Why Traditional Medicine Fails Menopausal Women [ Cynthia Thurlow, NP ]

Hello my friends. Dr. Kenberry here. I have the great honor and pleasure of chatting with Dr. Cynthia Thurlo again today. Uh I think you're a nurse practitioner, but >> I am a nurse [clears throat] practitioner. Yes. >> You're smarter than most doctors that I know. So I don't feel too bad about saying that. Uh she has a new book coming out or out called the menopause gut. And uh I wanted to bring her on and chat about this book today. And then also just all things menopause, all things uh women's health research uh because I think we'll probably talk about that. Uh women get the shaft very very commonly. Not in a good way when it comes to medical research. And so we're going to talk about that and how that probably affect your life. If it didn't, it affected your mom's life for sure. >> Yeah. >> Uh welcome Cynthia. It's good to have you back. >> Tell us about this book. >> Yeah. You know, it's it's interesting. Over the last 10 years, I've been myopically focused on women in pmenopause and menopause. And at the time, I don't think I fully appreciated all of the changes that were occurring as hormones were declining. I think we learn a little bit in our training, but not much. And so, I started seeing patterns, especially with regard to metabolic health, stool testing. And when I started interviewing more experts and more researchers, it really became apparent that no one is talking about the gut in a way that helps explain some of the metabolic changes, the immune system changes, the bone health changes, the autoimmune issues that we start seeing with greater acceleration in middle age. And so I think the book really is a compilation of a lot of conversations I've had on my podcast with greater awareness around the fact that to your point there's not enough information and even research made accessible or available to clinicians not to mention the the public. And so this book is really designed to elevate the conversation. It's both a resource for clinicians and also part of a love letter to all the tens of thousands of patients I've had the honor of taking care of over the past 25 years, but really bringing enough awareness to the fact that if we're not talking about the gut with our patients, we're missing opportunities. And you know, the other thing that I would say, Ken, is I I think that the greater awareness around pmenopause and menopause over the last three to five years is fantastic. But for anyone listening that thinks it's just about slapping a patch on and that's going to fix all the problems, we're really doing our patients a disservice. >> I totally agree. And um let's let's un unwrap that first. Let's talk about all things female hormone and menopause, parameopause. I can remember Cynthia years ago now, probably 23 years ago when I first discovered, and this was after medical school, this was after residency. I was out in private PL practice and I discovered that women have testosterone receptors in their brain and on their heart muscle. And I was like, [laughter] "Well, now wait a minute. If that's true, and it is, they have millions of testosterone receptors on their brain and heart." >> Then every time every woman has heard a w a doctor say, "Well, testosterone is a male hormone. You don't need to worry about that." >> Um, or, "Oh, my testosterone is low, doctor." And the doctor's like, "That's that's a that's a man thing. You don't I mean, literal ignorance." I was ignorant up until the moment I read that book and went, "Wait, what what other things are doctors mal trained in when it comes to female hormones?" And I know we don't have 12 hours to discuss this because [laughter] that's how long it would take, but just just that just that epiphany of mine like, "Okay, I don't know anything about female hormones if that's true because nobody ever told me that." >> Yeah. And if if if women have testosterone receptors on their brain and in their heart muscle, that means it's important by definition. And that means that they need it by definition. And so what about post-menopausal women in their 60s, 70s, 80s? Do do those testosterone receptors not matter anymore? Do they not need that? Right? Lots of questions. How did you kind of come to realizing that yeah, menopause may be a naturally occurring event in a woman's life, but we probably should do something to at least support them through that time hormonally, if not more. >> Yeah. No, I I think it's such a great way to start the conversation because I I think testosterone is thought of as a male hormone. Women make about onetenth of the amount of as men, but it's very potent in our bodies. And you're correct. I mean, there are testosterone receptors just like there's progesterone and estradiol receptors throughout our bodies diffusely. We're not talking bikini medicine. It is not just about fertility and having babies. There is so much more to the conversation. And so, I I think when we kind of originate the conversation, it's helping people understand that most of us come to a specialty or an interest because we ourselves have walked the path of either having poor health or or feeling like we haven't been supported. And and 10 years ago, quite transparently, I was in the throws of pmenopause and not my gyn, not my internist, none of them could help me understand why I suddenly had no energy, why I was gaining weight, why I wasn't sleeping, why I couldn't get through a workout, why I had terrible recovery, I was suddenly anxious and depressed, which was is not my personality. Had never had anxiety or depression. And you know, I think that as I was trying to figure out for myself how to because isn't that what we do as clinicians? We try to figure out like what am I missing here, I realized I was like, "Oh my gosh, >> that's what a good clinician does." >> Yes. I was like, "Uh, if they aren't able to help me, then I need to help myself and I need to find the right clinicians." And so I fired my gyn and went to a midwife who was amazing. I got a different internist and I had a very different relationship. But I started to understand, we're not talking to women about the changes in loss of muscle, which leads to a loss of insulin sensitivity. We're not talking about how alterations in progesterone, which is really this hallmark declining hormone is a hallmark of the beginning of pmenopause that impact sleep, anxiety, depression, um this relative estrogen dominance. And I know traditional alopathic medicine hates that phrase, but there's no other way to explain it. have relatively more estrogen than you do to progesterone. It explains a lot why I suddenly was stuck because every single thing that I'd ever told a patient no longer worked. And I thought to myself, you know what, my advice stinks. I need to go back to figuring this out. And so, you know, I came to intermittent fasting as a starting point. That of course led to a lot of other things. But I think it's oftentimes our own trajectory of our story that allows us to find a different path. And it also contributed very transparently to why I left traditional alipathic medicine 10 years ago. April 1st, no, it's not a joke. April 1st, 2016, I left traditional alopathic medicine and and kind of evolved into my own practice. And so from that point, I did everything I could to better understand the physiology of aging women and to better understand like what is it about women at this stage of life that their thyroid suddenly becomes disregulated. Their adrenals are in the toilet. Why are we thinking that if we just replace hormones, that's the answer to everything. It means a radical transformation in lifestyle. It means everything that you used to do is probably not going to work this time. And so that was hard for me as a very type A. You know, I worked in clinical cardiology. I had very demanding job, very stressful. My kids were young, my husband traveled. I probably exercised a little too intensely. I was probably a little bit too low carb for me with as active as I was. And once I started making changes, I was like, okay, I got myself out of this weight loss resistant phase. I got myself, you know, out of that and and had to kind of circumvent all these changes. And once I got to a point where I figured out what worked for me, I was like, I can help other women figure this out because there is no one listening and I know