Full Transcript Introduction and Cynthia Thurlowu2019s Background 0:00 I've read your book and there was a really, your story is insane. 0:04 It blew my mind how sick you got. 0:06 Were you in shape going into that? 0:07 You said you lost 15 pounds in the hospital. 0:10 And I can imagine that now. 0:12 I was the thinnest I'd ever been as an adult. 0:16 When I got out, my arms and my legs were so thin. 0:21 Other than to say, if you are not eating, you're body will catabolize muscle. 0:29 Welcome to the Integrative Medicine Roundtable, where practitioners lead, brought to you by the North Carolina Integrated Medical Society, 0:36 join integrative health care leaders, clinicians and innovators as they share practical insights, emerging research, and the conversations shaping the 0:43 future of patient care. 0:48 Welcome back to the podcast. 0:49 Today I'm here with Cynthia Thurlow. 0:51 She's a nurse practitioner who specializes in functional and integrated medicine, specifically perimenopause and menopausal and gut health. 0:58 she is a best-selling author, she has a speaker and educator. 1:02 And I am so happy to be sitting here. 1:04 We had you speak earlier today at our Synergy Conference and just pearls on pearls of knowledge. 1:10 So tell me a little bit about how You started getting into functional medicine. 1:15 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 1:23 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 1:31 then led to additional training but ten years ago I I got tired of writing prescriptions. 1:36 And so I took a massive leap of faith, which I never recommend to anyone to do, no business plan, nothing. 1:40 I just woke up one day and said, I can't do this at all anymore. 1:44 So I left traditional allopathic medicine, kind of created my own programs, my one-on-one work. 1:51 did a couple of TED Talks, wrote a few books. 1:53 But I now, over the past 10 years, have firmly been entranced in really helping support women in mid-life, because 10-years ago, 2:00 no one was talking about perimenopause. 2:02 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 2:10 menopase from a TEDX platform. 2:12 They had talk to about menapause, there were a-few, but noone talked-about peri-menopose. 2:16 And so I kept saying, if I didn't know what to expect, how could I expect anyone else? 2:20 And so I always think of functional integrative approaches really as the best of both worlds. 2:24 You know, you are really looking at things from a very foundational lens. 2:28 And I think that you ultimately are getting better results with patients long term. 2:32 Absolutely. 2:32 So that goes into your new book, The Menopause Gut, because, a lot of people are practicing and prescribing HRT for perimenopausal menopals, 2:41 but not looking the gut. 2:43 Why is that important? 2:45 Well, I think that it's the way that most of us have been trained. 2:48 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 2:57 or orientation to the microbiomes, but yet we know that interfaces with every single organ system in the body.
Why Functional Medicine Led to Midlife Womenu2019s Health 3:02 It's responsible for how we break down our hormones, it is important for immunity, its important to detoxification. 3:08 And so I that from an allopathic lens, we look at HRT like It makes sense. 3:13 We replace hormones that our bodies are no longer making. 3:16 But most people are probably not thinking about the other side of things. 3:19 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. 3:29 So I think we are a society that is heading into perimenopause and menopaus really at a disadvantage. 3:35 And it doesn't have to be that way. 3:37 Yeah. 3:37 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, 3:45 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. 3:52 There's more to this conversation. 3:54 Could it be, you know, Lyme or tick-throne illnesses or, chronic inflammatory response syndrome? 4:00 Absolutely. 4:00 But really what we're talking about foundationally is really with the gut. 4:04 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, 4:15 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, 4:21 digestive issues, weight loss resistance, which are just symptoms of bigger issues. 