Ep. 509 We’ve Been Ignoring This Vital Sign – One Of The Most Powerful Tool to Track Hormonal Health with Dr. Mariza Snyder

Today, I am thrilled to reconnect with a friend and colleague, Dr. Mariza Snyder, to discuss her new book, The Perimenopause Revolution. 

In our conversation, we explore some of the most pressing challenges around aging, including shame in a youth-obsessed culture, the lack of research on women’s health, and the physical toll of the aging process. We explain why the menstrual cycle should be considered a fifth vital sign, and what happens when metabolic health begins to decline in midlife, highlighting the value of apps and technology in empowering women to track their cycles. Dr. Mariza clarifies why biometrics, VO₂ Max, DEXA scans, and grip strength matter. She also shares her core pillars of metabolic health and the non-negotiables she believes make the most difference for women navigating the perimenopause-to-menopause transition.

I truly enjoyed Dr. Mariza’s book, and I know it will be a powerful resource for women who want to take charge of their metabolic health during perimenopause and beyond.

IN THIS EPISODE, YOU WILL LEARN:

• How hormonal shifts in midlife can alter energy, mood, and metabolism in unexpected ways

• Changes that ripple through sleep, stress, and cognition during perimenopause

• Why, in perimenopause, old diet and exercise strategies often stop working the way they used to 

• How cultural messages around aging fuel shame and confusion for women

• How DEXA scans reveal much more about your body composition than weighing yourself does

• What lab work can reveal about hidden risks 

• Why you should consider doing bone and muscle scans early in life

• The benefits of daily strength training for maintaining vitality and independence

• How regular movement stabilizes energy and glucose levels

• Why food choices become a critical foundation during midlife transitions

Bio: 

Dr. Mariza Snyder is a powerhouse advocate for midlife women, leveraging 17+ years as a practitioner, author, and speaker to spark a massive movement for women in perimenopause and beyond. With her top-rated Energized with Dr. Mariza podcast (13 million downloads) and a passionate social media audience with over 400K and 8 million monthly views, she’s a trusted guide—offering science-backed solutions for perimenopause and metabolic health.

Her upcoming book, The Perimenopause Revolution (Hay House, October 2025), is the ultimate resource for women ready to take charge of their health and embrace perimenopause with resilience and confidence.

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“Progesterone decline creates more inflammation and water retention.”

– Dr. Mariza Snyder

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• Check out Cynthia’s⁠ website⁠

• Submit your questions to ⁠support@cynthiathurlow.com⁠

Connect with Dr. Mariza Snyder

• On her website

• Energized with Dr. Mariza Podcast

• The Perimenopause Revolution

Transcript:

Cynthia Thurlow: [00:00:01] 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. Mariza Snyder. We spoke about her new book The Perimenopause Revolution, diving into common issues that we find around aging including shame and a youth-obsessed culture, the lack of research and the physical toll of the aging process, why our menstrual cycle is a fifth vital sign, and why apps and technology can be very beneficial for tracking our cycles, the impact of a decline in metabolic health and middle age, and the importance of biometrics including things like VO2 max, DEXA screenings and grip strength. 

[00:01:08] And lastly, we spoke about her pillars of metabolic health and non-negotiables that she thinks are particularly important and impactful for women as they are navigating the perimenopause to menopause transition. I really enjoyed Dr. Mariza’s book and I know that it'll be very beneficial for women that are looking to learn more about metabolic health at this stage of life and beyond. 

[00:01:34] Well, my dear friend, it's so good to have you back on the podcast, welcome. 

Dr. Mariza Snyder: [00:01:37] Thanks for having me Cynthia, honey. I'm so happy to get to see your beautiful face today. 

Cynthia Thurlow: [00:01:42] Absolutely, absolutely. Let's start the conversation today talking about common misconceptions around the aging process. I think we have a very youth-obsessed culture. There's a lot of shame with the aging process. And I say this even as someone who has a healthy sense of self did not grow up in an environment where, women avoided the aging process. But I think as a society, we really are in a position where there's a lot of misinformation, a lot of miscommunication, certainly a lot of fear around the aging process. 

Dr. Mariza Snyder: [00:02:16] I agree. I grew up with a healthy dose [laughs] of trying to stay young. And if you were to look at my mom who is about to be 65 years old, the one thing she loves more than anything is that people think that we're sisters. 

Cynthia Thurlow: [00:02:32] Oh yes. Oh, I can imagine. I can imagine. [laughs] 

Dr. Mariza Snyder: [00:02:36] For decades-- [crosstalk] 

Cynthia Thurlow: [00:02:38] I went through a period of time where my mother would say things to me like, “No one can believe that I have a-- insert, whatever age,- [crosstalk]

Dr. Mariza Snyder: Whatever age.

Cynthia Thurlow: “-40, 45, 50-year-old daughter” and I finally look at her because my mom will be 80 next year. And I said, “Mom, as good as you look, there's no way that they would not believe that you have a daughter.” I said, we're 25 years difference. I said, there's no way that they don't think that could possibly have a daughter this age.” And she would always just be very offended with that comment. But I completely understand what you're saying. [laughs] 

Dr. Mariza Snyder: [00:03:13] There was a time and I don't mean to-- she shared this a lot over the years. But my mom would easily pass for someone who was 10 years younger. And she had identification to prove it. 

[laughter] 

[00:03:24] And so, yeah, there were years where she was just flabbergasted at how old I was because, basically we were “10 years apart” at given times are 11 years apart, depending on what her ID said. So that was the world that I grew up in, for sure. 

[00:03:44] And I would say the biggest myth, I mean, definitely we live in a very ageist society, but I would say the biggest myth that I see particularly for talking about women in midlife is that often a lot of our symptoms are actually attributing. It said that our symptoms are attributed to aging, that they're not attributed to hormones declining, particularly in perimenopause. And I feel like that has been very harmful for women. There's been so much gaslighting and there has been so much dismissal about what women are experiencing as just getting older. And I believe that the hormone shifting and aging, they're running in tandem. 

