go perimenopause. So before we get into the menopause gut, let's look at the early warning signs in perimenopause. So this really is where women start to experience symptoms and they start doing all the things, you know, they'll start over exercising, way over, dieting, over calorie restriction, fasting for five to seven days. I mean, they're doing all of these things. But really, let's look at the gut. So what gut changes begin even before a woman actually hits menopause? She's just in that perimenopause state.
- [16:07]
A
It's such a great question. Well, I mean, at a very basic level, we know that, you know, what begins perimenopause is are these adjustments and decline in progesterone. And so progesterone kind of shows up for a lot of people. It might be initially, like, a little more anxiety, depression around your cycle, a little bit of insomnia. You may start noticing your periods are getting heavier. But what I think really gets magnified is this relative estrogen dominance. And so, you know, traditional allopathic medicine hates that term. But, like, it's a really good way of explaining you have more estrogen than you have to progesterone. It's all about ratio and balance. And this is a time when estradiol, which is the predominant form of estrogen, can be 20 to 30% higher than in any other time in your life. Usually associated with something called a loop cycle, which is a fancy way of explaining these, like, shorter cycles where you just get another blip. And so other than that, the other things that I think about is weight loss, resistance, breast tenderness, I think a great deal about brain fog. I think it depends on how sensitive a woman is to those alterations in hormones. Like, some people just seem to effortlessly breeze by. And others are very symptomatic. You can get skin changes, meaning you may have rashes, you may have what goes along with high estrogen is high histamine. And so histamine is a very important substance in our bodies. But when it's too high, you know, it's kind of like high estrogen leads to mass salad or granulation, which leads to high histamine. So it becomes a circuitous. So it may show up as hives or people having more itching. And that could be anywhere. I mean, I certainly experienced that. Like, I was like, what is going on? I've never had hives in my life. Would eat all these high histamine foods and it would trigger. It would just push things over enough that it would provoke this mass cell degranulation and I would just be itching all over the place. A lot of people will say that they feel more bloated. They may have alternating constipation and diarrhea. I think that we have normalized constipation just to kind of put a pin in this. I think loose stools. People may have that around their menstrual cycle and that seems pretty normal. But constipation is so normalized and constipation. I used to ask patients, tell me what that means to you. Because to me, if you tell me that you have one or two bowel movements a week, I'm like, ew, that's not ideal. We want to at least be pooping every day. And I'm going to use the non clinical vernacular because I've been told bowel movement is too clinical. So we're going to say poop. We should be having a poop every day. But if you're in this stage in your lives and suddenly you become more constipated, you may be having more bloating, you may feel that you've developed underlying food sensitivities. Like suddenly foods like dairy that you've never had problems with. All of a sudden you're like, why do I feel so rotten? Why do I. I call it affectionately the five pound dairy. A lot of women, there's so much inflammation when they are consuming, you know, otherwise healthy foods and they don't understand why. And it's helping them understand that, you know, one of the things that kind of drives this transitional period is where that's. Let me just back up even more. Our small intestine is one cell layer thick. So it's very easy to damage this, whether it's with Food or toxicants or any of these other things. So if those cell, if that, like those little gates open up, you can leak food particles into your bloodstream. And what's right along the bloodstream is our immune system. And so your immune system gets activated, and all of a sudden you have these very dramatic. We always say, like, hormones are dramatic. Food sensitivities can be very dramatic. People may have a lot of bloating, they may get diarrhea or constipation, they may get a headache, they might start having more skin issues. It might be itching, it could be that they develop a rash, it could be eczema, could be so many things. And so it's helping them understand that it's kind of like this domino effect that goes on. And as I always tell people, your perimenopause journey is as unique as you are. Like, the things that I'm saying may not apply to everyone. I certainly had most of these, but it doesn't mean that these are going to be the experiences of everyone listening. And then you add in, you know, alternating very heavy cycles, lighter cycles, maybe you skip a cycle. I mean, you start having alterations in your menstrual cycle. I used to call it the crime scene periods where I would pray that my period would not start when I was rounding on patients in the hospital because there was not enough tampons or pads to save me and my scrubs while I was rounding within an hour. It was wild. So those are kind of the more common things that I will see and patients will share with me. But the cool thing is that eventually you'll get towards mid to late perimenopause, and your symptoms tend to be a little less dramatic. They start to kind of settle in. And I think for most of us, we're concurrently making lifestyle changes. You know, you may stop drinking as much alcohol, you may prioritize your sleep, you may change the way that you exercise, because you just don't have the stamina to do what you used to do. And by that I mean Orange Theory Fitness. I'll pick on Orange Theory Fitness. I have a lot of patients that want to do that six days a week with no recovery days. And they'll find they're just really feeling like their body's are not recovering quite as well. And so it's multiple things that are happening. It's not just progesterone, it's also estrogen, it's also testosterone. We lose insulin sensitivity, we're losing muscle mass. When we lose muscle mass, it's not just an aesthetic thing, it's also a metabolic health issue. I always say that time in a woman's life can lead to catastrophic changes in our metabolic health. And, you know, we also become less stress resilient. And if anyone's listening and they're like, oh my gosh, I don't want to go into perimenopause, there are ways around all this. I can tell you it's a whole lot easier on the other side. But for me, it was a little bit of a mind screw because I was like, I've always done everything right. Why is it suddenly no longer working? Or, you know, the women that will say, I'm struggling with word finding. I just feel like I'm not as mentally clear. Those are the people that tend to be a little more sensitive to these alterations and hormones. There's always things we can do. And certainly the research suggests that making changes earlier, both lifestyle and hormone replacement therapy and hrt, I mean, all these things are really, really important to kind of lessen the impact. So you don't have as quite of a bumpy landing in late perimenopause into menopause.
