Ep. 512 The Hormone-Gut Masterclass – The Most Overlooked Fix for Women's Health
- Cynthia Thurlow
- 2 days ago
- 41 min read
I have received many requests for a masterclass on the gut microbiome, so I am excited to share one with you today.
In our masterclass today, I discuss the microgenderome, explaining how the gut microbiome changes throughout our lives, during puberty, pregnancy, and perimenopause. I cover the key shifts in the microbiome that occur, especially as estrogen and progesterone fluctuate. I unpack the symptoms women experience that indicate their microbiome may be non-optimized, offering practical solutions, including lifestyle strategies, hormones, peptides, and targeted supplements.
My goal is to do a solo episode every month. Please let me know which aspect you enjoyed the most, and what you would like to hear more about in my future monthly solo episodes.
IN THIS EPISODE, YOU WILL LEARN:
Why protein is critical in midlife, and how much of it you need to consume
An easy way to incorporate the many different plant varieties you need to consume every week into your meals
Why fermented foods and prebiotics are essential for your gut health
The benefits of giving your digestive system a 12-hour break each day
How chronic stress affects your weight, hormones, and gut function
The connection between sleep quality, gut health, and hormonal changes in midlife
How to balance exercise intensity in midlife to support muscle maintenance and recovery
Specific supplements to support gut integrity and energy production
How hormone replacement therapy impacts the metabolism and microbial diversity
The value of improving your gut health to reduce menopausal symptoms
“12 hours of digestive rest daily should be the basis for everyone.”
– Cynthia Thurlow
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Submit your questions to support@cynthiathurlow.com
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] Well, I have been asked often to do a little gut microbiome masterclass so that is what you are going to hear about today. We're going to talk about the microgenderome, we're going to talk about how the gut microbiome changes throughout the trajectory of our lives, through puberty, pregnancy, perimenopause, we're going to talk about key changes in the microbiome that happen with these changes in estrogen, progesterone in particular, we will talk about specific symptoms that women experience that can be a sign that their microbiome may be nonoptimized, we're going to walk our way through practical solutions that will include lifestyle as well as hormones, peptides, targeted supplements and more.
[00:01:14] I hope to be able to do solo episodes every month. That is my endeavor. If you take a listen to this podcast, I want you to share with my team support@cynthiathurlow.com what your favorite aspect was. I would love to know what you would like to hear more about from solo episodes from me, especially as I'm heading into this book launch timeline.
[00:01:40] I am just back from the National Menopause Show and was inspired to come home with jet lag, [laughs] not had a lot of sleep, to record a podcast today because so many of you came to the National Menopause Show to see me speak, as well as many of my talented friends and colleagues. And I got a lot of feedback and many of you indicated that you like the solo podcast episodes. You appreciate the guest podcast episodes, but really appreciate the solo episodes. And obviously with the new book coming out, The Gut Microbiome, Menopause Gut, many of you expressed a desire to learn more. So, obviously in a 30-minute talk, even in an hour-long talk, I can't dive into the science as much as I can in a podcast or in a Substack article.
[00:02:29] So many of you nurses, nurse practitioners, health coaches, nutritionists, fitness pros approached me, talked about the podcast and just indicated it's one of your favorite things that you get to listen to in your day to day in your car while you're exercising. And so, I take that not only as an enormous compliment, but it also inspires me to continue creating more content for you specifically. So, today we're going to dive into the gut microbiome, and I promise I'm going to be hitting on themes that I think everyone needs to be aware of. Obviously, I go deeper into this, into the book, and there'll be a lot of content coming out during the book launch timeline, which is to technically already started.
[00:03:11] So, for those of you that have already started buying books, thank you so much. Yes, there will be an audible version, but it probably will not be recorded until 2026. So, let's dive into this conversation about the gut microbiome. And first and foremost, there are so many changes that happen in the microbiome. And it's not just the gut, it's the vaginal microbiome, it's the oral microbiome, it's the lung microbiome. Like every microbiome in the body is impacted by alterations in hormones. And so, I always like to start from the beginning and help patients, clients, my community, understand that young boys and young girls, until they go into puberty, their gut microbiomes are very similar. It is the influence of estrogen, progesterone, a little bit of testosterone that helps differentiate our microbiomes as young women from young men.