you know this as well. You know, every single patient that is frustrated with the current medical model, it is because it is designed to fail us as individuals. It really is. You're given your your doctor or your nurse practitioner or PA is given 10 minutes. You get one complaint. The only way that they can oftentimes address your complaint is with a prescription medication. And let me be clear, there's a time and a place. But I think when you only have 10 minutes with a patient, you don't actually get to totally understand everything that is compounding what goes on in middle age. And how many women listening or men understand this? We're in the sandwich generation. My kids are 18 and 20. In 2024, I buried my father. You know, I've got aging parents. My husband has an a mom who has a lot of health problems. You're in this sandwich generation. You are responsible for kids and aging parents and other responsibilities. Most of us probably have more responsibilities at work. And you just feel the pressure from all ends. And so I think that it's a time when women get the opportunity to step up and in their power actually identify what works or doesn't work for them anymore. I think 70% of divorces are initiated by women at this stage of life. And so I think a lot of people go through quite a transformative experience. It doesn't have to be, you know, ending with ending a marriage. I'm not suggesting that, but I I think it's an opportunity for women to start advocating for themselves and actually demanding better care because, as you said, astutely stated, women really get the shaft. And and we have in many ways because the the research dollars up until 1993 were not focused on women. women's menstrual cycles were considered to be a confounding variable that researchers did not want to address. Not to mention the fact you have women in pmenopause where their estradile levels can be 20 to 30% higher than at any other time in their lives. Um they don't want to address these declining hormones and how that influences variables related to research. So I think menopausal women probably are included in more research right now, but I think in many instances it's the conversations that we need to be having with patients way earlier. Like I don't know about you, but I would love to be able to educate 25 and 30 year olds to have a sense of what to look out for because some women are experiencing pmenopause in their mid to late 30s and they're chalking it up to I'm tired because I have young kids. I'm tired because I'm, [clears throat] you know, my kids crawl into bed at, you know, two o'clock in the morning or, you know, I I'm just exhausted because I'm serving my family or other responsibilities when in essence, what they probably needed or need is a little bit of oral progesterone the week before their menstrual cycle, which might make them feel like a whole different person. And >> because here's the thing, you hinted at this earlier, but I want to say it very blatantly because first of all, let me tell every woman watching this, your doctor, and I can say this with a high degree of confidence. Your doctor does not understand female hormones. They [laughter] were they were inadequately trained. And I'm saying this because I used to be the same way. Only after years of reading and and trying and synthesis trying to figure out how all these things go together do you even begin to get a semblance of understanding. Okay. So, uh you've mentioned progesterone a couple of times and so for the average woman out there, you also mentioned early early onset menopause. for most women, which is forgivable because they're not doctors, but most doctors as well think that you're not in menopause >> until you start having hot hot flushes and night sweats. You're not menopause. Yep. >> This is wrong. This is false. Okay. The first hormone to nose dive is usually progesterone. >> Yep. >> The second hormone is usually testosterone. Mhm. >> So you can literally have 20 symptoms of being perry or premenopausal, but you don't have hot flashes and night sweats. Therefore, to the average doctor, you're not menopause. Nothing to worry about. I'm not checking your hormones. That's silly. It's all in your head. Here's some Prozac. You may think I'm making that up, but I promise you. Oh, I promise you I'm not making that up. That is that is standard of care in millions of doctor's offices around the world. So look up the symptoms of low progesterone. Look up the symptoms of low testosterone in women because testosterone is not a male hormone. It's a human hormone. >> Yeah. >> Also true for estrogen and progesterone. Men make and need both of those as well, but just at different levels. And so I think it's funny you mentioned this as well. It's so funny to me that during the menstrual cycle and during pregnancy, every doctor understands that the estrogen to progesterone ratio super important. Super important, right? Even to to conception, to implantation, to everything. But when it comes to menopause, the estrogen dominance, that's just irrelevant. That didn't make any sense at all. That's foolishness. How does it matter the entire woman's life except until she gets to menopause? Then it doesn't matter. >> Well, I think it I'm a doctor and I'm speechless. I don't even know how to explain some of the stuff that doc that comes out of doctor's mouths. >> Yeah. Well, I I think one thing that has really stood out to me in in working with tens of thousands of women having the honor of doing that is just the stories that I hear even now we're in 2026. I still hear stories that are astounding to me. People will say it's irrelevant to check any hormones. And when I say any hormones, they're talking about thyroid hormones, cortisol. It's irrelevant. There's no point in doing that. it fluctuates. And I was like, "Yes, they do, but that does not mean they're not worthy of checking." So, women feel gas lit. Um, I recall being told probably 12 years ago, uh, I was saying to my gyn at that time, "My menstrual cycles are really heavy." Not surprising to see in a relative low progesterone, high estrogen state. And I just so happened, it was my yearly exam, and she did an internal exam, and she said, "Oh my god, your period's really heavy." And I said, "I told you." And she said, "Don't worry, we can fix this oral contraceptives. We'll give you a progesterine IUD, which is not body identical progesterone. We'll do an ablation or you've told me you're done having babies. Let's just do a a hyerectomy." >> And I said, "Absolutely not." Like, first of all, I don't want synthetic hormones because I know for me how they make me feel. Um, how many women listening have been on oral contraceptives to prevent pregnancy and they think they have bad PMS? I was one of them. I didn't have bad PMS. it was because I was not on body identical hormones. But I I think for a lot of individuals, they're only given a few options. But really, what we should be suggesting to women if they come in and they say, "I'm anxious and I'm depressed and my menstrual cycles are heavy." And they've ruled out more concerning things. Shouldn't we think about a week of oral progesterone? Like start you conservatively at 50 milligrams. And the great thing about oral micronized progesterone is it's dirt cheap. Everyone listening, it's like5 to9 dollars a month. Everyone can afford that. And it drives me crazy, Ken. And I don't want I don't mean to get on a soap box. I understand that there are telemed companies that are out there that are doing a great job making uh hormone conversations accessible to women anywhere in the United States. What makes me crazy is when I know an estrogen patch can sometimes be $5 or $10 a month or oral progesterone's $5 to $9 a month that I see some of these companies and that patch is $150 a month and that oral micronized pro or that oral progesterone is now $100 a month and you go from helping women to suddenly you're putting them in a position where they're making decisions about, you know, are they buying groceries that month or are they paying a bill that needs to be paid or making their car payment and they really just need hormones. So, I I think there's a there's a multifaceted issue and it's number one, still this overwhelming lack of education and awareness. Number two, women being offered anti-anxiety and anti-depressants when they might just need a little bit of