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Ep. 407 Exploring Menopause: Ovarian Aging and Metabolic Health with Dr. Betty Murray


Today, I am excited to connect with my friend and colleague, Dr. Betty Murray. She is a women's health advocate, nutrition expert, PhD researcher, certified functional medicine practitioner, author, and speaker. 


In our conversation, we dive into the menopause controversy, looking at mitochondrial health, the development of visceral fat, aging, and senescence. We explore infertility, premature ovarian insufficiency, metabolic derangement, and poor metabolic health in menopause. Dr. Betty provides a fascinating overview of liver health and phases one, two, and three of liver detoxification, and we explain the critical role of bile in formal detoxification. We also cover the gut microbiome, estrobolome, the significance of enzyme beta-glucuronidase, and weight loss resistance. 


I am sure you will love this invaluable conversation with Dr. Betty Murray.


IN THIS EPISODE YOU WILL LEARN:

  • How menopause gets misconstrued as a natural state that women should endure without treatment

  • Why Dr. Betty believes menopause should be considered a disease state

  • How research on women gets neglected

  • Why personalized care is an essential requirement for women in menopause

  • How menopause affects various aspects of health, including heart disease, osteoporosis, and dementia

  • Why metabolic derangement occurs, and the domino effect it can create within the body

  • The role nutrition and lifestyle play in managing menopause symptoms

  • Why fiber, hydration, and adequate protein are essential for supporting liver function and detoxification

  • Dr. Betty explains the three-stage process the liver uses to metabolize hormones

  • The role bile plays in detoxification 

  • Why periodic detoxification is necessary for supporting liver function

 

“Most of the drugs given to women indiscriminately in conventional medicine have never been tested on women, and they are counterproductive in many cases.”

-Dr. Betty Murray

 

Connect with Cynthia Thurlow  


Connect with Dr. Betty Murray 


Transcript:

Cynthia Thurlow: [00:00:02] Welcome to Everyday Wellness podcast. I'm your host, Nurse Practitioner Cynthia Thurlow. This podcast is designed to educate, empower, and inspire you to achieve your health and wellness goals. My goal and intent is to provide you with the best content and conversations from leaders in the health and wellness industry each week and impact over a million lives.


[00:00:29] Today, I had the honor of connecting with friend and colleague, Dr. Betty Murray. She's a women's health advocate, nutrition expert, PhD researcher, certified functional medicine practitioner, author, and speaker. Today, we spoke about the menopause controversy, the role of mitochondrial health and the development of visceral fat, ovarian aging and senescence, the impact of infertility and premature ovarian insufficiency, the role of metabolic derangement and poor metabolic health in menopause, a dramatic overview of liver health including phase 1, phase 2, and phase 3 detoxification, why bile is so important, the impact on formal detoxification, the gut microbiome and estrobolome, the importance of the enzyme beta-glucuronidase, weight loss resistance and more. You will find this to be an invaluable conversation with Dr. Betty, and one I know you will want to listen to more than once.


[00:01:31] Welcome, Dr. Betty. Such a pleasure to have you on the podcast. I know we've spent quite a bit of time talking before the introduction, but I would really love to start our conversation around the menopause controversy. I feel like in many ways, if we speak about menopause as a medical condition versus a natural process, and how do we make sense and tease this out so that women can get the kind of care that they deserve to have without feeling like they've done something wrong. 


Dr. Betty Murray: [00:02:01] Right, right. So, I think you're absolutely right. We have this extraordinary controversy where on one side of the camp the menopause transition is just a passage of life, and we just need to buck it up and deal with it, and it's just what happens. And then on the other side of it, is it a disease state. So, I'm personally in the disease state camp, and I'm going to explain why. So, first off, we have to think about how women's research has been misused and actually not done, not even until the 90s. So, we didn't include women in medical research until the mid-90s because they didn't want our pesky hormones to mess up their data. And so, most of the drugs that we take for granted and we give to women indiscriminate in conventional medicine have never been tested on women. And in many cases are counterproductive.


[00:02:52] And so, when we look at menopause out of that lens. So, menopause is a natural state. It is a natural state of aging. However, we have to remember, surviving significantly after menopause is not a natural state. End of sentence. We are one of two mammals that live significantly after reproductive time. And so, in 1900, our average lifespan was 57 years. So, if you took a nosedive hormonally in your early 50s, who cares? Who cares if that accelerated aging in your heart disease and your osteoporosis and dementia because you died early anyway? But modern science and sanitation and medical science allows us to stay alive a lot longer, and menopause is the only state in the body that we say, “Oh no, that's natural, don't replace the hormone.” 


[00:03:44] Although, if your thyroid hormone fails to be made, we replace it. Insulin fails to be made appropriately, we replace it. Growth hormone in a young child who isn't growing appropriately because it's not being made, we replace it without question. But instead, in our clinical assessment and conventional care, we tell women, “Oh no, those symptoms are just something you need to have some cognitive behavior therapy around.” And all that is symptoms of hot flashes and night sweats. Don't worry about the fact that it's going to accelerate every disease of aging for you. And oh, by the way, your health span is poorer and you're going to live longer than your male counterparts.


[00:04:26] So, if we say that this is a hormone deficiency state, which it is and that it would constitute as a disease, it does two things. It allows our medical system and NIH and everybody else to put money into servicing women and helping identify how to treat it best. And it also opens the door to maybe that being covered by insurance and Medicare, because right now Medicare sets the standard and it says this is a lifestyle and preventative measure to make you feel better. Therefore, it is not something that is reimbursable. And I think that's the thing. We're not saying that women are broken. You're aging, you're living significantly longer than we were designed to live. And in this process, your disease states are going to increase. 


Cynthia Thurlow: [00:05:13] Well, I think it's so interesting because I know that I've gotten skewered on social media on a few podcasts when I've talked about menopause as a disease state, because I just want people to understand that you could be doing everything right. You dial in on sleep, you're eating anti-inflammatory nutrition, you're lifting weights, you're doing some joyful activity in your life, you have a loved one that you're close to. I mean, all the things that we know are so important. And even then, you will still have inflammatory changes, changes in metabolic health, if we live long enough, where you're going to have a dry vagina.


[00:05:51] I know that no one likes to talk about this, but I think the statistic for genitourinary symptoms of menopause, this is one of many things that can happen to us. By the age of 60, it's 70% of women. So, you just start to understand that it is a systemic change and are just like, when we go from prior to puberty into puberty, it's like we can become very, very different physiologically. And so, I love that you're speaking to helping people understand what kinds of services we can have access to, because, unfortunately, I still feel like the menopause space, even perimenopause space, a lot of things that women are offered have to be compounded. Yes, there are transdermal estrogen patches. There's oral micronized progesterone, which is not a sustained release formulation. It's immediate release. You can get compounded testosterone, but these things are not free. And the hope in the endeavor is that as we amplify women's voices at this stage of life, that more and more of these hormonal or menopausal replacement therapies will be covered by insurance.