[00:04:08] And the other thing that I think is so interesting is that Dr. Lisa Mosconi talks about the three Ps, and I think it's very applicable here as well. Because we know, based on the research, puberty is the first differentiator for the gut microbiome, followed by pregnancy. And most everyone that's listening to this will have gone through puberty and at least perimenopause and menopause. Maybe not everyone's had a pregnancy. And then perimenopause is again, when the terrain in the microbiome starts to shift quite significantly. And I think for a lot of individuals, they just don't realize this is happening because we can't see the microbiome. We can't actually see it. We can't touch it. It's not like our lungs or heart or bones or muscles, which are so much easier to visually see. And so, we don't really think about it until we have a problem.
[00:04:54] So, I think a great deal about the role of our life stages, peak fertile years 35 and younger, perimenopause 5 to 10 years preceding menopause. And for some people, they just blissfully blow through perimenopause and they don't even realize they're in it. I would say that's the minority, I think most of us will struggle. I certainly, ten years ago, oh my gosh, I never had the challenges that I had, and I didn't even realize this is what was driving it. So again, it just reaffirms why it's so important to have these conversations transparently, honestly, openly. And then obviously, menopause, again another abrupt shift, largely because of the loss of estrogen.
[00:05:31] And when we talk about estrogen, we're really talking about estradiol, which is the predominant form of estrogen that our body makes prior to going into menopause. And we know even with progesterone changes, we get alterations in immune function in the gut, which we'll talk about. So, let's just talk about statistics. We know that over 6,000 women a day go into menopause, and that's 1.3 million per year just in the United States. And if we're looking broadly outside the United States, that's 47 million women worldwide. 47 million. That's a lot of people. Average age here in the United States is 51 little earlier. In some other countries, like Southeast Asia, they can go in a little earlier. Obviously, there are women that go in a little later, but more often than not, 51 is the average.
[00:06:15] And we know the number of menopausal women is really going to rise significantly. When I was looking at statistics, it was 467 million in 1990 to now 1.2 billion by 2030. So, we are an army. [laughs] If you think that this generation is going into menopause quietly, we are not. And I think that's a good thing. I think we need to talk more about it. We need to destigmatize it. I went through a year or two where I didn't want to talk about it. I don't know why, it doesn't make any sense to me as an educator, as a clinician, but I just share that transparently. What's interesting is obviously these changes in hormones impact our entire bodies. It's not just the gut microbiome.
[00:06:53] But we know over 50% of women experience gut-related changes during menopause that impair and impact our weight, our immune function, our metabolism, our bone health, the way we perceive ourselves and the hormones themselves as they are shifting, change the ecosystem and then have profound effects on our physical, emotional and spiritual selves. And I think it's important to acknowledge this because a lot of women live in sheer fear and secrecy, they feel a lot of shame about the aging process, they don't like the changes they're seeing in their bodies. And I always like to think about the fact that, number one, we're all human, right? So, you may have that experience. And I'm sure I've had a few moments where I was like, “Why didn't I appreciate [laughs] how much easier it was when I was in my 20s.”
[00:07:42] But then I realized that I'm in a much better place emotionally and physically than I ever was. And with that is the growing confidence of feeling like you have a better sense of yourself and you can make decisions, not doubt yourself. So, if you're going through a time where you feel like you don't know your body anymore and you feel disconnected, just know that sometimes that's just a temporary process. I wax and wane. Transparently, some times in my life are easier when I'm trying to process all the changes I see when I look in the mirror or I'm looking at body composition changes and feeling like I have to work harder sometimes than I ever did.
[00:08:18] But then it's also the growing realization that a lot of stuff I worry about is really not important, meaning it's minutia. It's not substantial stuff that I need to be stressing about. So, when we're talking about the gut microbiome, we're really talking about the home of trillions of bacteria, protozoa, viruses, that have many functions. The functions could be as simple as helping to break down and assimilate our food. It can be producing vitamins, regulating immune function, helping support bone metabolism, impacting our mood, sexual health. It impacts everything. And think of it as a command center in the body, like it is that important. And there's a bidirectional relationship actually between the gut and the brain. So, you know when you're nervous and you get butterflies in your stomach, it is because of this bidirectional relationship.