hormonal support. And let me be clear, there are absolutely patients who need an anti-depressant or an anti-anxiety agent. There's no shame in that. However, the question needs to be, is this simply a hormonal thing that's exacerbating these neurotransmitters? And and for listeners to understand that progesterone is intricately interwoven with this main inhibitory neurotransmitter called GABA. And serotonin is intricately interwoven with this hormone called estrogen or estradiol. And as those hormones are going up and down, you better believe the bulk of the neurotransmitters are produced in our guts. And if our gut isn't healthy and we have these hormones in decline, it is going to impact the way that we perceive the world and ourselves. And also, you know, this connection between the gut and the brain that someone some people think the vagus nerve is irrelevant. I don't know if you remember, Ken, but back when I was uh probably a new ER nurse years ago, a vagottomy was not uncommon where literally the vagus nerve would sometimes be severed purposefully and sometimes it was a whoops during a cardiac surgery. um this communication superighway between the gut and the brain. And so I think on a lot of levels we have done women a disservice assuming that all anxiety depression is specifically related to neurotransmitters that are decreased in the setting of less hormones. And you know I I just think about so many missed opportunities. How many patients I took care of in clinical cardiology that came in middle-aged, the 40, 50 year old women, anxious, depressed, not sleeping, they felt edgy, they were uncomfortable, they were weight loss resistant. And I remember saying, I remember a male cardiologist I work with saying to this patient that we shared, he was like, whatever her name was, let's just call her an, you're 45 years old now. It's not it's not unusual to gain weight. And that poor woman feeling gas lit and unlisted to probably slinkedked out of the office and probably felt like she had zero chance of being able to figure this out. And how many women >> were left millions >> Yeah. lived in the wake of the WHI. >> Yeah. And let's talk about that. And remember I said earlier that women have testosterone receptors on their heart muscle. Okay. I think that when we actually start to do some meaningful research in women's health, I think that we'll find out that keeping a woman's testosterone optimized decreases her risk of heart failure, heart attack. >> Yep. >> And I I don't know that because we have no research because nobody's done it. But once that research is done, I predict that we will find a reduction in the in the risk of heart attack, stroke, heart failure in women who keep their testosterone optimized, but the jury is still out on that. Uh you brought up the Women's Health Initiative. Let's talk about that. Um, doctors don't have much excuse for not understanding female hormones, but the Women's Health Initiative study, which was a humongous study, which I'm going to let you describe to everybody, basically the lead researcher had a preconceived notion, >> that that hormone replacement in women is just uniformly bad, by definition, bad. And even though the research as it was progressing did not show that at all, he stopped the study prematurely without the knowledge of his co-ressearchers. I've I've looked into this extensively over the years. And there even his co-ressearchers, they were emailing him like, "Dude, what do you why did you do that?" He's like, "I just I feel like it's bad." But the research, the data was not showing that. Well, I've stopped it. It's too late now. And so the women's health initiative, I want you to help women understand how this screwed their their mom and maybe even them too and not in a good way. >> Yeah. It's so interesting. So the women's health initiative came out in 2002. So I was a baby nurse practitioner and you know I was so far removed. I was in cardiology where I was told to stay in my proverbial lane. But really it was looking at uh predominantly not a healthy population. And it was looking at women that were 10 plus years into menopause. Many of them were former smokers, high blood pressure, diabetes, lipid issues. So this is not a healthy population to study to begin with. They did two arms of this study. There was one that was looking at conjugated ecquin estrogen, which is a fancy way of saying premer that is pregnant Mar's urine and uh they call it MPA, but it's a progesterine, so it's a synthetic form of progesterone. The other arm was simply looking at Premrin and they extrapolated from the data that estrogen or this conjugated ecquin estrogen was going to increase the likelihood of developing specific types of cancers. And so it went from looking at the data and and unfortunately whether we're looking at relative or absolute risk, they they manipulated the numbers in such a way that I think the prescriptions for hormone replacement therapy dropped by 70% almost immediately. You had an entire generation of provi prescribers. Let me be clear. I'm going to use the word prescribers because there are faux people out there right now that are telling giving medical advice who are not actually able to prescribe. So, let's be clear. Prescribers, a whole generation of prescribers that didn't learn how to prescribe hormones. A whole generation of women, the boomers, that were either taken off their hormones or were never offered the option of having hormones. So, talk about no fully informed consent. I mean, I recall my mother was probably my mom was late 50s and she was taken off of all of her estrogen and her progesterone and my mom has like mild osteoarthritis and she had debilitating symptoms and that was the same for all of my patients, the ones that were taken off of their medication. So from the from the WHI over the past, you know, 20 plus years, what has come out of that is you have an entire generation of women that are increased risk for heart disease, uh, osteoporosis, um, you know, poor brain health, poor metabolic health, not to mention the constellation of of poor, you know, I just think about the quality of life metrics that have been these women have gone without hormones for 25 years that were never offered the opportunity They were never given fully informed consent. And so I think about how many women didn't need to go on develop arhythmias or heart disease or have bone issues. Like both my mother and my mother-in-law, terrible osteoporosis and they do everything right. I think about how many of my family members have been in and out of hospitals because they have atrial fibrillation. Where do we see atrial fibrillation? In low estradile states. You know, much more likely to see a lot of these arhythmias um as as people are aging. Not to mention just the quality of life metrics if you if you if a woman goes without uh systemic hormone especially estrogen testosterone in the genital urinary system. So we're talking about increased risk of urinary tract infections. You and I both know what comes out of that squelli is eurospepsis. I think a statistic that I heard Kelly Caspersonson mention is that or uh using intravaginal uh estrogen alone would decrease hospitalizations and ICU care for our older population by like 70%. >> Absolutely. You and I know what happens if you get grandma ICU [clears throat] because grandma in ICU doesn't just have the the uricepsis. She ends up getting heart failure and she ends up having kidney issues and it just becomes, >> you know, this this kind of slow decline and and not to mention the fact the relationships that have been impacted because women aren't offered any hormones. when I say relationships, you know, sexual health. Um, we don't >> I wonder how much of the the boomer versus millennial versus Gen X kind of conflict is because the poor boomer women had their hormones taken away. >> Oh, yeah. Well, I I want I'll be totally transparent and tell you I have four aunts and um they talk very openly with me, all but one, very openly about what they perceive has changed because they've been without hormones. And some of them will tell me like sometimes I just don't think straight like I just struggle. And you start to understand it has a lot to do this metabolic health effects of this loss of estradile signaling and loss of testosterone. I mean testosterone is thought of as this libido hormone. It is a executive