Episode 063: Menopause And The Gut

Everything can feel like it changes at once in midlife, and “it’s just aging” doesn’t explain the full story. We sit down with Cynthia Thurlow, NP and author of The Menopause Gut, to unpack a missing link many women never hear about: as estrogen and progesterone decline in perimenopause and menopause, the gut microbiome can become a powerful driver of how we feel day to day. If you’re dealing with bloating, stubborn weight changes, brain fog, new food sensitivities, reflux, or a body that suddenly feels unpredictable, this conversation gives you a clearer map.

We break down what the gut microbiome actually is, why diversity matters, and how shifts in inflammation and the intestinal barrier can ripple into immune health and autoimmunity risk. Cynthia explains short-chain fatty acids, the gut brain axis, and why mood and sleep can worsen when the gut gets inflamed. We also talk about hormone therapy research, including what it may mean for restoring a more “youthful” microbiome, while keeping expectations grounded in what science can and can’t confirm yet.

Then we get practical. We share a food-first approach to probiotics, easy ways to support digestion without buying a cabinet of supplements, why fiber is a midlife superpower (and how to increase it slowly), and how meal timing and stress management shape circadian rhythm. One of the biggest takeaways is surprisingly simple and surprisingly hard: boundaries. Learning to say no can be one of the most effective microbiome-friendly changes you make in menopause.

If this helped you connect dots in your own body, subscribe, leave a review, and share this episode with a friend who needs a smarter menopause gut health playbook.

Cynthia Thurlow is a nurse practitioner, host of
the Everyday Wellness podcast, author and
international speaker, with over 15 million views
for her second TEDx talk (Intermittent Fasting:
Transformational Technique).

With over 25 years of experience in health and
wellness, Cynthia is a globally recognized expert
in perimenopause/menopause and intermittent
fasting, and has been featured on ABC, FOX5,
KTLA, CW, Medium, Entrepreneur, and The Megyn
Kelly Show.

Website: www.cynthiathurlow.com

Cozy Earth: www.cozyearth.com

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Transcript

Welcome And Why Midlife Shifts

SPEAKER_00 0:00

Welcome to the Medovia Menopause Podcast, your trusted source for information about menopause and midlife. Join us each episode as we have great conversations with great people. Tune in and enjoy the show.

SPEAKER_01 0:15

Hey everybody and welcome back. Today we're diving into a topic that many women feel but often can't quite explain. Why does midlife suddenly feel like everything changes at once? Energy shifts, weight changes, digestion feels different, brain fog shows up, sleep gets disrupted, and a lot of women are told this is just part of getting older. But what if there's something deeper is happening? And our guest today is Cynthia Thurlow. She's a nurse practitioner and author of the new book, The Menopause Gut, which I loved, and host of the Everyday Wellness Podcast. She believes that estrogen when estrogen begins to decline, the center of the regulation in the body actually shifts to the gut microbiome. But before we jump in, I just want to say, Cynthia, I'm a big fan of your work. And I've been listening to the Everyday Wellness Podcast for a long time. You've been with me in the gym and on the road and doing chores along my house. And I love the way that you take complex science and make it understandable and practical for women navigating midlife. Cynthia has more than 25 years of experience in health and wellness and is widely recognized for her work in perimenopause, menopause, and metabotic health, metabolic health. Well, thank you. Cynthia, we're really excited to have you. Welcome to the podcast.

SPEAKER_02 1:34

Oh, such an honor to be here. And thank you for your kind words about the podcast. I mean, that is that is really the impetus to help educate, inspire, and empower women to know what their options are in middle age because, gosh darn it, when I was in perimenopause, I didn't know what to expect. No one prepared me. So I'm hoping other women will benefit from all the things that I've learned over the past, you know, 10 plus years and more.

Cynthia’s Health Crisis Awakening

SPEAKER_01 1:57

Yeah, I love it. Well, your story, oh, your book opens up with a story on a personal crisis that ultimately led you to study the microbiome and menopause. Can you share that moment and what changed in your thinking uh around this and women in women's health?