[00:09:08] There's actually like a little super highway called the vagus nerve and it carries information back and forth. The vagus nerve is called the wanderer. It's the longest nerve in the body, for good reason. Ironically enough, for those of you that are healthcare providers, when I first started in medicine, I can remember they used to sometimes cut the vagus nerve. Sometimes not done purposefully, but sometimes when they were doing cardiothoracic surgery, bypass surgery, sometimes it would get cut. And I can't even imagine the net impact that would have on someone's body knowing what I know now. I think back then were like, “Oh, it's the vagus nerve, not a big deal.” Now we understand a whole lot more. It is not insignificant. So, we're really thinking about the dynamic changes that we are seeing in menopause and that perimenopausal transition.
[00:09:51] One of the first changes that we see in the microbiome is we get shifts in diversity. So, what does that mean? It means we have less species and that equates to less resilience. So, less diversity in the microbiome. It means we aren't able to fight off infections as easily. We have less beneficial bacteria. So, two of the probably most common ones people may be familiarized with are things like Bifidobacter or Lactobacilli. And so, what happens when we have less healthy bacteria or beneficial bacteria that can lead to a rise in opportunistic microorganisms that have the ability to promote inflammation. And we'll talk about dysbiosis a little later. But I always like to remind people that we really want to think about this balancing act in our bodies.
[00:10:38] Our bodies are constantly striving for balance and menopause is when the balance tips not in our favor. So that is why in the book I talk about the things you can do. And you know, during the course of this conversation today, I will talk about some high-level things that we can do. When we're talking about beneficial bacteria, we know in menopause beneficial bacteria like the lactobacilli that I mentioned can drop by over 50%. And why is Lactobacilli so important? Number one, it helps support the lining of the small intestine. Small intestine is one cell layer thick. And lactobacilli is so, so important because if that one cell layer thick, small intestinal lining gets disrupted, it can lead to leaky gut, which can lead to provoking an immune system response and inflammatory response.
[00:11:27] It can trigger out food sensitivities, like suddenly, my menopausal perimenopausal women will say, “I've always tolerated dairy, now I can't tolerate dairy. Or I always tolerated grains, now I can't tolerate grains.” Or specific foods suddenly become-- you become sensitized to them. And it can because of these shifts in the bacteria in the microbiome leading to a susceptibility of developing leaky gut. We know that lactobacilli is also very important for estrogen recycling. And estrogen recycling, we'll talk about this awkward name. It's called the Estrobolome. And the estrobolome is responsible, the health of the estrobolome is responsible for packaging up-- kind of like a present packaging up. It's like you're wrapping up the estrogen to excrete it from the body. And it's not just endogenous estrogen, the estrogens that our bodies make, it's also what we're exposed to in our environment, personal care products and food.
[00:12:20] And then also the loss of lactobacilli is catastrophic for the vaginal microbiome. Remember I talked about all these microbiomes are connected. It's not like they're alone on an island. They are all interconnected. There's all communication between all these areas of the body. And when we have a die off of lactobacilli related to that loss of estrogen in the vagina, it changes the pH. And changing the pH kills off these beneficial bacteria, which mean we're more susceptible to infections. We are more likely to see more friability. That skin may not be as resilient as it once was. When the lactobacilli die off, we aren't producing as much mucus, so that leads to less moisture. And so, it becomes this domino effect.