[00:04:22] We could even argue that perimenopause into menopause in a lot of ways with the loss of these hormones or these declining hormones, that they are accelerating some of these processes as we move into the second half of our lives. Again, this needs women to be educated, I think is very important because women deserve to understand what's happening to their bodies as these hormones are declining, how these hormones are profoundly impacting the cardiovascular system, their bone, their muscle, their brain, their gut microbiome. As you know, I know your newest book is going to be deeply diving into. 

[00:05:00] And as a result, when we come on the other side of menopause or post menopause, and we haven't shored up, a lot of these help these biological processes or making sure that we have a lot of really beautiful, healthy habits and lifestyle medicine in place, we can find ourselves in a situation where we are struggling with debilitating health and chronic conditions. And so, I would say that, yeah, it's as if we're running away from age, but also, it's not being recognized that there are other processes at play that are driving some of the symptoms that we're experiencing. 

Cynthia Thurlow: [00:05:34] Yeah, I couldn't agree more. And I think certainly for all of us that trained in the 1990s and 2000s, there was no discussion about perimenopause, zero discussion about menopause. It was more like menopause is 12 months without a menstrual cycle, then you fall off a cliff and we'll worry about it later. And certainly, it's been my experience as a middle-aged woman that when I was in the throes of perimenopause, no one prepared me for that. And I was unknowingly gaslit by my own provider. And I say this with someone who has always been very conscientious about the people that are my providers.

[00:06:10] And I think it has so much to do with this traditional way that we view the aging process, this traditional view at which we consider the fact that this loss of hormones is driving the fatigue, it is driving the brain fog, it is driving changes in our menstrual cycle, it's driving the way that we feel about ourselves, it's driving the way we see ourselves with our partners, it is driving our digestion, our heart function, our lungs. There is no body system in our bodies that is not impacted by these changes and fluctuations in hormones. And so, I think in many, many ways the focus has been on most of the research up until 1993 was done on men. Women were excluded from research, which is number one. 

[00:06:59] Even now when we're looking at lab values, they're oftentimes based off of men and not women. And I think that-- [crosstalk]

Dr. Mariza Snyder: [00:07:05] We're talking about that exclusion was what 15, 16 years. 

Cynthia Thurlow: [00:07:09] Which is significant. 

Dr. Mariza Snyder: [00:07:11] Significant. When I was in college, I remember I dual majored in biochemistry and I dual majored in health psychology. And I remember being in all the health psychology classes in particular, and how every single study I learned about in terms of psychology were done on college men, college boys or older men. And I remember being in school thinking, is there any research being done on women? Like, what is going on? And lot of this research had happened in the 80s. And we have to understand that so much research happened in that timeframe of 16 years that really dictated diagnostics, medication, our understanding of human physiology, of even psychology. And we're experiencing the rippling effect, the consequences of that, even today in 2025. 

Cynthia Thurlow: [00:08:01] Well, and it's interesting when I think about conversations that I've had on the podcast with even experts like Dr. Lisa Mosconi, who's a neuroscientist, she said when she got really interested, invested in this research, that in 2016, there was little to no research on women's brains. And so, she's like-- [crosstalk]. 

Dr. Mariza Snyder: [00:08:18] Little if no scans. 

Cynthia Thurlow: [00:08:19] Yeah. She is-- [crosstalk]

Dr. Mariza Snyder: [00:08:21] Particularly connecting the dots between menopause and Alzheimer's or looking at women's brains in perimenopause and menopause. Just no research whatsoever in that landscape. She's really, in a lot of ways, she's leading the charge in that research. 

Cynthia Thurlow: [00:08:35] Absolutely. And I couldn't agree more. And knowing that over the past 32 years that there have been greater efforts to include women in research. But one thing that I think has been a confounding variable when I'm talking to researchers is that women's menstrual cycles are a confounding variable, whereas with a menopausal female or a male, they don't have to worry about fluctuations in estrogen, progesterone throughout a cycle. And you make the argument that our menstrual cycle is a fifth vital sign. And I would agree with you wholeheartedly. I tell women all the time that if you lose your menstrual cycle, there has to be a reason why and we need to determine why that's so important. From your perspective when you're talking to your patients and educating them about their bodies. Why do you think that we, as a society, it's not any one person, why do you think we do such a poor job of educating women about their menstrual cycles?

[00:09:31] I truly think I know more about the menstrual cycle now than I ever did when I was in my training or even post training. And there just wasn't an emphasis on understanding why women have more energy in their follicular phase, why women have less energy and more cravings in their luteal phase, and how that impacts how we work out, what foods we choose to eat, how we view the world, and certainly gets magnified in perimenopause. 

Dr. Mariza Snyder: [00:09:57] I have a lot of opinions as to why we have not educated women about one of the most important processes of their body. I think about the menstrual cycle being a, like you said, the vital sign and also being a report card, a monthly report card for what is going on with our bodies. I think any woman listening to this, we've had those months where, the months leading into this really bad menstrual cycle, this bad period, you’re very stressed out. May be our lifestyle strategies that fall into the wayside. Maybe weren't eating as healthy as normal. 

[00:10:33] I think if there was a time of the year where women are going to have a really bad period, it's going to be in January, after the holidays, after all the travel and the late nights and the excess alcohol and maybe extra sugar and a lot of our consistent habits begin to fall to the wayside a little bit in favor of spending more time with family and being in the celebration of things. And so, usually by the end of January, early February, oh, my goodness, that period, it feels like a nightmare unfolding. 

[00:11:02] And so, I think it's so important that especially in perimenopause, especially as we navigate that profound transition, that we really understand what's going on with our menstrual cycle so that we can get a lot of clues about what's happening to our bodies. But I would say if our medical system and our health care system was built with men in mind, I mean, I think about myself and who I want to study. I always say I serve everybody by serving women. And I am very interested in taking care of women, understanding women's physiology and really the nuances of a woman's journey, particularly the midlife journey. And I absolutely have stake in that because I am a woman and it is my own lived experience.

[00:11:42] And I think that's very much the case for our medical system, is that it was built on men. The foundation was built on financial wealth, built on men. And so, what do men want to study? They want to study themselves. They want to understand themselves. And that would be my very cleaned up PC way of saying why I think we have ignored women's bodies and understanding women's physiology. Thankfully, that is changing. We live now at a time where younger generations-- they're having parties to celebrate their menstruation especially when they start their period. We're celebrating ovulation and the multiple phases of the menstrual cycle. 