[00:06:57] And that, I think, is instrumental in helping women advocate for themselves, because I still have women tell me things like, as an example, my whole background as an NP up until eight years ago was in cardiology. So, 16 years in cardiology. And a woman wrote in yesterday and said, “My internist said because I have heart disease, I am not able to have hormone replacement therapy.” And I said, “Well, can you explain to me what that means?” This woman had a pacemaker put in. She has a sinus bradycardia, so slowed heart rate. She has a conduction system disease. That is not cardiovascular disease. And so, I was helping her understand, like, this is not medical advice, but that is very different than knowing you have known blockages in your coronary arteries. That is very, very different.


[00:07:44] So, helping her understand that we just need to find the right provider for you in your area that can actually sit down and talk to you about your risk assessment, talk to you about the benefits of hormone replacement therapy, if that's appropriate for you, and then allow he and she or you and this individual to come to a decision about what is best for you long term.


Dr. Betty Murray: [00:08:04] Oh, no, I would agree because that's an electrical problem.


Cynthia Thurlow: [00:08:09] Conduction system.


Dr. Betty Murray: [00:08:10] Yeah, arterial plaquing. I agree, we have enough research today to show that, like you said, “We could be exercising, eating right, taking the right supplements, all of those things.” We'll have mitochondrial changes with the capacity to be able to utilize glucose. We have changes to visceral fat deposits. So, the fat underneath the muscle in your abdomen that increases regardless of what you're doing. And it doesn't come off from diet and exercise. Research already shows that. So, the personal trainers out there that are telling women they just need to work it harder are completely inaccurate.


[00:08:44] And then you've got the changes to the brain and the risk for the bones and increased arterial plaquing because of the loss of estrogen and then UTIs, all of that. This is compounding effect. And women get told that you just need to work it out and get over it. And I think as a medical community, we have such systemic misogyny in medicine that it's so rampant that we're constantly hitting up against a wall, and women get stuck in the crosshairs, and then they almost feel like they have to fight for their rights. You know what I mean? Like, it's this is a fight every single day and I don't think there's enough pressure on physicians and clinicians to stay abreast of current research. And so, women get gaslighted every single day.


[00:09:38] And I don't know about you, but I see it also on social media. I'm a nutrition professional, PhD. Believe me, if I could create a supplement that would replace hormone replacement, I would have it. I'd be selling it. [Cynthia laughs] There are supplements that can absolutely make the symptoms better and improve some metabolic function. But it will never, ever replace hormones that your ovaries no longer make. And that frustrates me. I know that's got to frustrate you. I see all these ads and stuff, and I want to scream from the mountaintop, like, “That's not going to replace these hormones just because your hot flash has got slightly better.” It just doesn't. 


Cynthia Thurlow: [00:10:13] Yeah, well, and it's interesting, there was a person who will remain nameless on social media who was talking about, “Just increase your carbohydrate intake. That will help bolster your progesterone.” And I thought to myself, if you understand the role of ovarian aging. So, ovarian senescence, what is interesting is that women’s biological clock is really attuned to our ovaries. That is what drives aging in our bodies as females. And so, I find it so interesting when I’m like, “If people understood that at a very basic level, it would make sense as to why.” What are those beginning stages of perimenopause symptoms as you have less circulating progesterone, anxiety, depression, insomnia, the crime scene bleeds that all of us experience, which made us miserable. 


[00:10:56] And you would pray that or at least I used to pray I would not start my cycle while I was rounding on patients in the hospital because there was not enough pads and not enough tampons to save me. But helping people understand that, the role of these aging ovarian senescence, these circadian clocks, these clocks in our bodies. Let's speak to this because I find this really interesting, that this is the main driver of aging in the body. It is what distinguishes us as women. And I think the more that women understand that our ovaries really are the spoke in the wheel, if you will, that's driving a lot of the symptoms we start experiencing in middle age. 


Dr. Betty Murray: [00:11:33] Yeah. You know, so we have to think about it from a very simplistic standpoint. We can get really technical and talk about egg supply and ovarian reserve. But we have to remember Darwinism here, what does nature want? Nature wants us to reproduce and continue our species on the planet. We only need one man on the planet honestly. [Cynthia laughs] Truly, we need a whole lot of women. He might need to look like Brad Pitt. I'm just joking. But the reality is we need a lot of women in fertility that can keep the species going. So, our entire biological clock is wired to how fertile are we? And when that ovarian reserve, and I like to think of it as a very simplistic terms, it's like an egg carton. 


[00:12:13] And we're born with the number of eggs in our carton. And as those eggs get used up, the carton shrivels, it starts to fail, hormone stop getting replaced. And when the egg carton is gone, it's flat out gone. I don't know about you, but I started showing symptoms of perimenopause, the sleep, the anxiety, the irritability, particularly the insomnia. I started showing that in my late 30s. It was early and even in the functional medicine community, because I've owned my clinic for 20 years, everybody told me that, “Oh, no, no, no, no it can't be that yet. Yes, your progesterone's declined, but you're not really in menopause yet, you're just too much stressed. This is your progesterone.” But that's not necessarily true. 


Cynthia Thurlow: [00:12:58] Well, and I think you bring up some really good points that helping us process and understand at a very basic physiological level. I love the egg analogy because I think all of us can think about that from the moment we are born, we are born with a finite amount of eggs and from that point forward, we are losing eggs as we go. And each month-- It's interesting, I was interviewing Dr. Stacy Sims last night and she was saying that “When all three of us were growing up in the 70s and 80s that maybe two to three cycles out of an entire year when a woman is fully matured, she was anovulatory, meaning she did not release an egg. It is now four to six times a year. 


[00:13:38] So, you start to think about the net impact of less ovulation, on fertility, on procreation, on all of these levels. And you just start to understand that in many ways, our modern-day lifestyles have a significant net impact on our ability to procreate, reproduce if we choose to, and then also ultimately does that hasten our progression into a state where we're now seeing so much premature ovarian insufficiency, which we used to call ovarian failure. Now they have all this different terminology, but we're seeing it in younger and younger women. And the significance of a woman going into POI at 39 or 40 is catastrophic versus average age of menopause here in the United States is 51. That's 11 years of your lifetime that you were exposed to less sex hormones, more impact on brain, bone and heart health, which I think for many individuals, they may not realize is potentially catastrophic if it's not caught and addressed pretty proactively. 