[00:13:05] It is not just in your head. [laughs] Statistically, if you are a menopausal women woman, you will eventually develop genitourinary syndrome of menopause, which is why replenishing estrogen and I would argue actually DHEA and testosterone for the vaginal muscular layer is very, very important. So, maybe right now at 52, 53, you're not having those symptoms. They will eventually catch up. I cannot tell you how many of my patients in cardiology were on chronic low-dose antibiotics when what those poor women needed was vaginal estrogen. And then compounding that-- I'm just jumping off on a tangent, I think it's important just to say this. Those of you that work in healthcare know this. But a lot of the reasons why little old ladies end up in the ICU is because they get a urinary tract infection. They get septicemia, which means that urinary tract infection gets into their bloodstream. They become very sick, sometimes they don't make it out of the hospital. You do not want urosepsis, which is the septicemia infection that is related to having a urinary tract infection. I mean, it can happen to men too which is not as common. But if we know that vaginal estrogen is one of these easy fixes to prevent that. I think vaginal estrogen should be over the counter like it is in some other countries. For some reason, it's requiring planes, trains and automobiles to get the black box warning off of vaginal estrogen. And hopefully that will come to fruition very soon.
[00:14:30] Another change that happens in the microbiome is that with these changes in hormones, we start making less short-chain fatty acids. And you may be familiarized with some of these, like butyrate is probably the most commonly known one. There's also propionate and acetate. They tend to be the more popular, more well-known short-chain fatty acids. But they're signaling molecules and actually they are fuel for the colonocytes, the actual little cells in the colon, and they help regulate inflammation. They're also important for supporting metabolism. And again, their decline leads to leaky gut and chronic inflammation. So, you can see these issues compound on one another. And I think the greater awareness we can bring to this, the more we can be conscientious about adjusting our lifestyle and taking targeted recommendations. I mentioned earlier, there's this estrogen recycling process in our bodies. It's called the estrobolome.
[00:15:26] I didn't name it. It's an awkward name, but I just have to give homage to those who came before us and gave this very awkward name. The name that it is, the estrobolome. The estrobolome is where the gut microbes actually help process and recycle estrogen. If there's less estrogen, we then have less recycling bacteria and it can actually lead to more issues with processing estrogen. Think about this as we're packaging, we're wrapping a presentation and there's an enzyme called beta glucuronidase. And beta glucuronidase's job is to go in and help break down the estrogen, package it up and help your body poop it out, I'm oversimplifying things.
[00:16:11] There is two phases of estrogen detoxification in the liver, the rest is in the gut and we want to be able to package up the estrogen and poop it out. But sometimes it gets recirculated. It can get recirculated if we don't have a healthy microbiome. It can get recirculated, if we aren't able to properly break down and detoxify metabolites, it can break down if we are dealing with opportunistic infections, and we're more likely to deal with these issues in perimenopause and menopause. And I think for a lot of people, it really goes back to supporting detoxification. And I know there are people in the allopathic world that will say, “You don't need to do anything.” Well, I'm the first person to say we have so much estrogen exposure outside our bodies, we call it exogenous between our personal care products, our environment, our food. It's just important to be cognizant of how these things can influence making it harder for our bodies to process up the extra estrogen.
[00:17:08] And this is also why I tell people you should be pooping more than once a day. And if you're not, you need to be wondering why. And we'll talk more about that later. So, we know in menopause and perimenopause we're more likely to deal with leaky gut. And we know that declining estrogen actually weakens the gut lining and leads to more intestinal permeability and triggers an immune cell activation which leads to more inflammation, joint pain, brain fog, bloating, weight loss resistance. So, you want to think about your gut as a coffee filter. And in menopause, tiny holes can actually be punched in there leading to irritants and toxins into your bloodstream.
[00:17:57] Remember I mentioned earlier, the small intestinal lining is one cell layer thick. And so there's multiple things that are making it easier for our bodies to have issues related to leaky gut. And in a minute, we're going to talk about the immune system because I think it's really important to just understand this complex in a relationship. And I promise we won't get super sciency. I'll just try to keep it light. And something to consider is that if you have a leaky gut, you've got a leaky brain. Anyone that's listening that has had an autoimmune condition, you have a leaky gut, you very likely have a leaky brain. And it's just something to keep in mind. It doesn't mean that that's something that you can't get rid of or you can't fix. But I think a lot of people don't make that connection. There's actually a blood brain barrier and it's designed to keep things out.