[00:12:22] And so, we are living in a different time where women are beginning to understand their bodies a lot better and understand, trusting their bodies. I think it was one of the biggest things that we have been told is to not trust ourselves, to not trust our deep intuition, and to not trust our bodies throughout the cycle. Something I've been talking a lot about on a lot of podcasts is everybody loves day 12 us, even us, right? That high estradiol peak before we head into the ovulation season, and how amazing and exhilarating and high confidence, high joy, sensuality, that high energy and capacity. I remember growing up and being told to not love day 27 me, really be celebrating that ovulatory phase. 

[00:13:13] And we're now learning that we get to appreciate every version of ourselves as our hormones are shifting throughout the menstrual cycle, and that it all plays a role. It's all designed in this beautiful orchestra of how our bodies are meant to operate. And it's really about how we prepare every single month for the possibility of conception. Even that alone is so miraculous to me that our bodies are like, “Whether you want to or not, we are going to prime up for this.” And it is such a metabolically driven event that we prepare for every single month for what, you know, 35 years, give or take. It's incredible. And the fact that we don't have a lot of awe and we don't celebrate that is a little bit mind blowing to me. 

Cynthia Thurlow: [00:14:01] Yeah. I think about the fact that when I reflect on-- when I started menstruating, I was latter part of junior high school and unbeknownst to me, I probably had mild thin phenotype PCOS. So, I had very irregular cycles. And I just recall the messaging that I was taught from my parents was essentially menstruation is meant to be concealed. It is not to be discussed. You keep your tampons or your pads kept away. They're not meant to be seen. And I'm not even referring to something that's been used. I'm just saying, like, you go to buy a box of tampons or you buy a box of pads, and it's tucked away, hidden and I feel subliminally and this is not a criticism of my parents. I think that was a byproduct of that era- [crosstalk] 

Dr. Mariza Snyder: [00:14:54] The narrative. 

Cynthia Thurlow: [00:14:55] -for sure. Yeah. It's like you minimize, like, you have to carry a purse with you. You have to minimize what's going on. I had a younger brother and I remember my mother was very specific about how things had to be disposed of. It's like, “You just can't talk about these things, if you don't feel good you still have to go to school, you still have to show up for practice.” Whereas now I think there's a much more gentler, inclusive. Like, we're talking openly about menstrual cups and we're talking openly about symptoms that women experience. Look at the rise of social media, there's a lot of sharing--[crosstalk] 

Dr. Mariza Snyder: [00:15:29] Yes. Cycle syncing. 

Cynthia Thurlow: [00:15:30] Yes.

Dr. Mariza Snyder: [00:15:31] Same with me, Cynthia. Very similar. We're born at a very similar time. On the one side of my family, my parents were divorced, my mother it was very much of, like, you're stepping into motherhood, now you're going to be tolerating-- basically expect every month for you to be uncomfortable, PMS symptoms, be ready to tolerate discomfort and pain and this is what women endure. We just needlessly suffer. So that was very much the narrative from my mother's side. And then I had my dad and his wife, my stepmother, she weaponized my period against me.

[00:16:07] So, she would look through the trash. She would track my cycle, and when my period would be on its way, like the week prior, like late luteal, she would accuse me of mood swings and mood issues and would just berate me-- and goodness forbid, like, there ever be a mess or a situation, it was this whole thing. I remember just dreading and hating my period so much because it was this area of contention between myself and my stepmother to the point where the soonest I could get on hormonal birth control, not so much because I had real symptoms, but because I wanted to just hide it, I just didn't want to have it. I ended up getting on the Depo-Provera shot and it was such an awful journey for me. 

[00:16:54] I would say that first eight years, give or take, of stepping into womanhood, of onboarding my reproductive years was just yucky. I didn't trust my body, I didn't love it, I didn't want anything to do with my menstrual cycle. I had no idea that ovulation was the main event. I didn't know anything about my cycle except for the fact that I was bleeding. And that was not something women needed to cover that up. And it was something that we had to endure. The physiology of what happens during our menstrual cycle really wasn't broken down even in our sex ed classes. It was really about STD and abstinence, that was--[crosstalk]

Cynthia Thurlow: [00:17:32] Here's a tampon box and here's how to use it. Yeah, exactly.

Dr. Mariza Snyder: [00:17:34] Exactly.

Cynthia Thurlow: [00:17:36] And I think, for a lot of women it's that whole shame cycle of like, we're ashamed of our bodies, we're ashamed of what's happening to our bodies. To your point, whether it's oral contraceptives or Depo-Provera, which now that I'm like been in depth in the research on bone health, Depo-Provera, it's reversible. But how many women were not counseled, especially as teens, the impact of starting oral contraceptives and/or Depo-Provera has a substantial. It's got actually a black box warning on Depo-Provera for bone health, which again, I'm going to reemphasize is reversible. But I don't think any of our generation was counseled on those side effects. It was more like, this will control your symptoms, this will control your cycles. It'll be predictable. 

[00:18:20] That was how it was kind of sold to me. “Your cycles aren't predictable, but now they'll be predictable.” You'll know when you're going to get a bleed week, you’ll know when you're not going to get a bleed week, symptoms will be lower. Well, of course, because it's synthetic hormones that are suppressing all the natural things that are happening in our bodies. And again, that was a sign of the time. I don't think I have one girlfriend that wasn't on either depo, which is a longer-acting contraceptive- [crosstalk] 

Dr. Mariza Snyder: [00:18:45] or combination. 

Cynthia Thurlow: [00:18:46] -combinations or oral contraceptives, our entire generation, were just bathed in--

Dr. Mariza Snyder: [00:18:52] It was you had bad hair, get on hormonal birth control, acne get on hormone, bad boyfriend, get on hormone control. [Cynthis laughs] It was like it is fixed. I remember it being the fix all of everything. One thing that what the Depo-Provera was promised to me was that I would not have a cycle. They were like, this will guarantee you not having one. And we just give you a shot every quarter. I'm 18 years old, I think maybe I'm a freshman in college. And I was like, “Yes, sign me up for that. That sounds great.” And like that it was only touted as the benefits. And oh, my gosh, the side effects of that medication was so insane for me. And I remember I barely lasted a year and it took me a year to get my cycle back on track.