Dr. Betty Murray: [00:14:47] Oh, absolutely. Like I said, I've been in practice for 20 years, so I have this really long trajectory of just watching anecdotally what happens. And 20 years ago, I spoke to people about infertility in their late, late, late 30s, early 40s, they had waited to have children, and now they're really working on infertility. We routinely in our clinic have people come in their early 30s with a diagnosis of POI, and you go, “Okay, what's happening?” And we have all these endocrine-disrupting ingredients and chemicals in our environment that not only look like estrogen and mimic our sex hormones, but have a profound effect on how our body packages those to get rid of them. We have an extraordinary amount of stress compared to even 30, 40 years ago, which alters that sex hormone pathway pretty heavily.


[00:15:36] And on one side, we have more awareness. People are looking and trying to figure out if this is an issue, but there is an endocrine problem that a couple generations out from now may be very catastrophic, truly.


Cynthia Thurlow: [00:15:49] Yeah. It's so interesting because I have colleagues that are working with younger women that are saying, “We're seeing a lot of POI in women that have underlying autoimmune condition post pandemic.” I don't even want to talk about vaccine issues, but it's interesting that they're starting to see over and over again, these younger women, 20, 30 something women that effectively have no menstrual cycles, and they're not on the pill, they're not on an IUD, and as they're doing a workup, they're realizing they've got latent underlying autoimmune conditions that are driving some of this premature ovarian insufficiency issues, which again, we know if you go into premature ovarian insufficiency or even early menopause, it just magnifies the long-term effects that you can undergo if you are not being appropriately treated and managed. 


Dr. Betty Murray: [00:16:40] Absolutely, viral infections are an absolute trigger. And it doesn't matter which virus, really, honestly, we have research out there showing all viral infections are one of the many causes of autoimmunity, which, of course, affects women 10 to 1 to men, but particularly that one, COVID really did have this affinity for reproductive organs and impact both on testicular function and ovarian function. And I think, I haven't done a deep dive in the research, but I think if you were to really dig in, and over the next several years, we're going to understand much more deeply what really happened there. But I think that's a catalyst. And now we're almost four and a half years out and we're starting to see it more and more. 


Cynthia Thurlow: [00:17:21] Yeah, I think we're just seeing the tip of the iceberg. I know that people like Dr. Anna Cabeca, multiple times has shared with me that she had women 10 years into menopause that started bleeding. And so, I think there's more to this hypothalamus-pituitary-ovarian axis or even adrenal axis that we're just now learning, the net impact of specific viruses. Now, one of the things that I think is so fascinating to me as women are navigating perimenopause into menopause, is this use of the term metabolic derangement. I think about changes in metabolic flexibility, but let's speak to some of the high-level concepts as to why this is happening, because I think for women that are listening, it'll help them understand the net impact of this change in estrogen levels, how that impacts insulin sensitivity. It is not so straightforward. It has this domino effect in the body. 


Dr. Betty Murray: [00:18:14] Yeah. So, this was one of the things. So, I went back for my PhD, among many, many reasons, I came to functional medicine because of autoimmunity. So, this is a second career for me. But I can tell you my 40s were terrible. I gained 35, almost 40 pounds in my late 30s to early 40s, like, overnight, having been in the bodybuilding world for eight years. So, I knew how to manipulate body composition. And when I went back for multiple things. I went back from multiple things. I wanted to understand hormone metabolism, but I also wanted to dig in while I was in all that research and look at what happens metabolically. 


[00:18:47] So, we throw out the idea that estrogen, either extremely high in a perimenopausal state or extremely low in a menopausal or just the cusp and postmenopausal state, can drive some insulin resistance. But the mechanism was never really talked about. We throw that out there. So, if you don't understand the mechanism, you don't actually know how to address. The root cause is not just insulin resistance, it's where is it occurring. So, a couple of the things that I found when I was looking in my research is we have our mitochondrial function, our powerhouse in our cell. Insulin's job is to get it across the wall, get glucose there and help it move. 


[00:19:22] Well, the GLUT4 transporter, which I like to think of it as like, chutes and ladders, it's a very low-grade ladder. It's a passive transport, so it doesn't speedily take things into the cell, into the mitochondria. Well, estrogen has a direct impact on the GLUT4 transport. We start to lose that. Your significant mechanism, getting glucose into the powerhouse, has now slowed. So, think of it as the slide that had a really high pitch is now flat or almost flat. So, it's like a slow roll. So, you may be doing all the right things, but your body is actually less efficient with the insulin at the mitochondria. And then if we look at even adrenal receptors. The other thing is, women hate what we call the jiggly bits, the subcutaneous fat. We don't like that. 


[00:20:08] We get deposition there, too, as estrogen levels increase during perimenopause. And then, obviously, as estrogen levels decrease, we now get the increase of visceral fat in the abdominal cavity. Well, the adrenal nerves and the receptors for those adrenal nerves that are there to stimulate adiponectin, hormone sensitive lipase, all of that are also estrogen sensitive. So, the fat that we can't stand, that jiggles on our hips and thighs and lower abdomen is kind of first on, last off anyway. But when our body is in this perimenopause to menopausal state, that innervation has now gone to sleep. So, we feel like we're just banging our head against the wall, trying to do all the things that worked when were in our 30s. The other thing that I found that I thought was very interesting. 


[00:20:54] I know you've had Rick Johnson on your show, who I just adore, just, just adore. Uric acid levels and a menopausal woman climb significantly, which we know is a mitochondrial barometer for do we turn up mitochondrial function? And so, when you add that to this feedback relationship with insulin, and you add that to the increased inflammatory fat and the cytokines and all that other stuff the visceral fat are up to, the reality is without addressing hormones and getting hormones back on board, you are fighting somewhat of an uphill battle. I mean, the stats show that the average woman in menopause at that time period will gain 10 to 15% of their body fat. So, if you're 150-pound woman, that's 15 to 20 pounds off the bat. And then we go “Gosh, you know what's going on?”


[00:21:48] And so, we may not love the way we look in the mirror, but the other thing is all of that is driving disease activity. It's funny, my marketing people and everybody like “Betty, nobody cares about their long-term health. They just care about what's happening now.” And I'm like, “I consider it my nursing home avoidance plan. [laughs] I don't want cardiovascular disease and a stroke. I don't want dementia. I don't want osteoporosis because all of those things lead to potential time in an assisted living center.” And I think that's the other side is we have to identify and also recognize that all of those things are part of that and it's all metabolic. 