SPEAKER_02 2:14

Yeah, so I, you know, in 2018, I treated my husband to this incredible vacation. We were going to go to romantic Morocco in southern Spain. And when we were in Morocco, uh, my husband and I ate the same food. And evidently I carried a friend with me over to southern Spain. So by the time I got to Spain, first night in Spain, I spent the entire night in the bathroom, throwing up, having horrific diarrhea. Was so sick that I was convinced I had probably torn my esophagus, which as you can all imagine is an unpleasant thing. Um, I didn't feel right for the rest of our trip, but I was committed to seeing, you know, beautiful Granada and the Alhambra and all these amazing places I'd always wanted to visit. And I came home and I didn't think more of it. I was like, I just had crummy luck, you know, something unique to what I ate, although we ate the same food. Um, and a few months later, I went to Toronto for my first TEDx and got food poisoning again. Uh, this time it was E. coli. There was an E. coli outbreak, honest to God, in Toronto. And I just happened to eat the salad that was connected with the E. coli outbreak. But what was really most significant was that in February of 2019, I thought I had food poisoning again. And I realized after 12 hours of persistent abdominal pain that it was something quite larger than that. And so my husband took me to the emergency room where I they determined that I had a ruptured appendix and my entire length of my colon was inflamed, so much so that the surgeon wanted to take me to surgery and remove part of my colon and my appendix. And in my infinite wisdom, I explained that I needed my colon. And so I immediately was not the friend of the physician. She was pretty upset with me. I asked her to give me a tincture of time, which is something we talk about in medicine. Sometimes patients need a little bit of time. And so she was very angry. She told me I was being really foolish. You know, I love being admonished by physicians, especially when, you know, they're in a very kind of patriarchal environment where I feel like I'm being told what I need to do. And so that then started a 13-day hospitalization. I'm happy to report the female physician that came in in the morning completely agreed with me. And so that started a long, lengthy hospitalization with a slew of complications. I was very sick. And it probably wasn't immediately that I started putting together that where I was in time and space in terms of perimenopause, the impact on my immune system, the degree of inflammation, the exaggerated response I had to this exposure to several different pathogens was a direct reflection of this loss of estrogen and progesterone in the gut microbiome. And so you kind of fast forward, life happens. You fast forward, I'm at a business event in 2020. This is now not even a year later. And I'm talking to a female physician, Dr. Gabrielle Lyon, who I think is probably pretty well known. And she started asking me some very targeted questions. And so I explained to her, she's like, tell me some of the places you've traveled. And she said, Oh, you're like the special ops guys. You and your husband have been all over the world. She said, I think you have giardia. And I was like, No, I haven't tested positive. They've tested me. She said, Nope, I think you have giardia. Like, I think that is what drove all of these things to happen. And then ultimately this hospitalization, to her credit, she followed up with me. I got tested, and she was absolutely correct. And so in 2020 is when I really started to say, what exactly is happening in the microbiome for women that is impacting our immune system, that is impacting our ability to fight off opportunistic infections. What helps explain why my husband, who ate the same food, had no problems, but I got so violently ill? And so that started to unwind this deeper conversation for me that, you know, ultimately culminated in 2024 when I told my editor, because she said, Do you think you have a second book in you? And I said, Well, maybe. And so I pitched this idea. I said, I'm talking to all these experts, and the gut microbiome keeps coming up in conversations, all these researchers. And I just think there's a more nuanced conversation around the gut microbiome and perimenopause and menopause. And how if we do a really good job illuminating this, I think it's going to be the missing link for a lot of patients. Because unfortunately, what I think in many ways has been, you know, the menopause, perimenopause conversation has been reduced down to take HRT, cross your fingers, and you're going to feel better. And I wish it were that simplistic. And maybe for some patients it is. But what I think is the deeper question is that for a lot of women, they still don't feel 100%. And that's why I think, you know, this lifestyle piece plus the integration of the gut microbiome conversation is so vitally important. And one that I hope will open up conversations between clinicians and their patients and between women helping to educate one another. Because I really do think the gut microbiome is the missing link. I really feel so strongly about this, both from a personal and a professional perspective, because when I look back at, you know, why I got so sick in 2018, 2019, then learning as much as I have over the last several years and then having this objective colonoscopy in 2020, which of course they wanted to do it right after I was hospitalized, and my gastroenterologist was like, absolutely not. And then then the one I had at the end of 2025 reaffirms for me that I've been putting the missing links together that have translated into, you know, my colonoscopy in 2020 was vastly different than the one I had in 2020.

The Microbiome As The Missing Link

SPEAKER_00 7:41

Hey everyone, I don't know about you, but sleep has just changed. Some nights I fall asleep fine, and then I'm up at 2 a.m. overheated, kicking off the covers, trying to get comfortable again. And if you're in periomenopause or menopause, you know exactly what I'm talking about. It's not just bad sleep, it's disrupted, inconsistent, and honestly, it's exhausting. That's why I started paying more attention to what I'm sleeping in and on. I recently tried Cozy Earth's sheets and pajamas, and what stood out to me right away is how breathable they feel. They're made from fiskos from bamboo, and they really do help regulate temperature. So when your body is doing its thing in the middle of the night, you're not waking up drenched or uncomfortable. And for me, it's those small shifts that make a big difference. Because when sleep is already hard to come by in this stage of life, comfort actually matters more than ever. This is about supporting yourself through menopause. And sometimes that starts with something as simple as what you're sleeping in. If sleep has been a struggle for you too, you may want to try them. They offer a hundred-night sleep trial so you can really see if it works for you. You can head over to cozyearth.com and use code Modovia for 20% off because better sleep, even just a little better, can change everything. Back to the show. What surprised you most when you started connecting the dots between perimenopause and your gut health? What was the aha and the biggest surprise for you?