function hormone. It is a get your ass off the couch and get moving hormone. And so I I feel so badly for the boomer generation because they lost out. Now this does not mean anyone anyone listening with very few exceptions can start intervaginal estrogen like immediately like there's no in it is kept localized to the vagina. The issue is and I know you didn't ask me this but I'm going to mention it because I get asked this a lot. The concern is if you start hormone replacement therapy in a person who's 10 not really 10 maybe 15 20 years into menopause those receptors have been dimmed. So think of a receptor like a light bulb that got turned off. You try to turn the light bulb back on. There might be a lot of, you know, inflammation and disease progression that have occurred in the setting of those low hormones. And so uh women get very upset and they'll say, "Well, I wasn't given that option." And I said, "That is a that is criminal." But you can still do an evaluation. If you work with someone, you do a cardiac evaluation, you look at their, you know, their their risk factors, whether you're doing a CAC or CT angio or clearly which is an AI assisted CT angio or you're looking at special corateed studies or you're looking at lab work. I mean, you just need to work with someone that's willing to do that evaluation to then have a risk benefit conversation and fully informed consent. Uh because I I would be pretty pissed if I were a boomer. In fact, I would be I'm I'm mad for my loved ones because they're all incredible women and I'm sure there are women listening that are like, "Yeah, I'm I'm a boomer and I'm pretty upset about that that fact myself." So, that is why this conversation is so critically important because our generation is changing the narrative for younger generations. And jokingly, I have a 20-year-old who said to me, "Mom, um, someone approached me and said they had watched your listened to one of your talks or something about your podcast, and he said, I I'm so proud of you." He's like, "I know more about menopause than I bet most middle-aged men do." And I said, "Well, I don't know if I I'm embarrassed about that or I'm excited because it means you've been paying attention, but certainly subsequent generations are going to be so much more well-informed and they're not going to tolerate this." this like I I think I jokingly said they're going to have to pull like take my progesterone, my oral micronized progesterone out of my cold dead hands. Like there's no way we're going to stop any of these medications ever. But I think that the the biggest point is the WHI negatively impacted the care that we delivered to women. We let women suffer. And when I say suffer, I interviewed Aver Blum Blumble who wrote an incredible co-authored a book called Why Estrogen Matters is the title of the book with Carol Taver. >> He's incredible. He's a medical oncologist. >> Talks [clears throat] about his, you know, he's he's and he's an academic medical oncologist. I mean, he's just an incredible human being. And he said, Cynthia, the the medical establishment as a whole has allowed women to suffer. And he said if the same thing h if men went through something so drastic in andropause they would never tolerate it. And I said >> a revolution. >> Correct. Correct. And so I think now we're starting to see some of that but but I think what's coming out of this time period is that women are demanding better care which I think is really important because you know it's it's important to make sure that young women have access to contraception if that's what they want. They have access to decide when or when they want to become parents. If they do, they should have good access to care for pregnancy, postpartum period. And then somehow women, it's like they hit a certain age and then there's no access to to research or focus. And yet women are still really relevant. I think the the average woman is going to spend at least a third of their lifetime in menopause. You want your quality of life to still be high. You don't want to be put out to pasture and said, "Live with your dry vagina and your hot flashes and you know, your bones are going to crumble. and you're gonna get heart disease. I mean, no one wants to live like that. You know, low hormone state is not optimal. I mean, that's >> no, no one deserves to live like that. [clears throat] >> So, I hope that thousands of women hear your voice today and and and become empowered and go and talk to your doctor. But let me give you this, right? You need to know that there are many, many doctors out there, usually men, but not always, who still do not know that the Women's Health Initiative study was fatally flawed. They do not know that it's been reviewed and all but retracted. I mean, anybody who's [clears throat] looked into it, it's like, yeah, ignore that study completely. >> There are many doctors. So, if you go to a doctor to to ask about hormones and they say, "Well, I don't that you know, if you if you take hormone supplements, that's going to increase your risk of cancer >> or increase your risk of heart attack or increase your risk." Yeah, that's a huge red flag. That's not the doctor that's that's going to help you. You [clears throat] need to look for another doctor. There are many many doctors out there still like that. If you talk to your doctor about testosterone and they're like, "Oh, you don't have any sex." They just want to hang the testosterone harness just around your sex drive and nothing else. >> That's a big red flag. >> Yep. >> If they don't know what Cynthia just said, that testosterone is a mental executive function hormone. Literally, it gives you the drive, the motivation, the the the ability to think circumspectly and to reason and to think logically. That's what testosterone does for men and women both. If your doctor does not know that there is a brain component, that your brain fog, that your your muddled thoughts, that's probably because you have low testosterone, that's a huge red flag. You need to get back on the Google machine and find you another doctor because that's probably not the doctor for you. Because I I'm 100% with you, Cynthia. I want there to be a revolution in women just like there would be in men if we had to go through menopause. I want all women to be vocal and to not sit down and and stay quiet. I want you to stand up and speak up and say, "Hey, just because I'm menopausal or post-menopausal doesn't mean I'm not still a mom and still a wife and still a grandmother and still an aunt. I want to be able or a business owner or I've got a job or a career. I want to still be able to do all those things very, very well." And there comes a time when you just can't do that if you don't get your hormones optimized. Now, I could talk about hormones with you all day long, but I want to shift and let's talk about protein. >> Yep. >> Because another area where women get short drift is they don't get enough protein, but they're very often either misinformed that that it really doesn't matter how much protein you get, or it doesn't matter where you get your protein from. You can get it from broccoli or you can get it from, you know, beef. Really, it's protein's protein. It really doesn't matter. And I know that you've got some um strong educated opinions on the protein for women. Let's start from the beginning of how much protein does a woman need? Does a woman really need to think about how much protein she's getting? How big of a deal is that for her to age gracefully, strongly, sexually, etc., not just not die? [laughter] >> Yes. Well, I I think I I will tell you I have strong opinions about this and then I will talk to you about the science because I think when most of my patients hear the science piece, they're like, "Okay, this reaffirms that Cynthia is not just pulling this number out of thin air. We know the recommended daily allow allowance is enough to ensure we don't die. So we don't even want to think about that. My concern is always around and especially because I'm known in in the metabolic health space as someone that's a intermittent fasting expert and I always say here's the caveat. You need to eat enough protein that you're eating no less than 100 grams a day. For a lot of women they are not eating enough protein. That's why I think tracking macros for a few days or a week is critically important so you can objectively say I'm getting in 60 grams a day and I'm like that's way less than what you need. So we need to widen that feeding window and be very conscientious about doing it. So number one no less than 30 to 50 grams per meal. Why is that? Because as we get older we have something called anabolic resistance. We need more protein to stimulate muscle protein synthesis, which is a fancy way of saying, you know, stimulating. There's a amino acid called leucine, but we need enough to stimulate building and maintaining muscle. >> So, my very athletic I can't even say they're both teenagers anymore. 