Cynthia Thurlow: [00:22:27] Yeah. it's so interesting to me. And when I think about GLUT4 transporters, I think about muscles and the role of sarcopenia, this muscle loss with aging and how critically important it is to maintain and build muscle as you are navigating your 40s, 50s, and beyond. And I've spoken very openly, one of the things that contributed to my dad's death this summer was frailty, sarcopenia, malnutrition. And as good as I am about working out, I actually hired a trainer and I told the trainer, here is my goal, 5 pounds of muscle, that is the goal. And she works me hard and not in a bad heart. It’s a challenge to my muscles but not so that I’m wiped out and I can’t function the next day. 


[00:23:08] The workouts that I did in my 20s and 30s that I would hate to do now because it would just thrash the adrenals. But understanding that role of those GLUT4 transporters that has that connection to estrogen, also has that connection to insulin sensitivity. So, when we suggest to women walk after a meal, helping them understand, it's a way to actually utilize some of this glucose. It's like a glucose disposal system in some ways and helping people understand, like these are the things we must do. I used to lovingly make fun of neighbors that would walk after they ate. It was very much this kind of cultural thing, you would see people walk in the evening and I said to my husband, they were brilliant because it's one of the best ways to help with insulin sensitivity, glucose disposal, making use of those muscles, hopefully you haven't lost them all. 


[00:23:56] And understanding that so much of this is within our control. If we live long enough, we will eventually lead into menopause. Men go into andropause, although it's not nearly as traumatic. But people understand like there's ways to do this proactively. So, you don't have to be fearful, you don't have to be scared. I'm almost grateful I knew less in my perimenopause journey than I do now because I feel like perimenopause was wild and tough and challenging, just like you said. “I gained a bunch of weight seemingly overnight and everything I used to do no longer worked.”


[00:24:28] And yet now retrospectively looking at it, saying, what can we do to help women prepare for this transition but not fear it? Because I think for so many women, and you talked about changes in fat deposition, we are more prone to visceral fat, and visceral fat is what's around our organs. We have to work out differently in menopause to address the visceral fat piece. This loss of lean body mass and this gain of fat mass is a natural progression if we are not actively working against it. Do you find that in the research, in the literature, given the fact that women have been left out? 


[00:25:07] I think it was 1993 when things kind of improved, but still there are all these exclusion criteria. Women can easily be left out of medical research, which is unfortunate. But do you feel like, because there has been a magnification of supporting women through this menopausal journey, I feel like there's so many of us that are now speaking up, speaking out, trying to educate providers, trying to encourage women to advocate for themselves, to not take no as answer for navigating this time in their lives. For you personally, do you feel like there is more research that is being reported, that is being focused on to help women make decisions not just from a personal decision making, but being able to amplify the benefits of not just lifestyle, but also hormone replacement therapy? 


Dr. Betty Murray: [00:26:00] Yeah, so you're absolutely right. It's interesting because in 2021, there was an uptick in expenditure for Women's Health Initiative-related research, specifically on women. Because the other thing is, I personally believe that we need two additional arms. We need a male arm and a female arm to actually judge, particularly medication approval, because things can get lost in the data. And believe me, and you very well know this, they'll just quietly bury the individual age-related, sex-related differences. And if they can get the stats up enough, a drug will get approved regardless if it was good for everybody. There's just too much bias in that industry. So, in 2021, there was an uptick. Interestingly enough, by 2023, it also went back down, but the Biden administration earmarked $127 million.


[00:26:47] Melinda Gates just admitted that she was going to give over a billion dollars to women's nonprofit research. We also have an ARPA-H initiative, which is not actually grant dollars, but it's investment dollars into Women's Health Initiatives with some very specific things. So, there is an effort to put more money and more resources towards women's research. And we have had some very strong studies come out in the last two years that really call into question the dogma that we've had over the last two decades. This is a passion project for me. It's actually why I started my telemedicine company and an entire technology, digital technology arm. I went back to get a PhD to understand how to do research. And I was like, “I'm going to contribute to the research.”


[00:27:33] Because the reality, as you know this, from being in the functional medicine community, we have so much data, but that data isn't being assimilated and pulled into a way to be able to help give directive, because there's just not money in it. And so, I'm trying very hard to do that because I think until we see that, we're going to have this continued bias and this continued lack of change in the medical community. And I do think the other thing is, I'm pretty passionate, and it comes out on my podcast. And I really think that women in this age group, we have the opportunity to change the entire industry, the entire world, honestly. 


[00:28:15] Women have more buying power. Women make 87% of the buying decisions in a household. Let's face it, what mom does improves an environment. We know that even from small micro investments in other countries, as soon as you give a woman money and help her make money, the entire family and community changes. So, the reality is we collectively, particularly women in this age group, can radically change what's happening if we step up and demand. So, that's my other side, my other not political, but very much, let's move as a group to make things happen, because we can. We don't have to accept how things are today. We can change it with money. 


Cynthia Thurlow: [00:28:54] Well, I feel like our mother's generation probably accepted a lot. They were directly impacted by the Women's Health Initiative. I just started practicing as a nurse practitioner in the 2001 timeframe. 2002 is when the WHI came out. And although I was fairly shielded from a lot of it, my patients that would talk to me about how their estrogen patches were stopped, how they no longer were allowed to take progesterone, how their sleep was impacted, their joint pain. Gosh, in cardiology, I mean, you want to talk about lighting a match? I mean, the degree of inflammation, oxidative stress, progression of plaque formation. I feel like our mother's generation deserves for us to amplify our messages so that subsequent younger generations are able to make really good decisions for themselves. And it could look different for everyone. 


[00:29:45] I will be the first person to say educate, inspire, empower, but allow women to make the best decision for themselves, understanding the ramifications of whatever their choices are. I always say, “HRT is right for me, it might be right for you. There may be someone else who says that’s not what I want to do, and that’s okay. But helping women understand they do have choices. There’s not going to just be this blanket statement that, hormones are bad and therefore we should avoid hormones because they’re so problematic. We won’t even go down the rabbit hole talking about the WHI and why that was such a problematic study design in terms of study participants and etc. 


[00:30:24] Now, one thing that I know you particularly like to talk about, and we probably have not gone into too much detail, is talking about the role of the liver and processing hormones, why it is so important. This is not just woo-woo. We're going to go do a detox, although, there are things we can do to support the liver and detoxification, which are real things that go on. Let’s unpack why the liver is so important vis-a-vis hormone regulation and maybe some high-level explanations differentiating phase 1, phase 2, phase 3, because some of these terms might be new for a lot of people, but do it from a high-level perspective so people can have a better understanding why the liver is so important. 


Dr. Betty Murray: [00:31:09] Yeah. So, for me, I’m a real logical person. So, what always confused me was our hormones are perfectly fine when we're young and fertile, giving high doses of birth control to control reproductive rights, completely normal. But something magical happened at 50. And all of a sudden it was like, “Those are now deadly.” And I was like, “Well, that doesn't really make sense.” But the other part of it was that when you look at particularly breast cancer risk, ovarian cancer risk, it all accelerates radically when you go through menopause. And I'm like, “Okay, so if the party line is estrogen, your estrogen causes it, then 20-year-olds should have cancer, not 55-year-olds. So, my next obvious question was, what causes that uptick or what could be a potential cause? It’s a hard thing to prove out in science, honestly, but what could be potential contributors to that disease risk? 


[00:32:05] And really what the research points to as a potential player is the complex environment and complex process that our liver has to do to sort of, I like to think of it as wrapping up these hormones and toxins and other things that look like hormones to prep them, to get them to the dumpster. And this is a huge area of genetic variability. So, we've been doing genetics in my clinic for well over 13 years. And, one person may be great at it. And I like to joke that's the person with the Keith Richards genes. How does that guy--? You know what I mean? [laughs] Like, “How does he live like that?”


[00:32:42] Whereas if somebody else has one glass of wine and gets near a cigarette and can't function for three days. So, some of that is we just either won the genetic lotto or not. So, in the liver, we have a three-stage process that the liver goes through to package hormones, and they're very, very nutrient dependent, and they're also genetically dependent. So, let's take estrogen, for example. So, think of your estrogen as maybe it's a marker. I like to use this as an example. It's a marker, it's broken, it's leaking, you don't want it anymore, you've already used it. When you take it to the liver to get rid of it, the first step is designed to basically take a fat-soluble molecule like estrogen and make it water soluble, because then you can move it to the next stage. 


[00:33:27] So, we have one gene, the CYP1A1 gene that produces a metabolite called 2-hydroxyestrone. Don't have to remember that-- All you have to remember is that's the clean metabolite. So, think of it as, I've got that highlighter, I've got a green wrapper around it. Lots of green. It's the three little bears. That's the porridge. That's the best. I have another gene, CYP3A1 that makes a blue wrapper. Not so great. If I make a lot of that estrogen metabolite called 16-alpha-hydroxyestrone, I'm going to have a metabolite that is what they call proliferative. It can go cause cells to remake themselves again and again and again if it's excessive, then I have another route. It's CYP1B1, which makes 4-hydroxyestrone, which can attach itself to DNA and cause software damages. 


[00:34:20] That makes the cell replicate in a way that's not appropriate, which can cause tumor growth. Depending on how you're wired genetically, you either make a lot of green, a little bit of blue and a little bit of red, or you might make more red than you do blue or green. Now, that doesn't get it out of the body. You next have a gene called co-methyltransferase that needs to wrap a pink wrapper around it and that is nutrient dependent. It's folate, B12, B6, B2. It is dependent on your nutrition. And so, depending on how much of that I have, I either wrap a pink wrapper around it or I don't. And if it can only get to that point and it doesn't get the pink wrapper on it, it's going to get recirculated. 


[00:35:00] Once you have the pink wrapper on it, it has two more routes t can go. It can go to the glucuronidation pathway, which is basically the next stage, stage 2 to 3. And that's a black wrapper. Estradiol, which is your ovarian hormone, preferentially goes to estradiol, goes down glucuronidation and then goes into the stool through the bile to get excreted. Estrone, which is your other estrogen that you make and your fat cells make more proliferative, is a more inflammatory hormone and it has a preference to go through sulfation, which is an orange wrapper and that gets excreted through the urine. When we're fertile, we have a lot more estradiol and a lot more in the glucuronidation pathway, a lot more black wrapper. When we're in menopause, we shift towards more estrone.


[00:35:50] Our fat cells make it because our body needs that estrogen. That's the thing that people need to understand. Our body needs estrogen. It's screaming for it. So, we make more fat, we have an orange wrapper. And depending on how you eat, how you're genetically wired, it now gets to the dumpster. That's dumpster zone and it must go in order. So, the other thing to know is your pesticides, herbicides, plasticizers, BPA, all of that stuff, phthalates, all of that hit those same pathways. So, if you're not good at the wrappers and you can't do them in order, you don't get it out. And it ends up getting recirculated either from the stool or from the liver itself back into the bloodstream. So, ultimately what you get is a broken half functional estrogen like molecule now clicking into receptors that want a real estradiol. 


[00:36:42] And so that is where I think the next frontier is in understanding women's health, cancer risk and a hundred other things. And, I spent my entire research PhD digging around in that, and particularly what happens with the microbiome. And we just don't put enough focus there. But I think the big thing other people need to realize, too, is that what we eat, the nutrients we eat, the foods we eat, can shift the balance of how you move through those different wrappers. And that's the beauty of testing things like the DUTCH test or a 24-hour urine hormone metabolite. We can see it and watch it and manipulate it. 


Cynthia Thurlow: [00:37:21] What a great analogy, the wrappers, I think that allows people that are visually attuned, okay, that makes sense. You touched on bile. Why is bile so important? I think it doesn't get enough respect. I think we think about it breaks down and emulsifies fats. But there's so much more to bile that I think is really important. Understanding how we process and package up hormones.


Dr. Betty Murray: [00:37:45] Yeah. So, bile is made in the liver, and it contains all these metabolites. So, all these wrapped up ingredients, are basically encapsulated in the bile and then excreted into the gallbladder, if you still have it and expelled into the small intestines. And, yes, it's there to emulsify the fats, and it's there to help you digest and break down fat soluble vitamins, but it's also the exit route. So, I also think of it as the sewer system. It's the flood from the sewer, and it needs to get bound to fiber in the stool. That's how it gets bound up. And then most of it gets excreted in the stool. But then we have some of the bile acids get reabsorbed. They actually exert some behaviors in the body, and then the body can reprocess them, which gets done in the colon. So, colon health starts to play a role, the microbiome starts to play a role. And you're right, we don't pay enough attention to the importance of bile acid metabolites and then how we absorb them. 


Cynthia Thurlow: [00:38:42] So, interesting, because I feel like there's a supplement called TUDCA. It's an acronym, but it's long and complicated. But that has been life changing, not just for myself, but so many of my patients and clients, because the bile is not, as you appropriately stated, just about breaking down and emulsifying fats. There's this interplay between their mitochondria and brain health and all these other things, it's like bile is just thought of as this green, yucky, viscous substance, and yet there's so much more to it. I think back, I actually pulled out my pathophysiology book from 100 years ago, I mean, I think there was like five sentences on bile. It's just not respected. 


[00:39:28] And yet, I think for so many women, if we can optimize bile, it helps with detoxification, it helps with brain health, helps with mitochondrial health. I don't know if you agree, but it's just been my clinical experience, not even looking at the research, that this is one of these substances that or supplements that if utilized appropriately in the right patient, can have profound systemic effects. 


Dr. Betty Murray: [00:39:50]Yeah, it's a taurine bound bile acid, basically, but it's anti-inflammatory. So, it improves the viscosity or the liquidness of bile, if you want to call it that. And it's anti-inflammatory. Very, very helpful. You know, and how many women have had their gallbladder removed? That's a standard. My husband was, as a firefighter, paramedic recently, stepped away and is retiring. So, everybody listen to this, if they're over 40, Caucasian with abdominal pain, it is gallbladder until proven otherwise because hormones have an effect on that entire system. And I don't think we've dove in deep enough to that, but it's predominantly a women's problem compared to men.


[00:40:32] And the other thing I think about, I have a colitis history. That's actually what brought me to functional medicine. And one of the major things you see with, whether it's diverticulitis or colitis, Crohn's potentially is bile acid malabsorption. And we look at that, and we go, okay, so it might cause diarrhea and damage and change to the colon and intestinal walls because it can be inflammatory if it's not reabsorbed. But then also, it's like, what happens when you're not reabsorbing all those bile acid metabolites? And are they changing things like cognition and mitochondrial function? We don't know that. At least not any of the research that I've read. 


Cynthia Thurlow: [00:41:09] Yeah, it's so interesting, these little nuanced. And we used to have an acronym which isn't very kind, but when I was an ER nurse in my past life, it would talk about a female, 40, flatulent, obese. Almost always, if they came in with abdominal pain, it was gallbladder mediated. They would probably tell you I went and had a fast-food meal. I came in, I presented with this discomfort, waxes and wanes, almost always the gallbladder. And unfortunately, I think in many instances we’re so quick to remove organs without fully appreciating and understanding that losing an organ is not in and of itself the end of the road. However, every organ is necessary if we can find a way to fine tune, adjust lifestyle. 


[00:41:56] Just like I've had my appendix removed, and we jokingly used to call the appendix a vestigial organ, meaning there's no need to have it. Little did I know until after I had it removed has all these important immune system properties. And so, before we pull out organs, let's make sure we definitely, can't do a workaround. So, when I'm thinking about this process of detoxification, it is not just a program we put in a box that we utilize to support someone. What are some of the things that you have found to be most effective beyond testing, specific to perhaps nutrition and lifestyle that are instrumentally important to support this process in the body? 


Dr. Betty Murray: [00:42:39] Yeah. So, I think you of mentioned the detoxing. I think periodic detoxification where there's a bland support for liver function is always a good thing. But the reality is as soon as you detox, you re-tox, right? [laughs] You go outside, you come in contact with something, you're in your house, and things are outgassing. So, there's always this level that we need to support liver function. And I think some of the very basic things often get overlooked. The cool biology chemistry stuff is always exciting, but the basics need to happen. So, I always think about first, you can't detoxify your liver or anything else until you make sure the gut is functioning properly. So, if you're constipated, stuff's going to get reabsorbed anyway, right?


[00:43:22] Because think of it as you have a trash can, your house is 97.8 degrees, you left on vacation, and you left that trash can full of trash in your kitchen. When you come back, it's going to stink. And guess what? It'll have found a way to leak out of that plastic. So, our gut is the same way. We have to make sure that the things that are designed to exit get out on a regular basis. So, I want to make sure they're not constipated. I want to make sure that the bowels are moving. That means hydration. It also means fiber. There's so many different diets out there, obviously, and there's a million, and everything swings from one extreme to the other. 


[00:44:01] But the simple fact is there is no question that fiber is protective to the human body and particularly valuable for women because not only does it bind to the bile acids and help you excrete what needs to get excreted, it can help lower cholesterol, it can help even binding estrogen. The reality is fiber also keeps water in the stool, so it makes it bulky, easier to pass as long as you're hydrated, it'll make it like concrete if you're not hydrated. On the other flipside, if you have diarrhea or you have bowel frequency, like as somebody with a colitis history, knock on wood, I'm not on medications, but I'm always watching it. 


[00:44:40] The other thing is, if I have bile acid malabsorption and I'm having five or six bowel movements a day, I may have nutrient deficiencies, I may have things that need to get bound. I need to slow the thing down a little bit. So, we start there. Because you got to remember, if I'm trying to get all the way to the dumpster, I have to start at the dumpster and clear the pathway. And I see people that do heavy metal detoxes and all these other things, and they don't bother to clear the pathway. And you wonder why people get worse rather than better. And then the other side of it is you have to look at the most important nutrients that are part of the wrapper process in the liver.


[00:45:17] And I'm sorry to say, it is not a juice cleanse, that is not going to help you detoxify. You're going to get high on your own supply because you're going to dump a bunch of toxins into the bloodstream and your body won't be able to excrete them because we need amino acids, which are going to be found in your proteins. Yes, you can get proteins from vegetarian sources, but we need a lot of those to conjugate or stick to these ingredients and make that final wrapper. And we need B vitamins and vitamin C and antioxidants. And so, the other thing I look at is very basic stuff. I want to eat from a rainbow every day, and I want to eat seasonally and with variety. I'm not just eating spinach. I'm not just eating Kale. I need to move those things around. And I want to eat a little bit of every color in fruits and vegetables, nuts and seeds. 


[00:46:01] And then I want to make sure I get adequate protein, because if I'm not getting enough protein, my body is going to decide, do I make muscle? Do I support detoxification? Do I help make neurotransmitters? The body has to pick. And if it's underutilized and underserved, it's going to pick somewhere, and it's probably not going to help detox and brain chemistry. And so, if I do those basic things and include the cruciferous vegetables, your citrus bioflavonoids and phenols, and also think about your microbiome, because your microbiome either makes this worse or better.


[00:46:39] And our microbiome, the composition of that jungle, what if you think of your gut as a jungle and you've got all these different animals in there? We want a wide variety of animals, and a lot of each one, the composition of a baby to a toddler, to a teen to an adult, to a woman over 50 is very, very different because our hormones influence our microbiome and our microbiome influences our hormones. And so, that's another area to really attend to and try to support a good microbiome diversity and diet is the biggest impact on that.