SPEAKER_02 9:22

I think it just explained that, like, oh my gosh, I think now that I understand this, it explains why women tell me they feel like their digestion is off, why they're having so much bloating, while we're seeing escalating rates of autoimmune conditions, why we're seeing bone health issues associated with an unhealthy microbiome, why we know women that have significant adverse childhood events may be going into menopause earlier. So it was like all these connections, you know, the gut ovarian acts, the gut bone access, these were things that I had never been taught during my medical training. And that has a lot to do with the fact that this is burgeoning areas of research. Really, the last five to 10 years, we've been starting to really understand the gut microbiome at a much deeper level. But it's all these little pieces that as they started coming together, I was like, oh my gosh, the immune system and estrogen are like peanut butter and jelly. You can't have one without the other. And so I think for a lot of women, they'll start recognizing themselves in the stories that I share in the book, which I always say transparently are a composition of multiple women into one because I never wanted anyone to read it and say, oh, that's me. Really tried to keep everyone's anonymity there and you know, certainly protected. Yeah.

SPEAKER_00 10:36

Go ahead, Kim. I was just gonna ask you why you think it is so ununderrecognized. I mean, you you mentioned training, right? Um, as one. Are are there other reasons why this is just so underrecognized?

SPEAKER_02 10:51

Well, I mean, I think that I have a unique perspective because I have a podcast where I get to interview experts. And so for me, every time I interview someone, I take something new, some tidbit, some fact, something that's unique that I kind of internalize and I'm like, huh. And so for me, it was a cumulative, it was an accumulation of two or three years of talking to different people where I was like, gosh, all these experts, you know, one's talking about this one keystone bacteria, and this one's talking about nitric oxide, and this one's talking about um, you know, this one's talking about this particular hormone that most of us are not acknowledging, like oxytocin. And what I really think is that they're all speaking from a place of they have one little lens, and then I'm looking a little broader to say, I'm seeing things from a different perspective. I think also because I'm a nurse practitioner, I wasn't, you know, although I trained, this is laughable now, I trained in primary care because I was told at the time in the 90s that there was no room for nurse practitioners in an acute care environment. Ha ha. That's all I did. Um, I was, you know, I worked in cardiology for 16 years and never really worked in primary care ever. Um, but I think that a lot of us get very myopic. Whatever our area of focus is, we sometimes don't consider there's a larger conversation. So I think that's part of it. And I do think that this is really a burgeoning field. And I'm nerdy. So once I get interested in something, I kind of go down an exhaustive rabbit hole where I want to understand all of the things. Um, so I think part of it's my personality. And then I think it's also I get to view things from a 30,000-foot lens because I'm not, I'm not, you know, I'm not, I don't own a think tank. Uh, I'm not a researcher. Uh, I'm not, you know, I'm not like a GYN that's just looking at pelvic health and women's health. I'm I'm just viewing things from a different perspective. And so I think that's probably one of the contributory factors. I think we're still kind of coming out of this WHI B and helping people understand that hormones are not intrinsically bad. And so I think that's been a lot of the focus over the last couple of years. Like when I see colleagues that are doing incredible work that are talking about these subjects, um, I think a lot of the focus has been on like educating women at a very basic level. Like, yeah, this is why bone health is important, this is why genito-urinary health is important. So I'm just looking at things from a different perspective, equally important, but also kind of complementary to their messages.

What Changes When Estrogen Falls

SPEAKER_01 13:19

Well, let's talk about what's actually happening in the body. Like when estrogen starts to decline, what's going on in the gut microbiome that I should pay attention to, understand, not think that I have food poisoning, right? What's actually happening?