18 and 20 year old. They can probably >> You're getting old, Cynthia. >> I know. I'm like I I have two adult children, which is hard to believe. They're six feet tall and they're really big and muscular, but they're smart. >> I know. >> Yeah. So, so my kids, I jokingly tell them they could probably sneeze at 20 grams or 10 and they [clears throat] stimulate muscle protein synthesis because they're incredibly anabolic at the stage that they're still building very easily. Their, you know, their testosterone levels are high. But as we get older, we need more. And and the thing that's really important for us to understand is that as women are getting older, our relationship with carbohydrates needs to change. And the reason why I say this is I know that pasta and bread are fun, but what starts to happen is as we are losing muscle mass, we are losing insulin sensitivity. As estrogen levels are going up and down, we're losing insulin sensitivity. The type of carbohydrate that we choose to eat has to be very well thought out, which is why I'm a fan of like, you know, low glycemic berries and citrus fruits and, you know, uh, cruciferous vegetables. I think those are all great examples. So, I always say like you're thinking about the protein, you dial that in, and if you're not eating enough, that's okay. You can slowly increase that, track, and then adjust >> and then thinking thoughtfully about carbohydrates that are not processed, that are whole food carbohydrates. Find a few you like. Like for me personally, I'm a big fan of berries. I like just green bananas. I I think for a lot of my patients, they don't eat enough. They they eat too much fruit and not enough vegetables. And that's probably a separate conversation for a separate day. But back to protein. So 30 to 50 grams per meal, no less than 100 grams a day. You know, if you hear from some of the protein experts, they're like one gram per pound of ideal body weight. I just want women to get to at least 100 grams and then we can tease out the rest. But it's also helpful to know that as your estrogen levels are declining and your follicular stimulating hormone, which is a hormone that's secreted from the brain that tells your ovaries to release an egg, as that number is going up and your estrogen's going down, there's something called the protein leverage hypothesis. It's important to understand that if you don't eat enough protein, you're going to be standing in your pantry at 8 or 9:00 at night wondering why you are want to eat. And it's because your body, if you do not eat enough protein, is going to look for other ways to supplement the calories you are not consuming. Now, I normally don't talk about calories because I think macros are far more helpful. But if you're standing in your pantry or your frozen freezer or you're looking at, you know, the bag of chips or the ice cream at 8 or 9:00 at night, you've already had dinner and you're like, I'm not really hungry, but I feel like I want to eat. That is a sign that you have not eaten enough protein that day. Now, sometimes that happens. Like when I travel, I'm sure when you travel, Ken, it might be the same way. I never seem to get on my travel days, my my macros are off. So, I try to buffer that, but I think for a lot of women, it's helping them understand if you don't eat enough protein, your body is going to look for other ways to increase your caloric needs. And it's not going to be sitting down and have a plate of chicken and like broccoli, you're probably going to crave junk and crap. And that then disregulates your blood sugar more and impacts your sleep quality. And so, it just becomes this kind of domino effect. So, protein, protein, protein. And if you're intermittent fasting and you can't get your protein in, widen your feeding window. Most women I know cannot get 100 grams of protein into a four or a six hour window, maybe not even an eight. And I I think if your focus is if you're at a point where you're trying to build muscle, you probably need to have a very honest conversation. Like I have been very transparent that in 2024 when I lost my dad, it was very clear I needed to put more muscle on. And I now have 12 to 13 hours of digestive rest and that works just fine. People always ask, did I gain weight? I gained muscle. So yes, I gained some weight, but it's, you know, I'm leaner because it's muscle and not body fat. So there's always this [clears throat] body composition paranoia, fear that I hear from women all the time. I'm sure you do as well, Ken. And I always remind them like listen if your if the weight if you're if the scale goes up you have to think is it is it because I have more muscle mass on my body. That's why I think bio impedance readings are so important for women. I get them probably two to three times a year. It keeps me on check honestly. It's like I can say do I feel fluffy and I know my body fat has gone up and I need to like lay off the junk. I mean that does happen episodically. I'm not perfect but >> right >> you know it's also that honest checking in of how much muscle mass am I maintaining because that is you and I think about it right now from the perspective of it's important because we want to remain strong but you and I also know what happens the squelli of being sarcopenic or having that muscle loss with aging is that you eventually get to a point where you're frail frailty leads to falls and guess what falls leads to a loss of independence >> and a lot of people forget this you're not thinking about that in your 40s and 50s, but I'm telling you, you and I have taken care of hundreds and hundreds of patients. Sometimes they were the same age that we were. They couldn't get off a bedside commode in a hospital. >> Increasingly so, which I don't like, but that's just the truth of the matter. >> Yeah. >> Yep. And I I I love it that you're pushing this protein. I want to make one other point very clear to people because I know you know this. We always think, we always talk about muscle with regards to protein. But I want to make it very clear to every woman listening that your bone health, your bone strength >> will absolutely suffer. >> Yep. >> If you're not getting enough protein, your bones are 50% protein by dry weight. They're not just calcium. Okay. Your body builds this protein matrix and then puts the minerals, including calcium, in there. But without the protein, your bones are going to be brittle. They're not going to bend at all. They're going to break with just the least little fall. Osteoporosis, there's many, many things that increase your risk of it. One of the main risk factors in my opinion is not getting enough protein consistently enough for long enough that your your bones are just malnourished and they they get weak. Now, if you're watching this, you're watching a replay. This was filmed live in front of our private community. And [snorts] if it's okay with you, Cynthia, some of our tribe members have questions. >> Absolutely. >> Can Can we ask a question? Okay. So, if if you're watching this and you'd love the opportunity to ask questions to the experts that I have on this channel, consider becoming one of our community members. Here is uh let's do this one right here. This is Karen. Is 100 grams per day better than an average of 100 grams a day over five to seven days? So, for example, Karen some days gets 50 grams of protein. Other days she gets 150. Is it okay to average it out like that or should it be at least 100 grams every day? >> I love this question, Karen. Um, number one, I tell my patients good, better, best. And this is a great example, good, better, best, because if if you you know, I have some patients that if I say to them, you can't get less than X, that is what they will abide by. But let's be realistic. I'm sure Ken and I when we travel I know for sure