4:26 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 4:34 patch and saying, peace out. 4:36 Yeah, and what kills me is how many women that I see that say, I ask them, are they constipated? 4:42 Are they having bowel movements? 4:43 Yeah. 4:43 Well, how often? 4:44 Every seven days. 4:45 Yeah can you imagine? 4:47 No. 4:47 I can't. 4:48 So what does that do to our hormones when someone's constibated like that? 4:52 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, 4:58 can be a safety issue. 4:59 You know, someone's autonomic nervous system, if they're not able to get effectively into the parasympathetic. 5:04 Years ago, when our kids were low, we had to have our foot up against the door to go to the bathroom. 5:07 It's not like that anymore. 5:09 So I think that there's definitely the safety component. 5:11 People who are chronicly stressed, they perceive that they are not. 5:14 I think there is definitely this concern around the estrobalone. 5:18 So if I'm able to effectively break down, package up, and poop out the excess estrogen, I am oversimplifying just for time purposes. 5:25 But I start thinking about is it a biliary issue? 5:27 Is it detoxification issue, is someone who is chronically stressed, someone eating foods that are constipating? 5:35 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 5:43 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 5:51 them right so for a lot of these women if they're. 5:53 properly detoxifying their estrogen, they can't break it down, beta-glucuronidase is not working effectively. 5:58 They can get magnification of all these symptoms, whether it's breast tenderness, brain fog, skin-related manifestations,
The Gut Microbiome, Hormones, and Menopause 6:05 bloating, constipation, diarrhea, can almost always be pinpointed. 6:09 Their strobilome is And I think for a lot of our generation that we're on oral contraceptives and exposed to synthetic hormones, 6:18 the question is, does that impact the maturation of the astroblome? 6:21 And we are just starting to get the research in there. 6:23 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, 6:32 all the way up to all these lifestyle measures that could impact whether or not we were going. 6:36 The other thing that I would say is hydration and exercise. 6:41 I mean, I say all the time, like, hydration could be the reason why you're tired. 6:44 Hydration can be a reason you are constipated. 6:46 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. 6:53 So by the women get dehydrated, they're really clinically dehydrate. 6:58 Yeah, yeah. 6:59 and movement. 7:00 Movement is so key. 7:02 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. 7:10 I mean, movement is going to help with peristalsis in the gut, so number one for sure there. 7:15 We know strength training is gonna help us maintain and build muscle. 7:18 And what's really important for us to understand about muscle is that it's not just this aesthetics piece. 7:24 It's a critical organ of longevity. 7:26 it is also a huge glucose reservoir. 7:28 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. 7:35 We're are able effectively remain more insulin sensitive. 7:38 And we know that women after the age of four, you lose anywhere from three to 8% of their muscle. 7:42 So depending on how you were in your twenties and thirties, You could be at a competitive disadvantage in terms of that. 7:49 I think about exercise from that perspective. 7:52 Just from overall body wellness, like we knew that you released endorphins. 7:57 certainly really important for flexibility purposes, depending on zone two training, which is just the activity of daily living. 8:04 Just being physically active is so important, not just for mood, but I would say specific to the microbiome, specific, to heristalsis, 8:12 just moving food through the digestive system. 8:14 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 8:21 don t move much. 8:22 It can contribute or even worsen or exacerbate their motility issues. 8:27 Well, I read your book and it there was a really your your story is insane. 8:31 It blew my mind how sick you got yourself Were you in shape going into that? 8:37 You said you lost what 15 pounds in the hospital? 8:39 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 8:49 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, 8:56 other than to say, if you are not eating, your body will catabolize muscle.
