The Menopause Gut: Why Hormones Are Only Part of the Story

I've read your book and there was a really, your story is insane. It blew my mind how sick you got. Were you in shape going into that? You said you lost 15 pounds in the hospital.

And I can imagine that now. I was the thinnest I'd ever been as an adult. When I got out, my arms and my legs were so thin. Other than to say, if you are not eating, you're body will catabolize muscle.

Welcome to the Integrative Medicine Roundtable, where practitioners lead, brought to you by the North Carolina Integrated Medical Society, join integrative health care leaders, clinicians and innovators as they share practical insights, emerging research, and the conversations shaping the future of patient care.

Welcome back to the podcast. Today I'm here with Cynthia Thurlow. She's a nurse practitioner who specializes in functional and integrated medicine, specifically perimenopause and menopausal and gut health.

she is a best-selling author, she has a speaker and educator. And I am so happy to be sitting here. We had you speak earlier today at our Synergy Conference and just pearls on pearls of knowledge.

So tell me a little bit about how You started getting into functional medicine. That's something that people always ask Yeah, I think you know, it's I spent 16 years in clinical cardiology and it was evident to me that there was a lifestyle piece that no one was really focusing in on so I Initially kind of took a functional nutrition course and I got really interested in that which then led to additional training but ten years ago I I got tired of writing prescriptions.

And so I took a massive leap of faith, which I never recommend to anyone to do, no business plan, nothing. I just woke up one day and said, I can't do this at all anymore.

So I left traditional allopathic medicine, kind of created my own programs, my one-on-one work. did a couple of TED Talks, wrote a few books. But I now, over the past 10 years, have firmly been entranced in really helping support women in mid-life, because 10-years ago, no one was talking about perimenopause.

I mean, in fact, my first TEDx in 2018 was on perimentopaus, and the only reason why they let me talk about it is because no-one had talked about period menopase from a TEDX platform.

They had talk to about menapause, there were a-few, but noone talked-about peri-menopose. And so I kept saying, if I didn't know what to expect, how could I expect anyone else?

And so I always think of functional integrative approaches really as the best of both worlds. You know, you are really looking at things from a very foundational lens.

And I think that you ultimately are getting better results with patients long term. Absolutely. So that goes into your new book, The Menopause Gut, because, a lot of people are practicing and prescribing HRT for perimenopausal menopals, but not looking the gut.

Why is that important? Well, I think that it's the way that most of us have been trained. I mean, really the gut microbiome research has really been the last five to 10 years, and so most us went to graduate school with little to no explanation or orientation to the microbiomes, but yet we know that interfaces with every single organ system in the body.

It's responsible for how we break down our hormones, it is important for immunity, its important to detoxification. And so I that from an allopathic lens, we look at HRT like It makes sense.

We replace hormones that our bodies are no longer making. But most people are probably not thinking about the other side of things. And I think the cumulative net effect of chronic stress, the hyper-processed foods that we're eating, you know, kind of imprints that microbiome.

So I think we are a society that is heading into perimenopause and menopaus really at a disadvantage. And it doesn't have to be that way. Yeah. From my perspective, you 10 years ago, when I started working with women, biopically, it was evident that we were doing a lot of things consistently well, but there were still women that were on HRT and were trying to dial in on nutrition and trying exercise that still weren't feeling better.

There's more to this conversation. Could it be, you know, Lyme or tick-throne illnesses or, chronic inflammatory response syndrome? Absolutely. But really what we're talking about foundationally is really with the gut.

So I look at it as, this key longevity organ that no one's focusing in on or most people are not, but I think if we come to it looking at through a foundational lens, patients are feeling better, they're getting better long-term results, and you and I both know that middle-aged women, some of the biggest issues are like bloating, digestive issues, weight loss resistance, which are just symptoms of bigger issues.

And so, you know, from my perspective, the women that we're working on these protocols with are a whole lot better than just slapping on that estrogen patch and saying, peace out.

Yeah, and what kills me is how many women that I see that say, I ask them, are they constipated? Are they having bowel movements? Yeah. Well, how often?

Every seven days. Yeah can you imagine? No. I can't. So what does that do to our hormones when someone's constibated like that? Yeah, I mean, so almost always when I see people that are chronically constipated, even if it's two to three bowel movements a week, can be a safety issue.

You know, someone's autonomic nervous system, if they're not able to get effectively into the parasympathetic. Years ago, when our kids were low, we had to have our foot up against the door to go to the bathroom.

It's not like that anymore. So I think that there's definitely the safety component. People who are chronicly stressed, they perceive that they are not.

I think there is definitely this concern around the estrobalone. So if I'm able to effectively break down, package up, and poop out the excess estrogen, I am oversimplifying just for time purposes.

But I start thinking about is it a biliary issue? Is it detoxification issue, is someone who is chronically stressed, someone eating foods that are constipating?

Overdoing it with dairy are they eating too much fiber and for them that can be incredibly constipating but when i think about the whole detoxification mechanism predominantly liver and it goes to the guy i certainly if you're not properly eliminating things that your body no longer easy are you recirculating them right so for a lot of these women if they're.

properly detoxifying their estrogen, they can't break it down, beta-glucuronidase is not working effectively. They can get magnification of all these symptoms, whether it's breast tenderness, brain fog, skin-related manifestations, bloating, constipation, diarrhea, can almost always be pinpointed.

Their strobilome is And I think for a lot of our generation that we're on oral contraceptives and exposed to synthetic hormones, the question is, does that impact the maturation of the astroblome?

And we are just starting to get the research in there. So from my perspective, I there's many things that can contribute, but from simplistically saying people who are chronically stressed who don't acknowledge it, all the way up to all these lifestyle measures that could impact whether or not we were going.

The other thing that I would say is hydration and exercise. I mean, I say all the time, like, hydration could be the reason why you're tired. Hydration can be a reason you are constipated.

And I think as women's hormones are declining, especially estrogen, we kind of lose those receptors that remind us that we need to be hydrating regularly.

So by the women get dehydrated, they're really clinically dehydrate. Yeah, yeah. and movement. Movement is so key. I hear a lot like I just want things to easier now that I'm older and I am tired, but explain why, how movement, what effect that has.

I mean, movement is going to help with peristalsis in the gut, so number one for sure there. We know strength training is gonna help us maintain and build muscle.

And what's really important for us to understand about muscle is that it's not just this aesthetics piece. It's a critical organ of longevity. it is also a huge glucose reservoir.

So the foods that we eat You know, if we have enough muscle mass on our bodies, we're able to effectively utilize stored glucose. We're are able effectively remain more insulin sensitive.

And we know that women after the age of four, you lose anywhere from three to 8% of their muscle. So depending on how you were in your twenties and thirties, You could be at a competitive disadvantage in terms of that.

I think about exercise from that perspective. Just from overall body wellness, like we knew that you released endorphins. certainly really important for flexibility purposes, depending on zone two training, which is just the activity of daily living.

Just being physically active is so important, not just for mood, but I would say specific to the microbiome, specific, to heristalsis, just moving food through the digestive system.

That's why when we think about it, we take care of elderly patients who are chronically dehydrated because they don't want to go to bathroom and they also don t move much.

It can contribute or even worsen or exacerbate their motility issues. Well, I read your book and it there was a really your your story is insane. It blew my mind how sick you got yourself Were you in shape going into that?

You said you lost what 15 pounds in the hospital? I was I can imagine that now No, no I mean I I would yeah the thinnest I'd ever been as an adult and so I'm sure that I lost the bulk of my muscle at that point because I Was in a hospital bed for 13 days and I could tell you when I got out my arms and my legs were so thin and And I don't say this to, other than to say, if you are not eating, your body will catabolize muscle.

And that's what happened to me. They had me on TPN, which is total parenteral nutrition on day five. But I remember fighting them. I was like, isn't that soy, like crappy soy?

And my cousin who's a physician was, If you don' let them feed you, you're going to die. She's like you were in the right frame of mind. You clearly weren't feeling good.

Yeah. but I think for a lot of people, they're surprised to learn that if your sedentary, and sick, you are going to have this catabolic effect on the muscle.

Plus, I'm sure my cortisol levels are through the roof just from the stress, even though I wasn't perceiving it at that point. But I think for a lot of people, they're surprised to know that being sedentary or being sick and sedventary can kind of unravel that muscle mass.

And I thing fervently, this is now seven years ago, it has taken me seven to put the muscular mass back on. I am sure. Going into that, had you been in a good place, healthy, so probably made it through.

Well, and it's interesting because the surgeon at that time said if it had been any other 47 year old, you would have died. Really? Yeah, I was pretty sick.

And so it was very humbling as a clinician because I recognized how sick I wasn't they were like, we don't know why you're so sick? Wow. So it just speaks to how our immune system is changing, how susceptible we are to opportunistic infections.

And so romantic trip, hiccup a friend, and the friend ended up creating this cascade of events that came a few months later. Wow. That's amazing. Well, you look incredible now.

Seven years later to have gone through all of that. Yeah. Do you have any advice for a woman in her mid to late 30s coming into this era of perimenopause?

What can she do to keep her gut healthy and besides the movement in the water, are there foods that we should focus on? Yeah, I would say number one, you've got to manage your stress.

I mean, this is something I emphasized today in my talk was that Most of us think we're managing our stress, because we do meditation once a week. And I'm like, listen, you actually need to find things that you like that are going to regulate your nervous system.

So things like humming, singing, gargling, like really simple things, breath work can be incredibly effective. That's number one. Number two, I would say eating enough protein and eating a fiber.

I mean, fiber is not sexy, but there's so many ways to get it into our diets. Just being thoughtful, it doesn't mean that your aiming for 30 grams. We track first, measure, and then we respond accordingly.

And there's so many ways to do that without having it be incredibly bloating. Like I always say, one tablespoon of fresh ground flax and one table spoon of Fresh Ground Chia.

Okay. Life-changing. You can put it in a smoothie, you can it over a salad, although most people prefer the smoothie option. Yeah. When I say smoothie I'm talking about protein shake.

Sure. Not like a sugar bomb. But I think those are two things I would think about. Adding fermented foods. We know that the research is very clear that probiotic rich foods, whether it's miso, tempeh, If you tolerate dairy, so full fat organic yogurt, kefir, low sugar kombucha, fermented vegetables, having a serving with each meal can be really helpful.

And then I would say, you know, other things to really consider and think about is microbiome testing. Like I am a huge proponent. You know, for years and years I did straightforward stool testing and I do see utility there, but I think microbiome testing in particular is really reaching a new level where we're able to be incredibly customized.

Like now when I'm doing microbiomes testing, I could say, okay, well, you need more resistant starch. You need to more inulin, like you get that specific knowing exactly what that microbiom in particularly needs.

And so I would say that's maybe another thing and lastly, think about HRT way before you think you need it, because I find most women mid to late 30s, early 40s.

They need some progesterone the week or two before their cycle. Like don't suffer. My generation, we were kind of conditioned to believe like, oh, you know what you should do?

You should wait till you're in menopause. No, no, now you suffer those five to seven years without those hormones. And so I think what I would say lovingly and respectfully is I think that I probably would not have gotten quite so sick had I started HRT because, you know, now that we know about what estradiol's role is with immune system regulation and the tight junctions in the small intestine, I'm like, get on HRRT earlier rather than later.

And get, make sure you're working with a licensed prescriber. Nothing makes me more angry than people who, especially, it's usually men trying to dictate for women, like No, don't take hormones.

That's bad. I'm like, no, you don' get to tell me what to do with my body. Exactly. Yeah. Right. And I see you comment a lot online, like on Facebook groups and things like that, educating other women about, the difference between birth control, progestins and progeserone for perimenopals.

So I think that there's a huge gap in knowledge, not just the general public, but practitioners too. No. It's interesting because one of the things in the book that really stood out when I was reading the research was, the impact on synthetic oral contraceptives, so these are not body identical, or even deproprivera, the effects on bone and gut microbiome health.

And so I always say, like, there's no judgment. I was one of those people from my generation that stuck on oral contraceptives because I had heavy cycles, stayed on it for a long time because it was a set it and forget it option.

But we're not counseling in women to say hey, maybe what we need to do is two to three years at this option, then rethink this, think about what else might be available to us to address your symptoms.

because we're seeing a whole generation of women that are osteopenic before they even get to menopause. So if you miss out on those peak bone and muscle mass years, you don't get that back.

Yeah. I think that that education about how progestins are not body equivalent, ethanol estradiol is not equivalent to estridiol. And so I thing greater awareness allow women to make better choices.

To your point, there are a lot of clinicians that maybe aren't aware that they're not identity or maybe they choose not to be aware. But I think those conversations are vitally needed.

Yes, definitely. Going back real quick to the gut microbiome testing. I have a lot of women coming to me wanting to get on HRT and I've a hard time convincing them to do the Gut Microbiome Testing.

Like, how would you as a practitioner tell me who's kind of just getting into gut testing would be a good way to explain to people? I mean, I think it allows us to be very personalized and precise.

So when we talk about personalized dosing of a GLP-1, it's personalized. How do we specifically address your gut? Because we can talk fiber and resistive starch and probiotics.

But what do we know is specifically what you need? So I'll give you an example. I recently had vaginal microbiome testing done and I was like, I'm on vaginol estrogen, on DHEA, estriol, testosterone.

My vagina microbiomes must be pristine. Right. No, not so much. And so they made some very precise recommendations. Within a week, oh my God, it feels so different because I felt like if I missed a dose of my compounded product.

I was like, I could notice it. Yeah. And so now totally different. So I just say this as, as a clinician myself, a little skeptical, but the things that I've been doing differently personally, and then also with patients, for many of them, they're like oh my God, it's like subtle things like a specific targeted probiotic, specific nutritional intervention that can have a big net impact.

Number one, There are specific companies that I like, know, and trust for microbiome testing. They have some very cost-effective options, so much less expensive than doing other stool testing, I don't know if I'm allowed to say a particular brand.

Yeah, you are, okay. So Tiny Health, it has a really good product. But I, you know, I use free years. I used Genova, Doctors Data, GI Map, and I still think that they're good products, but I think this might be another, it's the next level of kind of personalized medicine.

And so I that is a direction that, like, that's my whole practice is going on. So even my clinicians that work for me, this is the bus we're on now. Because I it is, shotgun genomics is very different than you get a little sliver of the piece of pie from PCR or missing stuff, honestly.

And I say this as someone whose giardia was missed like three times. And so we did different types of testing. So from my perspective, I think it's the next level.

I expect from us is to stay current. It's easy to say, stop and using one particular paradigm. You're like, I know how to read this test. Right. it makes sense to me.

I'm like no, encourage people to challenge themselves to, say you know, maybe doing something differently is what the direction we need to go in. Yeah.

So tiny health has both the gut microbiome and the vaginal microbiomes. And they have a pro test that, you can use as a clinician and then they a consumer facing test, but I do find the consumer-facing test is actually very helpful.

And so, I think for individuals, people here that were tiny health, they think it's for kids and babies. And they can do those evaluations. But from my perspective, it is easy.

The ick factor is gone because you're not scooping up your poop in a french fry container. It's literally much less messy. Some of my patients are like, oh my god, this is amazing.

I'd much rather do this. Good, good. Well, is there anything else that you wanted to talk about or give us today on this podcast? Yeah, I would say, you know, little things, the little interventions have a huge effect on the microbiome.

So if you're hearing us talking, and you are like, oh my God, there's so much to remember. Something as simple as four to five deep breaths before you sit down to eat a meal will help get you into the parasympathetic.

Taking a five or 10 minute walk after your biggest meal today will hope with blood sugar regulation. And going to bed, you know, 30 minutes earlier than you normally do is going have a huge net impact on your health.

So those are the kinds of things I'm like, I am not talking about buying anything, right? You know I not selling anything. It's just these interventions we know based on research really are incredibly effective.

and can help your microbiome, can your sanity, and will certainly help you middle-aged body. Great. Well, that is so easy. Do you want to tell the listeners where they can find your new book?

Yep. Yeah. So, the Menopause Gut is out everywhere. I would say go to your favorite bookstore, Amazon, Barnes & Noble, Target, Books-a-Million, wherever you buy or purchase books from.

It's also on Audible. And then you can me on my website, so it's www. CynthiaThurlow.com. I tell everyone substack is where I'm really enjoying right now.

So trying to actively grow a substac. That's where you can, if you like to read, that's how you actually see. I've got a whole like longevity protocol that I am doing right.

And tomorrow there'll be a particular substact on nurse practitioners. Oh, perfect. Yeah. Okay. Wait. so I read her substacts every day. and one more thing, you have your own podcast too.

Every day wellness is one of my favorite things I do within my business. Get to interview the best and the brightest science writers, clinicians, researchers and topic experts and it's honestly my favorite thing I do in my business.

One of my favourite podcasts too. Thank you. So thank you for joining us here at Synergy and on the podcast. We're just thrilled to have you, thanks Cynthia.

Thanks for having me. Of course. Thanks for joining us on the Integrative Medicine Roundtable where practitioners lead. If you found value in today's conversation, follow our podcast, share it with a colleague, or visit us at ncintegrative.org and join our community today.

We'll see you at the next roundtable.