SPEAKER_02 13:35

Yeah, so let's let's at first let's define the microbiome because for a lot of people it seems very intangible. When we talk about the gut microbiome, we're talking about 40 trillion. That's with a T, bacteria, viruses, fungi, and protozoa. And so it is a very dynamic living organ ecosystem that's in the large intestine or colon. It intersects with every single organ system in the body. There's a gut ovarian axis, gut brain axis, et cetera. But what's interesting is the microbiome is imprinted heavily at birth. So whether you are vaginal delivery or a C-section, whether you are formula fed or bottle fed, excuse me, breastfed, there is an imprinting on the microbiome. And we can't control any of that. So, irrespective of how you were delivered or how you were fed, it's irrelevant at this point. We do know that that's a first kind of initial imprinting. The next is puberty. This is called the microgenderome. And this is where we see some differentiation between young boys and young girls. Not surprisingly, the other two pieces for women are pregnancy. If you choose to become pregnant, carry a pregnancy, and then perimenopause. But at a very fundamental level, the changes that we are seeing include changes to diversity. So there are keystone bacteria. Think of it as fruits and vegetables in a garden, right? We start seeing reduction in diversity. So the beneficial species start to decline, which can lead to more inflammation. And I think everyone listening probably has understood at a very basic level that at the basis of aging is inflammation. So the immune system ages right along with us, and that is inflammaging or immunosinescence. We also see rises in opportunistic bacteria. So more inflammatory species, more diotic organisms. We will see an alteration in the small intestinal lining. So the small intestinal lining is one cell layer thick. And if you think about that lining as a brick and mortar system, I love this analogy. The mortar is estrogen. So as estrogen is declining, you lose the ability to keep those tight junctions closed. So you will leak food particles into the bloodstream, it will provoke an immune response. So women will say, I used to be able to eat X, Y, or Z, but every time I eat dairy, every time I eat this particular item, I get bloated, I don't feel good. And it's because you've developed a leaky gut that has leaked food particles into the bloodstream, provoked an immune response, and you react, which can lead to food sensitivities. Women are four to five times more likely to develop autoimmune conditions in perimenopause and menopause. That is huge. 80% of autoimmune conditions are diagnosed in women. So by the time I finished my medical training in the early 2000s, we probably acknowledged 20 to 30 autoimmune conditions. Now they're over 100, including things like long-haul COVID and chronic Lyme. So the other things, kind of high-level things that can happen, we get a reduction in a particular signaling molecule. They're called short-chain fatty acids, which, you know, if we think about the more common ones, butyrate, acetate, proprynate, but they're really important because they are involved in creating mucus in the digestive system. I know that sounds kind of yucky, but it's important. It's protective. They help with reducing inflammation. They're integral in endogenous GLP1 regulation. I know GLP1 drugs are very popular right now, but we have our own endogenous ability to trigger this satiety. And the GLP1s that are created in our body, they last seconds, unlike the medications that last up to a week. The other thing that's interesting is one of these short-chain fatty acids can actually cross the blood-brain barrier. So I always remind women that butyrate, you can get it from grass-fed butter or ghee, it can cross the blood-brain barrier. So it's a really important signaling molecule. It's kind of like, you know, this is going to sound like I'm dating myself, but it's like telephone. It's like they're transmitting information, just like a telephone would transmit information. So at a very basic level, as the microbiome is changing, it changes, um, it changes neurotransmitters. Neurotransmitters are like little chemical messengers, similar, but not akin to hormones, but we'll see a reduction in GABA. So women may experience more anxiety, more depression. I always say you can tell when a woman's estrogen level is not optimal because they tend to be irritable, because it impacts serotonin synthesis, but helping people understand that there's a lot that goes on, but those are kind of high-level things that are happening in the gut microbiome as we are navigating middle age. The last thing I would just add to that is when we see reductions in progesterone and estrogen, we get alterations in gut motility. So women will say, oh my gosh, I'm having so much more reflux. I just feel like food sits in my stomach. Some of that can be the smooth muscle contractility issues that we get with progesterone or the loss of them. But estrogen is also a potent nitric oxide signaling molecule. So nitric oxide is important for dilating blood vessels. It's really important for endothelial function, which is the lining of the blood vessels, but that can also impact how food moves through the digestive system. So it's not in your head. In fact, I recall probably 10 years ago, I remember saying to one of my providers, I was like, I just feel like food sits in my stomach a whole lot longer. Why is that? And they couldn't provide an explanation. And so I kept saying, does estrogen have something to do with gut motility? And the answer is yes. So those are kind of high-level things that definitely impact the microbiome and how we kind of perceive our digestion and our immune system as we're navigating this transitional period.

SPEAKER_01 19:11

So, what exactly, when you say gut microbiome, what are we talking about? The stomach, the esophagus, like what what is what is what are we talking about?

SPEAKER_02 19:20

Yeah, so it's 40 trillion bacteria, viruses, fungi, and protozoa in the large intestine or colon. So it's really, if we're looking at the digestive system and thinking that the start of the digestive system is our brain, and that's really that's where it starts, the end is the rectum. And so right before we get to the rectum is the large intestine. So it's the area of the body that is kind of deciding it's like deciding what stays and what goes. And I think for many people, because the microbiome is not tangible, like the stomach, the brain, the heart, people have no idea where it is. So I think that's a really important question. And it's just helping people understand that it's a mini-city inside our bodies. There are more cells, there are more microbes in the microbiome than there are human cells. So it is exponentially, it's this massive ecosystem, this only biodiversified ecosystem within our body that is really important.

Probiotics Versus Food First Fixes

SPEAKER_00 20:13

It's interesting because I I um, you know, I'm a health coach, so I understand microbiome, I understand its connection to overall body and systems, but I don't think that the general public knows what that is. So, Kim, thank you for asking that question. Um, and I do think that there's a misconception that your gut microbiome just equals digestion, right? So I appreciate you unpacking the inflammation and metabolism and and all of the other things that are really um in control. The gut biome is in control of, rather. I am wondering though, um, you know, as we as we talk about this, and I I'm putting myself in one of our audience members' shoes, right? I'm thinking, yep, I have bloating, and yeah, I feel like I have inflammation. Yep. Um, I feel like my my food just sits in my gut. Um, yeah, and we're shaking our heads, I'm sure a lot of people that are listening to this right now. Um oftentimes I think we immediately go to probiotics, right? I'll just go take a probiotic because that's what I'm hearing and that's what I'm reading. Can you talk to us a little bit about probiotics and then and then let let's just kind of stepstone to strategies that we can implement in our 30s and 40s and well into our 50s as well?