Cynthia Thurlow: [00:19:36] Wow. 

Dr. Mariza Snyder: [00:19:37] Yeah. 

Cynthia Thurlow: [00:19:37] And that was it, I never went on hormonal birth control again. And I was like, “I'm good.” 

Cynthia Thurlow: [00:19:43] Yeah. And I think it's important to just note that one of the things that I'm certainly very pro. Women having the ability to determine when and when they do not want to run the risk of carrying a pregnancy. That is not the message. I don't want anyone to hear from me that saying that women shouldn't have that right but I do think it's important for-- 

Dr. Mariza Snyder: [00:20:01] Yes. And I think informed consent is important. 

Cynthia Thurlow: [00:20:04] Informed consent is critically important. I think most of our generation never received that. It was more like, if you get weight gain or you have weird side effects, well, that's the trade off, right? Like, that's the tradeoff. Remember when I went to Hopkins, that they switched my oral contraceptives up to a generic because that was covered under the student health plan. And I put weight on, and they told me there was absolutely positively no way it’s happening. 

Dr. Mariza Snyder: [00:20:28] No way it's connected. Like these hormones aren't connected to your metabolic health, your insulin sensitivity, the way that we store fat, water retention, inflammation. Oh, my gosh, the list is long. It's mind blowing to me that our regular hormones can do so much, “damage.” You know, the fear around hormone replacement therapy and yet synthetic hormones, no, there's no side effects. [laughs] 

Cynthia Thurlow: [00:20:53] Exactly, exactly. And a lot of the focus of your book, from my perception, is really talking about a very important topic, metabolic health, which I would argue is so critically important. Let's walk us through what's happening as we are navigating this perimenopausal transition. What is happening to our metabolic health? Good, bad, or indifferent? No judgment. But I think with information, patients and listeners can understand better about what's happening to their body so they can start making changes to help offset those. 

Dr. Mariza Snyder: [00:21:26] I love this question, Cynthia. And I will say that it is nuanced to some degree because it always is, the perimenopausal journey for every woman is going to be individual to them. We also know that many adults in the United States have metabolic dysfunction or a varying degree of metabolic dysfunction. And let me tell you, perimenopause doesn't do us any favors. We have been living a life, as an adult, a good solid 20 to 25 years before we even step in to perimenopause. For some of us, it could be maybe 18 years. But you know, life has happened, maybe children have happened, lots of changes has happened, full on careers. 

[00:22:07] And I will tell you that as we step into perimenopause, whether you are metabolically healthy or not, that erratic decline in hormones, I will tell you, doesn't lend to feeling our most optimized self. Whether it's the brain related symptom or it's the sleep issues, or it is the reduced workout recovery or the swollen joints, whatever that may be. We do know that changes happen that can absolutely impact the way that we operate in terms of lifestyle medicine. And so, if you're not getting good sleep, let's say you're only clocking five hours, 12 days out of the month. Because I find that sleep issues can be cyclical and perimenopause as well. 

[00:22:49] We know that if you're only getting five to six hours of sleep, there's a good chance that you're going to eat an increased calorie load of 15 to 20%. So, we think about how perimenopause and neurotic hormones are impacting just our habits in the way that we live our lives. But then we also know that these protective whole body hormones, which you and I have established already in this conversation, this isn't bikini medicine that we're talking about, right? We're talking about bones, our metabolic health, our insulin sensitivity, our muscle, fat storage, all of this is being impacted. And for some of us, it can be more exacerbated than others. It really just depends on how we're stepping into perimenopause. But we do know in the research that we have currently, and again it's not as robust as I would love it to be. 

[00:23:35] But that as estrogen declines, we do see a falter in insulin sensitivity. We see a shift in body composition changes and fat storage. So, we go from butt, hips, and thighs over to that visceral belly fat. And we know that visceral belly fat in its own right is inflammatory and can drive more insulin resistance. It's a beast that can perpetuate itself. And so, when we start to pack on pounds in that visceral belly fat area, that can lend to its own issues as well. We also know that as progesterone is declining, we see increase in water retention, increase inflammation as well. So, progesterone is also having an impact to some degree. And we also know that estrogen is involved in the regulation and the growth of our muscle. 

[00:24:23] And as it's declining, if we're not being extremely intentional about it, we are actually going to be losing muscle. And this isn't just aging, although aging is happening in tandem as well. And so, all of this is happening and what women begin to notice is that despite the fact that they're working out the same way that they used to, they're eating the same way that they used to. If anything, what we do best is we double down on the things we knew worked in the past. And yet, despite all those changes that we're making, we are seeing the scale climb, we're seeing fat move around. And I believe it's on average, throughout the perimenopause transition, women will gain an average of 5 pounds of fat, and up to 20% of us will gain 10 pounds of fat or more. 

[00:25:05] And so whether the research is fully, fully supporting this, we ask women what their experience is in perimenopause and they will tell you one of the most disruptive symptoms is that they are putting on weight without permission. 

Cynthia Thurlow: [00:25:18] Yeah. And I think this is an enormous pain point for most women, especially women that maybe perhaps their entire adult lives, they've never struggled with weight loss resistance. And all of a sudden, all of the normal strategies, whether it's exercise, whether it's caloric restriction, whether it's doing these crazy detox programs. And I say this, a little bit tongue in cheek. There's a lot of predatory marketing that's done for middle-aged women. 

Dr. Mariza Snyder: [00:25:43] Yes. Well, and we're told that it's our fault. It's your fault, you're lazy, you’re not doing enough. Every patient of mine, if anything, is overdoing because we're like this. What? It's not working. And so let me do the things that has worked for me in the past where I've dropped that extra 5 pounds or I've dropped that extra 10 pounds. And so, yeah, I do agree that there's a lot of predatory marketing around again, women being shamed for the changes that are happening to their bodies, but also being blamed. And there is a big distinct difference between ownership and blaming yourself. 

