The Melanie Avalon Biohacking Podcast Episode #352 - Cynthia Thurlow

TRANSCRIPT

Cynthia Thurlow
It's not like all inflammation is bad. There's a lot to inflammation that is good that helps protect us.

It's when it goes awry and certainly when it's out of control, it can accelerate the aging process like we do see in middle age and beyond. Some people will breeze through their 30s and 40s and others will not. And I think so much of it is really a reflection of what we're doing in terms of lifestyle, how we eat, how we choose to exercise. Do we have healthy relationships and boundaries or do we not? Welcome.

Melanie Avalon
to the Melanie Avalon Biohacking Podcast, where we meet the world's top experts to explore the secrets of health, mindset, longevity, and so much more. Are you ready to take charge of your existence and biohack your life? This show is for you. Please keep in mind, we're not dispensing medical advice and are not responsible for any outcomes you may experience from implementing the tactics lying herein.

So friends, are you ready to join me? Let's do this. Welcome back to the Melanie Avalon Biohacking Podcast. Oh my goodness, friends, what an honor to be back with a crowd favorite. You guys know her well, most likely. That is my former co-host of the Intermittent Fasting Podcast, Cynthia Thurlow, for her incredible new book, The Menopause Gut. I am so grateful to Cynthia for how deep she is diving into this incredible topic. It is wild just how much the gut microbiome plays a role in menopause symptoms and our hormones in general. We talk about so many things in today's episode, things like why the ovaries are a pacemaker of aging, the effects of trauma, stress, and adverse childhood events on the gut microbiome, the benefits of short-chain fatty acids, nitric oxide, and urolithin A, the powerful effects of estrogen, whether or not you should do hormone replacement therapy, how to support the immune system, problems with intermittent fasting. Yes, Cynthia has changed her perspective a little bit on intermittent fasting and so much more.

The show notes for today's episode will be at melanieavilon.com slash menopausegut. Those show notes will have a full transcript as well as links to everything that we talked about, so definitely check that out. I can't wait to hear what you guys think. Definitely let me know in my Facebook group, IF Biohackers, Intermittent Fasting plus Real Foods plus Life, comment something you learned or something that resonated with you on the pinned post to enter to win something that I love, and then check out my Instagram, find the Friday announcement post, and again, comments there to enter to win something that I love. All right, I think that's all the things. Without further ado, please enjoy this fabulous conversation with my dear, dear friend and former co-host, Cynthia Thurlow.

Hi friends, welcome back to the show. I am so incredibly excited about the conversation I am about to have. It is with probably one of my most popular guests of all time and probably, actually not probably, for sure, one of the people I have podcasted with the most in my entire life of all time. I am here with Cynthia Thurlow. She is the former co-host of the Intermittent Fasting podcast, so probably pretty familiar to all of you guys, and I've had her on the show multiple times in the past for her prior books. I actually think, I guess that's how we met, Cynthia. I guess the first time we met was me interviewing you probably for one of your books.

Cynthia Thurlow
Yeah, I think it was like 2020 2021. Like it was a long time ago.

Melanie Avalon
time flies. So in any case, Cynthia is back today for her newest book. And friends, it touches on all the things all the topics that are very, very important to so many people, including myself, it is called the menopause gut balance your microbiome to reclaim your health and midlife and beyond. And what's funny is I remember, I am pretty sure we were co hosting together either when you like we're locking down the proposal or I know we were still co hosting when this the idea of this book was in the ether. I didn't know much at the time about what it was. But I remember that you hinted that it was all about like the microbiome and its relation to menopause. And I was like, this is really, really exciting. Because obviously the role of the microbiome is so important in health. We talk about it all the time. But nobody's really talking about it in specific relation to, well, people talk about about aging, but not to this extent, and definitely not when it comes to different cycles that women go through in life.

And friends, this book was such a deep dive, I learned so much about the role of not just you know, are changing hormones and all of the effects of that as we age, but in particular, all of these different axes in the body that are related to our gut microbiome and then the other things so like the gut brain access, there's also axes with our ovaries and all these different parts of the body and the connections are just absolutely wild. So I have so much to talk about here. So many questions, I really think this book is going to be really empowering for women, you're going to learn about the different symptoms that you experience, why you're experiencing them and how you can truly take agency to make changes for the better and the answers might not be where you think or maybe they will be because we teased all of it now. But Cynthia, congratulations on the book. Thank you so much all that you do and thank you so much for being here.

Cynthia Thurlow
Yeah, thank you so much for that kind of lovely intro to the book. And, you know, I think for me, I'm such an organic person. And I think when you podcast, and I'm sure you feel this way too, you've got two podcasts, but one that's solely your own, you get to interview all these incredible clinicians and researchers and writers, and I just kept seeing common themes that certain guests would be talking about. And it just, you know, it's the power of the N of one. And you start reflecting on your life and saying, Oh my gosh, this makes so much sense.

Why did I get so sick in Morocco? You know, I kind of start the book off talking about this romantic holiday that ended with me being pretty darn sick. And so even as a licensed medical professional, I did not know I was never taught what starts happening as women's hormones start to kind of decline and it really impacts us systemically. It's not like it's the gut is in this own little silo and it doesn't impact anything else. And so the more that I learned and the more that I deep dove into the science and looked at the research and started talking to experts, I started to realize I was like, there's a whole conversation around middle age. That's not being had. And let me be really clear. Lifestyle is really important if appropriate for you, replenishing hormones can be really important, but there's this larger conversation about the complex in a relationship between the gut microbiome and every single organ system in the body. And when you start to understand that, it just makes so much more sense. And as I tell everyone, there's no hormone in the body that only has one direct effect. There's no neurotransmitter in the body that only has one direct effect and there's no organ system in the body that doesn't, that just has one direct effect. And so it really speaks to how beautifully synergistic our bodies are. And having the opportunity to share this information, not just with your community, Melanie, but kind of birthing the book into the world is something I'm incredibly proud of.

Melanie Avalon
Yeah, there's so many questions that I have for you here. And I mean, you mentioned just now, so the very beginning of the book, Cynthia tells her personal story about the insane different health related scenarios that you went through, which I know I had heard about them throughout the years, you know, co-hosting a podcasting with you, but reading it all like back to back, I was like, whoa, this woman has been through the ringer.

You know what's so interesting? I was just thinking about this and I don't want to make this too black and white way of looking at it that said, I do feel like there are two different types of people when it comes to help things. There are people who have had some sort of GI related issue that has lasting effects on their microbiome that they feel like in their gut, like literally in their gut, like the symptoms there, and then other people who don't. So like I can like remember myself pre inciting incident of food poisoning and my relationship with my gut and how like I never really experienced, I didn't like have a complex around digestive distress. I didn't, I wasn't like worried about food digesting. I didn't like feel things negatively in my gut so much. And then like post that I like had some sort of shift that happened in my microbiome and I know you had some things happen to you with your, your gut and like Giardia and you know, H. Pylori and all these different things. The reason I'm talking about that is I think for people like that, we become very much aware of the role of our gut because we're like so in tune to like how it can make us not feel well. So it might make more sense how that we can see that it's affecting other things as well. But I feel like some people go through life and they never have had like an acute gut situation. So it, it might be pretty eyeopening to think that all of the stuff in the gut is affecting all these other things, you know, to the extent that it is like with your personal story, did you have a change in your life where like you became more aware of like your gut?

Cynthia Thurlow
Yeah, you know, it's interesting, you know, when we reflect back on my 20s, like I was treated appropriately for Lyme and thank God that I was because there are lots of people listening who probably have chronic Lyme and, and it's because they didn't have that classic bullseye rash. And I did.

And so I was treated with a round of antibiotics appropriately. And then a couple months later, I developed psoriasis, but at that time, traditional allopathic medicine doesn't make those connections like, Oh, you were appropriately placed in antibiotics. You develop this transitory leaky gut. But that makes you much more likely to develop an autoimmune condition, AKA psoriasis. And so I never really put those things together until I ultimately saw a functional medicine provider in my thirties. And so I started to then think, Oh, okay, well, you know, for anyone listening, there's an appropriate time to be on antibiotics and hopefully we're really conscientious and judicious about using antibiotics appropriately and judiciously. But I think that, you know, each time I was on an antibiotic, I ended up developing an autoimmune condition. And so I probably was a little more attuned to this a little earlier than a lot of my peers, just because I was like, why do I keep getting autoimmune conditions, you know, like when I was pregnant with my, or actually after I delivered my second child, they developed alopecia areata. And for anyone listening, it means I started, it's this autoimmune condition where I had patches like quarter size patches on my skin where I literally had no hair growth. And so, you know, that was treated and now I've gotten over that. But what's fascinating to me is, is traditional alpathic medicine in many ways doesn't help us understand that if you're put on antibiotics, there's things you can do to mitigate the impact and lessen the likelihood that you'll go on to develop an autoimmune condition. And we as women are just tend to be a bit more prone to this. And certainly, as we get closer to middle age, we're much more prone to developing leaky gut and dysbiosis and all these, you know, kind of malabsorption related issues. And to your point, Melanie, I think a lot of people sail through life, like my husband's a great example, they sail through life, they don't really, it's not that they're intellectually incapable of being attuned to their bodies, they just kind of hum through life with, they don't, they don't feel any different day to day, week to week, whereas I think there are other people, perhaps like you and I, that are just a little bit more sensitized to changes, how we feel good, bad or indifferent. And I think some of that's just the way that we were raised. I was raised by a nurse who didn't allow, I don't, I don't think I ever missed a day of school growing up, and I would have to be literally dying to miss a day of school. But as I got older, definitely more attuned to like subtle changes in how I felt, whether it was like sleep or stress or recovery, or, you know, I was always the person that got food poisoning, aka being in Morocco and getting a terrible case of food poisoning.