- [22:07]
B
Well, you just answer my next question. I was going to ask you what. Yeah, like, what can we do now? We're going to get a little bit deeper into some actual healing protocols that women can do. But let's talk about that transition then. So in perimenopause, just like you said, that is the time where at least in our clinic we will get women coming in in that perimenopause state with low progesterone, just like you said, their estrogen is on a wild roller coaster ride, but testosterone is in the toilet. So this might be the time where we start VHRT or bioidentical hormone replacement therapy.
- [22:45]
A
Maybe we start with progesterone, we start
- [22:47]
B
with testosterone, we add an estradiol later. Once she is officially going well, not even officially. I don't want to say that. I don't. I don't mean we're going to wait till you're 12 months without a cycle. But once you are losing your estradiol and your FSH is climbing, then we add in estradiol. But there is this estrobolone that you had mentioned earlier, and this one is a big one for my audience because there are women out there that start bioidentical hormone replacement and they just don't feel different. They don't feel the results that they expected. They don't feel the results that people on Facebook are shouting out, that BHRT changed my life, it saved me. And I'm in that category. Like, I love my hormones. You're gonna have to prime out of my dead cold hand. But I feel so badly for the women that are like, yeah, this isn't going to do anything. Why don't I just go off of it? And now you and I are shouting, no, don't go off of it. You're protecting your bones, your breasts, your heart. But maybe it's as something as simple as their gut and the estrobolome and the gut literally determining how those hormones behave in their body.
- [23:53]
A
Yeah, I mean, I think a lot of when women say to me, I got started on HRT, I was really excited that I gained 10 pounds. Yes. Or I got started on HRT and I gained £15 or £20 or £5. I did nothing else differently. That doesn't mean that it didn't work. It just means there was foundational work that needed to be done before you ever started hormones. And in a traditional allopathic lens, we're not thinking that way. And so, you know, we have detoxification pathways in our bodies. Yes. When we sweat and when we breathe and when we poop and pee. And then we have to think, you know, the liver really is this major recycling process in the body. And so there's two phases of detoxification in the liver. Third phase is in the gut. So if you have genetic SNPs, like I have MTHFR, I have two copies, thank you, parents. And so it means my phase two needs a little more support. So there are things that I have to do that might be different than someone else. But I know this about my genetics and I can proactively address it. And so there can be genetic reasons why you need additional detoxification support. And this is where working with a practitioner who knows how to determine, you know, what phase of detoxification do you need support in? What specifically can they do? Starting with food based pieces first, then adding in supplements if necessary. But what's really interesting is what people may not realize if the liver is not optimal. And I know sometimes the allopathic trained providers get frustrated when they hear people say this. But if that's not optimal, it can also lead to not being able to break down and emulsify fats. And hint here, ladies, guess what? What helps with bile quality is estradiol. So as estrogen's going down, you're not gonna break down and emulsify fat. So a lot of women Become fat malabsorbed. They'll tell me I feel really good if I eat lean protein or if I eat plant based fats, but I don't feel good if I have duck fat fries or if I eat a ribeye or if I eat a big piece of salmon. And these are not unhealthy foods. Let me be really clear. But this is where that bio individual approach is so important and just being attuned to your bodies. But that third phase of detoxification is in the gut. So if you already have a gut that is dysbiotic and unhealthy and you've got opportunistic infections and we know you have poor digestive fire, maybe your hydrochloric acid has now decreased to a point you can't break down your protein properly or you don't have enough digestive enzymes. And hint, that's very normal to need some digestive enzymes at this stage of life. Like I take one, one digestive enzyme with my biggest meal of the day, it makes that much of a difference. But I will say to women, you have to think about how estrogen, it's like a Goldilocks. We want to break it down, we want to package it up and poop it out. Like I'm oversimplifying things, but the estrobolome, health of the estrobolome, which is in the gut microbiome, which is in our colon, if it is not optimal, we can recirculate that estrogen, which can magnify all of these higher estrogen symptoms, the weight loss resistance, the breast tenderness, the brain fog, the itchy skin, the digestive issues. And so you really want to use this as a litmus test of how best can you support your body? Because if you everything's going right, your body's going to package up the estrogen and poop it out again. Why pooping every day is important. I'm going to keep saying the word poop so that we can destigmatize talking about it because it is so incredibly important. But the estrobolome is this weird fancy way of explaining this is an estrogen processing part of the gut microbiome that is really important. And things as simple as like cruciferous vegetables and eating bitter foods can all be ways that we can support, support not only the microbiome, but also support the estrobolome. And it doesn't go away when we go into menopause. It is still there, we still want it to be working, but we have to do a little Bit more. It's like many things that we take for granted when we're younger. All of a sudden when we're older, we're like, oh, I didn't appreciate that enough about my body. I just worked and now I have to do a couple more steps to make sure that I'm supporting my body in a really beneficial way. So big takeaway. A strobalone is important. It's really important to know if your body is able to properly break down and assimilate hormones. And one of the ways it does that, it, you know, we process things through the liver. Two phases of detoxification goes to the gut. If not, things can get recirculated. And I think for a lot of people it's vitally important to understand like 25% of our cardiac output. So 25% of the blood are heart pumps out goes to the liver. That's how important the liver is, 25% of the blood volume. So maybe that'll help people understand, like it really is a critically important organ. But most of us don't think about it unless we have a problem with it. Right. Like you think about people that have hepatitis or cirrhosis, which is not a good thing to have, helping them understand. Like our liver is very, very important for breaking down, detoxifying things in the body. But in our modern day lifestyles, more often than not, people need a little bit of support.
- [28:52]
B
Well, I'm gonna even pull in the thyroid to that entire conversation because just like you said earlier, all the hormones are connected. We can connect it so beautifully. So the gut and the liver are the two main locations. Conversion. Right. And what else do we know about estrogen that you don't package up and poop out? We say poop on the podcast all the time.