SPEAKER_02 21:39

Yeah, such an important question. I I think that intrinsically I like my patients to get probiotic rich foods into their diet. So whether it's miso, whether it's tempeh, whether it is if you tolerate dairy, if you're having full fat uh Greek yogurt or having low sugar kombucha or fermented vegetables, probiotic rich. Foods are going to tromp a probiotic any day of the week. The probiotic companies would like us to believe the opposite. And one of the reasons why you have to take the probiotic every day is because it only, you know, there's a degree of transit time and then you have to repopulate again. I think that if we are doing diagnostic testing and I notice that there is a deficiency, I think that is the time to optimize adding in a probiotic, but always food-centric ideas first. I think when someone is saying, I feel bloated, I feel like my digestion is off, I start to think about digestive fire. Now, that is not a medical term, that is my coined term to talk about how we have less hydrochloric acid in our stomach as we get older. Hydrochloric acid is what breaks protein down into amino acids so it can be absorbed. So that can be one issue. We're oftentimes not making as much digestive enzymes. So sometimes patients need digestive enzymes to break down the protein, fat, and carbohydrates. And then the other thing about digestive fire is really talking about bile. So bile is stored in the gallbladder. It is designed to break down and emulsify fat. Fun fact guess what impacts bile estrogen. Those estrogen declines, women will sometimes say, if I eat a really fatty meal, I don't feel good. And it's not about the gallbladder. That's unfortunately where most people's mindset goes. If it's a cyclical problem around fat intake, then it might be your gallbladder. But more often than not, it's that as estrogen is declining, your bile synthesis changes. And so there are sometimes supplements like Tudka that can be helpful that helps with not only mitochondrial health, but it can also help with the quality of bile that you are producing. So just to kind of interject those fun facts, those are things that I think about at a very fundamental level when we're talking about by digestion. But if I want to think about three things that I think women should be conscientious about that will help digestion that don't necessarily involve buying anything, I think that's significant. So number one, understanding that digestion starts in your brain. So when I was growing up, my parents made us say grace. And I thought it was just because my parents were Catholic. And actually taking time to say grace or say a prayer or take four to five deep breaths before a meal is really powerful because we're trying to do is get ourselves out of that sympathetic state. So we have the autonomic nervous system. We have the sympathetic, which is fight, flight, glee, or flawn. It's a mouthful. On the other side is the parasympathetic, rest and repose. Our body needs to be in the rest and repose side. Otherwise, we cannot digest, assimilate, absorb, or detoxify. And that is fact. That is not, you know, just conjecture. So I would say take four to five deep breaths, you know, kind of good deep breaths, even if you like to box breathe, that might be a good time to do it before you sit down and eat a meal. That is telling your body, I am, I need to be in this parasympathetic state. Another thing that I think is particularly helpful is to walk after your largest meal of the day. Now, I used to laugh at people in my neighborhood, not at them, but I used to think it was peculiar. I didn't understand why that was so important. It's brilliant. It can help regulate your blood glucose because you have glute four transporters in your muscle. They help kind of scavenge up the glucose. And that's why muscle is such an important conversation that we typically have on the podcast. That's number two. I would say number three, there's a lot of protein-centric conversations right now. And that is important. We do indeed more need more protein with aging, not less, because there's a lot of anabolic resistance. But what comes equally important in my mind is fiber. And we're not talking about grandma's metamucle. We're talking about with the reduction of short chain fatty acids that I mentioned earlier. If we eat fiber, fiber goes to the colon or large intestine, the colonocytes break it down, ferment it, and then they create these short chain fatty acids. These are really important. And it's why I think if someone's eating a standard American diet, they might only be having five, maybe 10 grams of fiber a day. And if you look at the research, the kind of idealized range is 25 to 30 grams. Not everyone can tolerate that up front. And if you're currently eating five, please don't try to rapidly increase it. Exactly. Microbes need time to acclimate. Just like you wouldn't go from running uh a half a mile to running 10 miles. You need your body needs time. So increasing fiber intake. And I don't care if it's a combination of insoluble, soluble, resistant starch, fermentable fibers, just starting somewhere, it can be really helpful. And one of the tips that I always recommend if someone's trying to increase their fiber intake is to do a tablespoon of fresh ground flax and a tablespoon of chia. Not only will this be helpful, it's gentle. It's not as bloating as some of these other, you know, options like beans or lentils or, you know, cruciferous vegetables that need to be cooked, I will add. That can be very helpful for adding in some fiber that's generally really well tolerated. By the same token, you get a little bit of plant-based protein because I think being omnivorous is important. But those are easy things that you can do. And I always say, like, here's the thing like the amount of fiber that April tolerates versus Kim versus me might all be very different. But when we look at the research on how colorectal cancer rates are going up, when I asked the experts on the podcast, one of the things that's postulated is that it might be this lack of fiber in diets. I will sometimes have people tell me, I'm carnivorous, I don't need fiber. It's interesting. I just interviewed a microbiome researcher and she said, as we were finishing our conversation, she's like, I just read this paper. And it talks about in the absence of fiber, the body will try to ferment protein. And that stayed with me because I was like, protein fermenting is putrefacation. That's not even a pretty word. That's not what we want to have going on in that gut microbiome. So when people don't tolerate any fiber, I think it's oftentimes a reflection of what is going on in their gut microbiome. And I'll use myself as an example. So in 2019, I spent 13 days in the hospital. I had six weeks of antibiotics and antifungals. My microbiome was decimated. And that saved my life. So I cannot complain about that. It took me nine months of eating stewed meat. I'm not kidding, it was really unpleasant. That's all my that's all I could tolerate. And then around 18 months, I was able to start eating some fiber, but it took me many years to be able to eat fiber in my diet comfortably. But it is possible and it takes time. If you are in a position where you've been on antibiotics or there have been other things that have impacted the gut microbiome, it takes time. I mean, you really do have to think about it as a marathon and not a race. And I think most women, especially type A women, they're like, I want to get from zero to 60 right away. You have to learn to be patient. You know, you have to be patient with yourself as through this hormonal transition. And you have to be patient as you kind of bring your microbiome up to speed, get it to, you know, get it to, you know, over the finish line, bring it back to first place. And that's usually kind of the feeling or the strategies that I will use that I think are fairly easy for women without having to buy a supplement, without having to, you know, go to extremes, because most of my community loves supplements, they love extremes, and they love gadgets. And I'm like, all those things can be fun, but we have to lay the foundation so that we have great success.