Cynthia Thurlow: [00:26:23] Yeah. And I think it goes back to whether it's growing up in a toxic diet culture, which is a topic I discuss a lot on the podcast. Certainly, we were conditioned to believe that we want to be as thin as possible. We want to be skinny versus now I feel the messaging is definitely being strong over skinny. How important is to preserve muscle mass, understanding that we have satellite stem cells in our muscles that are very important that are tied into estrogen and testosterone. And not every woman loses all of their testosterone in that perimenopause to menopause transition but most of us do. 

Dr. Mariza Snyder: [00:27:00] Many of us do. Yeah. 

Cynthia Thurlow: [00:27:01] And so looking at what are the metrics we need to track as we are making this transition. And you certainly do a really nice job about DEXA scans, which I think it's criminal that in the United States, most women aren't getting these to their 60-[crosstalk] 

Dr. Mariza Snyder: [00:27:14] 65.

Cynthia Thurlow: [00:27:15] -or 65, I think and I tell everyone this, if you are breastfeeding, you need to have a DEXA scan because we lose so much bone because we get up regulation and bone remodeling while we are breastfeeding. And I was certainly one of those people I breastfed, I had two kids. I breastfed them for more than two years. I was osteopenic. And then my bone strength and bone quality got better and I got to a point where I was no longer osteopenic. 

[00:27:41] But helping women understand that we should be getting baseline DEXAs, I think, in our 30s as a baseline. I think we need to be monitoring body composition much more closely because the scale is a liar. Like, let's be totally transparent. It does not tell us how much lean muscle mass we have and fat free mass. And that is an important determinant of our health. I think that we get very weak. We as women are very fixated on the number. I cannot tell you how many patients say to me, I want to be the weight I was when I graduated high school. And I laugh-- [crosstalk]. 

Dr. Mariza Snyder: [00:28:16] Or my wedding day in my 20s, right? 

Cynthia Thurlow: [00:28:19] I laugh because when I look back to what my weight was, and I actually remember this because back in the day they'd put that on your college ID, honest to God. My height and my weight was on my college ID. So, I went back and looked at it because I had that buried stuff somewhere. I was like, “I didn't look healthy at 112 pounds. And I'm grateful that my brain knows enough to know that I was probably even then, probably too thin for me.” And I think that for a lot of individuals, when they get fixated on a number versus saying, it's really important to me that I have as much lean muscle mass on my body to stay as insulin sensitive for as long as possible, plus or minus, until I need to some hormones to support that. 

Dr. Mariza Snyder: [00:29:01] Support that. Yeah. 

Cynthia Thurlow: [00:29:02] Really important. Much more important. In fact, I would argue that body composition reading should be done at least twice a year. 

Dr. Mariza Snyder: [00:29:12] I agree. 100%

Cynthia Thurlow: [00:29:13] At a younger age. 

Dr. Mariza Snyder: [00:29:14] Yeah. We both grew up in a generation. I still think it's very pervasive when we're in our younger years, in our 20s and our 30s, that you train, that you work out to be thin,-

Cynthia Thurlow: [00:29:23] Yep. 

Dr. Mariza Snyder: [00:29:24] -that you work out to fit in this frame. And although I have been in the gym since I was 16 years old, that was always the goal for me. Not that I do want to be strong. [crosstalk]

Cynthia Thurlow: [00:29:31] You are way ahead of the curve my friend. [Cynthia laughs]

Dr. Mariza Snyder: [00:29:32] Yeah, I had a coach-- I played soccer in high school and I had a coach, he was a soccer player as well in college, and he was a college coach. So, he did both kind of volunteered to coach us and everybody in college at the time, they were in the gym and so he had us in the gym. We had a little gym room at high school. And so, I played soccer my entire four years of high school. And so, I was in the gym probably my junior and senior year and then I just carried that into college. 

[00:30:02] I know lot of us grew up as cardio bunnies. That's what women did. You're on the Treadmaster with your shape or your Cosmopolitan magazine or you're on the treadmill. But I was doing both. It was a yes. I knew if I wanted to drop pounds, I would get on that treadmill or I would get on the StairMaster. But then also I was lifting usually for about 30 minutes, five days a week, but I was always in the gym. I remember growing up in my 20s and my 30s, but to stay lean, to stay thin, that was the goal. Luckily, I'm sure I was getting strong as well, but it wasn't my mindset. That wasn't the way that I was thinking. 

[00:30:35] And then as you creep into your mid to late 30s, into your 40s, even some of those strategies just weren't working anymore. But again, still the goal, I think, that has been embedded into our DNA was that to be lean. And that's the myth I want to dispel, is that thin is not the goal in midlife and beyond. It really shouldn't have been the goal when we were younger either. It's about being strong and resilient. And yes, it's important for us to be measuring this. It's hard to change what we don't measure. And that clear way of measuring it would be a DEXA scan. And they're so inexpensive, we're talking about under $100. You can get them in pretty much any city across the US and even internationally as well. 

[00:31:17] But also, if you can't get your hands on a DEXA scan, I would be looking at other biomarkers of metabolic health if technically only 7 to 8% of us as adults are metabolically healthy or that we meet the criteria for being metabolically healthy. It's important for us to know those numbers as early as our 30s as well. I can't tell you how many times I was looking at labs at late 20-year-olds when I was in full clinic. And many of them had early signs of fatty liver disease. So, we know that there's an epidemic of metabolic issues arising. And I think, the demographic that becomes very vulnerable is going to be women in perimenopause as hormones begin to decline. 

[00:31:58] And so, when we're looking at biometrics, when you think about those five big biometrics that are determining metabolic syndrome, we know three or more of these being out of range, that's going to determine your metabolic syndrome. But even one or more out of range is a red flag as far as I'm concerned that we need to walk things back. So, fasting glucose is the first. It's going to be 100 mg/dL. And just note that once you're at 100 mg/dL, that is technically prediabetes. And if you're like me, I don't really believe in prediabetes. Diabetes is diabetes. And what we know too is when women are between 100 and 110 mg/dL, we have a greater risk of cardiometabolic disease as well. 

[00:32:37] We don't need to wait until we're type 2 diabetic for that to be a massive concern for us. So fasting glucose 100 mg/dL. Next, high density lipoprotein cholesterol. So, our good cholesterol that's cleaning things up. What we say is if it's under 40 mg/dL, but again if we're at 40 mg/dL, I am concerned. But that's going to be that next marker. The next marker is triglycerides 150 mg/dL. I know that you and I would agree that we'd love it under 100 at all times. And then it's going to be your waistline. So, 35 inches for women. 

[00:33:12] Girl, I am 5’2” and my waistline was 35 inches, goodness gracious, and so I always say half the inches of your height should be your waistline. So, for me that would definitely be a lot less than 35 inches. And then the last one is going to be your blood pressure. And this one is really deeply important because we don't feel blood pressure changes. You don't feel your blood pressure creeping. And there's more and more functional data that's coming out in terms of blood pressure where that number is going to be 130/85. That is hypertension. Anything above 120/70, we're creeping into the range of prehypertensive. And so, when we have three or more of those biomarkers out of range, that is metabolic syndrome. 

[00:33:57] But I would argue that even one of those biomarkers out of range is an indicator that your metabolism needs some support. And that's really what the book is all about is how do we shore up our metabolic health, especially when we know that some of these biomarkers are moving out of range. 

Cynthia Thurlow: [00:34:14] Yeah, and I think you bring up so many good points. You know, first and foremost, even those ranges, like we would argue like fasting glucose, went between 70 and 85 mg/dL. I know that when I interviewed Dr. Robert Lustig, he talked about how a fasting glucose between 90 and 99 gave you a 30% greater likelihood of developing diabetes. And to your point, we do a really crummy job managing prediabetic or people that are at risk for diabetes. You want to do everything you can to avoid getting a diagnosis of diabetes because it lends itself to higher risks of heart disease, dementia and Alzheimer's, certain types of cancers, fatty liver disease, these are not benign entities. And many of these things we have within our control. 

[00:35:00] So, thank you for kind of identifying those signs of metabolic syndrome because many of these things, it takes a long time to get there. And I would argue as someone that wrote for blood pressure medications for 16 years, a lot of people, that's why we call it the silent killer. How many of my patients, especially young African-American patients, were in their late 30s, early 40s, they came in with kidney failure because they had many, many years of chronic high level high blood pressure and they were not aware of it. So, there is a reason why we call it the silent killer. We know that high blood pressure can damage your kidneys, it can damage your eyesight. Really important that you're getting that screened. It is not just a, “Oh, I go to the clinician's office and they're checking vitals, just to check vitals.” 

[00:35:49] It's really to help screen and address things as they are brewing. I will give you an example. I think about how many of my patients were in their 30s and 40s. And it's unusual, well, seemingly unusual. 

Dr. Mariza Snyder: [00:36:02] Not anymore-- [crosstalk]. 

Cynthia Thurlow: [00:36:03] But not anymore and we would have more and more patients that had creeping blood pressure problems, early chronic renal insufficiency, kidney insufficiency. They were starting to get visual changes. And I used to tell them so much of this is preventable and that's why these screenings are so important. In the book you also talk about grip strength. Why is grip strength so important for overall metabolic health as it's a proxy of overall strength and vitality. 

Dr. Mariza Snyder: [00:36:35] Oh, I love this question. I also wanted to just quickly point out that 84% of people don't know they are prediabetic either. Even if they ran the labs-- [crosstalk] 

Cynthia Thurlow: [00:36:44] It because we do a crummy job of telling patients. 

Dr. Mariza Snyder: [00:36:46] I can't tell you how many times I've taken care of a patient of mine whose blood sugar was 102 or 110. They had no idea. And I'm looking at labs that I didn't run, that they had had run by somebody else and it wasn't indicated. I love this question because there are so many different ways too-- I want to just pivot so many different ways to it to figure out how healthy we are. I was actually looking on my WHOOP strap today. I wear a WHOOP. I'm a big fan of bio-observability in terms of understanding our bodies. And again, when we live in a time or we've lived in a time where the narrative is to diminish what women are experiencing to for women to just suffer needlessly and for women to not trust their bodies. 

[00:37:27] This has happened to me where my body has been telling me, but I'm like I need to pull forward because that's what women do. We ignore the symptoms and we just keep moving forward like a freight train. And I wish I would have known how to understand what was going on with my body. I wish I would have listened to the changes of my follicular phase. I can't tell you how many times I would be-- the days before my period or on my period and I would be in CrossFit or I would be in a crazy HIIT workout and I would be so angry with myself because I wasn't able to hit the gym. 

Cynthia Thurlow: [00:38:02] Probably exhausted. 

Dr. Mariza Snyder: [00:38:03] Yeah, my body was like, “Why are you doing this to me?” [Cynthia laughs] And I'm just whipping myself just to go harder. And I was like, why can't I train like I was training two weeks ago. Girl, you don't got hormones. 

[laughter] 

[00:38:19] And I just didn't know. And so, I listen to my body so much more today. But I feel like after decades of not listening, I do like to look at the data every day. And I was looking at my WHOOP data and my VO2 max is in the top 5 percentile of women my age, whatever that means, [laughs] 46-year-old ladies out there. But I really do deeply appreciate that because honestly, I'm not looking at my VO2 max all the time. Like that's not something I'm monitoring. I know that you just monitored your-- [crosstalk]. 

Cynthia Thurlow: [00:38:51] Holy cow. There's a reason why you only do that with once a decade. 

Dr. Mariza Snyder: [00:38:54] Exactly. And so, it's nice to have this data whether it's a continuous glucose monitor or it's a WHOOP strap or whatever, however you to look at your data. Like I track steps every day. I know that I'm going to clock 10,000 steps every day. But there's something to be said about actually seeing that level of accountability. And at least once a month I get on-- We have a pull up bar in our house for my son. We actually have two pull up bars in our house. We have one for my son where he can just swing on it as he gets into his bedroom and then we have the big adult one, daddy's, obviously daddy's pull ups, can't be mama, God forbid. [Cynthia laughs] Just like this office is my husband's office. 