- [29:17]
A
Good for you.
- [29:19]
B
Say poop all the time. What happened? And I agree with you, we have to poop every day because what happens when that estrogen isn't escorted out now you go into an estrogen dominant state that you may or may not see on your labs.
- [29:32]
A
You're.
- [29:32]
B
When we say estrogen dominance, we're not necessarily relating that back to a flagged high estradiol level on your blood labs. We are just talking about that estrogen dominance, that state where your body has too much circulating estrogen, not enough progesterone, it's out of balance. Now that estrogen dominance state binds up your thyroid hormone. So I mean, it's just so fascinating how everything is interconnected and you start messing with one system or you don't support one system and multiple systems are affected, and then you have all the symptoms of those multiple systems being affected.
- [30:12]
A
Yeah. So, yeah, it's not even uncommon when people start hrt that sometimes they need adjustments in their thyroid medication for exactly that reason. It's a bigger issue with oral estradiol than it is with transdermal, because transdermal is, like, I tell everyone, we typically do not worry about, you know, blood clots and things like that with transdermal skin absorbed estrogen versus oral estrad, which some people are on appropriately. So that kind of magnifies the fact because it goes directly to the liver. We call it the first pass effect. It has to break it down before it's bioavailable. And those patients generally need adjustments in their thyroid medication. You are absolutely correct.
- [30:52]
B
Yes. And I just love uncovering how all the systems work together. So, kind of along the same lines, with thyroid, we see a lot of anxiety, depression, brain fog with low thyroid function. But there's also this beautiful gut and brain access, where what's going on in our gut can absolutely affect our mood, our cognition, our focus. And we know that this is really big in midlife because this is the point of time where women will walk into their doctor's office and say, hey, dog, I'm all of a sudden anxious. Out of nowhere. There's nothing going on in my life, and I'm. I'm really depressed. And they get handed the band aid antidepressants that I'm going to assume also does some destruction of the gut. So now we have. We have that issue going on. But can you go deeper into how the gut is actually affecting our mood as well?
- [31:46]
A
Yeah. So we know that about 70% of the neurotransmitters we make in our bodies are made in the gut. So whether it's a dose of antibiotics appropriately. Appropriately prescribed, like if you are being treated for Lyme, you are getting an appropriate therapy to address your Lyme. You may. I mean, it's interesting, and I say this from familial experience. I have a family member that's being treated for Lyme appropriately. Two months into therapy was like, I'm anxious, I'm depressed. I don't know what's going on. This is not my baseline. So we know that one round of antibiotics can disrupt the gut microbiome for anywhere from 18 to 24 months. I don't want to scare anyone off from taking appropriately prescribed antibiotics, but just understanding when we're killing off beneficial bacteria at the expense of. Well, at the Expense of trying to kill off what doesn't belong. So the antibiotics are there to appropriately kill off things that don't belong. We can alter the composition of the microbiome both in terms of neurotransmitters, serotonin, dopamine, gaba, et cetera. But it also can, you know, vis a vis. It's impacting signaling molecules. Thinking about the communication pathway, we already talked about the vagus nerve and how important that is. So if we're not making enough of the substrate in the gut, that is going to go on and super high weight up to the brain because there are specific signaling molecules called short chain fatty acids which can cross the blood brain barrier, which is really cool. Like butyrate's one of the key ones. It's helpful to understand that it isn't just the beneficial bacteria, it's not just the neurotransmitters, it's all these other players that impact mood, cognition, how we perceive the world. Some things can be temporary. This is why when you're taking antibiotics, if appropriately prescribed, I'll just keep saying that fermented foods become important. Probiotic rich foods, prebiotic rich foods, all become very important because we're trying to repopulate the gut with foods that we know can be of benefit. And this is why it's also like that. Vagal nerve tone is so important. So being in the sympathetic versus parasympathetic. So autonomic nervous system, sympathetic is fight, flight, flee or fawn. Parasympathetic is this kind of rest and repose. Most of us are in this sympathetic dominant mode all the time. We don't even realize it. And if we're communicating that to the gut, that can just exacerbate a lot of these feelings that we experience. So I remind people, vagal nerve tone, whether that's humming, gargling, you know, cold water exposure, anything that is going to kind of get your body into this rest and repose side where your body can repair. So if your body thinks you're being chased by a rabid animal, it's not going to be in repair mode, it's in flea mode. It is not thinking about food, it's not thinking about having sex. It is thinking about fighting for its life and running away. And so when I talk about things that are important for mental health, when I talk about alterations in hormones and neurotransmitters, I would be remiss if I didn't talk about vagal tone and why it's so important. Again, not the gadgets I mean, the gadgets are fun, let me be clear. But it's that kind of macro view of what are the things we need to be doing that are foundational. And it means getting off electronics, and it means putting your feet up the wall, and it means saying no and having boundaries. And one thing I know about Amy and she knows about me, we have super healthy boundaries. And so helping, you know, one another, like, set expectations of what is realistic. I think for so many of us women, until we go into perimenopause and menopause, we're just huge people pleasers. So we're taking care of everyone else's needs and not our own. So, again, it goes back to the same conversation. Every hormone, every neurotransmitter, all these signaling molecules do not just have one role in the body, they've got multiple roles. And understanding that the interventions, the things that we do, whether it's antibiotics or smoking or alcohol use or toxic relationships, I mean, all these things can impact the health of the microbiome and then also impact the mental health symptoms we may experience. And the other thing that I would say is when people are chronically stressed, if you're chronically stressed, your body goes into that fight or flight mode. And so you will have trouble with executive function. You're going to have trouble sitting down to do your taxes when your brain thinks that you are, you know, struggling, just making one decision after another. So it's amazing how different parts of our brain. The amygdala is the lizard brain, the primitive brain, the brain that when we get triggered and we feel anxious and upset and frustrated, that's the amygdala. And the prefrontal cortex comes in and says, okay, hey, let's like, think through this. Let's problem solve. But in perimenopause and menopause, for a lot of women, it's a huge struggle to make decisions. It can be a huge struggle to be able to think beyond the immediate issues that you're experiencing. And this is where all those lifestyle pieces become important. But most importantly, that bagel tone. And so humming, singing, gargling, all can be very helpful. And with the exception of maybe gargling, you could sing quietly to yourself. But, like, gargling obviously is a loud activity, but those things can be very helpful, like deep breathing exercises. Like, there are things I do before I talk on stage that no one would know I'm doing, but stimulate that vagus nerve and tell my body, you're safe, you're doing something you enjoy. Who cares? You're standing up in front of 500 people. It's all good. You're helping the greater good. So I think those are like, tangible ways of explaining what's going on, but helping people understand. Like, we don't want to not take an antibiotic if it's appropriate. We don't want to drink excessively. We want to avoid toxins in general. We want to be conscientious about what we put in our body because ultimately, all those decisions add up over time.