I am buffering protein intake all day long. We're looking for consistency over time and I would say if you are averaging 100 grams over five to seven days I think that's fantastic and that's to be celebrated because you are part of a minority. I think a lot of women are grossly undereating their protein intake and it's really really important over time that we're getting much more conscientious. So, I would say we're looking at average over time and the good, better, best philosophy that applies to everyone. But I think that's a good kind of prevailing theme like I'm doing the best with what I have today. >> Yep. Love that. And here's one more. Uh, what about women or men who've had Rowan Y surgery and they just have this tiny stomach pouch and they can't do like I do and eat one gigantic carnivore meal a day or even two [laughter] giant carnivore meals. They they have literally a three pouch. How are they going to get a 100 grams of protein? >> I probably would suggest um essential aminos. I've gotten to be a big fan of these largely because I have many patients that are in similar situations or maybe they've got a little bit of gastroparesis which means they have slowed kind of gut motility. Um there's lots of brands that are out there. Ken, I don't know if you want me to mention one or two, but there's lots of brands that are out there and I I think it's finding what works best for you. I personally like capsules because I don't like the way uh essential aminos taste. That's me personally, but in my house, my kids will drink the powders, but like Keon makes a good uh brand. Uh, and the capsules are easy to swallow. Um, there's also companies like Perfect Amos. I think those capsules are harder to swallow. I think they're a little bit bigger. Um, but that's probably what I would try and and I would go from there just to see, you know, how do I feel? Because what ends up happening is I think it's seven capsules of Keon is like 35 grams of protein. that that might be a good way to buffer, see how it it works for you. But I would probably try that without stressing. I mean, you can consume things like bone broth, but but I find for a lot of the patients that have um their digestive system has kind of been uh in terms of quantity, they have to be careful about their quantity of food that they're eating, sometimes liquids can make them feel very full. Um but I would probably try the capsules and see how they do for you. >> Excellent idea. Now, on protein, there's this huge argument online about is plant protein equivalent to animal protein. Uh, I have my opinion, but I I I'm going to table that. I want to hear yours. Is it possible for a woman to eat a vegan diet and get enough protein, usable bio usable protein to meet your criteria? or do you think there there needs to be meat, eggs or fish andor in their diet? >> Yeah, I mean I they call it the omnivore's dilemma, but I I do think being an omnivore is a great option. Uh what I find is that with a lot of the sustained vegans, they end up having vitamin deficiency. So that's number one. Number two, the other great concern, and this doesn't mean that you can't have a little bit of, you know, if you like like you can add a little bit of lentils to a salad. I mean, I'm not talking about copious amounts. maybe add a little, you know, a tablespoon of beans on top of something. My other concern is that most of my female patients are no longer metabolically healthy. And that's when carbohydrates become a bigger conversation. And so if if you have to consume um if the option is consume steak versus quinoa, which I know everyone hates that comparison, but I'm going to use it because I know the stats on it. I think like a cup of quinoa might be like 38 or 40 grams of carbohydrate. And you have to eat a lot of quinoa to get to an equivalent amount of steak. So number one, the macros don't work. That doesn't mean that if you say to me like my favorite thing in the world is quinoa, I would say great, but keep the portions small and make sure you have animal-based protein on board because 30 grams is about my max. I will tell women because most of them again are not metabolically healthy. So working on that insulin sensitivity piece, it's like let's be mindful of your carbohydrate intake. That doesn't mean that you don't eat any because, you know, there's lots of wonderful vegetables and low glycemic berries which I think are great. But what I find typically is the problem is people will sit down and have cups of rice and cups of beans and cups of lentils and then they've really negatively impacted their macros. And so if you're losing insulin sensitivity and you're trying to buffer your protein intake, I would say if you can get it from animal-based protein and maybe you buffer with a small amount of plant-based protein, that is probably okay. I end up getting a lot of hate when I say this, but I'm like, listen, I say this with love. The math doesn't math. If you think you are going to have a hemoglobin A1C at nine and your fasting glucose is 175 and your fasting insulin is 20 and if you think you can continue on the path that you are, you're not heading in the right direction. So let's let's you know smaller portions of carbohydrate >> and increase your protein intake from predominantly animal-based sources and be really granular. Like a lot of us talk about eggs. Eggs are great. >> One egg is six grams. So, if you want to try to get to 30, you've got to eat a pretty good size omelette. You do. >> Um, >> you got to eat a Dr. Berry size omelette. >> Yes. Exactly. Or you've got to buffer it with, you know, sausage or some bacon or maybe you're having a leftover protein from last night. Like I think today I had for lunch I had a burger. I had a burger and I had some leftover chicken and I had some salad and that was, you know, because I wanted to buffer my protein intake. And so I think for a lot of women, I respect people that are are in conscious about about animals and how they're raised. I respect that. But at the end of the day, you have to do what's best for your body. And that sometimes means you may have to do a little bit of omnivore, you know, dilemma and and find the right balance of uh animal and plant-based and being conscientious about the carb intake. I know a lot of people get very upset, but if you look at the carbohydrate content of a cup of beans or a cup of rice or a cup of quinoa or any of these things, you have to get really honest with yourself and it maybe you have a quarter cup or half a cup or it becomes something you put on top of a salad and it's just something that you love and you enjoy. But you have to in middle age, the word pause is important. P menopause, menopause, you have to be really conscientious about rethinking your lifestyle choices. >> Yep. I totally agree. And I would I would just only add that if you're pre-diabetic or type two diabetic, that is so dangerous that put that increases your risk of heart attack and stroke so much that the other stuff that s Cynthia and I have talked about, you might not even live long enough to be able to worry about your bone density or your your post-menopausal symptoms because you've already had a heart attack or a stroke and you're now in the nursing home because pre-diabetes and type two diabetes are the biggest risk factor. And so I I agree with you, Cynthia. I I I understand and honor people's decision if they think it's unethical, immoral to eat other animals. I get that. But at some point, if you would like to take care of the uh familial animals in your life, like your children and your grandchildren, they're also animals, and your nieces and nephews, also animals. if you'd like to take care of them instead of being in the nursing home waiting for the minimum wage person to come and wipe your dirty butt and wondering why your your your little uh familial animals never come to visit you because your room stinks because you had a stroke and can't wipe your own butt. That's why. And so I I want to take care of all animals including my children and grandchildren who are also animals. And if that involves me having to eat some other unrelated animals in order for me to have my best health to take care of the animals that I love, I will do that. >> Yeah. And I I think that for a lot of individuals, it's helping them understand what is changing in the terrain of our bodies as we're getting older. And