[00:18:40] But if you have a breach of your small intestinal lining, you very likely have a breach in your blood brain barrier. And it's why we can get neurologic symptoms when we have leaky gut. And the research shows that leaky gut markers are two times higher in menopausal women versus those who are not in menopause. The research talks about premenopausal women, so that could also be lumping together perimenopause and premenopausal women. It's very likely looking at younger women who tend to have more robust microbiomes. The other thing is very common to see changes in gut motility. I know for myself in clinical cardiology, we would sometimes see severe manifestations of this, especially with patients that had poor metabolic health or diabetes. They can get something called gastroparesis, which is really, really bad. If anyone's familiarized with this, you don't want it.
[00:19:27] But we know the loss of estrogen and progesterone impacts nitric oxide production and nitric oxide production, I did a great podcast with Dr. Nathan Bryan. He's a nitric oxide researcher. Nitric oxide is a signaling molecule, really important one, but it innervates the gut, and it can lead to a reduction in motility. So, as we are losing estrogen, we are losing nitric oxide production. And we may see changes or alterations in how quickly we digest our food or how quickly we feel like our food moves through our digestive system. And sometimes people will have more reflux. They'll have history of hiatal hernias. They'll have delayed gastric emptying. It can feel like you have a rock sitting in your stomach, which is not a fun thing to experience. No one wants to have that experience. There's also this rise in opportunistic pathogens.
[00:20:15] So, you probably have heard me talk about dysbiosis, weeds in the garden. We know dysbiosis is more common to see in menopause. This is why I really like stool testing. I like to be able to look a little more deeply. And we know that dysbiosis allows harmful bacteria, fungi, viruses to thrive, leading to more inflammation and digestive symptoms. So, think about a garden. You plant fruits and vegetables. Those are the things you desire to be in the microbiome. And we'll call that the gut microbiome. What grows up in between that are weeds are the dysbiotic organisms. And so, we want to do all the things we can to not encourage those dysbiotic organisms to flourish. We also know that dysbiosis impacts chronic inflammation. Acute inflammation is good. You break an ankle, injure yourself.
[00:21:05] Acute inflammation is what helps your body heal. It's chronic inflammation we want to avoid. And we know the changes in the gut can increase systemic inflammation. They can actually accelerate the aging process and chronic disease risk. And so, if you're looking at markers for this, it might be interleukin-6, tumor necrosis factor alpha, high-sensitivity CRP, all of which can be elevated as a sign and a proxy of other types of inflammation. And then, as I mentioned earlier, there's this complex interrelationship between the gut and the brain. Our gut microbes actually produce the neurotransmitters that influence our mood, sleep and cognition. One of those is serotonin. I'm sure everyone has heard of serotonin. We know the gut bacteria influence serotonin, which influences mood, sleep and memory about 60%, so it's quite significant.
[00:21:57] And I always remind people, the health of our gut microbiome impacts our mental health. And so, the brain-- there's this constant communication, the bidirectional super highway through the vagus nerve. The gut communicates with the brain through immune pathways, endocrine pathways, neural pathways, the gut microbiome released factors. And then the brain is communicating with the gut through the autonomic nervous system. You hear me talk a lot about that, especially people that are chronically in sympathetic dominant state, they're never relaxed. That impacts the gut, the enteric nervous system, the HPA axis, the vagus nerve, all important communication pathways between the gut and the brain. Now, it's interesting if you look at the research, there's a rise in mood disorders in women in middle age. And we know women are twice as likely as men to suffer from depressive symptoms and disorders.
[00:22:50] And the risk for high depressive symptoms and disorders is greater during and possibly after the menopausal transition. I think this is multifactorial meaning. It's not just the changes in progesterone and estrogen, it's changes in neurotransmitters, serotonin, dopamine. It's a direct reflection of what's going on in the gut. And we know that mood disorders put us at greater risk for other comorbidities, including heart disease, diabetes, and other poor metabolic health issues. So, it's not benign. And it's not to suggest that there's not a place for antidepressants, antianxiety agents, even stronger medications than that. But I think it's really having a very comprehensive understanding that it's never just one thing. I think the tip off can be, especially when women tell me they're really irritable, I'm like, “Oh, you probably need some estrogen and a little more progesterone.”