SPEAKER_01 29:26

I really, really appreciate that you were saying this takes time. Yes. We're such a culture of, you know, get your prescription and you're better and moving on, right? And this is one of those things that and and there's a lot of things to pay attention to to get things right in your gut microbiome, but it's not something you're going to be able to do overnight.

SPEAKER_02 29:46

No, in fact, there was a uh a recent guest I had on. His name is Dr. Karen Rajan. If you don't follow him, he's uh a UK-based gastroenterologist and he's funny. Like he's a funny gastroenterologist, which is the best kind. And he was talking about a paper, how one round of antibiotics can impact the microbiome for up to eight years. So I don't share that so that people worry. It's just the microbiome takes time to adjust. Like we have to give it time, like a tincture of time. I always talk about how that's so important in medicine. Same thing that applies to us in our personal lives, that you might not be able to get your microbiome back to where it was instantaneously. It may take time. And I think that for those that need antibiotics, like I needed antibiotics very clearly, there's no shame in that. That's why they're there. But we want to be judicious when we take them.

Can HRT Improve The Microbiome

SPEAKER_00 30:38

I love that. Can I ask a question too? Because we talked about um estrogen declining, you mentioned progesterone. Does hormone therapy help with our gut microbiome?

SPEAKER_02 30:52

Yeah, this is such a great question. So the research is pretty clear that if we look at a pre-perimenopausal woman and a postmenopausal woman, obviously there are changes to the gut microbiome. But if we give the menopausal woman HRT, it can start to resemble a younger woman's microbiome. So although it is not a primary indication like estrogen for osteoporosis prevention, I think we will eventually get to that point. And I think it's really interesting because both estrogen and progesterone have immune modulatory properties, as does testosterone. And it's all about the symphony of hormones. It's like the right amount in the right amount in the right time. And so I think we will get there. It's certainly looking like, and I don't know what those levels are because that's always the next question. We don't know yet. Like we know where we are with bone protection, like where we need those estradiol levels. We don't yet know that about the gut microbiome. And I think that's the emerging research. There'll be more and more people investing in research in that area, but I think we will eventually get there. That's my prediction.

SPEAKER_00 31:53

Okay. Thank you for that. And I hope that the research continues then.

SPEAKER_02 31:57

Yes. Well, and I think the more that we understand about the microbiome, I think with the more we understand about ourselves. It's not just willy-nilly we throw anything and down our, you know, down our esophagus drops into our stomach, and that somehow miraculously it ends up in the toilet eventually. There's a lot more to what goes on in the digestive tract than we probably give credit for.

Sleep Circadian Rhythm And The Gut

SPEAKER_01 32:17

Yeah. I want to talk about some of the menopause symptoms and how your gut microbiome is impacted by it. You know, many women, me, um, sudden sleep becomes an issue and it sort of falls apart at midlife. How's the gut involved in circadian rhythm and sleep?

SPEAKER_02 32:34

Such a good question. Um, well, first and foremost, you know, we have to remember there's a gut-brain connection. So we talk about the vagus nerve, it's the longest nerve in the body. Um, it is a communication superhighway. So it's bi-directional, meaning the brain transmitted information to the gut and vice versa. But when I'm thinking about sleep in particular, it's helping people understand that this constant communication. So if you tell yourself, if you have limiting beliefs, I'm not going to sleep, I'm never going to be able to sleep again, your body is hearing that from a very fundamental level. I think about not just a hormonal deviation. So we know progesterone as it's declining impacts an inhibitory neurotransmitter called GABA. So that will impact sleep. I think about how estradiol helps with staying asleep, and that also impacts serotonin, which is a precursor to melatonin, which is this hormone that is thought of simply as a sleep hormone, but as a master antioxidant in the body. But we know based on the research that if you have non-beneficial bacteria, lots of dysbiosis, a lot of inflammatory organisms, that inflammation can get transmitted to the brain. So there's also that. So I would say leaky gut, leaky brain, inflame gut, inflame brain, which can also impact sleep quality. But from a very fundamental level, when we talk about circadian biology, we're really speaking to how our body responds to light and dark cycles. And so there is the suprachiasmatic nucleus, which is in the brain, that is kind of like the master clock. But we have digestive, we have circadian clocks throughout our digestive system. I mean, when I say all throughout the digestive system, this is why if you try to eat a large bolus of food before bed, you will sometimes not be able to fall asleep because your body is, you're telling your body suppress melatonin, increase cortisol, help me bolus, help me process this bolus of food. So meal timing has an impact on that. Light exposure in the morning has impact on that because we're suppressing melatonin, increasing cortisol. You know, not having light exposure at night also helps not suppress melatonin. So there is this complex in a relationship that is both light and dark mediated, food mediated. It is mediated by neurotransmitters and hormones. There's a lot that goes on that is certainly the interplay, but sometimes the missing link for a lot of women is that they have a lot of diotic or opportunistic infections in the microbiome that is driving some of the issues relevant to sleep. And I, and that's why I think, again, it's this nuanced conversation. If you notice there's multiple things that are layered into what impacts sleep. And the other thing that I would say is show me a woman who doesn't manage her stress and show me a woman who doesn't sleep. So we know that we become less stress resilient as we are getting older. And one of the ways that this shows up is it impacts sleep. Like I know for myself, if I'm stressed about something, even with all of the supplements and all of the HRT and all of the things I do that are good, if I'm not properly preparing my body, I'm not going to be able to sleep as well as I should. So I think that that is a very important kind of distinction to make, is that most women think they are managing their stress and they're not. And that shows up in their sleep. So there's multiple things that impact sleep. I actually had a woman on a group call the other night who was saying, you know, I try to manage my stress and I exercise the right way and I eat the right way. And so we were kind of troubleshooting through some of the things that might be precipitating her poor sleep. And I finally said, I think you're just stressed. I think based on what your sandwich generation, you have aging parents, you've got older children, you know, everyone is needing you and pulling you in different directions. And you probably are feeling that push-pull of the sandwich generation, which is super stressful. Uh, and maybe not something that we talk about enough is women. I think we just internalize it and we're like, we have all these responsibilities, let's just suck it up. And instead, we should probably be talking about the challenges. I mean, that was my 2024, having my dad be very sick and my stepmother, and then my oldest was graduating from high school. And it's like you're pulled, there's like happy things going on and sad things going on. And I think for so many of us, that is the juxtaposition of midlife, is that we have this duality in our lives. We have to show up for everyone. And sometimes it's not all fun. Sometimes it's sad stuff. It's some of it's fully adulting. Like I said to my husband at that time, I was like, you know, my brother and I knew at some point we would be dealing with this, but this is not the fun part of adulting. Like I want to give my adulting card back and go sit in a corner and decompress.

SPEAKER_00 37:10

Uh-huh. A free pass. Can we take a free pass right now? It doesn't happen. I think oftentimes we don't even realize how some of those life um situations affect us in the way of stress, right? You talked about graduation and um relatives passing away and caregiving. Um, you know, it's heavy and we don't we don't give it enough credit at times.

unknown 37:36

Yeah.

SPEAKER_02 37:37

Well, and then we don't, we also don't want to complain about it because we're like, this is the life that we chose. Here we are. I recall in 2024 when my dad was in the trauma ICU and was essentially dying. And my brother and I made a decision not to tell our kids what was happening because not only was my son graduating, his lacrosse team went to states. Uh, he had a graduation party, so did my niece. And it was like we didn't want to take away from you know these beautiful moments in their lives. And I remember saying, like, this really stinks, but it is what it is. And this is, you know, this is, you know, as Sean Stevenson says, this is life is lifing. This is just the things that we do as we navigate being, you know, adults. Yeah, for sure. It's true.

Stress Boundaries And Saying No

SPEAKER_00 38:21

I want to, I want to leave our audience members with uh how to. I'm a checklist person, and you gave us some great starts. Pause before we eat, whether that's grace, whether that's box breathing, um, take your fiber, eat your fiber, chia seeds and flax seeds, and make sure you're getting enough fiber. Start slow. Take it from me, start slow on the fiber. Yeah, she means it when she says that. Um, and then you also talked about walking um after your biggest meal of the day. Are there any other tips and lifestyle changes that you would recommend women make to have a big impact on their microbiome?

SPEAKER_02 39:07

Learn to say no. This is probably the hardest thing I'm going to recommend, uh, but it's something that I find I'm talking about a lot around this book is that for so many of us, I am a reformed people pleaser. I was the take care of everyone else before I worried about myself. And I'm here to tell you perimenopause and menopause, it is time to take pause. It is a litmus test of how well you are taking care of yourself. And one of the biggest lessons I have learned that I try to make sure I talk to people about is we have to learn boundaries. We have to learn to say no. We have to let other people be disappointed because you they aren't necessarily going to get their way. And that may change relationships with loved ones. I mean, I had a lot of changes in relationships with my parents as I was navigating perimenopause and menopause, and they weren't happy about it. But I share this because I think that while we are navigating a decline in hormones, while we are navigating alterations in neurotransmitters, the research is pretty clear about the impact of stress and not just acute stress. Like the acute stress, I'm having a podcast. I'm sure if you measured my cortisol, my cortisol's up a little bit because I'm engaged, I'm having conversation, I'm excited. That's very different than chronic unrelenting stress, which is what most women are experiencing. And that can be cost, chronic stress can be caustic to the microbiome. So a really big pearl that is easier said than done is learning how to have boundaries, establishing your boundaries, and learning how to say no. It is hard to do. But once you get there, there's no looking back. Like because I'm an entrepreneur, I'm now an entrepreneur. I remember my husband and I usually will unpack my day before we start our work days. And I was saying to him, in the midst of the book and all these professional responsibilities I have, I've had to push back to with my team as an example, politely, but no, I can't do that today. No, that's not gonna work. Between these two days, these two weeks, I'm not doing anything extra. So if you need me to do anything extra, it's ask me before I leave for LA because I'm not making any promises. And the old me would have felt badly or would have felt like, oh, are they thinking I'm being rude or brusque? Or there's very polite ways to say, no, this doesn't work for me and let that be a full sentence. It doesn't have to be, you know, a doctoral dissertation as to why you feel a certain way. It's, you know, reestablishing your power as a middle-aged woman and also protecting your sanity. But again, that microbiome piece, like what we say to ourselves internally, our microbiome understands that. Like it is very sophisticated. The gut-brain connection is so sophisticated. My piece largely is impacted by whether or not I protect my boundaries. And we all know how we feel when we don't. We get irritable, we're irritated with ourselves, we're disappointed. Um, that's why our boundaries become even more critically important at this stage of life.

SPEAKER_00 42:16

Yeah. And more stress, right? It increases your stress when you do say yes and you really didn't want to say yes.

SPEAKER_01 42:23

Yeah. Well, the metaphor was is an incredible read and also really important for us to all wrap our heads around. And you're doing work that I haven't heard anywhere else. So um, kudos to you. Where can people find you?

Where To Find Cynthia And Final Advice

SPEAKER_02 42:42

Probably easiest to go to my website. So www.cynthurlow.com. You can get access to all my social media channels. Access if you go to the top um top banner at the on the website, can take you directly to purchase the book through Amazon, Barnes and Noble, Books A Million, uh, Target, whatever your preferred retailer is. And then my podcast is Everyday Wellness. And to know that that is my favorite thing I do within my business. I'm pretty active on Instagram. I do have a free Facebook group called the Midlife Pause backslash my name. I use it as a litmus test for what people are interested in. Um, it really is a place like I will ask questions there when I want honest feedback. You know, sometimes it's like, what do you want me to do a midlife minute on? It's sometimes it's that basic. Sometimes it's deeper. But I would say that that's a great opportunity to connect with me there. And I would say for those that purchase the menopause gut, you're gonna want a physical copy of the book because there's a lot of science in there. You're gonna want to earmark pages, uh, you're gonna want to take your highlighter out. And you probably want to purchase a copy for a good friend, your sister, um, even your husband. You know, in fact, the last podcast I had today, he was saying, you know, is this a book for men too? And I said, absolutely. If they want to better understand their significant others and be able to support them. And I said, any man that asks that question is probably a keeper. That's probably the guy that's going to weather. all of the changes and the bumps that women experience in that perimenopause to menopause transition.

SPEAKER_01 44:06

Your social media is fun. I appreciate it. It's a thank you. Most of the time it's informative and it's also a break in the day. So thank you for that. Yeah. Thank you.

SPEAKER_00 44:16

Well the last question that we always ask is what the best piece of advice you've ever received has been. So give that a skinny second to think about.

SPEAKER_02 44:25

Yeah it's funny I was going to say my boundary no thing because that that is almost always like on the tip of my tongue that people really struggle to understand that. What I would say is trust your gut. And I'm not just saying that because of the context of my book. It's just intuition. We are encouraged to suppress our own intrinsic intuition and yet I've come to find the older I am, the first opinion I have of someone or something is almost always right. We are so connected to our bodies and yet we are taught at a societal level to ignore all of that. And so I would encourage you truly to lean into your intuition because more often than not it will lead you in the right direction. Like I said I think I was taught for most of my adult lifetime to just suppress that. And so a very good therapist friend of mine said one time, what would happen if you would just trust your intuition more and I was like oh my gosh I think that's brilliant. And so now I embrace that and I encourage you to as well.

SPEAKER_00 45:29

So true Cynthia so true. Yeah yeah listen to your gut when we haven't Kim oh no every time every time every time why didn't we listen to our gut yeah absolutely love that reminder and love the conversation audience members you're going to love this book go grab a copy grab a copy for friends and until we meet again go find joy in the journey thanks thank you for listening to the Medovia Menopause podcast if you enjoyed today's show please give it a thumbs up subscribe for future episodes leave a review and share this episode with a friend. Medovia is out to change the narrative learn more at medovia.com that's M I D O V I A dot com