- [37:25]
B
If you are exhausted, get gaining weight, you have brain fog, you just feel off, and you're tired of doctor hopping and wasting money. Listen closely. So many women bounce from provider to provider, trying supplements, protocols, and then functional approaches that never truly address the thyroid. Months turn into years and you're still stuck feeling like garbage, wasting your precious life. So this is why we offer a thyroid and hormone solution call. It's not a lab review. It's not treatment. It's clarity and strategy to determine whether you're a good fit for working with our clinic. We specialize in thyroid optimization and hormone optimization together because they go hand in hand. You can't do one without the other. You have to do them both. We prescribe in all 50 states, and if you become a patient, we take care of you from start to finish. Testing, treatment, optimization, and ongoing support. You don't have months or years to waste feeling this way. And you shouldn't have to keep throwing money at people who don't truly understand the thyroid and hormones. So if you're ready for real help, go to drami.com that'S-R-A-M-I-E.com and click book a call in the top right corner to schedule your thyroid and hormone solution call and just let all us help you get your life back and be that badass human that you are meant to be, that you deserve to be. Now, is that also why then as you're talking, I'm kind of thinking of this, piecing it together. Is that also why trauma like the big T and little T almost have a resurgence in a woman's 40s? I'm thinking of a particular patient that out of the blue, I mean, out of the blue, Cynthia, she was on 60 micrograms of T3 total split dose and just bam, started having all of these hyper symptoms. The hormone therapy that she was on all of a sudden, like not working, producing all of the symptoms. She has major trauma that she has not dealt with, that she admittedly has not dealt with. And it's it's almost like I'm thinking, is there a gut dysregulation that all of a sudden is. Is stripping her of this protective layer? And the trauma is coming up, making her cortisol rise, making her more sensitive to T3, making the hormones not work. Am I piecing this together in my mind with trauma the correct way?
- [40:07]
A
Yeah, you absolutely are. So, you know, there was a joint venture between Kaiser Permanente and the cdc, and they came up with this questionnaire, and it's adverse childhood events. Anyone can go online. It's not gatekeeped. You can do your scores pretty quickly. And when I trained years ago, we talked about trauma, like murder, suicide, rape. And then we didn't think about trauma in any capacity beyond that. And I was like, well, I didn't experience any of those things, so I didn't experience trauma. Well, trauma is more subtle than that. And so when I did my score, I have a nine, which is actually quite high. And we know people with high ACE scores are at greater risk for multiple things. Autoimmune conditions, eating disorders, poor metabolic health, cancer. And what's interesting is when I dove into the research, Amy, looking at the role of trauma and how that ages our ovaries, not surprisingly, cortisol is something that breaks things down so over time. So, like, cortisol, like, I'm sitting down, having this conversation, I'm excited. My cortisol goes up a little bit because I'm really alert. But, like, cortisol, chronically elevated, is catabolic, breaks down muscle, wrecks your immune system, leads to a leaky gut. I mean, it can be destructive. Same thing for those ovaries. So the health of that gut goes back to the ovary. So that gut, ovarian axis, chronic stress, chronic trauma, can absolutely, number one, age your ovaries faster. Number two, we know that a lot of these women, if they don't deal with their stuff, with all those hormonal neurotransmitter changes that are happening, it becomes much harder to pretend you don't have stuff that you need to deal with. And these show up in perfectionistic tendencies. A lot of times when I'm working with someone and everything is perfect all the time, they're very busy. They never sit, they never take a nap. They don't enjoy being on an airplane because they have to work. They're busy, busy, busy. And that's a trauma response. And so I find it really, really interesting when I got into the research, adverse childhood events, chronic stress, toxic relationships, sexual abuse, all these things can lead to an earlier menopause. And so average age here in the United States is 51, but anywhere from 45 to 55 is normal. That's a huge like distribution of ages. And quite frankly, the really high functioning people that I know have a lot of trauma went into menopause earlier than a lot of their peers did. And so I don't say that in any way to shame anyone. You know, our childhood experiences are what they are. But I think therapy and being able to deal with your underlying stressors becomes more important. We become less stress resilient in perimenopause and menopause. And if you don't deal with your stuff, I mean, why do we see so many divorces? 70% of divorces are initiated by women. Now I'm not saying that it's all attributable to adverse childhood events and trauma, but I think as we are losing estrogen, we are losing our people pleasing tendencies. And so for a lot of women, they find their voice, they're like, hey, this doesn't work for me anymore. But I think for a lot of women it's that underlying stuff that starts to bubble to the top. And it has been my clinical experience that a lot of these women, they just don't actually deal with it until they get to this stage. And, and for some women, they're incapable, unwilling, don't have the right person, whether it's psychologist, psychiatrist, therapist, social worker, reiki, energy, whatever it is that people choose to do. We just know that if we look at the research, there is absolutely a connection between adverse childhood events, chronic trauma, bad relationships, sexual abuse. I mean there was a, a research article that I read that said if a woman is sexually abused and goes on to have children who are sexually abused, she's more likely to go into menopause up to eight years earlier. Now that's significant.