[00:23:38] But it could very well be that you need more than that and that's okay. So, the big thing for me is making these connections between the gut and the bone axis. I think a lot of people don't make those connections. And I was talking to Vonda Wright when I was recording my last podcast with her, and we were talking about this complex interplay, like, the health of your bones has a lot to do with the health of your microbiome. And so, we know a healthy microbiome promotes the improvement of calcium reabsorption and reducing bone breakdown. So, for anyone that doesn't know, estrogen and progesterone work to build bone and prevent breaking down too much bone. So, it's a seesaw up until, the perimenopause transition, and then we have an acceleration in bone breakdown.
[00:24:23] And that's kind of where we are at greater risk for osteoporosis, osteopenia, as we are having these alterations in hormones. There is certain gut microbes that produce metabolites that actually protect bone density. And if we don't have the right microbes, it can actually accelerate osteoporosis. And we know that women can lose up to 20% of bone density in the first five to seven years after menopause. That's significant. Like, that's where I am right now and why it's so important just to make people aware that bone health and gut health are interrelated. And how does this happen? So, we know short-chain fatty acids, which I mentioned earlier, they inhibit bone resorption and promote bone formation. So, if you have less short-chain fatty acids, you're at greater risk for bone issues.
[00:25:06] There's actually tryptophan metabolites that modulate bone via signaling molecules and mechanisms. We know dysbiosis that I mentioned earlier, promotes inflammation and osteoporosis. We know that our diet shapes the microbiome bone access. So, this is where ultra-processed foods, lots of alcohol, smoking, etc. Alcohol are all bad for the bone. We know that prebiotics, postbiotics and probiotics can improve bone outcomes, and bile acids can be important for regulating bone. So, this is why it's important to have healthy fats in your diet and make sure that your bile, which is designed to break down and emulsify fats and is also involved in mitochondrial function, etc., really, really important to make sure that we have digestion optimized so that we can help support our bone health. Because it's more than just taking HRT, right? I think HRT can be very beneficial.
[00:26:04] And I just dropped a podcast with Dr. Elizabeth Yurth and we were talking about other ways to see support bone health, including peptides and anabolics. And I have a whole bone health series coming out with Dr. Doug Lucas. And I've got whole several bone mashups with different experts. So, there's going to be a lot of bone centric conversations. Did you know that osteoporosis affects greater than 50% of Caucasian women over the age of 50? And what's interesting is osteoporosis tends to be less prevalent, although, if you look at the research, sometimes Asians and Caucasians are at greater risk, but black and Hispanic women tend to have stronger bones. And we know each year 1.5 million women are treated and are impacted by fractures to their hips, their wrists and their vertebrae. And these are fragility fractures.
[00:26:55] I have a colleague who recently shared on social media, so I'm not sharing anything that she hasn't shared publicly. But she fell and broke her wrist and then she broke work some ribs. And it just typifies why those kinds of fractures are not benign. Sometimes they can be a sign that you already have bone health issues, that you've lost muscle strength. And as you've heard me say before we lose muscle strength before we lose muscle mass. So, if you're already weak, that's really putting you behind the eight ball. And then the importance of DEXA scans and REMs, and Dr. Doug talks about REMs, so I will defer talking more about that. But it's another way to evaluate bone and as well as bone markers.
[00:27:36] So, the key bone markers are CTX and P1NP, and those are things that you can track with your primary care provider, internist that really give you another perspective on bone health. So, it's not just the DEXA or the REMS. It's also looking at those bone health markers because that can be very helpful. Now, I would be remiss if we didn't talk about metabolic impact of menopause. It is catastrophic to metabolic health. The loss of estrogen directly impacts insulin sensitivity. I'm going to say that again. The loss of estrogen, predominantly estradiol, leads to a loss of insulin sensitivity. And the loss of insulin sensitivity, many women will poo poo and they'll say, I don't need to have a conversation about HRT. I'm going to do it naturally. And I respect that because lifestyle’s very important.