Cynthia Thurlow
And so just understanding there can be changes that are underlying our immune system and kind of impact us hormonally, where we can just be a little more susceptible to these opportunistic infections in the situation where I clearly was, had an opportunistic infection. But I think for a lot of us, it's just putting all these pieces together to make sense of what exactly is going on in our bodies to help explain why we feel the way we do.

Melanie Avalon
Yeah, and then also to that point, because you have a really interesting, I mean, it's all throughout the book, but there's a really interesting section talking about the role of our immune system and innate versus adaptive immunity. And you point out the fact that the stats on autoimmune conditions in women versus men and the role of hormones and that.

And so for example, with that situation, why are women's immune systems, are they more intense? Is that a good thing? Why is that? What's happening there?

Cynthia Thurlow
Yeah, it's it's interesting. You know, certainly I'm not an immunologist. So let me just say that but obviously for The book I got to know my immune system the immune system a whole lot better than I ever learned even in graduate school and so Helping us understand that we just have a much more kind of Attuned immune system we tend to especially as we are navigating the aging process We understand that these hormonal, you know, we can call it immune Recalibration that starts to happen. We know that as estrogen Predominantly estradiol and progesterone fluctuate and then decline our immune system actually shifts in terms of how it's balanced and how reactive it is And so women will sometimes find Depending on where they are in their menstrual cycle even that they may be feeling more inflamed They may notice that they're more likely to experience Hives like one of the common things that I see in middle-aged women is that they have We know that during perimenopause our estradiol levels can be 20 to 30 percent higher in certain times During perimenopause and so you can imagine if you have an imbalance of estrogen to progesterone You will feel the effects of more estrogen and that could be breast tenderness and weight loss resistance and brain fog It can be a constellation of symptoms and along with that with this overly reactive Immune system women can develop mass cell degranulation and a histamine response So maybe they're eating really healthy foods melanie like fermented foods.

Maybe they're having fermented vegetables and some kombucha And maybe they you know had a salad at a restaurant and they throw on some I use this kind of lovingly But sometimes when you go to restaurants you get fresh turkey and sometimes you get processed turkey And so maybe there's some lunch meat that's thrown on a salad in the context of the greater good is healthy But you get this histamine release That leads to mass cell degranulation and then you'll develop hives or you'll get reactivity, you know sometimes women start developing new food allergies in this stage of life and it's really looking at How our immune system starts to shift and it's helpful to also understand the immune system is closely tied to the gut So about 70 to 80 percent of our overall immune system is housed there So the health of our gut directly impacts how well we can fight off infections Aka picking up a friend in morocco or it can impact how our body perceives things that are not ourselves And so I think about this immune cell Excuse me this immune recalibration that happens in middle age and some of it is That you know, we we become you know, we have two sides of the immune system. So Very basically we have the innate versus the adaptive and the innate immune system is It's a generalized way that our body is protected whether it's, you know mucus whether it's silly in our nose the skin It's all designed.

Cynthia Thurlow
It's not specialized. It's designed to just help decrease the likelihood that we'll get sick Versus the adaptive immune system and this is when you start thinking about antibodies and Tea help ourselves and things that are that are designed to take a little longer to work But are much more precise and fine tuned and what starts to happen is as we are navigating this perimenopause to menopause transition We become a little more inflamed We start finding that we struggle more with Developing autoimmune conditions because we have this more provoked immune system overall It really gets tripped up when we start losing estrogen and as i've mentioned estrogen is probably the most immune Modulatory hormone that I read about while I was doing research for the book So estrogen is really important for a lot of things remember I said there's no hormone on the body that just does one thing but estrogen and the immune system are really intricately interwoven down to They help fortify the gut.

So when we think about the One cell layer thick of the small intestine lining estrogen plays a role there So as estrogens declining we're more likely to see leaky gut and to go back to my initial comment about antibiotic therapy So let's say melanie you're prescribed appropriately antibiotics And over the course of time even though it's killing off some of the bad bacteria It's also killing off some of the beneficial bacteria And so you have these little I call it like a gate of the small intestine and it's one cell layer thick and so it's very easily broached whether it's with antibiotics or chronic stress or Toxins you're exposed to and so you start leaking food particles into your bloodstream and the immune system is right there I mean, it's right alongside your bloodstream And so you kind of provoke this immune response and this is where you will sometimes see this reactivity where the body starts Looking at itself. It's attacking itself and it's this autoimmune piece So suddenly someone develops celiac or someone develops hoshimoto's thyroiditis or someone develops Psoriasis like I did and does this mean that this is a forever thing?

Not necessarily But once you've had one autoimmune condition, you're more likely to develop others and we know that women in Middle age are three to four times more likely to develop autoimmune conditions just from these shifts in these key hormones progesterone also plays a role But estradiol is that really important immune modulatory hormone? So women may find in middle age that they are experiencing again Maybe they're more reactive to certain foods. Maybe they you know, pick up a new rash Maybe they're you know suddenly diagnosed with an underactive thyroid so incredibly common Also very common to see women that are being diagnosed with other autoimmune conditions.

Cynthia Thurlow
There's over a hundred now There's so many autoimmune conditions even chronic Lyme is now considered to be An autoimmune condition. So when I think about the immune system, it's at a very basic level We have you know, like the grade school, you know Guards at the gate all the way up to these fine-tuned precision like ninja warriors that are out there to fight off viruses bacteria Etc and all of these things start to falter a little bit In middle age, but there's a lot that we can do.

I want to be really clear But it makes a great deal of sense. We become less responsive to vaccines. We're more likely to develop autoimmune conditions We're more likely to you know succumb to opportunistic infections in general aka giardia And this slow burning inflammaging so we talk about inflammation In the context of acute inflammation you trip and fall you skin your knee. That's acute inflammation It's the chronic inflammation that over time that can be hugely problematic and again with those changes in estradiol in particular A lot more inflammation that goes on but again, I want to make sure everyone knows there's a lot that we can do but it helps us understand why like You know the little ladies in the icu are going to have a harder time fighting infections than a 35 year old female who still has a constellation of her hormones not just estrogen and progesterone and testosterone but a constellation of other hormones That optimize the way our bodies fight infections and the way that we interact with our environment

Melanie Avalon
Question for clarification here because I was so fascinated by everything you were talking about with the role of estrogen versus progesterone and the different types of estrogen on the immune system. And so like when I was reading and you mentioned it here that, you know, estrogen actually can encourage this histamine response or forms of it can and then progesterone can actually tame down the immune system.

My question here is because it was hard for me to, or it is hard for me like in general to understand especially like with estrogen because I feel like there's this idea out there with estrogen that oh we're estrogen dominant like because of our lifestyle and everything we have too much estrogen but then there's an idea that no actually we might be needing estrogen or losing estrogen. So what is the role of the different types of estrogen and how they change throughout our life and then the effect of those on the immune system? So like is all of estrogen bumping up the immune system or is some of it taming it down and does it matter what form it's in? You mentioned estradiol.

Cynthia Thurlow
Yeah, such a good question. I mean the predominant form of estrogen that I'm really speaking about is estradiol and that is the predominant form of estrogen our bodies make until before menopause. So we know when I'm talking about these immune modulatory aspects of estrogen, I'm really speaking to estradiol. We know that there are weaker forms of estrogen. There's estrone that's predominantly made in fat tissue and a lot of people think estrogen is bad and I tell them, I mean if we think about it, one of the reasons that we are able to go through puberty and get to a point where if we choose to have children go on to sustain and carry life, we have to have some degree of fat tissue in our bodies, right? Otherwise we don't menstruate.

So estrone is not all bad. Women in middle age will be very frustrated with changes in body composition which can be a direct reflection of an increase in estrone rich fat added post tissue. And then there's another type of estrogen called estriol that's made by the placenta but not involved specifically in what I'm talking about. But estradiol is the predominant form of estrogen that we're really speaking to that's driving these immune system changes especially in this kind of perimenopause to menopause transition. And I think what's also interesting is this complex interplay, it's not like estrogen is good and progesterone is bad. They're really designed with balance. Everything in the body is really looking for balance and so if we think about progesterone having anti-inflammatory effects and immune regulating, it's understanding that it's all about helping to kind of tame some of these inflammatory signals and all inflammation is not all bad. That's the other thing that was really clear to me when I was in the research was it's thought of that inflammation is bad and we should all be anti-inflammatory and it's actually not the case. It's finding balance between inflammation and de-inflaming and making sure that they're in balance.

And prior to menopause or perimenopause frankly, I think women do a better job with this. I think it's when those hormones start to fluctuate that our bodies are really looking to recalibrate and I don't use that word lightly. I think sometimes when I hear that on social media, it's a recalibration. For every woman listening, their perimenopause to menopause transition will be as bio-individual as you are. Just like every woman listening that's still having a menstrual cycle, your menstrual cycle is as unique as you are. And so I want to provide some context that some people will breeze through their 30s and 40s and others will not. And I think so much of it is really a reflection of what we're doing in terms of lifestyle, how we eat, how we choose to exercise. Do we have healthy relationships and boundaries or do we not? I know Melanie, you and I talk about this a lot personally, but to get back to your question about the estrogen that I'm speaking of that has these potent immune modulatory effects.

Cynthia Thurlow
And it's also the hormone that as it is declining in our bodies, in the latter stages of perimenopause and menopause, that we start to see this provocation of the immune system. And let me be really, really clear. When I talk about these changes that are happening, it's this lack of predictability, which is what women find frustrating.

There are certain times in their cycles they may feel that they're more prone to getting infections. They may feel that they're more prone if they don't get enough sleep, that they're more likely to experience opportunistic like the virus. You're traveling like Melanie, I know you travel, I travel. Sometimes you pick up things doing a lot of flying and being exposed to other people, but it's understanding that the overall loss of estrogen and progesterone impacts immune intolerance and leads to more inflammation overall. But to really re-emphasize that inflammation is not all bad. And I think that's a common misconception when I'm talking to other podcast hosts or talking about the book or talking about things on social media. It's helping people understand that it's not like all inflammation is bad.

There's a lot to inflammation that is good, that helps protect us. It's when it goes awry. And certainly, when it's out of control, it can accelerate the aging process like we do see in middle age and beyond.

Melanie Avalon
It's so funny because I'm so happy that you're saying all of this because I think it's very easy to get really extremist and all or none approach in how we view things. And I literally remember I went through a period of time in my life where I was convinced like inflammation was literally like the worst thing and everything.

And I'd be with my therapist, my therapist would be like, Melanie, not everything is inflammation. I'd be like, but it is. I have to get rid of the inflammation.

Cynthia Thurlow
Yeah, I want to blame it on something.

Melanie Avalon
Yeah, exactly. Okay, so question here.

So, you know, you've made a very clear picture of just how influential our hormones, especially progesterone and estrogen are in our immune system as we're aging. So bringing the gut microbiome into this, and I have been going recently deep into the rabbit hole, like reading your book and just like looking into it in general about like the signaling molecules that are produced by the gut microbiome and everything that they're telling our body. And so I'm really curious like practically how this pans out. So is the gut microbiome creating hormones that speak to the body? Is it influencing the creation of hormones? Is it speaking through hormones? Like what is the actual communication system that's happening here? And if you want to get esoteric, like why? Like I'm just like, like I think about this a lot, like the gut microbiome, like what does it know? Like does it, I know it's, I guess it's in a symbiotic relationship with us. I'm just fascinating about how it actually does this and how does it know to like create these metabolites or if it does create them and how does it communicate?

Cynthia Thurlow
It's such a good question and I love how conscientious you are about thinking through how all these processes work. So as I understand it, there's a lot of crosstalk. So the microbiome, the gut microbiome is housed in the colon or large intestine. It's 40 trillion bacteria, fungi, protozoa, and viruses. There are more of them than us than human cells, just to give people some context. And so I really look at it as there's opportunities for cross-communication. So I think the gut microbiome is in cross-communication with every organ system, our ovaries, our bones, our brain, et cetera, our lungs. I mean, it is fascinating to me.

And one of the ways that it communicates is with hormones. Obviously these are chemical messengers, neurotransmitters, again, chemical messengers, but also we have this incredible innate ability to produce other ways of communication. And so think about it. When we consume fiber, fiber, if we properly break it down, goes to the colon, ferments, and then we create things called short chain fatty acids. And so everyone, people's eyes kind of glaze over like, that's not important. Well, what is important is that short chain fatty acids and common names of these things, acetate, propionate, butyrate, I think butyrate is my favorite. It's one of the main fuel sources for the colonocytes, which are the colon cells that are there, but they're all involved in like regulating metabolism. They are anti-inflammatory. They cross the blood-brain barrier, like butyrate is a potent agent that crosses a blood-brain barrier. They help nourish and strengthen the gut. And they're also immune regulatory. So one fun fact is that as we are aging, and as we see alterations in estrogen in particular, we start seeing a reduction in short chain fatty acid production. So why is this important? It's important, number one, because I just mentioned how estrogen is this potent immune regulatory hormone. But guess what happens? Without as much estrogen, we are more likely to develop leaky gut. Leaky dysbiosis is commonly also seen with autoimmune conditions. So we get an increase in inflammation. We get a reduction in the strength of the gut lining. We are seeing alterations in metabolism. So I think we could all argue, anyone that listens to this podcast knows how important our metabolism is, how important it is to be able to use both stored carbohydrates and fats as a source. We also know as estrogen is declining, we become more insulin resistant. And so you start to see all these patterns. And then there's keystone bacteria that cross-communicate with short chain fatty acids like acrimonsia, which is certainly really important not just for insulin sensitivity, but also for endogenous GLP1 regulation. So GLP1 drugs are synthetic and they're really powerful, but our bodies actually make endogenous, which means our bodies make GLP1 as well. And that's where short chain fatty acids become really important.

Cynthia Thurlow
So that's one type of signaling molecule, but I look at it as crosstalk. It's almost like playing telephone for anyone who's listening. Hopefully I'm not aging myself terribly, but there's communication going on with the colonic cells with this crosstalk between the microbiome, the short chain fatty acids, which is telling, regulating and helping communicate with keystone bacteria, which is communicating with insulin sensitivity, the little insulin receptors on cells. I mean, there's so many, so much crosstalk that goes on.

So I really think, Melanie, whether it's nitric oxide, whether it's urolithin A, whether it's the short chain fatty acids, it's just a communication crosstalk. So from my perspective, I am certainly not a gut microbiome researcher, but I've certainly read enough of the research to feel really comfortable and confident in saying, if we understand at a very basic level what these items do, and we can talk about nitric oxide and we can talk about its role with estradiol and how is estrogen decline. So does nitric oxide production, which also impacts vasodilation, which impacts stiffening and hardening of arteries. I mean, there's so many things that go on as well as nitric oxide innervates the gut motility. So when women tell me that in middle age, they feel like food just sits in their stomach and they just don't feel like their stomach contents empty as readily as they once did, that it takes longer to have a bowel movement, takes longer to feel like they've digested their food. That's courtesy of nitric oxide changing in the setting of less progesterone and estrogen.

And we can have an unpack the research around urolithin A, which again is signaling molecule, but what's really fascinating about urolithin A, whether or not we can create enough urolithin A is highly dependent on our microbiome constitution. So for everyone listening, I think they say it's about 30% of us that might actually be able to create enough urolithin A on our own. And we're just not at a point yet where we're doing point of care testing on this, but most of us don't create enough on our own. We could eat buckets of pomegranates and buckets of berries and we might not be able to create enough urolithin A. And that's yet another kind of important crosstalk communication between the microbiome and the rest of our bodies.

And so I kind of humbly sit back and really think about how unique the microbiome is, Melanie, in terms of all this communication that's going on behind the scenes that we're not even aware of, that's so important. And hopefully I've made the argument for why I like playing telephone between the hormones, the microbiome, giving the hormones information. It's like this constant communication that goes back and forth that is designed, as you astutely said, this very symbiotic relationship. It's designed to be supportive of the body, but we want to make sure we're doing the things to help optimize and support it so that we're not making it even harder as we transition in middle age.

Melanie Avalon
Yeah, I love this so much. And I really appreciate the complexity like the complex lens that you're bringing to it. And it's funny, you're saying, you know, people's eyes glaze over when they hear short chain fatty acids. That is that is the rabbit hole I've been going into recently and been obsessed with. Like it is fascinating that, you know, that the microbiome can create these postbiotic compounds, these these signaling molecules that then like communicate so much to our bodies. It's like, like you said, it's like this communication system that is so important and influential. And I feel like we're just now learning more about it. Something I really appreciate is you're talking about how it how it's communal and how there's, you know, all this different signaling going on. And I think, again, going back to people wanting to be binary, I think a lot of people think we'll look at my gut microbiome studies and think, oh, there's a study that found like we need this bacteria and then that's good or we need this bacteria is bad. When really they all work together, they can take on different roles, like even with processing food, you know, one bacteria might process it and then another bacteria uses like the metabolites of that to like do something else. So like, it's way more complicated than I think like, oh, just take this probiotic and fix yourself or, you know, oh, just do this one simple thing. Like it requires a much broader approach and picture that I really appreciate.

And that was something I noticed in your book is that you're not saying like, oh, this is the one thing that will fix it or like it's much more complex than that. It requires, you know, overall lifestyle interventions rather than necessarily one thing per se. Or like with the urolithin A, people might think, oh, okay, we make that from pomegranate juice. So I'll drink pomegranate juice when like you just said, maybe only 30% of people can even make urolithin A from pomegranate juice. So it's just so, so fascinating. So speaking of this signaling mechanisms that come from the gut microbiome, like I said, I was fascinated to learn about all the different axes to all the different things in our body. And in particular, one of my other favorite parts of the book was on the ovaries, which obviously relates a lot to women. So you were talking about the aging timeline of the ovaries. So what is going on with the aging of the ovaries and the significance of that? Like why are they the pacemaker of aging?

Cynthia Thurlow
Yeah, I mean that was like something that really stood out to me when I started looking at ovarian senescence, which is a fancy way of saying ovarian aging, that our ovaries are as old as we are. So we are born with a finite amount of eggs, estimated to be anywhere from like one to two million at birth, and it's the most mitochondrial dense tissue in the body. I think astutely I used to always say, oh, it's the heart and someone else says it's the brain and no, actually it's our ovaries are the most mitochondrial dense tissue in the body. And so what's interesting is during the course of our lifetime, we lose about 300 to 500 of these eggs that were born with just through ovulation and the rest are lost through something called atresia, which is just they just die off. And so at puberty, we have about 300,000 eggs left, which sounds like a lot, right? And then through the course of whether we ovulate or not, whether we're on hormonal contraception or not, by the time we get to menopause, which is 12 months without a menstrual cycle, we'll have about a thousand.

So we still actually have some eggs in menopause, they're kind of dormant and gone off to pasture. They're in retirement, right? And so what I find fascinating is we know there are things that can age our ovaries faster. There are things that contribute to this crosstalk communication between the gut microbiome and the ovaries, not surprisingly, based on what I've been talking about. And then what I find even more fascinating is when we look at things that can age our ovaries faster, some of it we have control over and some of it we don't. There's genetic reasons why this can happen, toxins, infections. I was reading a fascinating study that was looking at how mump infections. And I say this non-projoratively, whether people vaccinate their kids or don't, that's not my business. But infections like mumps can actually age the ovaries, which I thought was really interesting, even contribute to premature ovarian insufficiency, which used to have a different name. It used to be called premature ovarian failure, but now we're insufficient and not in failure. And so when you just look at this kind of bigger picture, it's looking at the things that can prolong the ovarian aging process, the things that impact us in a negative way. And then trying to figure out, which I find even more interesting is looking at genetics to say, okay, well, my mother went through menopause at X age, what's the statistical likelihood? That's when I'm going to go into menopause or looking at your family history or thinking about, are you doing all the things to prolong fertility, which I know there's a lot of people doing research in this area, but was not even on my radar, or I was not even thinking about this 10 or 15 years ago, but now we're really at this forefront of consideration. And so I think the ovaries are fascinating. I think we don't respect them enough. And I find it utterly fascinating all the ways that we can influence how quickly our ovaries age or can we actually slow down the aging of our ovaries?

Cynthia Thurlow
I was reading an article yesterday that was saying women over the age of 35 that want to have kids really should consider the possibility of some of these interventions or even thinking about freezing their eggs, because after 35, they start to age more readily, not surprisingly. Unlike men, they replenish their sperm, I think every 72 hours, women, unfortunately or slash fortunately, we are born with all the eggs we will ever have. And so we have to take great care of them.

Melanie Avalon
I'm trying to remember I had, I don't remember who it was, I was interviewing somebody and they were talking about because the ovaries have all those mitochondria and because they do age the fastest basically of our body, that they're a really amazing thing to study for the mechanisms of aging because of how fast they age.

Cynthia Thurlow
Yeah. No. And I think for me, the, the one thing that really, you know, one of many things that stood out, I could probably say that about every chapter there's something that really stood out to me in this chapter, but you know, I guess I really didn't appreciate all the variables that can impact, you know, whether a woman goes into premature menopause or premature or variant and sufficiency and how important that is. And I know, you know, your listeners, you have a younger listening group, probably runs the span of, you know, people my own age down to younger women is really understanding the impact of a loss of hormones at an earlier age is much greater than it is at 52 or 53. You know, if you're 32 versus 52, much larger impact of not having those hormones at a much younger age.

And if anyone falls into that category or they've been diagnosed a premature menopause, which is before the age of 40, or you're told that you have POI, you definitely want to be working with a practitioner or prescriber that can ensure you are getting the level of hormones you should be at at that age so that it lessens the likelihood that you develop some of the longterm sequelae of, of a loss of hormones. And I want to make sure I kind of dovetail that into the conversation because I still do meet women that, you know, went into menopause. Maybe they had a hysterectomy at 38 or 41 and they were never offered a replacement of those hormones. And so I think it's really important to just help educate women that there are options. I know that wasn't your conversation, Melanie, but I feel a sense of responsibility to just kind of interject that and say, I think it's really important just to be aware of what your options are. If you're going in earlier than the average woman.

Melanie Avalon
No, I'm so glad you brought it up. And you know, that is a whole section of the book as well. So the role of hormone replacement therapy, and in particular, and I know, I know it's been talked about a lot. I know you and I have talked about it historically, I still think it's important to talk about because I feel like we're still working against the potential damage that was done by the women's health initiative and all of this fear of hormone replacement therapy that happened for women.

You pointed out that was it in 2022 that the menopause society kind of they wrote like a official rebuttal? Yeah.

Cynthia Thurlow
Kind of a soft rebuttal, but I feel like that was a great step forward for women, and especially women that are working with providers that are certified through the National Menopause Society, which I'm a certified provider, but I think that we're moving forward, but we have a whole generation like my mother's generation. Many women listening will appreciate this.

My mother is going to be 80 years old in February, and her entire generation were the ones that were the most impacted by the WHI, meaning most, if not all, of them were taken off their hormones. We see the long-term sequelae when women aren't given choices. Let me be clear. It's a choice. If women choose to take hormones or replace hormones, that's a choice, as is the choice to not take hormones. I think every woman should be afforded the opportunity to have a fully informed conversation with their prescriber so they can decide what's best for them, but that generation has really missed out on a lot of the benefits of hormones. My mom is one of four daughters, and I have an aunt on my father's side, and they talk about all of them have osteoporosis, all of them have genitourinary syndrome of menopause. Some of them are starting to experience some neurocognitive changes, some bone changes, and so I think the bigger challenge is just making sure women know they have choices.

I think that's the most important thing that we can convey with regard to that topic, because knowing women have choices, and if you are working with someone who won't give you choices, then you need to find a new provider. We're happy to provide some direction. I have a list of, and I don't get any kickbacks from anyone that I refer to on that list, it's just a list of providers here in the United States that colleagues have worked with and many of whom are personal friends, people that I know will guide women in the right direction.

Melanie Avalon
It's always been really ironic to me, my interpretation of everything that happened because you would think that I feel like the world is so, especially like the US, we're so heavily saturated in the pharmaceutical realm and it's such a money making business. I mean, it's honestly, it's pretty impressive that the Women's Health Initiative kind of single-handedly short-circuited that role of like shut down the prescription of hormone replacement therapy so effectively.

And once you get the menopause gut, there is a whole chapter on this, but just briefly, what was the vibe that came out from the Women's Health Initiative? And then what were the problems with the study?

Cynthia Thurlow
Yeah, so it's interesting, you know, the average age of menopause here in the United States and most Westernized countries is 51. So they used women that were significantly older, women that were more than 10 years into menopause. So already we talked about inflammation and inflammation. So in a subsect of the population, people that were former smokers, some of them were obese, overweight, more than 10 years into menopause. So that's number one. So they weren't looking at a truly healthy population.

Number two, you know, they had two arms to study. One was using conjugated equine estrogen. And for any of you, like the normal way that the trade name is Premarin, which is pregnant marys urine, and yes, pregnant marys urine, along with a progestin. So this is a synthetic form of progesterone. It is not bioidentical or body-identical progesterone. And so in one arm, they use two synthetic versions, and the other it was just conjugated equine estrogen. And what's interesting is they extrapolated from the data that if you utilized these medications, that you were going to be at greater risk for developing breast cancer and other types of cancers. And so they shut the study down kind of prematurely, and then extrapolate it without even really looking at the data that HRT was causing cancer and therefore, and I'm oversimplifying things, but unhealthy population, older population, using synthetic hormones and extrapolating that anyone that is in this arm of the study, they're going to have a higher risk of developing cancer, which they actually think might have had more to do with the cancers that were reported had more to do with the progestins that were being utilized. So they took away a lot away from that study that then heavily influenced prescribing practices. And I was literally a baby nurse practitioner. This is around 2002, changed prescribing practices. Prescribers decreased prescriptions by, I think it was like 90%. Literally women went from taking, whether it was premarin or estrogen or progesterone or progestin, when literally overnight women were taken off their hormones. And you have this entire generation of women that really missed out on the benefits for, in particular, for bone.

We know that estradiol has primary prevention for osteoporosis, presumptively also cardiovascular disease protection risk. We know that heart disease is the number one killer of women. One in three women will develop atherosclerotic cardiovascular disease or to make it easier heart disease. And just the whole sequelae that comes from that, you know, it's interesting, Melanie, right now, even the best neuroscientists are saying we're not 100% sure that HRT is going to prevent neurocognitive decline. We don't know this yet with certainty, but we do know that in particular hormone replacement therapy will protect bones and protects the heart. So that's huge. And there's other benefits, of course, but we're looking at musculoskeletal protection.

Cynthia Thurlow
We're looking at sarcopenia concerns, genitourinary syndrome of menopause. It's not a question of if but when.

We know that vaginal estrogen plus or minus DHEA or testosterone, very, very helpful for reducing the likelihood of urinary tract infections, pelvic floor issues. And so unfortunately, the WHI got extrapolated, you know, how things kind of trickle down into the media and all that was being shared was hormones cause cancer and therefore don't take them. And that was the prevailing thought process. So physicians and nurse practitioners were not learning how to prescribe HRT and their programs. And so it really shut down opportunities with these patients. And the worst thing of all is, again, there's no hormone in the body that just has one, that has one effect. So think about it, estrogen has, we have estrogen receptors and progesterone receptors everywhere in the body. And you think about your eyes, your heart, your lungs, your gut. I mean, you just start to think about the long term sequelae of not having enough of these, you know, very important hormones at optimal levels or even at suboptimal levels. You know, sometimes hormone replacement therapy is like a whiff of hormone. It's not enough to do much, but getting them to optimal levels so that women feel like they have some semblance of their life back. But the WHI I think was well intentioned, but in many ways kind of set women's, not just their longevity, but their quality of life metrics back by 50, 60 years.

I think that, you know, if you look at Marty McCarrie's work, I've seen, I've heard Peter Atiyah talk about this. It's the greatest travesty of modern day medicine that has ever happened. And I could not agree more because it has, it has allowed a lot of women to have to suffer needlessly and that to me is unacceptable. And so I think in many, many instances, the WHI gives us opportunities to change course so that subsequent generations, certainly my generation, Milly, you're younger than me, your generation will benefit from a lot of voices in this space that are helping bring greater awareness to the limitations of that study. And yet at the same time, allow women to understand there are other options. And as I've said over and over and over again, every woman has to decide for herself what the right choices are, but we should have choices. It should not be, you know, fear mongering and, you know, telling women this is just the way things are at whatever stage of life that they're in, because there's nothing more frustrating than hearing that from a licensed medical provider.

Melanie Avalon
Yeah, I cannot thank you enough for speaking about it so clearly and eloquently and it's really, really empowering to women. I mean, just hearing what you said about the protective effects on bones and the heart, which are like two of the main things related to mortality, that's huge.

You mentioned a study in the book, I think, where women on... Was it that women on HRT and menopause, their gut microbiome looked more like the perimenopause gut microbiome?

Cynthia Thurlow
Yeah, so it's really interesting. There's something called the microgenderome, which is a term that was entirely new to me. And basically, I'm going to oversimplify this, but you know, when young boys and young girls are born, their gut microbiomes are fairly similar until they go through puberty. So the influence of these hormones, testosterone, estrogen, progesterone, they change the microbiome dramatically in puberty.

And then we call it the three P's. So we go from puberty to pregnancy, if and when women choose to go through pregnancy, and then perimenopause. And so we have these dynamic shifts in these hormones that influence the gut microbiome. And what I find fascinating, Melanie, is that life comes full circle. If a woman goes into menopause, and you know, we live long enough, we will, our microbiome starts to resemble males again, because the influence of these changes. But hormone replacement therapy, it's my hope and my intention is by bringing greater awareness to the benefits of hormone replacement therapy, the women will understand it's beyond just the bone and the heart effects. We have the potential to impact the diversity, the changes in keystone bacteria, the changes in short chain fatty acids, the influmaging, etc., that are more likely in menopause, that we get to kind of maintain some of the protective effects that we have when we have optimized estradiol and progesterone levels when we're younger. And so I think this is really fascinating because, you know, unlike we can look at the heart, you know, through imaging, we can see bones, you know, we can evaluate bones with lab work, and also through DEXA scans or REM scans, you know, it's a little more challenging sometimes to get a sense of what's going on in the gut microbiome, not impossible, but that diversity and the reduction in inflammation that we're starting to see as the research is emerging, I think is incredibly encouraging. To me, it's, you know, it's like the forefront of like the next big thing that we'll be talking about when we talk about benefits of replenishing hormones.

Melanie Avalon
Yeah. It is beyond fascinating.

And so from a practical perspective, so we've mentioned hormone replacement therapy and its role. How much effect does diet and lifestyle come into play? Is it both required, one or the other? Are they symbiotic? And could somebody be following, like could a woman be following quote, and there is no perfect diet, but could they be following quote, the perfect diet, the perfect lifestyle, the perfect things, and still like they need hormone replacement therapy.

Cynthia Thurlow
Yeah, I mean, so here's my thoughts. Lifestyle is foundational. No one listening can get away with not prioritizing sleep and not managing your stress. And I would make the argument we have to be more proactive about stress management and middle age because quite frankly, less circulating progesterone means we have less inhibitory GABA, which means we become a little less stress resilient.

I think diet is really critically important. And it doesn't mean that everyone has to eat the same way. What I do think is there are some really key tenants, like protein-centric diets, Being conscientious about fiber, fiber is very bio individual for every person that is listening that says Yeah, I try to be good about fiber if I eat too much I get bloated and miserable. I get it For every one of us. It's a little bit of the end of one So, you know the amount of fiber that melanie eats might be different than the amount of fiber I eat But I can tell you at this stage of life I'm really conscientious about my fiber intake and I can explain more in terms of context I think carbohydrates, you know fiber I think about separately from carbohydrates So obviously we get plenty of fiber in some carbohydrates We have to change our relationship with carbs and carbs are not bad. I think that Processed carbs are the things we should be limiting and you know It doesn't mean that you never have a cracker or a piece of bread But the bulk of your carbohydrates should come from unprocessed options And if you're not insulin sensitive, you should be eating less carbohydrates overall I I do think The the consistent lever that I see is Our relationship with alcohol needs to shift that doesn't mean that every person listening shouldn't drink alcohol. That's a personal decision But the research is certainly lending itself that the way that we process alcohol Its impact on vasomotor symptoms hot flashes sleep quality Really starts to change in middle age. And so There's a very vibrant mommy drinking culture I I know when I lived in washington d.c. That was part of like every social event I went to there was a lot of drinking that went on and I I think for so many of us when we're in the throes of child rearing and Little people and you know a very very busy social calendar for them and sports and birthday parties and all the things You can get a lost a little bit lost in your identity And so I understand why sometimes alcohol becomes a release kind of mechanism You're like I sit on the couch. My kids go to bed and I have a glass or two of wine. I get it But we need to change our relationship with alcohol and you know looking at the research and and certainly I talk about the research in the book quite a bit increased risk for certain types of cancers Disruption and quality of REM sleep and non-rem sleep Increase in blood sugar dysregulation.

Cynthia Thurlow
I mean, there's there's so many side effects that you really have to be strategic about what you're doing And then the other thing that I think is really helpful is you know, I look at my relationship with intermittent fasting I've shared this transparently over the last 18 months My relationship with intermittent fasting has changed and it doesn't mean that it's still not an incredibly valuable strategy But I find for a lot of my patients. They can't get enough protein into their diets And so it becomes 12 hours of digestive rest so when I when I think about kind of the vignettes and consistencies when i'm talking to patients about Lifestyle as medicine that is all foundational like we have to kind of dial that in and then you know, the supplements Plus or minus hormone replacement therapy is really dependent on testing symptoms What you need specifically I have some patients that are like i'm all for the estrogen patch Give me all the estrogen patches and I want some oral progesterone Plus or minus testosterone And then we add in other things like maybe it's creatine monohydrate Maybe it's you know, you use some adaptogenic herbs to help with stress reduction I think so much of it is really dependent on the individual and then you know The other piece that I didn't mention is exercise how important that is for overall, you know longevity metrics and I'm sure i'm certainly we could spend an hour just talking about exercise, but exercise becomes important largely Because we start losing muscle mass and we need to you know, maintain body composition goals, whatever they may be They may look a little different for every person But really looking at The way to navigate supporting the microbiome with all these different levers It really goes back to the basics and then adding in the additional pieces that you need I think that i'd be the first person to say that all the tech gadgets in the world They're a lot of fun But you start with the basics.

I always say major in the majors. It's so important to make sure that we are Conscientious about sleep and stress and nutrition and exercise Before we even think about the fun fancy gadgets like I love my aura ring and I have lots of tech gadgets that help with Sleep with stress reduction But you have to major in the majors before you worry about the fun sparkly Gadgets that are out there that I know all of us love to play with and are a lot of fun But they don't take the place of these foundational elements that i'm talking about

Melanie Avalon
I could not agree more. And oh my goodness, so many hot topics, alcohol fasting, all the things. I will say so. I mean, I know listeners know I'm a big fan of wine over here. At the very least, I don't think I can express enough how important if you are drinking that you're making like clean, low alcohol wine choices. Like if I were to drink conventional wine, I would just feel so horrible. I would not feel good. So if you are drinking, I would make conscientious choices there and also consider the effects that maybe like Cynthia was saying, that depending on where you are in your life, maybe it's not the best thing for you.

I can totally get behind that. And then so the fasting, I'm very curious because I was curious when I was reading your book, I was like, okay, I was curious to see where you were now with fasting. You mentioned the wait, 12 hour, 14, 12 hour.

Cynthia Thurlow
Yeah, I call it digestive rest because I jokingly say even my very athletic now adult sons can do 12 hours of digestive rest I'm like, this is something everyone can do But for my super type a super stressed out not sleeping over exercising over restricting food people Like that's that's a recipe for more stress on their bodies And so we kind of ratchet things back to make sure they're getting enough protein. They're getting the right types of carbs They're dialed in on sleep.

And again, I want to be really clear. I still believe in the value of fasting. I just Like to think about it in a gentler way because middle-age women do a really good job of being hard on themselves already and when their bodies Aren't doing or aren't responding the way they once did We're so good at self-flagellation like we just make it so much harder We're like oh If a little bit of fasting is good more is better if a little bit of food restriction is good more is better if a little Bit of exercise good is good more is better and that mentality does not serve us well In middle age. Unfortunately, like I I recognize like those strategies work Okay in your 20s and 30s and they can actually work against us as we get older. So it's it's be a little kinder Go to bed a little earlier do a little less intense exercise Maybe be very strategic about when you fast and when you don't fast Like don't do it on a night when or a day when you didn't sleep well the night before and your dog is sick and you Know you're argued with your spouse. Like don't do it on that day. Maybe save it for a day We're a little bit more relaxed and it doesn't feel like so onerous and overwhelming

Melanie Avalon
I'm going to be so curious, Cynthia. We should place a bet, because I do my really intense, massive amount of protein, one meal a day, how long.

I wonder when I reach these life stages if I will enter the struggle bus to get my protein in. I'm very curious.

Cynthia Thurlow
I just, I don't have any patients that can get a hundred grams of protein into one meal. And so inevitably there's always a unicorn. Like I always said to Melanie, you're a unicorn, but like most of us, you know, 50, 60 grams is about the max I can consume in a meal.

So I think for a lot of women having a little bit of a wider feeding window still allows them to feel like they have plenty of digestive rest, but they also don't feel like they're rushing to get more protein and like, you know, maybe their first meal is at nine and maybe they ate at one and maybe they ate at five. And so they're getting three boluses of protein in during the day. And that feels a little more manageable. And I think the big, you know, kind of the big shift for me was the realization that, you know, my father got sick. I've talked very openly about this on social media, on the podcast, that when my dad got sick, I was like, if I don't start pumping up my protein intake, I'm going to be dealing with sarcopenia issues. And now we're monitoring my body composition like every three to four months, really, really diligent about it. And I'm weight training very diligently harder than I worked before.

And so I just think that there are seasons in our lives when one strategy may work well. And then sometimes there are other seasons in our lives and we need to do something different. And so I just invite anyone doesn't have to be about fasting could be any one thing. Like I was low carb for so many years and gosh, now I don't even count my carbohydrates or even think about it. I just eat whatever I feel like my body needs at that moment. I just invite people to change their minds or to change what they're doing or change it up. I think that's very important that, you know, rigidity, I think at this stage of life can make things a lot more challenging to navigate.

Melanie Avalon
Exactly. And actually, that was something I learned in your book that I never read before.

You pointed out, for example, you're mentioning how you used to be more low carbon, now you don't even count count carbs. You pointed out that estrogen plays a role in emulsifying fats. So decline in estrogen at these later life stages could make a keto diet potentially, you know, more difficult for women, for example.

Cynthia Thurlow
And it's interesting. There's even research to demonstrate that depending on the composition of your microbiome, you may or may not respond to a ketogenic diet. So how many women have gone on keto because their best friend, their significant other, or someone they know had great success, and then they go on a ketogenic diet and they gain 10 pounds? And they're like, wait a minute, this is not the outcome I was looking for.

And so I think for a lot of individuals, it's really thinking thoughtfully about the power of the N of 1. And, you know, back to your point about estrogen, this is why so many women become fat malabsorbed in middle age. You know, I'm looking at stool studies and trying to figure out why they're not breaking down and metabolizing their fats. And estrogen plays so many different roles in the digestive system, but it helps with the breakdown in assimilation. So if you're eating a high fat diet, because maybe keto is what makes you feel good, and then you're later finding out you're just not breaking it down and absorbing it, that's a whole separate issue. And so I think the more that we understand about the role of these hormones in the digestive system, the more we will think more thoughtfully about what are the things we need to be doing differently to support our bodies at this stage of life.

And it might be that you eat more cruciferous vegetables because you want to support the estrobolome, or you are more conscientious about your protein targets, or it's, you know, you eat a little bit more fiber. I mean, I'll share with you and your community that I get colonoscopies every five years, because I have a bad family history of precancerous polyps. And thankfully, I've never had a precancerous polyp this past year was my five year and my colonoscopy was perfect. And my colorectal surgeon said, what are you doing differently? Because he was looking at my 2020 colonoscopy. And I said, I've just been eating more fiber. And he said, there's no inflammation, you have no hemorrhoids, internal or otherwise. And the only intervention that I've done differently is that I've been really conscientious about my fiber intake, not so that I'm bloated and miserable, because that's no one wants to be consuming foods that make them bloated and miserable.

However, I've just found what fiber dense foods work really well for my body. And I think for everyone listening, I would encourage you like, if you're consuming five grams of fiber a day, try to add a couple more grams. Like don't go from five to 30, you're going to be really unhappy with Melanie and I find things that you like and that you can incorporate into your diet. Like I will tell you it's easy to get my fiber up to 30 grams a day, because I've just found the things that work well for me, like even fresh ground flax and chia seeds together in a smoothie, like super easy, like stupid, super easy to do.

Cynthia Thurlow
It's like effortless, you just throw it into the smoothie and you're like, done, that's 10 grams right there. And so for each one of us, it's finding things that we like that we can incorporate into our nutritional philosophy that don't make us feel like we're having to think too much. Because the last thing we need is more things to have to think about.

Melanie Avalon
And to that point, that's actually another rabbit hole I've been going down recently because I know for me, I historically and currently, I can have a fear of fiber in a way. I eat a very high fiber diet, but it's a lot of like one type of fiber, like the fiber that I digest. So cucumbers will various things like that. I get a fear mindset surrounding bloating and something that I've been reading and researching a lot about recently is how maybe like bloating itself or experiencing increased sensations from eating fiber, the importance of going slow and also how we might've confused that as a negative thing.

Like it's not necessarily a bad thing per se, it could just be the gut microbiome adjusting. So like you were saying, going slow, not jumping into like 30 grams of all the things and then getting bloated and never doing it again, but rather going slow and letting the microbiome slowly adjust because it does adapt and adjust to what you're feeding it. Of course, if you're like staying bloated perpetually and it's not getting better then that would be a sign that you probably should not keep doing that.

Cynthia Thurlow
that tends to be like the most common symptom women will report is bloating. And so, you know, what one person experiences is bloating is very bio-individual. Just like when someone tells me they're constipated, I'm like, tell me what that means to you because constipation to me may mean something completely different than it does to you. And so, you know, bloating where you're not bloated in the morning and you look like you're six months pregnant at night, yeah, that might be something I want to have checked out. It's sometimes such a nonspecific symptom, but always worth discussing with your prescriber, your licensed medical provider, just so they can evaluate you.

You know, I always use the example, like I love cruciferous vegetables. Like I love Brussels sprouts, but I'm the first person to say I have to, like the max amount of Brussels sprouts I can eat is about a cup, which for some people that price sounds like a huge amount, but if I eat more than that, I'm guaranteed to be a little bloated and gassy and that's not ideal. And so I think that so much of it is just figuring out like what is a recurrent pattern or what is a constant pattern and evaluating like, is this something worth discussing with my provider or is this something that I know is, you know, I'm like, I'll use an example. A lot of these artificial sweeteners can be very, you know, gas centric and, you know, these sweeteners that are non caloric sweeteners, that can be problematic. Sometimes people just chewing gum can produce a lot of gas in their intestines or, you know, wearing yoga pants all day long that are constricting your abdomen can, you know, sometimes lead to bloating just by virtue of the fact there's pressure on your abdomen. So I think for each person, it's, you know, where are you in your menstrual cycle? Some people will tell me I'm so bloated right before I get my period. I'm like, okay, well, that's a little bit expected given some of the hormonal, you know, dysregulation or regulation, depending on how you'd like to phrase it. But I think for every person, it's just being honest with yourself about what's working and what isn't working.

And, you know, I'm a huge fan of diagnostic testing. I like stool testing. If we need to do an elimination diet, if we need to do food sensitivity testing, or if we want to look at, you know, hormone testing, which I know can be controversial depending on which expert you listen to, I think that there's, you know, I'm a big fan of data. Like I like to look at data and decide, you know, what are we doing with said data? How can this influence choices that we're making? How can this influence how we feel about this transitional time in our lives? There's a lot you can do with that. I'm sure that you're a fan of that as well, Melanie.

Melanie Avalon
Oh, yes. All the data.

One last note on the bloating. There's even, I used to see this as a negative because I thought it meant like, oh, it's all in my head. But it's actually pretty validating because it means what you're experiencing is real, which is something called visceral hypersensitivity, which is they'll do studies and the same amount of objective amount of bloating. So like the same amount of gas in a person's system, one person will feel it is bloating and the other person won't. So some people are just interpreting it differently. But it is real. It's just it could be, you know, similar to somebody who's not experiencing it as bloating, which I find fascinating.

Cynthia Thurlow
Well, and it goes back to how attuned we are to our bodies. Like I think there are people that are just very, very attuned to subtle shifts, whereas someone else is flying at 30,000 feet and they're just not as cognizant of checking in with themselves. You know, maybe there's a trauma history and maybe it, you know, they don't feel comfortable or secure in their bodies. So it's easier just to not think about how they feel or what they're experiencing.

So I think that a lot of it has to do with, you know, how we've experienced our lives and how we perceive changes in our cycle or changes in our life stage. I think for so many women, you know, they're, they're so busy in their thirties that when they hit the wall of perimenopause, like many women do, including myself, they're kind of like, wait a minute, I'm aging. I don't feel my age, but wait a minute, why are all these things happening? Why, why are things that, why are things that used to be so easy suddenly so hard? And so it can be a little bit of an adjustment to a new normal or a new way of doing things and, you know, providing the validation that that is entirely normal and entirely normalized.

Melanie Avalon
And I'm so glad you mentioned the trauma piece because I did want to briefly touch on because that is another section of the book, which I highly appreciated. And you reference it in the beginning and then you get to the actual chapter about it, which is the role of adverse childhood events and ACEs and how they affect a woman's health and her experience of menopause.

And you share in the book, I think you said you had nine out of 10 of the ACEs because there's a quiz that you can take. So that's something again, where like you could be doing on paper, I don't like the word perfect, but you could be doing all the right diet, lifestyle, sleep, all the things. And yet, if you have this trauma that you haven't dealt with, how impactful might that be on everything?

Cynthia Thurlow
massive, massive. I think that. Well, let's back up. So this Adverse Childhood Events score was a joint venture between Kaiser Permanente and the CDC. And anyone listening can access this quiz online.

It's quick to take. The higher your score, obviously, the more you experience as a child. And so we can't change what happened in the past. But what I've come to experience is individuals who have experienced significant trauma are more likely to be diagnosed with eating disorders. They're more likely to deal with poor metabolic health. They're more likely to experience autoimmune conditions. They are more likely to have disorder relationships with food. There's a lot. It goes on and on and on. It doesn't mean everyone that's experienced trauma develops all those things, but it just means you're more likely to deal with that. And we're really speaking to this chronic overactivation of the nervous system. And our body gets exquisitely attuned to higher levels of cortisol. And for a lot of people, they become, depending on how they interpret what they've experienced, some people just become very high functioning. And that's part of their trauma response. But what I find really interesting is when we look at the research, I will make the argument that women that have significant underlying trauma histories are going to have a harder time navigating perimenopause and menopause. Because I just mentioned earlier, with those changes in alterations in progesterone, we become much less stress resilient. This is not that you are incapable. It's just physiologically what is changing. Less progesterone means less upregulation of the inhibitory hormone or neurotransmitter, depending how you view it, GABA. And GABA is very important for calming the nervous system. And so I would make the argument that women that have not dealt with their stuff, it's going to be harder to navigate perimenopause and menopause. Not impossible, but this might be why so many more women initiate divorce. 70% of divorces are initiated by women. As we have alterations in all these hormones, estrogen impacts serotonin. It has impact on dopamine. I just mentioned progesterone impacts GABA. Not to mention, testosterone is also important for executive function. So a lot of women get into this time period in their lives. Not only does it impact the way they perceive the world or themselves, chronic stress dysregulates nearly everything in the body. I remind people cortisol is a wonderful hormone, but it's catabolic, so it breaks down muscle, it lowers immune system function. You're going to be more likely to develop opportunistic infections. You're more likely to deal with metabolic health issues. You're more likely to have leaky gut, which leads to that piece about autoimmunity. And so it really becomes this massive domino effect. And why I think so many women in middle age, if they haven't gotten the support and the help that they need, finding a really good psychologist, therapist, psychiatrist, whatever it is that you yourself need to find the support that you need, critically, critically important.

Cynthia Thurlow
Because with those alterations and hormones that I've mentioned, you're going to view the world differently. I jokingly say that I'm a reformed people pleaser. A lot of how I navigated my life was that I was super high achieving, very likable, very affable. And a lot of that was the influence of the trauma that I grew up in. So I'm now not a people pleaser. I have very firm and healthy boundaries. What I find interesting about the hormone estrogen in particular is that estrogen is this people pleasing hormone. It's a bonding hormone just like oxytocin. As women have less circulating estrogen, they finally find their voices. And it may be that they're still very nice people, very kind people, but they have healthy, firm boundaries.

And maybe that's one of the benefits of being middle age is you care a lot less. When I say care, care in the right way. You care about the things that are important, but you care a lot less about what people think of you. And you're able to kind of navigate. But the one thing about trauma that I have not mentioned that I think is important is if you look at the research of trauma and how that ages the ovaries. Nearly every person I know that underwent significant childhood trauma. And we can talk about big T trauma, suicide, homicide, etc. versus little T trauma, which is the quieter things that happen. Physical abuse, verbal abuse, shame, things like that, I think can be equally impactful. And for a lot of these individuals, that chronic over activation of the sympathetic nervous system can age the ovaries. And so I would make the argument that significant underlying childhood trauma has the ability to age us faster, age the ovaries, and put us into an earlier menopause. A lot of the women I know with significant underlying trauma. did not go into menopause at 51. They were in their mid to late 40s. And so I think that there's evolving research. I'm certainly not a trauma expert, but I've certainly lived enough and experienced enough, and both as a clinician and as a human being, that it's in my clinical experience that a lot of the women with significant trauma go through into menopause earlier. And I would make the argument that there's probably a lot of things that contribute, but I think that trauma is a contributory factor for ovarian senescence, the ovarian aging piece that we were talking about earlier. Just like other toxins, you can have emotional toxins that can age the ovaries just as readily as a virus or genetics that are doing it just as quickly.

Melanie Avalon
And what's so fascinating, and you talk about this in the book, because I think in general, the conversation around adverse childhood events, the effects of it are typically talked about in not in the health sphere, like normally it's talked about like how is it affecting your or the physical health sphere. Normally it's talked about as in how is it affecting your social life, your mental health and wellness, but there's not as much of this conversation that you're having around how it's affecting aging and entering menopause.

But the actual like history, like isn't the guy who came up with ACEs, he was because he realized the connection between sexual trauma and weight gain, I think.

Cynthia Thurlow
Yep. And that's what I'm talking about. I mean, that metabolic health, disorder relationships with food. I mean, there, there is a, there is a research article that I think Dr. Mary Claire mentioned in a conversation that if a woman is sexually abused, goes on to have children that are sexually abused, she is more likely to go into menopause eight years earlier. I mean, that is, I get chills every time I state that bit of research because I think in, in a world where we are so focused on appropriately focused on a lot of other things, we still don't fully appreciate or understand the role of complex trauma and how that impacts the body at a really at a tissue level, not just organically in our organs, but at a tissue level.

And you know, everyone that has, has had those experiences, good, bad and indifferent. I wouldn't be who I am today. Had I not experienced those things as a child and young adult, I think that we don't yet fully appreciate the impact of that kind of chronic stress response and how it kind of unwinds otherwise healthy physiology and understand that, you know, we need to intervene earlier, you know, we need to start screening people earlier before middle age when all the wheels kind of can potentially, I don't want to make it sound negative. I don't, you know, before the wheels fully fall off the bus and someone's really suffering, like how many women have I known that really suffer in middle age because they never realized, they never realized all the things they had gone through when they were younger. It's only when they're a little older and maybe when they don't have the same neurotransmitter production, their hormones aren't at the same levels that suddenly they feel like they're free falling. And I speak from personal experience. I mean, there's a lot about, you know, my personal history that it has kind of availed itself over the last several years. And I'm fortunate to have a very loving patient spouse, but not everyone has those kinds of relationships. And that's why I think it's so important to ask for the help that you might need, even if you're not aware of it at the time, sometimes it can take a while to untangle it all to figure out like, oh, this is actually something that happened to me when I was a child. That's, you know, rearing its ugly head in adult in my middle age years. And it's something I need to deal with so that I can be a happy, healthy middle age person.

Melanie Avalon
Yes, I really cannot thank you enough for drawing attention to this, all of the time and the pages that you dedicate to it in the book and for listeners. This is a good moment to mention because we've talked a lot about the science of all of this and the effects of hormones and the gut microbiome and everything in these different life stages.

Something really incredible about the menopause gut is it's very implementable and actionable. So every section where Cynthia is talking about these different things, be it the effects on the ovaries or the diet or the sleep or the stress, the trauma, she provides a lot of resources for things you can do to address that. So I just remember in the stress section there was a laundry list and a good way of things that people can look into for trauma and stress relief and things like that, which side note, one of the ones that you mentioned, which is one I haven't tried, but you said you've been doing it now is, have you been doing holotropic breathing?

Cynthia Thurlow
Yes. And I was really, my functional medicine doc has been on my case for, I don't know, probably for the duration of time I've been working with him. He's also a very good friend and really cares. And I remember him telling me to do holotrophic breathing and I was like, no, no, I don't want to do it. And so I was at an event and Sachin Patel, who's wonderful, he actually facilitated this holotrophic breathing exercise and it was incredible. And so I think that I had been, sometimes the things we need to do most we are inclined to not want to do. And so I think I knew that I needed to do it. So I found it incredibly humbling and definitely necessary work.

Now I may not do it every day, but I do endeavor to try to do it a few times a week. And I do think it's, I mean, it's made improvements in my HRV, which says a lot because your HRV is largely kind of genetically kind of attuned. You can only improve it by only so much, but I can tell when I'm on vacation and I'm doing holotrophic breathing regularly at home, I do see significant improvements in my HRV. And if my HRV is in the 50s, I'm happy. That's pretty good for me. So I think for, I tried to be expansive in my suggestions because some things are free, some things are not. It goes all the way up to psychotropic, mediated therapy, which I've not done. Let me be clear. And the research is evolving there, but really tried to be encompassing so that it incorporated things that can be free all the way up to things that are larger investment points. And certainly anything I put in the book or things that I've either done a lot of research on or I was really conscientious. In fact, my editor was great and really encouraged me to just be very research-based in recommendation so that we had things we could refer people back to. It's like, if you want to learn more, this is where you go. In fact, all the references are going to be kept in my website because there were so many references from all the writing that I did for the book. But thank you for bringing that up. But holotrophic breathing can be really powerful. But for me, I was really hesitant to do it because sometimes we avoid the work we need to do and I had to just get my head in the right place to be able to do it successfully.

Melanie Avalon
Yeah, I was just so curious about it because again, you talk about all these different modalities people can try. And that was one of the ones I also haven't tried. And then you specifically mentioned in the book that it's something you're doing now. I was like, oh, I have to ask her about this.

Okay, so friends, so we will be releasing this episode around the launch date. So people should be able to get the book now, which is very exciting. So again, it is the menopause gut balance your microbiome to reclaim your health and midlife and beyond. I cannot recommend it enough.

Rapid fire really quick fun questions. Did you are you narrating the audiobook?

Cynthia Thurlow
I am. I start that next week, in fact. Oh my goodness. Yes, and I don't have the same producer, so I'm not going to sound like a robot.

Melanie Avalon
Oh my goodness. Well, I wish I seen good vibes with that because that is not an easy thing to do.

It takes a long time. It takes a long time. And I'm just dying to know the book cover, how involved were you in designing the book cover, which I love.

Cynthia Thurlow
Thank you. No, well, I figured out after the last book and title that, well, I love my last title. My title for my first book was way too long. So we decided on the title pretty quickly.

And then I'm not kidding. They gave me a couple variations of book covers. And as soon as I saw the book cover that you have, I was like, that's it. Because it's, it's a double entendre. So the menopause got me into two things or three things, depending on who you are. And then it's so descriptive, like you see it and you know exactly what it's about. Like there's no question, it'll stand out on a bookshelf. And so this time around, I just started to be a lot more strategic, you know, keep it like, keep the title short and very descriptive and make sure that cover is really clear what the book is about. So I'm really excited. But yeah, this time around, it didn't take a long time. I was shocked to be honest with you. It was pretty easy.

Melanie Avalon
Awesome. Well, I love it. So anything you want to share with listeners about getting the book resources, following your work, what are all the things there?

Cynthia Thurlow
Thank you. Thank you so much for having me, Meli. Such an honor to be a guest again.

Easiest to go to my website, www.syntheatherlo.com. There are book bonuses for those that buy a physical copy of the book, and they will all be on my website. You can also follow my podcast, Everyday Wellness. Meli has been a guest multiple times. I'm active across social media. I would say I'm kind of really focused right now on Substack. I've been enjoying the writing process after I recovered from writing the book, but I'm active on Instagram. I am on Twitter, although I'm not there every day. I have a free Facebook group called the Midlife Pause backslash my name, and it's an amazing group of women that are in that community. And then we post YouTube content. We repurpose a lot of our podcasts and put them on YouTube so you can also get a sense of what I talk about there as well, but very gut-centric these days.

I really think the gut microbiome is the burgeoning field for all of us to better understand our physiology as women and be able to support our bodies at every stage of life. Even though the book title says menopause, it really is for all women. It's all tenants that you can walk away from. If you're listening and you're a partner of a woman in middle age or pre-middle age, it's a great way to better understand her and how she's going to navigate middle age and beyond.

Melanie Avalon
I cannot agree more. Exact same page.

So friends, go get it now. We will put links to everything in the show notes. Congratulations, Cynthia. And the last question that you may or may not remember, but it's what I ask every single guest on this show. And it's just because I am so obsessed with the role of mindset, kind of like what we're talking about with the stress and the trauma and all this stuff. So what is something that you're grateful for?

Cynthia Thurlow
Oh, gosh. Well, I would say in the past month, really incredibly grateful for my husband and my boys and the new team that we onboarded. They've just been incredible.

It is for any listeners that may or may not know this, being in the midst of a book launch is a wild time, very energetically rich. And so they've been able to allow me to exist in my zone of genius and be able to come on and do podcasts with Melanie and so many other incredible people in the health and wellness space. And so I just sit with tremendous gratitude because I wouldn't be able to do it if they weren't helping to support me. And so really important to acknowledge those that are allowing me to do the work that I'm doing.

Melanie Avalon
Well, I love that so much. I'm just so grateful for everything that you do. I'm so grateful for our friendship over the years. And I just love, I just so eagerly look forward to all the content and the amazing resources that you create for the world. So thank you for what you're doing.

Congrats in advance on the book launch, even though I know it's a little bit in the future right now. And I can't wait to do more podcasts in the future. Thanks for having me, Melanie. Thanks, Cynthia. Bye. Thank you so much for listening to the Melanie Avalon biohacking podcast. For more information and resources, you can check out my book, What Win Wine, as well as my supplement line Avalon X. Please visit Melanie Avalon.com to learn more about today's guests. And always feel free to contact me at contact at Melanie Avalon.com. And always remember, you got this.