Constipation, Detoxification, and Estrogen Clearance 9:01 And that's what happened to me. 9:02 They had me on TPN, which is total parenteral nutrition on day five. 9:06 But I remember fighting them. 9:07 I was like, isn't that soy, like crappy soy? 9:10 And my cousin who's a physician was, If you don' let them feed you, you're going to die. 9:13 She's like you were in the right frame of mind. 9:15 You clearly weren't feeling good. 9:16 Yeah. 9:17 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. 9:26 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. 9:32 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. 9:40 And I thing fervently, this is now seven years ago, it has taken me seven to put the muscular mass back on. 9:45 I am sure. 9:47 Going into that, had you been in a good place, healthy, so probably made it through. 9:52 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. 9:58 Really? 9:58 Yeah, I was pretty sick. 9:59 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? 10:05 Wow. 10:06 So it just speaks to how our immune system is changing, how susceptible we are to opportunistic infections. 10:12 And so romantic trip, hiccup a friend, and the friend ended up creating this cascade of events that came a few months later. 10:19 Wow. 10:20 That's amazing. 10:21 Well, you look incredible now. 10:23 Seven years later to have gone through all of that. 10:25 Yeah. 10:27 Do you have any advice for a woman in her mid to late 30s coming into this era of perimenopause? 10:34 What can she do to keep her gut healthy and besides the movement in the water, are there foods that we should focus on? 10:42 Yeah, I would say number one, you've got to manage your stress. 10:45 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. 10:52 And I'm like, listen, you actually need to find things that you like that are going to regulate your nervous system. 10:57 So things like humming, singing, gargling, like really simple things, breath work can be incredibly effective. 11:03 That's number one. 11:03 Number two, I would say eating enough protein and eating a fiber. 11:07 I mean, fiber is not sexy, but there's so many ways to get it into our diets. 11:11 Just being thoughtful, it doesn't mean that your aiming for 30 grams. 11:14 We track first, measure, and then we respond accordingly. 11:19 And there's so many ways to do that without having it be incredibly bloating. 11:22 Like I always say, one tablespoon of fresh ground flax and one table spoon of Fresh Ground Chia. 11:27 Okay. 11:28 Life-changing. 11:28 You can put it in a smoothie, you can it over a salad, although most people prefer the smoothie option. 11:33 Yeah. 11:33 When I say smoothie I'm talking about protein shake. 11:35 Sure. 11:35 Not like a sugar bomb. 11:37 But I think those are two things I would think about. 11:39 Adding fermented foods. 11:40 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, 11:49 kefir, low sugar kombucha, fermented vegetables, having a serving with each meal can be really helpful. 11:56 And then I would say, you know, other things to really consider and think about is microbiome testing.
Movement, Hydration, and Muscle Health 12:00 Like I am a huge proponent. 12:02 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 12:10 a new level where we're able to be incredibly customized. 12:13 Like now when I'm doing microbiomes testing, I could say, okay, well, you need more resistant starch. 12:17 You need to more inulin, like you get that specific knowing exactly what that microbiom in particularly needs. 12:23 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, 12:32 early 40s. 12:33 They need some progesterone the week or two before their cycle. 12:35 Like don't suffer. 12:37 My generation, we were kind of conditioned to believe like, oh, you know what you should do? 12:41 You should wait till you're in menopause. 12:43 No, no, now you suffer those five to seven years without those hormones. 12:47 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, 12:56 you know, now that we know about what estradiol's role is with immune system regulation and the tight junctions in the small intestine, 13:02 I'm like, get on HRRT earlier rather than later. 13:04 And get, make sure you're working with a licensed prescriber. 13:07 Nothing makes me more angry than people who, especially, it's usually men trying to dictate for women, like No, don't take hormones. 13:14 That's bad. 13:15 I'm like, no, you don' get to tell me what to do with my body. 13:18 Exactly. 13:18 Yeah. 13:18 Right. 13:19 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, 13:28 progestins and progeserone for perimenopals. 13:32 So I think that there's a huge gap in knowledge, not just the general public, but practitioners too. 13:37 No. 13:37 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, 13:44 so these are not body identical, or even deproprivera, the effects on bone and gut microbiome health. 13:51 And so I always say, like, there's no judgment. 13:53 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 13:59 a set it and forget it option.
Cynthiau2019s Illness, Muscle Loss, and Recovery 14:01 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, 14:07 think about what else might be available to us to address your symptoms. 14:11 because we're seeing a whole generation of women that are osteopenic before they even get to menopause. 14:16 So if you miss out on those peak bone and muscle mass years, you don't get that back. 14:20 Yeah. 14:21 I think that that education about how progestins are not body equivalent, ethanol estradiol is not equivalent to estridiol. 14:30 And so I thing greater awareness allow women to make better choices. 14:34 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. 14:41 But I think those conversations are vitally needed. 14:43 Yes, definitely. 14:44 Going back real quick to the gut microbiome testing. 14:47 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. 14:55 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? 15:04 I mean, I think it allows us to be very personalized and precise. 15:07 So when we talk about personalized dosing of a GLP-1, it's personalized. 15:11 How do we specifically address your gut? 15:14 Because we can talk fiber and resistive starch and probiotics. 15:17 But what do we know is specifically what you need? 15:19 So I'll give you an example. 15:21 I recently had vaginal microbiome testing done, and I was like, I'm on vaginol estrogen, on DHEA, estriol, testosterone. 15:28 My vagina microbiol must be pristine. 15:31 No, not so much. 15:32 And so they made some very precise recommendations. 15:36 Within a week, oh my God, it feels so different because I felt like if I missed a dose of my compounded product. 15:43 I was like, I could notice it. 15:44 Yeah. 15:45 And so now totally different. 15:47 So I just say this as, as a clinician myself, a little skeptical, but the things that I've been doing differently personally, 15:54 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,
Practical Gut Health Tips for Perimenopause 16:01 specific nutritional intervention that can have a big net impact. 16:05 Number one, There are specific companies that I like, know, and trust for microbiome testing. 16:11 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. 16:18 Yeah, you are, okay. 16:19 So Tiny Health, it has a really good product. 16:22 But I, you know, I use free years. 16:23 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. 16:32 And so I that is a direction that, like, that's my whole practice is going on. 16:36 So even my clinicians that work for me, this is the bus we're on now. 16:41 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, 16:49 honestly. 16:51 And I say this as someone whose giardia was missed like three times. 16:54 And so we did different types of testing. 16:56 So from my perspective, I think it's the next level. 16:59 I expect from us is to stay current. 17:04 It's easy to say, stop and using one particular paradigm. 17:07 You're like, I know how to read this test. 17:08 Right. 17:09 it makes sense to me. 17:09 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. 17:17 Yeah. 17:17 So tiny health has both the gut microbiome and the vaginal microbiomes. 17:20 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. 17:29 And so, I think for individuals, people here that were tiny health, they think it's for kids and babies. 17:34 And they can do those evaluations. 17:37 But from my perspective, it is easy. 17:39 The ick factor is gone because you're not scooping up your poop in a french fry container. 17:44 It's literally much less messy. 17:46 Some of my patients are like, oh my god, this is amazing. 17:49 I'd much rather do this. 17:51 Good, good. 17:52 Well, is there anything else that you wanted to talk about or give us today on this podcast? 17:57 Yeah, I would say, you know, little things, the little interventions have a huge effect on the microbiome.
Microbiome Testing, HRT, and Where to Find Cynthia 18:04 So if you're hearing us talking, and you are like, oh my God, there's so much to remember. 18:07 Something as simple as four to five deep breaths before you sit down to eat a meal will help get you into the parasympathetic. 18:13 Taking a five or 10 minute walk after your biggest meal of the day will helped with blood sugar regulation. 18:17 And going to bed, you know, 30 minutes earlier than you normally do is going have a huge net impact on your health. 18:24 So those are the kinds of things I'm like, I am not talking about buying anything, right? 18:28 You know I not selling anything. 18:29 It's just these interventions we know based on research really are incredibly effective. 18:34 and can help your microbiome, can your sanity, and will certainly help you middle-aged body. 18:39 Great. 18:40 Well, that is so easy. 18:41 Do you want to tell the listeners where they can find your new book? 18:43 Yep. 18:44 Yeah. 18:44 So, the Menopause Gut is out everywhere. 18:47 I would say go to your favorite bookstore, Amazon, Barnes & Noble, Target, Books-a-Million, wherever you buy or purchase books from. 18:53 It's also on Audible. 18:54 And then you can me on my website, so it's www.CynthiaThurlow.com. 19:01 I tell everyone substack is where I'm really enjoying right now. 19:04 So trying to actively grow a substac. 19:06 That's where you can, if you like to read, that's how you actually see. 19:09 I've got a whole like longevity protocol that I am doing right. 19:14 And tomorrow there'll be a particular substact on nurse practitioners. 19:17 Oh, perfect. 19:18 Yeah. 19:18 Okay. 19:18 Wait. 19:18 so I read her substacts every day. 19:21 and one more thing, you have your own podcast too. 19:24 Every day wellness is one of my favorite things I do within my business. 19:27 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. 19:36 One of my favourite podcasts too. 19:37 Thank you. 19:38 So thank you for joining us here at Synergy and on the podcast. 19:42 We're just thrilled to have you, thanks Cynthia. 19:44 Thanks for having me. 19:44 Of course. 19:47 Thanks for joining us on the Integrative Medicine Roundtable where practitioners lead. 19:52 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. 20:02 We'll see you at the next roundtable.
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