[00:28:24] But you get to a point where you start to understand that body composition changes are multifactorial. It's not just the insulin sensitivity loss. It's more fat free mass to muscle mass. It is being less physically active. It's having alterations in your appetite. It's all these crazy things that happen with these changes in estrogen, progesterone and testosterone. I want to not use the word sex hormones because I think that it minimizes their impact. We have estrogen, progesterone, testosterone receptors throughout our bodies. But the average weight gain in menopause is 1.5 pounds a year. And people hear that and like that's not that bad. But over the course of 10 years, that's 15 pounds. And we spend a third of our lifetime in menopause. And I just want you to think about the cumulative net impact of that over time.
[00:29:15] That is yet another reason we have to really be conscientious about maintaining insulin sensitivity, maintaining muscle mass, all very, very important. Okay. I mentioned there are immune function changes and immunology was never my favorite subject. But I'm going to try to break this down so that it is very tangible and takeaway. We know the immune balance changes after menopause and so partly due to microbiome shifts that we've been talking about, that's a common theme that impact our susceptibility to autoimmune disease, infection risk and inflammation. And there's actually this shift. There's the thymus gland, which they use the term thymus involution, which essentially is a terrible way of saying your thymus gland becomes a fatty blob, it shrinks and it really doesn't do much after puberty.
[00:30:02] But they call it thymus involution, which is nicer than saying your thymus gland shrunk up and now it's a bit of fatty tissue. So, there's this shift in thymus activity toward Th2 dominance. And what this means is that we have a hyper responsive immune system that just gets dialed up. We know that the immune system becomes so reactive in menopause that it raises our autoimmune risk by three to five times. Now what's interesting is our immune system is regulated to be a little hyper responsive and that's what protects the fetus if we choose to become pregnant, have a baby. But it works to our disadvantage as we get older because Th1 and Th2 are speaking to either cellular or humoral immunity. And why is this important? Well, one's innate and one is acquired immunity.
[00:30:53] So, our ability to fight infections changes. We're more susceptible to infections with viruses, which is why many people that were impacted by COVID significantly were individuals that were older and we were less likely to be responsive to vaccines. And this conversation is not about vaccines. I'm just saying, like this is what the research says. So, we're more likely to get autoimmune disease. And once you've had one, you're more likely to get others. Like I have several and I think a lot of my autoimmune stuff is because of childhood trauma. And I know many of you have shared with me that you too went through a lot in your childhood. So, I think that just revved up my adrenals, my sympathetic nervous system and prime things for me to be more susceptible.
[00:31:35] So, just know that if you have one autoimmune condition, you're more likely to have others. And you know, kind of like the big takeaways about autoimmunity, the things I see most often with patients, Hashimoto's, lupus, celiac, psoriasis. There's over 100 autoimmune conditions now, but those tend to be the ones I see more commonly. And so, remember the impact of aging in the immune system. Remember the 3Ps, so puberty, pregnancy, perimenopause and these endocrine transitions exert a significant influence on the innate and adaptive immune system due to the interaction between the hormones. All comes back to the hormones. The innate and adaptive immune systems as well as pro and anti-inflammatory cytokines. Remember I mentioned cytokines, there are anti-inflammatory, there are pro inflammatory. It just ramps up the inflammation.
[00:32:25] And we know that there is concentration dependent effects of estrogen on the immune system. As estrogen is faltering in the latter stages of perimenopause and menopause, it also impacts progesterone, androgens like testosterone impacts leptin. Leptin is one of our satiety hormones. Oxytocin, which is our bonding hormone and prolactin. And this interplay between the immune system, it's all a very delicate balance. I mean really, that's what it comes down to. Big takeaway is we get alterations in immune system and we're more likely to develop autoimmune conditions. We don't fight off infections quite as well. And this is why I think again, we go back to lifestyle hormones, peptides if appropriate for you, all of which I think are really important. And so common autoimmune conditions that I see in perimenopause and menopause, as I mentioned, there's over a hundred documented.
[00:33:18] It's the third most common category of disease in the US after cancer and cardiovascular disease, and affects 5 to 8% of the population, which is anywhere from 14.7 to 23.5 million people, so a lot of people and as I mentioned, like some of the more common ones, lupus, rheumatoid arthritis, multiple sclerosis, type 1 diabetes, sojourners, psoriasis, hepatitis, Hashimoto's, celiac, all of which can be very common. And just to give you a gestalt of common symptoms that I see in middle-aged women, number one's weight loss resistance, and that is again, multifactorial is not just one reason, but gas, bloating, belching, constipation, diarrhea, fatigue, poor sleep, brain fog, hot flashes, which can be from a lot of different things. But more often than not are multifactorial.