Cynthia Thurlow: [00:47:13] I love that you brought that up because I think for so many people, it's so intangible, the gut microbiome. People are like, “I can't see it. Therefore, it's not important.” I can see my hand, I can see my arm, I can see my foot. I do understand the interrelationship between food I eat and elimination. I don't understand the gut microbiome. I'm not sure how this works. I think that it would be very beneficial for listeners to understand and this has become a greater interest of mine. Obviously, the topic of my next book is really exploring the gut microbiome and the changes that go on. 


[00:47:48] And something that I found interesting, as I have been doing a lot of research, is that, yes, we start with our mother’s microbiome influences the fetal microbiome and then depending on how we are born, whether it's vaginally or C-section, no judgment. I had two breech kids, I had two C-sections. They weren't coming out any other way. Whether we breastfeed, whether we formula feed, what types of foods we eat, depending on our exposure to dirt, and just normal things throughout our lifetime. And then, the gut microbiome starts to shift when we go into puberty. Men and women have very different microbiomes until women go into menopause, when we get significant and profound changes to the microbiome vis-a-vis the changes in sex hormones and the impact on immune function. How many women have no idea of the net changes that are occurring as they are navigating late perimenopause into menopause?


[00:48:45] Estrogen is just one of these amazing hormones. And we think about it just in terms of bikini medicine and yet estrogen, progesterone, testosterone will have profound impact on the gut microbiome. So, let's talk around the subject, and I want to make sure we at least reserve some time to talk about the estrobolome, which we haven't talked about a lot on the podcast, but it's certainly really important and very relevant to our conversation today.


Dr. Betty Murray: [00:49:12] Yeah. So, the body uses estrogen at every single cell except for red blood cells and one other cell in the brain. So, it's a full body effect. The microbes also utilize hormones as well. And when you look at the function of the microbiome, it's there to actually influence everything. I was having dinner with a gentleman that has been in neurological inventions, so has created an auricular device for vasovagal tone. And so, he's done three different patents on neurological function. And what he admitted to me at dinner was, we're constantly messing with the brain. We're constantly trying to poke holes in the blood-brain barrier so we can get a medication across it to help Parkinson's or Alzheimer's, all of which are usually visceral failures. 


[00:50:01] And we failed to realize that the true gut brain is actually the influence here, and that most of our neurological diseases are diseases of the gut first. it's because they produce all of these neurotransmitters, they produce all of these enzymes that influence what's happening, and they constantly are speaking back and forth to the brain through the vasovagal nerve, and we've only very much scratched the surface of that. And I think if people could understand that we want to keep that jungle really, really healthy, and we want to keep them fed and appropriately balanced, and that we have the ability to do some of that, right. 


[00:50:39] A lot of it is set in stone with those early childhood experiences, but we can improve it, then what we may see is a reduction in all of those disease states and those microbes are so, so very important. And if we look at, some of the early studies where they did studies looking at people's microbiome and Burkina Faso, and then they did some westernized European countries, and it was like night and day. The average westerner, I think, has like 140 and 150 different strains, whereas somewhere else that's not so westernized, maybe 400, 500. So, we have a zoo, not a jungle.


Cynthia Thurlow: [00:51:18] Yeah, it's so interesting to me. And I think that for a lot of people, again, it seems so intangible, but yet the gut microbiome influences so much. And if we better understand how to take care of this zoo/jungle, depending on where we originate from, can be very helpful. So, we were talking about detoxification, we were talking about phase 1 and phase 2, you did a beautiful job. And then this phase 3 where we're trying to package up estrogen and get rid of it. Talk a little bit about the estrobolome, I know that it's pronounced differently depending on who I hear referring to it, but why is this so important as it pertains to packaging up hormones and excreting them properly?


Dr. Betty Murray: [00:52:00] Yeah. So, the estrobolome was coined back in 2011. And essentially what the estrobolome is, is a set of bacteria, a bunch of different families. I like to think of our bacteria as like cats, dogs, birds, fish, squirrels, snakes, cockroaches. So, different ones from different families. There are several groups, Escherichia coli some of your clostridium families, some of your bacterides families produce this enzyme called beta-glucuronidase and beta-glucuronidase is actually produced in the human body. It's produced in lysosomes, so it has a role in immune function. It's involved in cellular function and metabolic function. It's actually part of our developmental function as we develop from a fetus to a growing adult. So, this enzyme is used inside the body. We just so happen to be able to pick up the microbiome production of beta-glucuronidase in the gut. 


[00:52:53] Now, the reason why we call it the estrobolome is depending on the amount of beta-glucuronidase enzyme these bacteria make. Essentially what it does is when it's in the gut, the things that have been slated with the black wrapper on it going out through glucuronidation. So, all your estrogens, all your xenoestrogens, all your toxins, and even some of your medications that are wrapped with that black wrapper and they're bound in the bile to the fiber in the stool, the bacterial enzyme pulls that black wrapper off, and then at that point it can't go out. It has to have the black wrapper on it. So, what happens is it gets recirculated into the liver and then back into the bloodstream. 


[00:53:31] What I found captivating when I was in this research so much, I'm probably one of the world's expert on this enzyme, unfortunately and fortunately from my dissertation, is that the beta-glucuronidase enzyme a little bit has a role in development. And then we stabilize, generally speaking. And then when we go into menopause, we see a significant shift in these microbes and a massive increase in beta-glucuronidase. So, of course, my logical self says, why? Right. Well, Dr. Mosconi’s group, when they did the imaging studies of women premenopausal, perimenopausal, and menopausal for the first time this year, they showed that as a woman went through menopause, the number of estrogen receptors went up in menopause as went through that process, not down. So, the dogma up until that study was that we lose those receptors. 


[00:54:23] If we look at that and use the brain as a proxy for the rest of the body, the increase in changes to the estrobolome, that increased number that we see in menopause is probably because of the loss of estrogen in the body's radical desire to need more. We make more bacteria that allow us to de-wrap or deconjugate those hormone metabolites to allow n-estrogen to get circulated. Doesn't matter what kind, any kind of estrogen, whatever we got estrone, xenoestrogens, your own estradiol. If you have a little ovarian function left, any of that is going to try and get recirculated. And that's why we see so much and then different disease states. So, for instance, estrobolome and increased levels are seen in things like colitis, right? 


[00:55:10] Higher levels of beta-glucuronidase is seen in colitis, not in all parties, because colitis can have different presentations, but we often see it. The other thing that I found fascinating is the same enzyme that's made by bacteria, obviously changed drug metabolism, because drugs go through this pathway. Some of our chemotherapeutic agents become toxic or not, depending on the number of bacteria that are in the estrobolome and how much they're producing beta-glucuronidase. It induces chemotherapy-related toxicity. It's related to colon cancer if it's elevated. So, it's one of those things we want enough, not too much, but we have to understand that the bacteria are changing their numbers and changing composition to accommodate that loss in estrogen.


Cynthia Thurlow: [00:55:56] It's so interesting for me. There is specific tests that we run, like the GI-MAP as an example. You can get hints on the DUTCH, the precision analytical testing about the byproduct of high beta-glucuronidase. And I think in a lot of instances, it speaks to, not per se, that there is a maladaptive mechanism that is ongoing. It could speak to the fact that we just have to do a little bit more work, a little bit more nuance. I find that most women that have very, very high beta-glucuronidase are generally not feeling great. They’re probably dealing with some degree of weight loss resistance. They may feel like they are having some energy level issues, they're not sleeping well. And it makes a great deal of sense.


[00:56:39] I think it's interesting about the estrogen receptor upregulation, because I think any of us that are critically thinking through this are thinking, oh, we go into menopause, we have less estrogen receptor activity, but that's actually not the case. I find that so interesting and so tying into this is women that are listening that are in perimenopause or going into menopause. One of the biggest pain points is weight loss resistance. And your clinical experience and obviously, your incredibly, your wealth of knowledge with regard to research in these areas, what are some of the high-level things that you like to focus in on when a woman comes to you? Because that's normally why they don't, per se, it's not the sleep, it's not that they don't have a lot of energy. It's generally like, I can't move the scale, I can't move the number. Something is clearly going on. When we're dealing with weight loss resistance, what are some of the high-level concepts that you think are important for women to understand? 


Dr. Betty Murray: [00:57:36] Yeah, so definitely in my clinical experience, which is why I picked this as my research topic, was that beta-glucuronidase was definitely involved in IBS symptoms. Anecdotally, I was like, okay, this has definitely got to be a player. And again, like colon cancer and colitis, but I also would see the same thing. So, the clinical correlation with it seems to be higher and these women seem to be more insulin resistant and estrogen dominant in that perimenopausal state. And again, that might make sense. It may be that their ovarian reserve is actually declining, but the body's already starting that mechanism to create a microbiome that produces more estrogen byproducts. So, I still go back and look at, the bacteria that produce a lot of beta-glucuronidase love a low-carb environment. 


[00:58:25] So, this is going to run in the face to a lot of people that are like, I love carnivore. And the reality is the very low-fiber diet is going to raise the estrobolome levels. In the short term, it does create insulin sensitivity if you've been eating the standard American diet but long term it's going to create a shift in that microbiome that's going to preferentially lean into beta-glucuronidase-producing microbial changes, at least that's what the research shows. I still look at those things and go, “Ok, we need to improve the microbiome.” And how do we do that? Fermented foods, fiber, prebiotic fibers, postbiotic activity afterwards, even things like your calcium D-glucarate can also bind to that beta-glucuronidase to keep it bound. So, essentially, for everybody that keeps that black wrapper on what you have to excrete so you can get rid of it.


[00:59:20] We use all of those things to improve that microbial level of beta-glucuronidase production. And then we double down on helping the insulin sensitivity with the right kind of exercise, which is usually dialing back. Dr. Sims, I'm with her 100%. I make fun of Orangetheory almost every time [Cynthia laughs] I'm on a podcast because believe me, I've never gone to CrossFit and I've never gone to Orangetheory because I know me, I'm crazy competitive, particularly with myself. And I will go in there and crank it out five days a week and destroy my health, because I like the endorphin rush of the immediacy of it but the damage done is extraordinary.


[00:59:59] So, the appropriate exercise to help make sure that we're balancing that adrenal function, I think, is so important, and it's getting adequate protein, but not too much. Because whether you can digest it well as part of it, whether you have enough hydrochloric acid, because I see that a lot as a decline in the ability to digest food, which is, I think, why women kind of go, “Oh, I don't really like to eat meat,” and it's because they can't digest it well. So, supporting digestive function is also really important. And then we look at all those other detoxifications support, sulforaphane and indole-3-carbinol and citrus bioflavonoids and [unintelligible 01:00:33] that can help manipulate those other pathways. I think it's really important. 


[01:00:37] I will say my study, I was using retrospective data, which in itself can be a little difficult because you can't control for every variable. You're looking backwards in times to at least extrapolate potential causality. And our data set was a little over 450. It was a pretty decent data set, but not a huge one. And at least what I found was that beta-glucuronidase, at least in the sample size that I have, with no control over where were in cycles, because in a perfect world, I would run hormones and the stool test at the same time. But we didn't find a statistically significant difference in beta-glucuronidase in IBS in general, between women with and without IBS. However, when we looked at it in constipation, it was significant. 


[01:01:19] And so, I'd love to go back and do a deeper dive and control for all those hormone measures and get the data all at once at the same time. So, I can control for all the variables. There is something there. There is something there, and we don't understand it enough. And the other reality is beta-glucuronidase is one of thousands of enzymes these guys make. And we don't know what they're up to. [laughs] We just don't. And we have to keep helping our scientific stuff move forward so we can get more answers, because health really starts in the gut in every system. 


Cynthia Thurlow: [01:01:50] No, I could not agree more. And I always humbly say that the more I understand about the microbiome, the more I’m amazed that we are walking upright and alive, truly because you just realize, so many things have to go right every day for us to be functional, and yet we take so much for granted. Obviously, this has been an invaluable conversation. We could have talked about so many different things. I was trying to jump on several areas that I thought would be helpful, but we'll definitely have to have you back. Please let listeners know how to connect with you, how to learn more about your work, learn more about your podcast, or find you on social media. 


Dr. Betty Murray: [01:02:28] Sure, sure. So, if you like to listen to me, my podcast is called Menopause Mastery, so you can find me on all your favorite podcast platforms. You can also look me up at bettymurray.com and then my telemedicine company, you can look up at gethormonesnow.com. We do all of the functional medicine approach to hormone replacement. And, look at me on Instagram. I'm on there as @bettymurray_phd. I try and be more on social media now that I'm not doing my research. [laughs]


Cynthia Thurlow: [01:03:01] Oh, well, I can just imagine. It's probably been, I felt like when I finished graduate school, it was like a solid year before I could back then, read a magazine, read a book for pleasure because my brain had just been pummeled after years and years and years of being in school. Such a pleasure to connect with you my friend. 


Dr. Betty Murray: [01:03:17] Yeah. So great to see you, Cynthia. 


Cynthia Thurlow: [01:03:21] If you love this podcast episode, please leave a rating in review, subscribe and tell a friend.



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