the gut has a lot to do with our metabolic health, has a lot to do with our immune system, our bones. I think a lot of people don't realize that an unhealthy gut leads to that, you know, that gut bone access. And I I think for a lot of people, it's it's it's helping them understand that everything goes back to the gut, whether we want to realize that or not. Um, and one of the ways that we can help support repair and uh reprocessing in our body is consuming adequate amounts of protein. I mean, I think a lot of people don't realize that amino acids are at the basis for our hormones, for our skin, cartilage. I mean, there's so many things. So, when I when I kind of bring that back to that conversation, patients will go, "Oh, yeah, that makes sense. Okay, now I can do that. >> Yep. Let's get one more question and then we can turn to the gut. This question, it's a this is a good one. Uh this will apply to millions of people. What about protein powders? You hear, you know, kind of the the scare stories that there's high levels of lead in some of the protein powders. Um my opinion is is the best protein powder is eggs and meat and fish. Uh what say you about protein powders? Should we worry about the heavy metals and other stuff? Are they a good option for some people? What do you think? >> Uh, well, I'm a realist. Uh, I think if you tolerate dairy, I probably would get the cleanest powder that is available. Meaning, it's just a couple ingredients. Um, you know, you can flavor it with some fruit. Like, you don't necessarily have to be adding copious amounts of sugars. But I I think that number one, I want to meet people where they are. And for a lot of people that might be like I have some patients that will say to me, "My protein shake because it's chocolate or vanilla or whatever flavor it is, that's my treat for the day." And it's not because they're adding junk to it. It's just it is something they drink and they sip and they enjoy because they're trying to buffer that 100 grams of protein. And so if you can get to 100 grams of protein all on your own, awesome. Some days I need a protein shake. I think if you tolerate whey, you go with whey because that that's a complete protein. There's a lot of other incomplete protein. So then you have to do the workaround. Do you need to have some essential aminos like bone broth protein for those that are dairy sensitive? I'm not a huge fan. I'll be transparent. I I have not had a vegetarian protein powder that I didn't dislike >> transparently. I mean, I'm sure they're out there, but I have never tried one I've liked. And I've tried I've tried to be, you know, the citizen scientist and try them all and I buy them myself. I don't have someone send me their [clears throat] free product. Um I have not found one that I like at all. So, I typically will say if that's what you need to get to that 100 grams of protein and you're otherwise doing a really great job, I think there's no shame in doing that occasionally. Now, yes, there's this heavy metal concern and that's why I think sourcing from some of the better companies that are out there. You know, no shade on Amazon, but I I don't think that's necessarily the best place to source things. There's companies like Maragold that use like New Zealand grass-fed whey. Um, and yes, they're going to be a little more expensive. I don't have any affiliation with them. I'm just mentioning, you know, one of the brands that I know is pretty clean. Uh but but I think it always goes back to make sure you're getting most of your nutrition from food first and then if you need to layer in a shake, I think that's okay. But again, it's >> I totally agree with you. I think a protein uh shake is a treat and I think most people, if they're being honest, they'd be like, "Yeah, I freaking love it. It's it's so tasty." Yeah. And I understand that. Uh, but try to get your protein from meat, fish, and eggs if you can. Okay, let's talk about the gut. Um, your book is called Menopause Gut. >> Yeah. >> And so I think that we'd be remiss if we didn't talk about the gut and the microbiome. How how in the world is the gut microbiome related to a woman's menopause? >> It's such a great question. Well, first let's define what the gut microbiome is because we didn't learn this when we were in school, did we? It's it's really been the last 5 to 10 years. So it's 40 trillion bacteria, viruses, fungi, prozzoa that reside in our large intestine or colon depending on who I'm talking to. So I just use both those words and they interface with every single organ in the body. And what I find fascinating is as we are so let's just back up even more. There's three key times in a woman's life where the terrain of her microbiome is heavily influenced by hormones. Not surprisingly puberty. Same things happen to men. Pregnancy, if you choose to become pregnant, and pmenopause. And as you can imagine, hormones ramp up in puberty and pregnancy. Hormones ramp down in pmenopause. And so, there's a lot of things that change in the microbiome that impact the body systemically, but a lot of people may not put these things together. So, as progesterone declines, that impacts like motility in the gut. So, women will say to me, "When I eat a meal, I just feel like it sits in my stomach longer." And if they're medical people, they'll say, "I'm worried about gastroparesis." And I'm like, "Well, before we worry about that," which is a terrible side effect from insulin resistance and diabetes. I'm like, "Let's try some other things first." So, as progesterone declines, you may notice slowed motility in the gut. Progesterone impacts our immune system. Progesterone is certainly important for neurotransmitters. I mentioned GABA, which is this main inhibitory neurotransmitter. And as that declines, you may feel more anxiety, more depression. obviously impacts sleep. Then you have estrogen on the other side and estrogen also impacts motility. It's very involved with nitric oxide production which is a potent vasoddilator. It's also a signaling molecule. And when we talk about heart disease and women, I think I suspect one of the main reasons why we see an uptick in heart disease in women in menopause is this loss of endothelial function vavv this loss of nitric oxide signaling. So very very important. Um, in fact, I laugh because I had this professor in college. Her name was Dr. Hart of all things. And she nitric oxide had just been discovered. This was the 1990s. And she talked about it nonstop. And I thought she was just, you know, it was like ad nauseium. Every semester we hear talking about it. And now I feel like I need to I need to actually acknowledge how important that was. I don't think I appreciated it enough. But as estrogen is declining, we get changes in gut motility. We get alterations in the immune system. And many people may not know that our immune system ages right along with us. So part of aging is the immune system aging. They call it amunosineessence. And estrogen is a potent immune modulatory hormone. Which means when your estrogen declines, you are more likely to get alterations in your immune function. So more autoimmune conditions. Four to five times more in pmenopause and menopause. We're likely to be less responsive to vaccines. That's based on research. That is not a political statement. Number three, it's we're much more likely to get opportunistic infections. And that has a lot to do with this decline in estrogen. And one of the things that I think is really interesting, uh, Ken, is that many women don't know what sets the pacemaker of aging in our bodies are our ovaries. And the gut ovarian access is really important. We know that there are things that age the ovaries faster. Not even so much related to the hormonal decline. It's just the role of cortisol which is not a per se a sex hormone but a very important hormone. So we just do all these this it's kind of like the domino effect changes in digestion changes in immune system regulation changes in insulin sensitivity we get reductions in something called short- chain fatty acids which a lot of people poo but I tell them all the time these are important signaling molecules and if you have less circulating short- chain fatty acids you're not getting signaling molecules that go to the brain. So butyrate is a short- chain fatty acid that sends information to the brain. Remember we talked about that gut brain access. Um there's more inflammation. I mean there's a lot that goes on that is in the absence of these key hormones. Testosterone also plays a role though the research on that is more around PCOS and how testosterone changes the train of the gut microbiome. But I think for a lot of people they're surprised to know that if your gut microbiome is relatively healthy, you're going to have less symptoms. You're going to have less vasom motor symptoms, less hot flashes, you're more likely to be able to process and package up and poop out your estrogen. It is that I'm oversimplifying the estrobolone, but I think for a lot of people, they're surprised to know that the gut really is this major I say it's the major quarterback of the body that you've never heard of. And I also say what goes on in the gut, it's not like being in Las Vegas. What goes on in the gut doesn't just stay in the gut. It literally intersects with every other system in the body. So if you get an opportunistic infection or you go on antibiotics and your gut terrain is altered, that can impact your risk of depression. I think one round of antibiotics can impact your risk of depression by up to 30%. Just one round. And how many of us have had multiple rounds of antibiotics? So >> we probably didn't even need >> correct >> to to add insult to injury. Um I totally agree with you. The hormone gut axis is huge. um probably 20% of the cases of gastroparesis that have been diagnosed as such could absolutely be uh progesterone deficiency that it has just slowed down the gut motility so much that it looks and feels like gastroparesis but it's just low progesterone that absolutely could be a thing. Now, with regards to the microbiome, do you think because you you you said this, I mean, we've only known about the gut microbiome for just a decade or so, maybe not even quite two decades. Do we know enough about the gut microbiome to be make to to be able to make recommendations with regards to diet? You should eat more of this for this particular bacteria, etc. Do do we have we made enough breakthroughs and discoveries in the gut microbiome yet to even be able to make those sort of recommendations in your opinion? >> Yeah. So I think there's there's a couple things that are important. We we talk about the role of polyphenols. So these are brightly pigmented fruits and vegetables. There's clear-cut evidence to show that these can be very important for feeding healthy gut bacteria because what starts to happen with this hormonal decline for women is suddenly we have more opportunistic organisms. the ones that create dispiosis or are much more likely to lead to leaky gut. And so these polyphenols, these kind of powerful compounds like things that are found in green tea and coffee, probably things everyone probably doesn't even think about, you know, potent. I actually have some uh some iced tea right next to me, iced green tea. Um >> yeah, these are not polyphenols, right? >> Yes. And that's actually why I drink green tea every day. I'm like, I don't necessarily love it, but it's really good for me. I think you know there are other types of potent signaling molecules that research has shown like uroliththna which helps with mphagy which is waste and recycling process of uh disease mitochondria which is another thing that's kind of at the basis I would say fiber you know and it's not that I let me be very clear fiber is very bio-individual every single person listening you probably tolerate a little more or a little less than the person next to you I think when we make blanket recommendations what would one of my patients would tolerate with 30 grams. Another one would be miserable and bloated. So, what I typically will say, just like I say, track your protein, track your carbs to get a sense of where you are. I think being conscientious about fiber intake and just aiming for a little more. The standard American diet is anywhere from 5 to 10 grams a day. And in talking to all these gastroenterologists and researchers, I keep saying like, why are we seeing so much colurectal cancer in the United States? A lot of their postulated hypothesis is they think it might be exacerbated by the standard American diet. this kind of lack of of fiber. Let me be clear about what fiber does because I think when you hear what it does, it helps explain why I do think that there's value in consuming some fiber in your diet. Fiber feeds the colonocytes and out of this the colonocytes will actually make these short- chain fatty acids that I mentioned earlier. They're anti-inflammatory. They're signaling molecules. They do a lot of other things, but you need a little bit of fiber to be able to support that. Our short- chain fatty acid production declines with these hormones. So what your body can buffer in your teens, 20s, and 30s, your body may not be able to buffer quite as effectively. I know that fiber can be controversial, but I think it's very bio-individual. So if someone's consuming five grams a day, we're not asking you go to 20. We're just saying like, let's get to 10 and see how we do. When people tell me that they're fiber intolerant, I usually will say, well, it's either the choice, the quantity, or both. You know, sometimes people want to take the supplement. Like I always think about inulin. I can tell you transparently, you know, Lily's dark chocolate might be a thing I eat once a month, but Lily's dark chocolate has inulin in it. Do you know what that does to my gut? It doesn't matter how small of a portion or not, it bloats me. I'm uncomfortably bloated. But I can eat vegetables and I have no problems. Zero. I could eat some lentils or beans, no problem. So, I think for each one of us, it's really getting granular about like is there a food-based product that you can try first before you add in Metamucil. Think all of us think about grandma's like Metamucil, that gelatinous gross mess. Um, you know, there's there's inulin, there's phggg. I mean, I get asked all the time about all these fiber powders. I'm like, not everyone tolerates them, you know, and that's why I think try to get it from food first and then if you need to supplement beyond that. But I do think given the research that I've looked at, that fiber piece becomes important because of the alterations in the terrain of the microbiome that are specific to declines in estradile predominantly, but also the progesterone piece as well. >> Cynthia, this has been in very enlightening. I appreciate you hanging out with us this afternoon. Uh, where can people find you and tell us once again about this new book? >> Thank you so much for having me, Ken. Always a pleasure to connect with you. So, probably easiest to connect with me on my website. It's www.synthialo.com. You can grab a copy of the menopause gut, which I am really, really proud of and excited about. Um, I'm Cynthia Thurlo NP across most social media platforms. And I do have a podcast called Everyday Wellness. And I think Ken, I think you've been on guest four times, which you might say I think I think you might be like one of those top tier guests that have been multiple multiple times. Always a fan favorite. Um, always bringing so much wisdom to my community. But thank you again for the opportunity to connect with yours. >> Absolutely. It's been a pleasure. Thank you so much. See you guys. >> Thanks.

Menopause is a confusing time in a woman's life, made even worse by bad advice from her doctor. Even today, many doctors still believe that hormone therapy increases cancer risk, when no research supports this. Listen to this hour and then advocate for your own hormonal health with your current doctor, or find a new doctor! Ready to Reclaim YOUR Health? Join us: phdhealth.community Cynthia Thurlow is a nurse practitioner, host of the Everyday Wellness podcast, author and international speaker, with over 15 million views for her second TEDx talk (Intermittent Fasting: Transformational Technique). With over 25 years of experience in health and wellness, Cynthia is a globally recognized expert in perimenopause/menopause and intermittent fasting, and has been featured on ABC, FOX5, KTLA, CW, Medium, Entrepreneur, and The Megyn Kelly Show. Her mission is to help empower women to live their most optimal lives in perimenopause and beyond. Metabolic Health is Possible for You: phdhealth.community https://www.cynthiathurlow.com/ https://www.instagram.com/cynthia_thurlow_/