- [44:00]
B
Eight years is significant.
- [44:01]
A
That is quite significant. And when I heard that I was like, okay. It really speaks to how chronic overactivation of this pine system, so this psycho immuno neuroendocrinology kind of perspective, looking at what all this interaction, there's nothing that goes on in the immune system, the neurologic system or endocrine system that isn't interconnected can absolutely contribute to a lot of the things that we see with women. And so I very humbly share that. I think we just have to be honest with ourselves about what's working, what's not working at this stage of life, and you know, making some changes and alterations. I Mean, hopefully we have partners and loved ones that can support us through this journey. I feel like a lot of it's equally important, like this book is equally important for men or for the partners of the women that are listening to this because the more they can understand about what's changing in your body, they can support you because they, men don't want to get divorced in most instances. They want their partners. They want their partners to be happy or whatever cohabitating relationship you're in, your partner wants you to be in a happy, fulfilled relationship. I think most people do. And therefore I think that it kind of comes back to the same thing. Like if you don't deal with your stuff, it will find a way to deal with you once or another.
- [45:16]
B
Great. Yeah, there you go. That, that sentence, that's the mic drop sentence right there.
- [45:21]
A
Yeah.
- [45:21]
B
Now you had mentioned autoimmunity and immune and immune system regulation, and we know that that is affected by stress, trauma. Absolutely. As well as just hormonal shifts. I talk about thyropause all the time. When the, when Hashimoto's can basically present itself. My, my definition of thyropause is when the thyroid gland shits the bed after the. Due to fluctuating hormones. So not, not a clinical definition by any way, shape or form, but basically to say when, when we are dealing with the stress of perimenopause and menopause, just even those hormones shifting is a stressor. And then we have again what we just talked about, trauma kind of resurfacing and rearing its ugly head. Almost as if to say, you haven't dealt with this in your 20s and 30s, so now it's time. So we add that layer on top of it. And then of course we have to layer in the gut because we know the, the gut immune system. I mean, we heard for years, immunity starts in the gut. Immunity starts in the gut. So how does that relate to. What have you seen with the gut in relationship to autoimmunity? Things like Hashimoto all of a sudden present itself in perimenopause and menopause.
- [46:36]
A
Yeah, you know, it's, it's interesting. I spent a whole chapter talking about the immune system, and let me tell you, I jokingly told a friend of mine who's a rheumatologist, I was like, I think the immune system is the most complicated, hardest system to learn about in the body. Me personally. And she said, oh, if it makes you feel any better, I've been doing this for 20 years. I still don't feel like I fully, fully understand the immune system. So let me just start off the conversation there. The immune system is complicated. And when you start to understand what is changing in our immune system, if the bulk of our immune system is in the gut, so the gut is still very important. Estradiol plays a huge role in regulating the immune system. It is this immunomodulatory hormone. What does that mean? That means that estrogen's kind of like the glue for the immune system. When estrogen starts going down, the immune system starts becoming. It starts to shift. There's these T helper cells and there's th1 and th2. And I'm going to try to keep it simple just so that it isn't, you know, again, I said the immune system's complicated. We become TH1 dominant, which means we're more likely to see more autoimmune conditions. We tend to be more inflammatory. It's like we get this shift in the immune system that just. It's almost like a match is lit. And so we just tend to be more opportunistic infections. We're less likely to respond to vaccines. This is not a political statement. This is just based on the research. Whether you choose to vaccinate yourself or not, that's not my choice or decision. I have nothing to say about that. But you just start to understand, like, why are we more likely to see more autoimmunity? And it's because the immune system just gets. It gets turned up, this inflammation piece. We become less anti inflammatory. Even with hrt, we become less anti inflammatory, more probably pro inflammatory. We're more likely to see this disregulation of the immune system. You start finding you're getting more opportunistic infections. Like women will say, how did I get this weird gut infection? And in the start of the book, I talk about this trip to Morocco and so romantic. And my husband and I eat the same food and I'm the one that gets horrific food poisoning. Like the worst food poisoning of my life. And I was like, why did this happen? And I'm like, now I understand. We ate the same food. He had no issues. I ate it and was sick as stink for like five days. So the big kind of overarching message is that the immune system ages along with us. It's called immunosenescence. You better believe that there's cross talk between the immune system and the gut. The health of our gut becomes vitally important. In fact, I would argue it's this longevity organ that no one is talking about. And so we want to do as much as we can before we make this transition to ensure that we are, are supporting our gut and supporting our immune system. To go back to the basics, like we alluded to all these basics, but the quality of food that we eat, it's important that, you know, we don't have toxic relationships. We want to be conscientious about getting enough sleep and doing the right amount of exercise and all these things that have a huge net impact. And I would argue that, you know, after we've done the basics, then we layer in some hormone replacement therapy. Do we know that definitively that HRT is going to bolster the immune system? There's starting to be some research that's suggesting that, but everyone's focused on brain, bone and heart health, and that's good. And there's evolving research on the gut microbiome and hrt, which is also good. But this stuff is more emerging. It's a little less tangent. But if you look at lab markers, what are the things that you see? You can see more cytokines. So cytokines are these inflammatory molecules that are communication. You know, they're like little communicators or messengers in the body and the immune system. And you can see more inflammatory cytokines. You see more elevation of like high sensitivity crp. You might see alterations in commune, like, you know, some of these other signaling molecules that we can test for. Now, I'm not an immunologist, and I'm the first person to say that, you know, those are the things that stood out in the research that I was looking at. And I would say most of us are probably having HSCRP drawn. We might be looking at insulin sensitivity markers, you might be looking at metabolic health markers. You're probably not doing a lot of cytokine, you know, interleukin 6 and other types of inflammatory cytokines. But if you're seeing a specialist, you may. But those are typically not routine things that we're seeing. And so I just remind people that, you know, we just have to think broadly when we're understanding that nothing exists in a vacuum. Everything is interrelated. As those hormones are declining, Our immune system is also aging. And it's why we look at people during the pandemic as an example that a lot of people that didn't do well if they got the virus, we're older people, and it's because their immune systems just aren't as vibrant like they would be. If you're looking at a 20 year old or a 10 year old or an otherwise healthy 35 year old, everything starts to age. But we can do things to offset that.
- [51:23]
B
Absolutely. And a lot of that does start in the gut. And you've already provided just some nuggets that people can do and implement to start healing their gut. Yes. Even getting off electronics and dealing with your trauma has that direct effect on your gut microbiome like we've been talking about. You mentioned something earlier though, that I want to circle back to, and that is fiber. And, and let me set this up. I'm going to set it up by first commenting on the multitude of diets out there that let me say I don't have an issue with. But when used appropriately and possibly more strictly short term because they completely eliminate fiber. The carnivore diet, the keto diet, now we know that these can be used therapeutically, like when we're dealing with autoimmunity or when we have someone that is in that autoimmune fire. They're just a ball of fire of autoimmune. Yeah. Something like the carnivore diet, which is basically a total and complete elimination diet, will calm that fire down. But when we look at the long term effects, we just don't know. And specifically with women that lack of fiber in menopause, how does lack of fiber affect women that are possibly doing carnivore keto? And then where does fiber come in to help us?
- [52:46]
A
That's such a great question, Amy. Let me just say one thing. When I came back from that trip to Morocco and then I ended up being hospitalized a couple months later, I went nine months without being able to eat any fiber because I was on six weeks of antibiotics and antifungals. I do believe in the value of an elimination diet short term. So let me be very clear. I want to make sure that I give that declaration upfront. So I went through about 18 months where I could eat little to no fiber. I think when a patient tells me they cannot eat fiber, I'm like, I automatically think, what's going on with the gut microbiome? Because you should be able to eat fiber. Unless people are crazy and they want to eat like buckets of Brussels sprouts and it's not like a quarter cup, they're eating cups and cups and cups of Brussels sprouts. Fiber becomes critically important in perimenopause and menopause. And that has a lot to do with this decline in microbial diversity, this increase in inflammation. We start making less short chain fatty Acids. And these are things like acetate and butyrate and proprionate. These are signaling molecules. And what happens is when we consume fiber, you know, we chew it, we swallow it, goes into our stomach, goes in the small intestine, goes to the large intestine, and that's where those, those fibers will ferment, and then that later becomes short chain fatty acids. And these are signaling molecules. And remember from earlier in this conversation I mentioned butyrate in particular can cross the blood brain barrier. So it is not just localized to the large intestine or the colon. It is something that can travel throughout the body. But it's important for reducing inflammation. It's important for, for endogenous GLP1 production in conjunction with things like Akkermansia. It's important for people to understand that there's never one thing in the body that has just one role. They have multiple roles. And so less fiber, less diversity, more inflammation, less source chain fatty acids, less communication between the gut and the brain and everywhere else. And so when someone says to me, I don't tolerate a lot of fiber, I always say, okay, well, let's talk about it. If you find particular types of fiber bloating, maybe it's quantity, maybe it's food specific. Maybe instead of, you know, eating two cups of beans, you really need to eat a quarter cup of beans. And maybe you can add in like chia or flax seeds, or maybe you need some artichoke hearts, or maybe you need some green banana flour, or maybe you can use some resistant starch. All of. There's so many options. Find a couple things that work really well for you. And the other thing is, don't go from consuming. I always say, this is why I like to track macros. If you track macros for a week and you're like, oh, geez, I only have 15 grams of fiber a day. Don't go from 15 to 30. You will be very unhappy. Go from like 15 to 18 or 15 to 20 and do it slowly over time. I'll share this with you. So I've been getting colonoscopies every five years because my father had precancerous polyps in his early 40s, which mean I started in my 30s. And I've never had a polyp. But the last time I had a colonoscopy in 2020, I had some hemorrhoids, which I wasn't aware of. I and my gastroenterologist, like, I'd like you to eat more fiber. And I was kind of like, yeah, Whatever. But then I was like, okay, you know, she's pretty reasonable. And so I did that. And I've been very conscientious about a certain amount of fiber every day consistently. I just had my five year colonoscopy. All those are resolved. And actually they were like, this is the best colonoscopy you've ever had. And so the only change I've made other than HRT was more fiber in my diet. And so I think fiber has become the new F word. Like, people don't want to hear it, they don't want me to speak about it. And it's because they have preconceived notions of the benefits of fiber. It's not grandma's Metamucil. We're not talking drink that terrible orange drink that's gelatinous and disgusting. Like, there's so many options. Like, find a couple that you like and try them. Track your macros so you know where you are and then understand, like, you may not be able to see what's going on in your gut microbiome, like, from the outside, but I'm telling you, those little microbes, those short chain fatty acids, they're like, thank you for supporting me, because now, in the presence of lower estrogen levels, and let me be clear, in menopause, even with hrt, in very few instances are your estrogen levels ever going to be what they were in a normal menstrual cycle when you were younger. And that's not what we're aiming for in most instances. I know I have interviewed people on the podcast that have differing opinions, but I would just say for now, from what I know, we're never going to have those levels like we were when we were 25, and that's okay. But we do want to do everything we can to support the microbiome, because I would make the argument the health of our microbiome is vitally important for the health of our bodies. And if I haven't made enough of an argument today for anyone that's listening, like, just understanding that that little gut is communicating with your bones and your brain and your ovaries and your immune system. It's literally your lung. I mean, literally the heart. I mean, literally every single organ in the body communicates and cross talks with the gut. So we want to take care of it and be kind to it, be
- [57:37]
B
kind to your gut. I love it. And you totally set me up for my next question, which I love. And this one is going to ruffle the feathers of many, many listeners I just have a feeling. You mentioned GLP production.
- [57:51]
A
Yep.
- [57:52]
B
What is your opinion on the crazy use of GLP1s by pretty much every single woman I know.
- [58:03]
A
Yeah. I mean, so. So here I'll just say I have personal and professional opinions on this.
- [58:09]
B
Yes.
- [58:10]
A
I think there's probably no other drug in the time that I've been in medicine that has had a greater impact. With that being said, I think that most people that are prescribing these drugs are doing so responsibly and encouraging their patients to monitor body composition, eat enough protein, lift weights.
- [58:26]
B
Yep.
- [58:27]
A
But I think there are equal amount of people that are, you know, whether it's a pill mill that's. We used to call them pill mills or like GLP1 mills, I think that there are people out there that are just prescribing and not doing so responsibly. And this is where I think that you have to be open and honest with the prescriber and to be open and honest, like, yes, I'm doing a great job with getting my protein in. Great. No, I'm not. I'm doing terrible job. And I need to probably bolster it with, you know, whether it's protein powder or, or aminos or whatever it is that suits your fancy. For me, I take essential aminos when I'm traveling because I can never get enough protein in when I travel because I can't fly anywhere direct or very, very rarely. So I'm like, all right, we're going to take our essential aminos and call it a day. But I think that they're also. On the other side is the dark side of GLP1s. I think there are people that are using them. I'm not sure why they're using them. I think some people are using it because they're like, hey, we know the research suggests if you are an HRT and you take a GLP one, they're going to work better together. And I think that's so encouraging because how many women listening have become weight loss resistant? They can't shift their body composition. They're doing everything right. They're even on thyroid replacement and they still can't make a difference. It's like they are doing all the right things and they cannot get that inflammatory body fat to move. And the GLP one does that for them. And I think that's awesome. But I also think the dark side is influencers. People on social media that do not disclose that they're taking a GLP one and they use that either for their fitness program to say, hey, look at me, I'm so lean, I'm, I'm 65 and I'm so lean. Or I'm 48 and I'm so lean. And they don't ever disclose, like, oh, by the way, I'm micro doing. And there's no shame if you are. And I will tell you my personal use of the drug, just of the drugs myself, but they're not sharing any of that with you. And I think that's very, very important. I started micro dosing. When I say microdosing, I'm on such a stage, small dose, it is so teeny tiny that like when I have to pull it up in an insulin syringe, I have to really be. I have to put my glasses on and make sure I get the dosing proper. I did it as an N of one experience to see if I could drop my lp. I'm sad to report I haven't dropped it much, but I felt like for me it helped shift body composition just a little bit, like just in the direction it needed to go. That I was like, okay, this isn't such a bad thing. But I've talked publicly about this. I think it's really important for people that are using them to be honest about it. The other thing is there are people using them who have an eating disorder behavior already. Just like the people that say that they're intermittent fasting but they actually don't eat. And that scares me more because I met someone recently who disclosed they were in their 30s, they haven't had a period in five years, and they were excited about a GLP1. And I was like, you should be using that. In the back of my brain, I was like, not my place to say this, but you should be using one. When young women drop their body fat so precipitously that they stop getting a menstrual cycle, it is so catastrophic to their bodies. It's different at 35 than it is at 55. You know that hopefully that 55 year old who maybe went into menopause at 52 had all those hormones up until 52. This 35 year old is setting herself up for really poor quality of life. And so that's the dark side that I get concerned about. And every once in a while someone will share a story with me and I just kind of sit back and I'm like, this isn't from a place of judgment. I'm just like, I just hope you understand that that is the potential to really be truly. I don't overemphasize this word enough. Catastrophic to your longevity. Different at 35 to go without a menstrual cycle for five years than it is at 55. And I just want to kind of leave it there. I think these drugs are powerful. They need to be prescribed responsibly. And I think that people taking them, they need to take them responsibly. And that means if you lost £40 and you're like concerned for the rest of your life, like, I'm worried that if I stop taking it, I'm going to go back to being obese or overweight or unhealthy or whatever it is. I think it's okay to continue taking these drugs if your budget allows you to do that. There's no shame in that. The other side of, of the GLP1s that I find frustrating is people that shame individuals like, oh, you're cheating. And I'm like, oh, stop it. Just like saying it's you're cheating if you're taking hormone replacement therapy. And I'm like, no, I don't believe that to be true. So I think on a lot of different levels they have the potential to be life changing for a lot of patients. I think it has to be done responsibly. That's always my concern, is like, please make sure you're eating enough protein. Please make sure that you are lifting weights. Please make sure that you're checking your body composition whether it's a couple times a year or twice a year, or whatever your practitioner wants you to do because you don't want to end up being skinny fat. Like, I, I look at, I'm going to pick on my Pilates studio for a second. I go to a place for Pilates not often, but when I do, I'm surprised that pretty consistently I see the same type of women. They're teeny tiny. Like teeny, teeny tiny. And I'm like, they do not have any muscle on them. They're just teeny tiny because they were part of that generation that was taught Finn is in skinny is best. And I so desperately want to say to them, like, what we're not thinking about in our 50s or our 40s is what I think about because I have taken care of so many patients over the years that couldn't get off a bedside toilet or couldn't do activities of daily living because they didn't have the strength to pick up their groceries or go up and down the stairs. And so we don't want to get to a Point where we lose so much muscle that we become frail and then we lose independence. Like that is the biggest. I think about this a lot. I don't know if it's because I'm 54 and I'll be 55 this year, but I think about it a lot. Like what are the things I need to do to make sure I don't ever lose my independence? Because that to me is the greatest tragedy.
- [64:11]
B
I totally agree and I agree with everything that you said about GLP ones. And what's interesting and why I kind of wanted to to pick your brain about it in relationship to the gut is that slowdown in gastric motility that we're seeing and how that would affect the gut microbiome essentially because we have to poop every day, how that would affect the gut microbiome. I think the issue is that people, just like you said, now we have influencers and we even have like multi level marketing stacks of GLPs. I'm like, what are we doing? And the issue is patients are using it at a much higher dose. Not a micro dose, but a much higher dose. And they're experiencing the side effects. They're experiencing the acid reflux, they're experiencing the nausea and then the gastric slowdown in gastric motility. And that is going to create a backup in the system, thus affecting the gut and your hormone balance and every other system that we talked about today
- [65:12]
A
that's tied to the gut. Well, and I think you bring up a good point. Like the first generation, like semi glutide or ozempic, you're more likely to get more, more nausea, more dyspepsia, more reflux, which is why tzepati, which is slightly different, it's a GLP one and a gip. So it has two different mechanisms of action. It does a really good job. And in fact I was watching something on the news last night that was talking about they're finding that tir Zepatide is helping people with addiction. So like alcohol in particular, that it's just turning off that pleasure center in the brain. But I think for people when they're on larger doses, you're absolutely correct. Some of the side effects can be nausea, dyspepsia, reflux. I think about we go back to that pooping thing and I think at the expense I sometimes will say to patients, like maybe we need to alter that dosage so that you are hungry enough for two meals.
- [66:01]
B
Yeah.
- [66:01]
A
And these are things I think about like we don't want to get to the point where only one meal a day. Just like I have women that tell me, oh, intermittent fasting. I lost £100 on intermittent fasting. I only need one meal a day. And I'm like, no, that's bad. So I think we have to be. Using medicine is both an art and a science. And for anyone that is listening, it's understanding. Like, there's not a standard dose for everyone. It's like finding the right dose for the right person. Because we want to mitigate and minimize side effects, but we also want to maximize. Like I say all the time, like, how many women do I take off of intermittent fasting because they aren't eating enough food? It's like the same thing. Like, maybe you're on too high of a dose and maybe that needs to be reduced so that you have enough digestive fire. You're interested in a second meal because you can't get by on just drinking protein shakes and eating protein bars. Like, you really do need to eat, like, a real meal. Like, I was in LA last week and because of the time change and the amount of, like, travel back and forth to podcasts, I wasn't eating, like, the regular times that I normally do. And I was like, oh, my God, if I go back out to la, I have to be like, getting room service. Like, I'm gonna get an omelet at six, six o' clock in the morning if need be. And just because I realized, like, being off of my schedule was impacting the way I felt and my blood sugar and everything else, I was like, wow, like, this has been interesting for me because I'm so regimented at home and I can be. I have that luxury that I can be conscientious about when I'm eating what I'm eating. But when you're traveling, sometimes you don't have as much flexibility. So very insightful.
- [67:31]
B
Well, thank you for indulging me and answering that question. I just wanted to pick your brain about it. So as people are listening to this, the menopause gut is now out and they can buy it and dig way, way, much, way deeper into the conversation that we just had today. So can you tell people where they can find more about you, but where specifically they can purchase your new book, the Met Pause. Get.
- [67:56]
A
Yeah. Thank you so much for having me, Amy. So probably easiest to go to my website, www.cynthia thurlow.com. i've got everyday Wellness there, which is. Amy's been a guest multiple times and will be again soon with her new book you can purchase books anywhere where books are sold. I always say if you have the ability to go to a brick and mortar store, I always encourage people to go and give them your business. I think brick and mortar bookstores have really taken a hit over the last couple of years. But obviously all the normal Amazon, Target, Barnes and Noble books a million. All those places sell the book and I'd love your support. And you know we have some really cool bonuses that are available. You can go to my website and take a look at those. I tried to make sure they were actually valuable, not just sometimes we no one wants another pantry guide. Hopefully valuable resources that you can use that'll just be a great adjunct to the book itself.
- [68:44]
B
Amazing. So we'll put all the links down the show notes. So all you guys have to do is go down scroll, click the link below and you can order her book right away if you don't feel like going to Barnes and Noble. But yes, I agree with you. I encourage that as well. So Cynthia, thank you so much for just an amazing show. Like I said this, we have not dove into the estrobolome and the gut and the microbiome and hormones. So this is beautiful and I love how it aligns with your book coming out. Much needed, much anticipated. I just thank you for your time, your knowledge, your expertise in this area, and for sharing it to the world. Thanks so much Amy the information shared on the Thyroid Fixer Podcast is intended solely for informational and educational purposes. It is not a substitute for professional medical advice, diagnosis or treatment. Always consult with your physician or other qualified healthcare provider with any questions you may have regarding a medical condition, treatment or before making changes to your healthcare regimen, including medications, supplements, or other therapies. Use of the Information Information provided in this podcast does not establish a doctor, patient or client provider relationship between you and the host or between you and any other healthcare professionals featured on the show. Any medical opinions or statements made by guests are their own and do not necessarily reflect those of the host or affiliated parties. Statements regarding dietary supplements or health related products mentioned in this podcast have not been evaluated by the fda. These products are not intended to diagnose, treat, cure, or prevent any disease. Some episodes of the Thyroid Fixer Podcast may include sponsorships or affiliate links. The host may receive compensation for discussing or promoting certain products or services. Any such sponsorships or affiliations will be clearly disclosed during the episode. All opinions expressed are those of the host or guests and do not necessarily reflect the views of any sponsors. The inclusion of a product or service does not imply endorsement by any healthcare professional featured on this podcast.