[00:39:33] If this is daddy's office, I'm like, “Oh, mama's the CEO. Okay,” [laughs] like I'm kidding. But so, we have a pull up bar and every month I hang from that pull up bar and I can hang for a little over two minutes. I'm working on that. And I believe that we want women to be able to hang on a pull up bar. And this is really determining grip strength for at least 90 seconds. For men it's two minutes. And that is determining our strength, our resilience, our muscle. And basically, our grip is one of the best predictors of our longevity because it's showing how strong and resilient we are. But equally as important, I think is going to be a DEXA scan. 

[00:40:10] Equally as important as can you get your butt off the floor and get back down on the floor. Like these are the things that are really going to also indicate whether we've got resilience or not. And the sooner we look at that. Another one that I talk about in the book, I believe, or at least I hope I mentioned, is a Farmer's Carry. Can you basically carry close to your weight in weight and carry those weights for one minute? That's really going to determine your longevity and your resilience as well. So, all of these are predictors of overall health and resilience. And in my number one goal-- if there's anything that you get from this book, my number one goal, one is to rewrite your midlife journey, to rewrite your midlife story. 

[00:40:51] But more importantly is I want to shove back as far as possible any chronic condition that could be brewing so that you have more quality years. Like, I don't know about you, Cynthia, but I'm not interested in living to 105, not really. I just want the years that I'm here to be very, very quality. I don't want to have to negotiate with myself about what I can and can't do when I'm in my 80s. I want to just be able to do it. That's I would love for this book and that's the reason why there's such a powerful metabolic slant in this book is because I want women in that window of metabolic opportunity, in that perimenopausal window. 

[00:41:32] And yes, there's definitely we have more time on the backend of that as well, but that tends to be a very critical window for us that in those years, in that decade where things are shifting and changing, goodness knows, we all know, because all of a sudden, we feel symptoms are coming up without permission. Often, we don't feel like ourselves. But in that time, in that decade, even when you are not necessarily feeling like yourselves, this is the time where we have the most ability to set ourselves up for the second half of our lives. This is where we future proof our health. And so, I want women to know their numbers, I want women to know their grip strength, I want women to know their DEXA scan. 

[00:42:09] I want us to have this data. I want us to live in a time of bio-observability and take advantage of that so that we are double dipping to feel amazing now. Like I want to feel good today, girl. And I also want to feel good 20, 30, 40 years down the road. Like I want what I'm doing today to matter for my future self at 80 years old.

Cynthia Thurlow: [00:42:31] Such important information and just to bring it back to grip strength and why these metrics are so important. So, grip strength is actually highly correlated with health outcomes. And one study found that adults with the strongest grip strength had a 30% reduced risk of all cause mortality. So that's number one. There was another group of researchers and this is when we talk about this frailty index, whether it's VO2 max. I know Dr. Vonda Wright talks a lot about this. In fact, it was her last conversation with me that pushed me to do VO2 max when I was in Mexico with my husband as well. And VO2 max is not fun training. It's like, [crosstalk] all-out effort and you've got a mask on your face. 

[00:43:12] Go look at my Instagram account. You can look at all the photos of me looking goofy. But it was purely just to get a sense of what was going on. The frailty index is very important because what leads to falls is frailty and falls are the leading cause of disability, injury and death in elderly people. I don't know how they determine elderly. [crosstalk] 

Dr. Mariza Snyder: [00:43:31] One in two women will have an osteoporotic fracture--[crosstalk] 

Cynthia Thurlow: [00:43:34] Occurring each year more than 30% and 50% of the population age, 65 and older respectively. So, what Dr. Mariza is really focusing in on is what are the things we can do to avoid frailty as we get older. And I think perimenopause is a particularly important time to be considering these things. Grip strength you can do with a dead hang or you can actually buy these devices that you can use. My physical therapist did it with me after I sprained my wrist and it was important to get a sense of where is your grip strength. Mine are still unequal almost a year later, but my right wrist is getting stronger. 

[00:44:13] So, it's continuing to go up. But I think for many people it's understanding that we have some things within our control. Long enough, we're going to transition into menopause. 

Dr. Mariza Snyder: [00:44:23] Yes. 

Cynthia Thurlow: [00:44:22] Then we'll go through andropause, although it's not nearly as dramatic. But it's important to be able to have this sense of where we are. We can always course correct. That is the point that we are making. But having a sense of like what can I do better with? Do I need to intermittent fast for a period of time to help with insulin sensitivity? Do I need to strength train? And I would argue everyone needs-- [crosstalk] 

Dr. Mariza Snyder: [00:44:44] All of that. Yes, please.

Cynthia Thurlow: [00:44:46] Do I need to be monitoring these labs and these metrics and I would tag in that low HDL can be a prognostic indicator as can be high apolipoprotein B. We talk a lot about high Lp(a). Important for women to know those numbers because sometimes when we see a high LDL which used to be called the lousy cholesterol and I would argue is just information that we need to look at a little differently.

Dr. Mariza Snyder: [00:45:12] I was going to say look at a more advanced cardiovascular panel. 

Cynthia Thurlow: [00:45:16] Yep. If your LDL is high, you very likely have a high apolipoprotein B and you need to look at that Lp(a). And that's all I'll say about that because we have talked a lot-- [crosstalk] 

Dr. Mariza Snyder: [00:45:26] And I love looking at the triglyceride/HDL ratio. 

Cynthia Thurlow: [00:45:29] Ratio. It's the poor man's ApoB. 

Dr. Mariza Snyder: [00:45:32] Yeah and insulin resistance. And also, I mean demand a fasting insulin, demand a fasting insulin-- [crosstalk] 

Cynthia Thurlow: [00:45:38] Its dirt cheap.

Dr. Mariza Snyder: [00:45:39] Because again insulin resistance more than prediabetes or diabetes, that is the risk factor for cardiovascular disease. That's the risk factor for stroke and heart attack. That's what we need to be looking at. That's what's making that. That's what's causing that increased risk and that goes up unfortunately as we start to decline in these life-giving whole body hormones. 

Cynthia Thurlow: [00:46:00] What are some of your favorite strategies you like to use with your patients to help support metabolic health? You do a really nice job with these pillars and-- [crosstalk] 

Dr. Mariza Snyder: [00:46:08] Yeah, I was going to say the whole book all the pillars are going to be-- [crosstalk]. 

Cynthia Thurlow: [00:46:13] What are some of your favorite strategies? The things that you feel like are non-negotiables for patients. 

Dr. Mariza Snyder: [00:46:19] Nonnegotiable is, I want us to be, ideally, we're eating in a way that is honoring our gut microbiome, reducing inflammation and balancing our blood sugar. And so I have whole-- all the chapter I would say the second pillar is about how to eat metabolically healthy meals. And really, I think we can all agree that refined grains, added sugar, ultra-processed foods really don't have a place in helping to support our metabolic health. And the question that I always pose, even myself, particularly, I think about women 67% of adults, women are going to be the ones who have Alzheimer's and dementia. And so, the question that I ask myself every day is what I'm consuming, what I'm eating right now is this going to fuel, is this going to support my future brain? 

[00:47:09] So, I want to be thinking about it in those terms. But I build out, like basically my five tenets of these metabolically healthy meals is going to be antioxidant and micronutrient-rich foods, probiotics and prebiotic-rich foods of fermented foods, omega fatty acids. So, I packed my son salmon for lunch today in his little lunchbox including blueberries, strawberries and carrots. And I was just thinking about all the ways like, “Okay, I've got my micronutrients, my phytonutrients, my omegas, my healthy fats for him.” That's how I'm thinking about building meals, but also making sure that we have adequate amount of protein. That's going to be a big one. And making sure that we've got some healthy fats including those omegas. 

[00:47:50] And so that's really how I'm building meals and how I teach people to build meals inside of the book with tons and tons of recipes, meal plans, everything that you need to make this possible. The other tenet I will really emphasize in the book is going to intentionally move your body as much as possible. You had mentioned strength training. I am a big proponent of strength training, but really initially I just want you moving. I think about the Blue Zone researchers and a lot of the Blue Zone-- people are not going to hit classes or power yoga. They're just fitting physically active. Their whole life is built around movement. And so, one of the best ways that we can do that at the very least is just moving after meals. 

[00:48:30] Just even 5 to 10 minutes, up to 20 minutes moving after meals. Now, if you're like me and your son doesn't want to go outside after dinner every single day, which I totally understand, he wants to build Legos. I am often building Legos and doing jump squats. Building Legos and doing jump squats. Yeah. Or I'm doing pushups and doing puzzles and so getting where you fit in. If you are in a season of life where you're raising young kids or you're raising children, you can't get outside all of the time because life is happening. Build in that micro movement, build in those exercise snacks or those-- that neat movement to ensure that you are staying physically active. And then the other thing, I think you and I talk about this a lot. I know you talk about this on podcast. 

[00:49:09] You really spent time on this when you were on my show last time. But that is prioritizing your sleep like it is a million-dollar meeting. Now, I get that about 70% of women in perimenopause and menopause are struggling with sleep issues. And there's a lot of sleep aids that we can talk about. But I think what's important is that we have really good sleep routines and foundations in place as well. So, a big part of what I talk about in the book is sleep consistency. Going to bed at the same time, waking up at the same time, getting morning sunlight on your eyes so you are literally resetting your sleep cues and your circadian rhythm. If you're still struggling, we can talk about oral micronized progesterone. We can talk about CBTs. 

[00:49:49] We talk about magnesium glycinate and L-Theanine and all the different things that we can use to help you get that deep restful night's sleep. But I think that foundation that we tend to shrug off is having that consistency and really honoring our circadian rhythm. So those are going to be three major tenets of the book that I really emphasize. I would say the one that has been the biggest needle mover for me is movement. Movement for regulating my stress response system, movement for supporting my digestive system, movement for balancing and optimizing my blood sugar and just feeling alive in my body. I will tell you the benefits of movement for me and I do a lot of exercise snacks throughout the day is more mental energy, more physical energy, better deeper quality sleep and good phenomenal metabolic markers. Like my markers look amazing. 

[00:50:42] I just had a blood draw a couple weeks ago and my ApoB was 72 and my triglycerides were in the 50s and my HDL was 87 and my insulin was 4.2 and I was like, that's what I'm talking about. Like, I think my fasting glucose was 77 mg/dL. Obviously eating the right substrates are super important, but this is what movement does. Movement helps to optimize us in such a beautiful way. I do believe that movement is life. 

Cynthia Thurlow: [00:51:11] Well, I so enjoyed this conversation and I think of The Perimenopause Revolution as a love letter to middle-aged women. Thank you so much for the work that you're doing. Please let listeners know how to connect with you, how to purchase your new book, which we are going to have out around your launch week. How to connect with you, how to learn more about your podcast and your work. 

Dr. Mariza Snyder: [00:51:34] Oh, thanks so much Cynthia honey. So, the podcast is Energized with Dr. Mariza and it's such a blessing to get to have you on the show. I'm so excited to have you back on the show for your book. The book you can go to drmariza.com/book and depending on when this goes out, whether you preorder the book or you get the book on the backend once it's available. I have such incredible bonuses including a masterclass, workout videos, beginner and intermediate. I'm going to meet you where you're at, tons and tons of recipes, tons of meal plans, tons of how to, symptom tracker, lab tracker, everything that you need to get started especially if you get the book before the book is out.

[00:52:12] I know that when I'm ready to get started, when I'm ready to take that step into feeling more optimized in my health and wellbeing that I want to start now. I'm very much now is the new later and so I want to make sure that you know that all the bonuses are built for you to start today. Especially, if you are waiting for the book. I don't want you to feel like you have to wait to get started to feel more alive and more like yourself than ever before. 

Cynthia Thurlow: [00:52:38] I so love it. Thanks for the work that you're doing my friend. 

Dr. Mariza Snyder: [00:52:41] Thanks honey. 

Cynthia Thurlow: [00:52:45] If you love this podcast episode, please leave a rating and review subscribe and tell a friend. 

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