[00:34:16] So let's talk about practical solutions because I always want-- number one, I want this podcast to be empowering. Like I'm going to give you the facts. This is what the research says is what I've seen clinically, but now we're going to talk about practical solutions. And I always tell people that this is probably where I spend more time is just talking about, like, let's get real about the things we need to do as we get older. And so, number one, it always starts with nutrition. And so based on the research, we really want to be incorporating different types of plant compounds. So, it's 30 plant species a week. And every time I say 30 people are like, but I only eat three vegetables a week and make a big salad. There are a bunch of different things in a cabbage, herbs, nuts, seeds.
[00:34:58] I mean, get a bunch of different things. Like get eight different varieties of vegetables and nuts and seeds and things into your salad that you have a couple days a week and you will easily get to 30 plant varieties a week. It needs to be protein centric. I tell everyone when I'm looking at diet recalls, 99.9% of the time people are eating at least half of what they should be eating in terms of protein. So, it needs to be protein centric, no less than 30 g, 3-0, 30 g per meal. So, if you're having two meals a day, you really got to push the protein. So, you want to have at least a 100 g a day.
[00:35:33] I know sometimes we'll talk about 1 g per pound of ideal body weight, I think for a lot of people that is daunting, overwhelming and frankly may not be sustainable. So, I always say a 100 g a day is what we're really working towards. We actually need more protein with age and not less. So that means we need more protein to trigger muscle-protein synthesis. I always use my kiddos. Now they're not kiddos, they're both adults. But my 18- and 20-year-old can probably sneeze and trigger muscle protein synthesis with 10 g of protein. Ladies, we need more. So, it may be 30, 40, 50 g in a meal.
[00:36:03] If you don't know what you're eating or how much protein, just track Chronometer, no affiliation with them. They have a free option that you can check out track for a week and see what you're doing. Fermented foods are important. Pre and probiotics, fiber, which we'll talk about in a minute and then eating less often. It doesn't necessarily have to be that you're fasting, but 12 hours of digestive rest should be the basis for everyone. Now, the carnivore community hates when I talk about fiber. They are convinced that fiber is not important. And I'm here to tell you, when someone tells me they don't tolerate fiber, I start to think about the health of their microbiome and I'll use case in point. Number one in 2019, many of you know that I was hospitalized. I had six weeks of antifungals, antibiotics. My gut was wrecked. When I say wrecked. I had nine months of diarrhea. I could not eat anything other than protein.
[00:36:55] And I missed brussels sprouts, I missed fruit, I missed all of it. But if I reintroduce it into my diet, it was a disaster. But over the past six years I've been able to try different things out and now I feel great. My husband just went through six months of treatment for tuberculosis. It's almost like chemotherapy, it's really intense antibiotics because tuberculosis is hard to kill, it's hard to catch. And my husband had a double whammy. So he just finished that and went to SHA Wellness which I think many of you know and they have a very plant-centric focused menu with protein and he could not tolerate all the fiber. It was giving him gas, bloating, diarrhea.
[00:37:35] And I said, I think this has more to do with the changes in your gut because I've been with him for 23 years, I've never seen him have this problem before. So, I share this with you to reemphasize if you feel like you do not tolerate fiber, it could be the portion of fiber you consume. Maybe you're eating five cups of Brussel sprouts and you really need to be doing half a cup and seeing how you do. Or it could very well be it's, you know, finding the right fiber-dense foods for you. Less about supplementation. But we know that fiber feeds the colonocytes in the gut and it's beneficial for microbes. And as we talked about before, it helps restore diversity and short-chain fatty acid production. So, we want ideally 25 to 30 g of day.
[00:38:15] If you don't know where you are, track and see where you are. Then we talk about pre and probiotics. So, prebiotics are like garlic, asparagus and onions and they help feed the good bacteria. And then probiotics, like probiotic-rich foods add beneficial species, so low-sugar kombucha. