106 | The Menopause Gut: The Missing Link Between Hormones, Mood, Sleep & Energy with Cynthia Thurlow

What if the brain fog, the broken sleep, the mood swings, the weight that won't budge, and the libido that has gone missing are not a collection of separate problems? What if they are one connected story and the missing piece of that story is your gut?

In this episode of Pleasure in the Pause, Gabriela sits down with Cynthia Thurlow, nurse practitioner, bestselling author, and host of the Everyday Wellness podcast, to explore her groundbreaking new book The Menopause Gut: Balance Your Microbiome to Reclaim Your Health in Midlife and Beyond. Cynthia has spent a decade working exclusively with midlife women, and what she keeps seeing is this: women doing all the right things and still not feeling like themselves. Her book offers a fascinating new lens through which to understand why, and what to do about it.

Cynthia Thurlow is a nurse practitioner, two-time TEDx speaker, international speaker, and CEO and founder of the Everyday Wellness Project. With over 25 years of experience in health and wellness, she is a globally recognized expert in perimenopause, menopause, intermittent fasting, and women's metabolic health. Her latest book The Menopause Gut: Balance Your Microbiome to Reclaim Your Health in Midlife and Beyond is available everywhere books are sold.

In this episode, we discuss: 

• What the gut microbiome actually is and why it sits at the center of midlife health 
• The estrobolome — the part of your gut that processes and eliminates estrogen — and why it matters on HRT 
• How the gut and brain are connected through the vagus nerve and what that means for mood, anxiety, and desire 
• Why 90% of serotonin is made in the gut and what that means for midlife mood swings 
• How trauma history contributes to weight loss resistance and early menopause 
• Practical starting points: protein, fiber, sleep rituals, strength training, and the power of saying no 
• Why supporting your gut ripples out into energy, vitality, mood, and pleasure

My hope is that this episode helps you see your symptoms as one connected story — and gives you a clear, practical place to begin.

Cynthia says it simply: major in the majors. Before the supplements and the protocols and the testing, it is the basics — how you eat, how you sleep, how you manage stress, and how honestly you honor your own limits — that move the needle most. Your gut is not a separate system. It is the ecosystem everything else depends on.

If this episode resonated, subscribe to Pleasure in the Pause and share it with a woman in your life who has been doing all the right things and still not feeling like herself. And grab Cynthia's book — it is one of the most practical and comprehensive guides to midlife health I have come across.

If you're seeking to reclaim your pleasure and vitality, join Gabriella at⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.pleasureinthepause.com⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ for this enlightening journey into the heart of female pleasure and empowerment.

CONNECT WITH CYNTHIA THURLOW:

Website

Instagram

Podcast

Substack

CONNECT WITH GABRIELLA ESPINOSA:

Instagram

LinkedIn

Work with Gabriella! 

Full episodes on YouTube.

The information shared on Pleasure in the Pause is for educational and informational purposes only and is not intended as medical advice. Always consult your healthcare provider before making any decisions about your health or treatment. The views expressed by guests are their own and do not necessarily reflect the views of the host or Pleasure in the Pause.

Transcript

Introduction and why the gut is the missing piece

0:00

Welcome to Pleasure in the Pause, a podcast dedicated to empowering midlife women to connect with their bodies, pleasure, and power in Perimenopause, Menopause, and beyond. I am your host, Gabriela Espinoza. Each week I sit down with leading medical experts, thought leaders, and trailblazers for bold, thought-provoking conversations that educate, inspire, and challenge the myths we've been taught about our bodies, aging, and sexuality. I also share solo episodes with evidence-based insights and real talk to help you feel informed, supported, and in charge of your health and pleasure in this season of life. Because your pleasure matters in and out of the bedroom. So take a deep breath, settle into your body, and let's begin. Hello, beautiful listeners, and welcome back to Pleasure in the Pause. What if so much of what we've been told about menopause, the brain fog, the broken sleep, the body that suddenly doesn't feel like ours, and the libido that's gone missing isn't a series of separate problems, but one connected story. And what if one of the missing pieces of that story is the gut microbiome, an inner ecosystem that plays a powerful role in our stress resilience, immune health, mood, sleep, energy, and how we feel in and about our bodies. My guest today is Cynthia Thurlow, a nurse practitioner, best-selling author, host of the Everyday Wellness Podcast, and one of the most trusted voices in women's metabolic health. Her latest book, The Menopause Gut, Balance Your Microbiome to Reclaim Your Health in Midlife and Beyond, offers a fascinating new lens through which to understand women's health during the menopause transition. For so long, we've been taught to think about our symptoms in isolation. But as Cynthia's work reveals, the gut may be one of the key links connecting many of the changes women experience in midlife. Over the last decade, research has transformed our understanding of the gut microbiome and its role in our hormonal health and how we age. In this conversation, Cynthia helps us understand how the microbiome is shaped not only by what we eat, but by how we move, how we manage stress, and even by experiences that may have happened decades earlier, and how those factors may contribute to the all-too common feeling of not quite feeling like ourselves anymore. If you're looking for a deeper understanding of what shapes your health, energy, and vitality in midlife, this episode is for you. Let's get into it and welcome Cynthia Thurlow to the show. Cynthia, welcome to Pleasure in the Pause. So good to be here with you. I am so excited for this conversation. The gut and gut health is something

What inspired The Menopause Gut

3:00

I've been passionate about for a long, long time, not only from my personal journey with my gut health, but from the woman I work with in my health coaching practice. And what I love about your book congratulations, by the way, The Menopause Gut, Balance Your Microbiome to Reclaim Your Health in Midlife and Beyond is exactly what you say in the opening chapter. It's all connected. Our gut health isn't only connected to digestion, it's connected to our mood, our stress, our energy, how we feel in and about our bodies, and of course, to pleasure. Over the years, I've read so many books about these topics individually. I've read about the gut separately, about the mood separately, about stress, about trauma, which you address, about weight, and of course about pleasure. But you did something I think is so brilliant. You placed all of these interconnected systems under one umbrella and you called it the menopause gut. You made them one story instead of many. So tell us why did you go there? What made you want to write this book now? I think having my own podcast is always a litmus test, if you will, of what are people talking about, what's new that's interesting. And so I felt like I had this in printing in 2018. I start the book talking about this trip to Morocco where I got horrific food poisoning and how that led to a lot of other health issues. And coming through the podcast as different researchers and medical experts, and I was like, there's a whole conversation. No one is talking about this. The irony being that in 2024, my editor came to me and said, Do you think you have a second book in you? Because I had been saying, no, no, no, no, no. I'm not going to write another book. And I said, I have this idea. And to give everyone that's a podcast listener some context, like a normal book proposal is about a hundred pages. Book number one was a hundred pages. Book number two was a page. So it's both good and bad when you write a chiped page and your editor knows you. And so she was like, Green light, start writing immediately. I had nothing really organized or synthesized in my head, other than there are these premises that I think are vitally important, both as a licensed medical provider myself, and then also as a woman who felt really lost in perimenopause. I was like, there's a bigger conversation that no one's having because we still, traditional allopathic medicine, everything is siloed. We think about the heart's in one bucket and the guts in another bucket and nothing's intertwined. And then on the other hand, you have functional integrative medicine that thinks about everything being interconnected. And I said, there's a much more nuanced conversation here. I think it explains why I have interacted with tens of thousands of women that have said, I'm doing all the right things and I still don't feel better. I don't feel like myself. And so I think it really speaks to the fact that the gut microbiome is interfacing with every single organ system and every single cell in the body.

What the gut microbiome actually is and how it shifts at perimenopause

6:00

So if you think slapping on an estrogen patch is all you need in perimenopause and menopause, I'm here to say that there's a much more insightful conversation that I think most of us are missing out on. And it's largely because the gut microbiome isn't tangible. We think about the heart, we think about the bones, we think about the brain. We're like, those are tangible entities. This is a mini-city in our large intestine that we cannot see. And because of that, I don't think it gets the respect that it deserves to have. Yeah, absolutely. And I hear the same messages. I don't feel like myself anymore. It seems like everything is shifting all at once. Sleep, mood, digestion, energy, libido. It can feel so chaotic, like the body you knew suddenly stop making sense. Can you help us understand what's actually happening underneath all of that and why the gut sits right at the center of it? Yeah. Before I answer that, I just want to give everyone context because people are like, what's the gut microbiome? That's like a mini city in the large intestine. Okay, what does that mean? So when we are born, we are largely imprinted by how we're delivered. So whether we're a vaginal delivery or C-section, whether we're breastfed or formula fed, that is our first big imprinting. Then thinking about these 40 trillion, yes, with a T, bacteria, viruses, fungi, and protozoa that encompass this part of the large intestine or colon that are heavily influenced by all the lifestyle things that I know we will talk about, but also hormones. So in puberty, the microbiome shifts dynamically. So young men and young women, their microbiomes, they have some of the same hormones, but they're in different percentages. So obviously, men are heavily influenced by testosterone. We are heavily influenced by estrogen, but also progesterone and testosterone. Whether or not we go on to become pregnant, another time when the microbiome changes dynamically, not surprisingly, as hormones are declining in perimenopause, this is another time where we start seeing changes in immune function, in digestion, in food sensitivities, in our ability to focus, our mood, anxiety, depression, sleep all go together. And I think that because we cannot tangibly touch the gut microbiome, and because it's still relatively new science, we're really talking about the last five or 10 years. I learned none of this during my medical training years ago. It's understanding that every single organ system intersects with the gut. So I'll give you an example the gut ovarian access that determines in many instances when we go into menopause, the gut bone access. So if your gut is not healthy, your bones are not healthy, and the gut brain access, and it goes on and on. So this interconnectedness becomes much more important as we're seeing declines in hormones because where are most hormones metabolized? In the gut. So the health of the gut really becomes important. 70% of our immune system is in the gut. The bulk of the neurotransmitters we make, GABA, serotonin, dopamine, are made in the gut. And I think for a lot of people, we have siloed off these different body systems. And as an example, how many people listening have been prescribed appropriately so, an antidepressant, an anti-anxiety drug, a mood stabilizing drug, when very likely a contributing factor to why they're having their symptoms is the health of their gut. And so I think in many instances, the more we learn about the gut microbiome and how it interfaces with every body system and how it interfaces with how we view the word, our reproduction, our metabolism, our immune system, the better we understand ourselves, quite honestly. Absolutely. And I love how your book, if you look, it's an encyclopedia of the gut. I learned so much. I thought I knew a lot about the gut, again, from my own personal journey, but I learned so much more. One of the ideas in your book that really stayed with me is another interesting word, the estrobolome,

The estrobolome and how it processes estrogen

10:00

this collection of gut bacteria that helps regulate our estrogen. And again, I think it matters so much, as you say, during this perimenopause to menopause journey. Can you help us understand how the gut shapes what our hormones actually do in the body and what this estroum is actually doing as we move through the menopause transition? Yeah, it's such an important part of the microbiome. So it's an area in the microbiome where we process and package up, hopefully, and help eliminate estrogen. So we are exposed to estrogen mimicking chemicals and our personal care products, our environment, our food. We also make estrogen. Now, the predominant form of estrogen our bodies make prior to menopause is called estradiol, but there are some weaker forms of estrogen. And ultimately, the liver handles the bulk of the detoxification. So there's two phases in the liver, and then the third phase is really in the gut. So, not surprisingly, the health of our microbiome is instrumental in whether or not we can find the Goldilocks effect. And by that I mean for every woman listening, there's a certain amount of estrogen our bodies want to package up and poop out. And there's a certain amount of estrogen our bodies will likely recirculate. Now, the issue is heading into perimenopause, how many women, including myself, were not made aware of all the impact of all these kind of environmental, personal care products, toxins we're exposed to, how that influences the microbiome. So, you know, as we're younger women than we're middle-aged women, understanding that the estrobilome is largely regulated by food choices that we make, how we manage our stress, do we sleep enough? What's fascinating to me is this little mini city, it remember I mentioned it interfaces with every other organ system. So if you're not sleeping enough, that affects your microbiome, that affects the estrobilome. If you're eating a hyperprocessed diet and you're super stressed out and you stand and eat all the time, you're not in any way, shape, or form providing for any optimal digestion, let alone optimal detoxification. So ideally what should happen is I mentioned the liver handles phase one and phase two detoxification. So it breaks things into water-soluble compounds that then go to the gut. Interestingly enough, estrogen is responsible for bile acid synthesis. And as estrogen is decreasing in the latter stages of perimenopause and menopause, it really messes up this detoxification process. But ideally, we break things into water-soluble compounds, it interfaces with beta-glucaronidase, which is this very important enzyme in the estrobilome that's helping to cleave off estrogen. Hopefully, we can package it up. That means the estrogen and poop it out of the body. So this is why talking about poop and normalizing is so important because as a medical provider, we talk about this all the time. But most of my friends, they kind of like giggle and laugh. And I'm like, no, I'm serious. We should be able to talk about this, should be destigmatized. But what can happen is if our detoxification pathways are not open or we're chronically stressed, or we're eating hyperprocessed foods, we're drinking too much alcohol, et cetera, et cetera, you can not be able to optimize packaging up the excess estrogen and getting rid of it. It can be recirculated. And this is where I see a lot of women that are estrogen dominant. I know traditional allopathic medicine hates that terminology, but it's really speaking to less progesterone relative to estrogen. But these symptoms, weight loss resistance, brain fog, breast tenderness, bloating, digestive issues, et cetera, et cetera, you can recirculate that estrogen. And then it just magnifies all those symptoms. So for so many women that I talk to, it is so evident to me that at a very basic level, their digestion is not optimal, their tetoxification pathways are not optimal. And because of this, they're in no way, shape, or form are they able to effectively move estrogen and process it through the body. I want to reemphasize we don't want to get rid of all of our estrogen, but we just want it to be the perfect Goldilocks effect. And yes, this can happen even in menopause when our bodies are making less estrogen. And this is why talking about the estrobilum, which I did not make that name up. I get asked that all the time. That's been around for 12 years, that terminology by researchers that are this is all that they do, but it's helping women understand there's a very special part of the microbiome that is responsible for handling and processing, packaging up estrogen. And that is the estrobilome, but heavily influenced by lifestyle. And that includes women who are on HRT as well. We've had lots of conversations on this podcast about hormone therapy. I love seeing the uptick in use in hormone therapy by women, even though we're experiencing some of those estrogen path shortages. How do you see the esterbone loan working with women who are starting HRT? And I've also had a conversation with Dr. Gila Senemar here about optimizing your hormone therapy, estrogen when you're still not quite feeling right. So there are lab tests that can measure that. And then you bump up your estrogen patch dosage. Should we be worried about that in terms of the detoxification of estrogen when we're using hormone therapy? And how can we address that? Yeah, such a great question. I would say number one, let's start with what are we looking for when we're testing? So if we're looking at serum labs, so blood labs, we're looking at estradiol. We want our estrogen levels to be above a certain amount based on study research to protect bones and to look at cardiovascular health. I think we will eventually have an indication for the gut microbiome too. We're just not there yet. So greater than 60 picagrams per ml is what we're looking for. So if your doctor, nurse practitioner, PA is checking your labs, you want to know that level's at least there to protect you. Number two, the things that I think about when we're talking about detoxification. So it's elemental things as a beginning, starting point. It's sweating, it's infrared sauna, it's exercise, it's hydration, it's are you having bitter foods that we know are super helpful for not only detoxification, but vitamin C. Lots of fruits and vegetables, brightly pigmented fruits and vegetables, adequate amounts of protein is a starting point along with like the sweating. There are tests that we can look at. I think a great deal about the Dutch hormone test, which I don't use as often as I used to, but we can get a sense of phase one and phase two detoxification as well as phase three. And do we need to add supplements? Are you someone that is doing all the right things? And we know that we now need to add dim, which is a supplement that can be helpful for phase one, or do we need something like calcium deglucurate for a phase two defect? Not everyone has access to these tests, but the point that I'm making is there's lots of things that we can get from nutrition. And I think a great deal about the cruciferous vegetables as a going example. I always tell patients, don't go overboard and eat five cups of vegetables because if you do in one sitting, obviously a lot of fiber, your body's not used to all that fiber, you're gonna have quite a bit of bloating gas and be unhappy with me. But I think from a very elemental level, it's thinking thoughtfully about what are the goals, what are we working on? Is this a woman in perimenopause who still has fluctuations in hormones, or is this a woman in menopause where things are much more stable? It's thinking about what are her symptoms and what could be driving the symptoms. If someone is not having a bowel movement every day, if someone is really having a tremendous amount of bloating, indigestion, obviously we want to rule out more serious things. There's now a rise in colorectal cancer. So I always remind women, I'm like, listen, we want to rule out the serious things first. So if someone's having persistent symptoms that aren't getting better, it's probably time to have a screening colonoscopy if you haven't. Screening guidelines are now age 45 and up. I still interact with women in their 50s that have never had a colonoscopy. I'm like, the worst part is the prep really isn't all that bad. But if you're having persistent bloating without other symptoms, do you need to see your GYN for an internal pelvic exam? So for a lot of people, it's ruling out the more serious things, and then we can do the deep dive and detective work. But always starting with lifestyle, are you sleeping? Are you managing your stress? Because digestion starts in the brain. So detoxification is part of digestion. And I remind women all the time: if you're standing and eating up, yelling at your kids, eating in the car, eating on the go, eating hyperprocessed foods, those are not things that are going to optimize detoxification pathways. There's some genetic things that play a role in here too. SNPs like MTHFR, which I have two copies of. It does not mean that you have to be on a ton of different supplements. It just means I do more to supplement my detoxification pathways than probably the average person. But that's because I know what I know. And so that means that I'm super conscientious about those cruciferous veggies. I'm really conscientious about sweating. I'm really conscientious about hydration. So before we even get to complicated tests, I always say the basics are still something we need to emphasize. That's so helpful. Yeah, we forget about how those basics work on such a deeper level that they literally go gut deep. And so I'm glad that you mentioned stress and sleep because I tend to sometimes forget how those things can be affecting my gut

The gut-brain connection and why mood takes such a hit in midlife

19:00

health. I try to do all the other things, and your book does a great job. There's a whole chapter there on nutrition, some delicious gut healthy recipes that I love. But yeah, thinking about the simple things that we can do every day. And we'll get into more on stress and sleep. But something I don't think some of us know is how our mood is affected by our gut health. You state in the book that about 90% of our serotonin is actually made in the gut. So when we hit midlife and suddenly there's more anxiety, more emotional flatness, mood swings. It's not that we're going crazy or that it's a character flaw, it's biology. So can you walk us through what's happening between the gut and the brain and why our mood takes such a hit when the gut is struggling? Yeah, I think it's multiple things coming to, it's like the perfect storm for mood issues. So, number one, as progesterone is declining at the beginning of perimenopause, progesterone is a hormone that is intricately interwoven with GABA, which is our main inhibitory neurotransmitter. So you may notice that the week or two before your menstrual cycle, more anxiety, more depression. You may have trouble sleeping. That is a byproduct of alterations in progesterone as well as GABA. On the other side is looking at quite transparently at estrogen. Estrogen and dopamine are pleasure hormone, looking at how estrogen is intricately interwoven with serotonin. And so, number one, when the hormones are fluctuating, so are those neurotransmitters. Number two, if the bulk of them they're made in the microbiome or in the gut, if the gut isn't healthy, you're going to have more disruptions. And I think that I would even dare say women that have bad PMS or bad PMDD, they are very likely going to have a little bit of a rockier perimenopausal transition because they're already a little more sensitive to those fluctuations in hormones. This is not anything that's wrong with them. It is what makes them unique. It is very bioindividual. The other thing is there's a bi-directional superhighway between the gut and the brain called the vagus nerve. Nerve in the body runs from the brainstem all the way through the digestive system into the microbiome. And so I always remind women, I'm like, you have to understand most of the information that goes from the gut to the brain, not the opposite direction. So if the gut is inflamed, if there are opportunistic infections, if you don't have enough serotonin dopamine GABA, that gets referred to the brain. And so I remind people all the time: leaky gut, leaky brain. The blood brain barrier is designed to be impermeable. But guess what? Just like you can get a leaky gut, you can get a leaky brain. So inflammation, whether it's insulin resistance, whether it's poor metabolic health, whether it's inflammatory foods we eat, too much alcohol, chronic stress, poor sleep, all that information gets sent from the gut to the brain. And so I remind people that we become a bit less stress resilient as we are navigating life with less hormones, less neurotransmitters being produced. And so we have to do a little more. Like I always say, find something you like and do it often. I don't care if it's legs up a wall. Or staring at a tree and that brings you joy, or secreting oxytocin, hugging your pet, hugging your loved ones, having an orgasm, all these things become very important because they will help lower cortisol. And I remind people all the time that lack of stress resilience is not that we are incapable. It just means that we have to adapt to our changing physiology. So what I got away with in my teens, 20s, and 30s is not what I get away with as a woman in my 50s. And the sooner that we can embrace that understanding, the easier it makes us navigating midlife and beyond. Because I feel like a lot of women that fight everything, they're mad about how their body is changing. They're mad about their sleep not being as easy, they're mad about this loss of stress resilience. And I always remind people the word pause, whether it's perimenopause or menopause, the word pause is designed to make us stop and reflect on what is working in my lifestyle and what is not. Because more often than not, by the time women get to midlife, they have been people pleasers for years and years and years. And all of a sudden they're like, this doesn't sit well with me. I can't do this anymore. I need more boundaries. And so part of that evolution of self is just the acknowledgement that we have to manage our stress and we have to be proactive about changes in our mood because it is not as easy as saying, I just need to be on a mood stabilizing drug. And there are people out there that need to be on that. And I'm in no means am I encouraging anyone to stop anything. But it could also be that you need some hormone replacement therapy. It could be that you need an adjustment on your estrogen, or more you need more progesterone, or maybe you honestly need a higher dose on your antidepressant, but that's okay too. But the point being that we cannot look at mood through this very narrow lens of this is a neurotransmitter problem. And the way to address the neurotransmitter problem is with a prescriptive drug, because it might just be that you need some hormones to help you navigate your new normal. And listening to you speak about all these neurotransmitters, the very same chemicals that govern desire, pleasure, the capacity to feel at home in our bodies, connected to our bodies. Something that came up for me when I was reading the book and listening to you speak is that, okay, oh, so there's also a gut-brain pleasure access. I'm sure that framing lands for you. When women begin to work with lowering their stress levels, addressing their gut through nutrition, do you see them come back to themselves in a way that goes deeper than just digestion? Oh, absolutely. I think there's so much that comes into play here because we're in the sandwich generation. Our parents are getting older. If we have children, they're getting older. All of a sudden you have more time. You have more time to think about yourself. What makes you happy? What do you find pleasurable? What do you not find pleasurable? I think women in the setting of less hormones, we speak our minds. Like I jokingly say, I think me at 54 is the person I've always been, but I was impacted by so much estrogen regulation that I was just a people pleaser. And it's like suddenly we find our voice. And so I think that the truer you are to who you are as a person, and that may take working with someone professionally. That may take inner work, that may take personal development work, which I'm a huge fan of. I think the women that are happiest with where they are in time and space right now are the people that are doing the internal work on themselves to help navigate changing worlds. We were talking about before we started recording, how you have three adult children, I have two adult children, and how your relationships with them change, but also probably correspondingly, our relationships with our significant others change because suddenly we're not parenting. We're doing a lot of that, less of that. And we're like, oh, we've been focused together on raising children. And now all of a sudden the children are raised essentially and are like, oh, maybe we should take a trip together. Maybe we should start doing more date nights. Maybe we should work on more emotional intimacy moments. I think for a lot of women, sex becomes painful. And

The vagus nerve, the parasympathetic system, and stress resilience

26:00

a girlfriend of mine was saying the other day, I know this is tangential, but we know the gut microbiome and the vaginal microbiome are intricately interwoven. And she was saying to me, like, oh, twice a year I have sex now. His birthday and, you know, our anniversary. And that's the only time I'm obligated. So I don't think about sex anymore. I just don't even think about it. And I think on a lot of different levels, partners are having to navigate changes in hormones, changes in self, changes in body composition, changes in if they even think about sex, how they think about sex. And these are bigger conversations that I think are so vitally important because there's still a degree of discomfort talking around intimacy, even emotional intimacy. So I love that you brought that conversation up because I think it's so vitally important for women. Sometimes I think we lose ourselves in mothering our children. Yeah. And I love how you mentioned the vagus nerve earlier. You focus on that in the book. Why does it matter for us so much in midlife? You bring up some practices to help us work with the vagus nerve, and then you link it to the nervous system, which is equally as important when we're thinking about stress and the effects of stress on the gut. Yeah. So the vagus nerve is important because it is vital for the parasympathetic nervous system. So we have the autonomic nervous system. So we have the sympathetic and parasympathetic. Sympathetic, I think we're all aware of fight, flight, flee, or fawn. Most of us tend to be in the sympathetic. We're actively engaged. I'm sure if you measure my cortisol and yours right now, we're interested in this conversation, we're actively engaged. That's not the cortisol response I'm talking about. I'm talking about just people are irritable and on edge, and they're always going and doing, and they don't actually relax. And what a lot of people don't realize is the parasympathetic side of our bodies is what allows us to digest, assimilate, detoxify, have an orgasm. All those things fall underneath the parasympathetic. But the vagus nerve is one of many ways that we can engage the parasympathetic. So it can be as simple as gargling, humming, singing. Maybe gargling might not be what you want to do in public. But for me, sometimes I will hum when I'm getting ready to go on stage or I'll do breath work. But anything that's going to evoke the vagus nerve, that's where breath work becomes important. Fox breathing is a great example. I will sometimes do that before I speak on a stage. But the point of why I'm sharing this is if we become less stress resilient in midlife, we suddenly become much more interested or should in how we can get ourselves into the parasympathetic, whether that's through more concentrated practices like holotrophic breathing, which I talk about in the book, whether that's with a vagal tone device. But I remind people, let's start with the basics because if something as simple as I'm eating lunch and I'm looking around in my house, we have a lot of windows, see a lot of greenery. Every window that I'm close to, I see a lot of greenery. So when I'm eating, I'm generally looking outside because I find it to be like very calming to my nervous system. I would encourage anyone that's listening. You probably, most of us grew up saying, Grace, or you said a prayer before you eat, taking four to five deep breaths before you eat a meal can help you get out of the sympathetic into the parasympathetic. And I think it's a very underrated, fairly simple thing to try and do because the better regulated your nervous system is, the better you can respond to stress, the better your digestion will be, the better your detoxification pathways will be. And what I find for a lot of women is that they are chronically stressed. They don't acknowledge it in their body. So that's problem number one. And problem number two is they're so chronically stressed that it inhibits their ability to have a good sleep, it inhibits their ability to have an orgasm, it inhibits their ability to have good conversations, it inhibits their ability to connect with others because their brain is just constantly going. And so I think in many ways, being able to stimulate the vagus nerve becomes a vitally important aspect of midlife health because the women that are doing the best in midlife, personally that I've seen and professionally, are the ones that can manage their stress effectively. Now, for everyone listening, it might be a little bit different. I always say find something you like and do it often. Like connection to nature is a big thing for me at this stage of life. And I don't think I appreciated that enough. In fact, I said to someone the other day, 10 years ago, my kids were 10 and eight, and they were still in the throes of elementary school and riding everywhere, and there are multiple activities and it's go, go, go, go, go all the time that I don't think I recognize the seasons changing, let alone noticing a tree outside. So I think for many women in midlife, life slows down enough that you start to pay attention to things again. And so finding joy in small things is part of nurturing the vagus nerve, nurturing the parasympathetic, and quite honestly, regulating your nervous system. Yeah, and I love the point that you bring up about doing one thing that you love and doing it often, eating if you have the chance while you're looking at it, nature. I've been traveling quite a bit. And I notice when I'm traveling and I'm not eating the right foods and I'm off my schedule, I get that inflamed, puffy feeling. Nothing fits. I'm so angry that I have a whole suitcase full of clothes, nothing fits. And then for so many women, the weight that won't budge, the bloating, that puffy, inflamed feeling touches so much more than how they look, right? It touches on their confidence, how they carry themselves, how they show up in intimacy. And I noticed the first thing that happened when I got back home, I live in Austin, so I'm surrounded by trees. We back up into a canyon. I literally see deer and birds as I'm eating my food. All of a sudden I notice everything feels and fits better. I feel lighter. I feel not only lighter in my own body, but in my mood. I feel like being more playful and intimate with my husband when we start to support our gut. We start to see the trickling effect on all these other aspects of our lives. And you guide us in the book through some of the foundational pieces to help women feel more comfortable in their bodies again. You mentioned the vagal toning exercises. You mentioned being out in nature and doing one thing you like daily. Any other things with regards to feeling more comfortable in our bodies, especially when it comes to the weight gain or the inflamed bloating feeling. That's so common. One of the things I would say before I get to some of the kind of tactical things I talk to patients about is just the role of boundaries. I know as a reformed people pleaser, I have the best boundaries right now. And de-obligating yourself from things you do not need to do is step one, like learning the power of saying no without explanation. I think that as a reformed people pleaser, and I keep emphasizing that to say, like, I have been there. That's why I was such a good nurse practitioner, because I was such a people pleaser working in a male-dominated field or two male-dominated fields of medicine. The way that I've

Weight loss resistance, muscle mass, and the role of trauma

33:00

really found my way back to myself as a woman was learning how to say no and be very clear. I don't feel a sense of pressure like I did 20 years ago that, oh, I wanted to be at all those big neighborhood parties with all these other women and families. Now I'm like, I have a core group, close group of friends. That's who I want to spend time with. And I don't need to be part of these huge neighborhood events where I felt like it was very superficial when I reflect on it. And it's not to say that people weren't wonderful, it's just it felt superficial to me as an introvert. So I think having boundaries and being very clear about that. But when we're talking about weight loss resistance, which is a huge pain point for women, I've experienced that twice in 10 years. So I like to be transparent. Number one, we really want to understand when you're feeling weight loss resistant, what exactly is going on? So this is where bioimpedance readings become critically important. What is your fat-free mass to muscle mass? Because we start losing 3 to 8% of our muscle mass in our 40s. If you're in your 30s and you're not working on strength training and building muscle, you're probably going to be closer to the high end or the 8% range. And muscle mass becomes very important because the more muscle we have, the more insulin sensitive we are. Meaning you can eat more healthy carbohydrates. You get to eat different types of foods than someone who's insulin resistant or diabetic. And so maintaining muscle mass becomes important. And it also allows us to differentiate what are we really dealing with? And then I think doing the bioimpedance readings at least two to three times a year is important as a check-in. So then once you have a sense of where you are, it's really looking at what's your sleep quality like? Are you actually sleeping seven to eight hours a night, or are you getting by with four or five and you're chronically tired and you can't make good food choices? And we know if you're getting less than six hours a night of sleep, your blood sugar regulation is not the same as it would be if you were getting adequate sleep. The stress piece we've talked a lot about, but I remind women if you're not sleeping well, it's probably because you have chronically mismanaged stress. Looking at nutrition, are you eating too frequently? Most women are eating too frequently. They eat too many processed carbs and not enough protein. So dialing in on macros and really looking at there's lots of free apps online. You can track your macros. Are you eating enough protein? No less than 100 grams a day. That's a non-negotiable. Are you eating enough fiber in your diet? Now, this is very bioindividual. So what Gabriella can eat might be different than what I can eat, but we want to be aiming for more. So if you're eating 10 grams a day, you don't go to 30. You're gonna be very unhappy with me. You go to 10. You go from 10 to 12, maybe 12 to 15. You slowly increase it and you get it from nutrient-dense whole foods as a starting point. If you need to add in a fiber supplement, we do that only if we can't get it enough from food. Then it's the meal frequency. The eating too frequently, are you eating six mini meals or do you have two to three meals a day? Because we know, again, we should be able to go four to five hours between a meal. I'm obviously known for intermittent fasting, and I always say that's not the right choice for everyone. Maybe you're doing 12 to 13 hours of digestive rest. That's actually what I do now because I'm trying to maintain and build muscle. And then the exercise piece. You and I grew up in an age where it was all about being thin as in, lots of cardio, lots of grinding it out on the treadmill, or we used to call it the dreadmill, all these marathon training. And I'm like, that is not going to help you build and maintain muscle. So strength training becomes important. The right types of exercise. For a lot of women, they're just not even strength training. They think doing five pound weights is going to give them the body that they're looking for. And I'm like, generally, for most people, that's not going to be effective. Now, again, this is also very bioindividual. And I'm not an exercise trainer, but I know that for myself personally, I'm constantly looking to increase my weight while I'm training with my trainer because that is what challenges my body. And that's a starting point. Beyond that, we're really looking at what's going on in the gut. Do you have an inflammatory pathogen, something that's opportunistic? Do you have H. pylori? Do you have SIBO? Do you have candida? Do you have dysbiosis? Do you have poor digestive fire, which is a fancy way of saying, is your stomach still producing enough hydrochloric acid to break down protein? Do you have enough digestive enzymes? Remember, I mentioned earlier estrogen and bile go together. So if you don't have enough estrogen, you might not be able to break down and emulsify fat. So there's lots of things that can contribute. But the one thing that I think is a hidden source of weight loss resistance that is not talked about enough is significant underlying trauma history. Because if you look at the research, individuals that have high adverse childhood events scores. And so we're looking at a joint venture between Kaiser Permanente and the CDC that was done many years ago. Anyone that's listening can go online and get access to a fairly short quiz. If you have a high ACE score, you are probably going to be at greater risk for autoimmune conditions. You're probably at greater risk for poor metabolic health, disordered relationships with food. And we know that chronic stress will age your ovaries. To me, one of the things that I did not know until I was in menopause was that chronic stress ages a lot of things in our bodies, but our ovaries are the most mitochondrial dense organ in the body, which it's not surprising, right? It's designed to help create life. That makes sense. But it's also very sensitive. It's the canary in the coal mine. So how many women have I met that didn't hit menopause at 51, 52, 53? They were early 40s, mid-40s, 46, 47, 48, going into menopause. And when you talk to them, they're individuals that have a significant high trauma history, things that we can't control. I remind people all the time I trained in inner city Baltimore, where we saw lots of abject violence. It's the little T traumas that are equally corrosive. It's the abuse, the neglect, addiction in parents or caretakers that can rewire our nervous system and make us more susceptible. So I think one of the most underlooked and underappreciative reasons why women are weight loss resistant is because of that trauma history. That let's be honest, a lot of clinicians are not comfortable. Their prejudice is not allowing them to have that conversation with that patient. Thank you so much for bringing that up. I had psychotherapist Brooke Bray Love on the show recently where we address trauma. And yeah, she made this distinction between big T trauma and little T trauma. A lot of women coming in saying, Oh, I didn't experience, we think of it as big T trauma. I didn't experience war or a major car accident, but it's those little T traumas, the ACE, it's spelled ACE. I took that test quite some time ago. And yeah, I was surprised to realize, yeah, my parents' divorce did have an impact on me. You think, oh, everyone gets divorced. Most of my childhood friends had divorced parents. And you think, okay, yeah, this is a normal thing, but you don't realize the impact that has on a deeper psycho-emotional level. And I'm a big proponent of therapy. And some of the modalities that you advocate for in the book, somatic experiencing, which I love, for helping us work through that trauma and help us discharge what our body is holding, because our body is still holding on to those little T traumas, however insignificant you may feel they are, and engaging in practices, vagus nerve practices that you mentioned too can help us discharge those deep-rooted feelings and emotions that our bodies are holding on to. I I think it's interesting. I did a Substack post in February and probably the most personal Substack or anything I've ever done, talking about what I experienced as a child and young adult and how these things are cumulative. The body truly keeps a score. And so it was interesting putting all that on paper. And I think our generation is certainly doing a great job creating space for women to have conversations, to share. It's interesting. I wrote that Substack article, and I remember I had people that I had known throughout my lifetime, my childhood, sorority sisters from college, nurses I had worked with years ago that were reading that article and crying and saying, Oh my, I've never told anyone I was raped in college. And I just told you, I'm not sure I've ever processed it. And I was not raped. Let me be clear. I just had any things that cumulatively happened over time. But I think we're starting to acknowledge the net impact of little T trauma, big T trauma, and how that influences us. And I really feel fervently that's why we see more autoimmune disease in women. And then you, you know, couple that with what we see in midlife. It's four to five times more likely in midlife to develop lupus, rheumatoid, psoriasis, et cetera. And yet we normalize it. We're like, oh, you have one autoimmune disease, no big deal. And you're like, no, that should be the canary in the coal mine. That should be the time that women are saying, okay, I got to change something because already I know that my gut is compromised. I hear from a lot of women, they put those kind of modalities, we might want to call them self-help or personal development modalities, inner work modalities. They put them on the bottom of their to-do list when I really think they should be at the very top. I hear from women, oh, I'm too busy. If you're too busy, whether it's sex or therapy or exercise, then you're too busy. Think about that. You're way too busy and try to move those things further up the to-do list. And I've already asked you this question, but I just think it's just want to reiterate this that when women start to support their gut and address all these issues that you're talking about, it really does ripple out into so many other aspects of their lives, right? Their energy, their vitality, their sense of being at home in themselves again. Yeah, it's interesting to me, having had the privilege over the last 10 years of working exclusively with middle-aged women, it's become more and more apparent to me that I think people assume, okay, I'm going to work on my gut so I can lose weight, but then they have all these trickle-down effects of my mood improves,

Where to begin: the menopause gut plan in practice

43:00

I have more energy, my sleep is better, I feel like I can better regulate my nervous system. All of these things become vitally important. And I think for many women, we've been so distracted for so many years. And you mentioned you have three 20-somethings, and I have an 18-year-old and 20-year-old. We have been so distracted parenting for so many years. It's like we almost kind of the veil comes off, and we're like, oh, okay, I get to focus on myself again. And I don't say that the most wonderful thing I've ever done is be a mother. And I have loved every stage and I adore my boys. But it's also you realize as they become more independent, you're like, oh, it's time for me to focus on myself again. The things we take for granted when we're teens, 20s, and maybe early 30s something, we're like, oh, yeah, I have to remember, come back to myself and figure out what are the things I need to be doing to make myself healthy, emotionally well grounded. Well, the whole second half of your book is the menopause gut plan. And you've already addressed some of those things nutrition, movement, sleep, testing. I mentioned there's some delicious. Recipes. Where would you want a woman to begin? It can feel a little bit overwhelming when you're like, okay, all these things. Where can a woman begin to start getting her gut health back on track? Yeah, I would say keep it simple. I think people expect me to say, go buy this gadget, but really it's four to five deep breaths before you eat a meal. Make sure you're seated. Walk after a meal. That helps with blood sugar regulation. Being thoughtful about tracking your macros, not forever. Just get a sense of how much protein you're eating, how much fiber are you consuming, getting really clear and intentional about sleep habits, because just like I was telling my 18-year-old recently, when you were a toddler, young child, we had a whole ritual to tell your body it was time to gear down, it was time to go to bed. We need the same thing, ladies. We can't just jump from giving a presentation at eight o'clock at night underneath bright lights and jumping into bed. Your body needs some downtime in between. So whether it's blue blockers, whether it's reading a physical book, putting your legs up a wall, maybe you meditate. Some people love meditation, others hate it because they can't quiet their mind, which to me says a lot. And I'm like, we're all a work in progress, but the little things become the big things. I think for so many of us, another kind of prevailing theme in the work and the things I talk about is the boundary piece. We all need to work on it. I have a family member who I was no contact with for 10 months. And this family member was very bothered by this. I had done everything. I had exhausted every other option before I got to the point where I had gotten no contact. And it was very peaceful. So I worry a lot less about what other people think, and I worry more about honoring what's best for me and my family. And I would encourage other women to do the same. I think we feel so obligated to take care of everyone else. No, it really starts with you. Not only do your children, and I don't care how old your children are, if you're mirroring healthy boundaries, they see that. My kids are so far beyond where I was at 18 and 20. I'm like so proud of the young men that they are. But I always say, like boundaries piece. They'll even say to me, nope, I don't want to do that right now. And I'm like, I respect that. That's totally okay. So learning how to say no becomes a really critically important piece to navigating midlife. And these things all help based on science. These things are all good for the microbiome. They sound trite, but they're very important. And these are the things we worry about first before we get to protocols and supplements and testing. And I would say major in the majors. Cynthia, your book is an incredible roadmap for whole body health. I feel so much smarter after reading it. And again, appreciate so much how you connect all the dots. It's been such a rich conversation. Thank you so much. Before we close, I'd love for you to tell everyone where they can find the menopause gut, where they can keep following your work, your podcast, your community, all of it. Oh, thank you so much, Gabriella. I'm so grateful that we met in Miami through Gila. So thank you for having me. Probably easiest to go to my website. So www.cynthurlow.com. The menopause gut is out everywhere where folks are sold. I always say if you have a book retailer near you, brick and mortar, try to give them your business. But Amazon, Barnes and Noble, Target, Books a Million, they all sell it. In fact, I went to my local Barnes and Noble the other day to sign books. They only had one copy left. And I was like, oh, that's so exciting. And the guy was like, What? Behind the counter. I was like, no, this is good. It means you've sold all your copies. And he was like, yes, we have. So if you connect with me outside of this podcast, my podcast is Everyday Wellness. I'm active across social media. I'm almost always Cynthia Thurlow NP. We've had a hard time changing Instagram over. So it's Cynthia underscore Thurlow underscore, but I'm active across social media. And Substack is my favorite new platform. So if you'd like to read and you'd like to read science-driven content that's designed to be very informative and actionable, you'll find me there. Thank you so much, Cynthia, for your work and for joining me here today. Thanks for having me. I hope you enjoyed this episode of Pleasure in the Pause. Want to help me spread more pleasure in the world? Hit the share episode button and send it to a friend or post it on your Instagram stories and tag me, Gabriella Espinosa. And if you really love this podcast, please leave a rating or review, as this helps the show get in front of new listeners. Finally, if you would like to access even more pleasure and stay in touch, sign up for my free pleasure upgrade bundle of powerful mind body practices by going to pleasureinthepause.com. Remember, your pleasure matters.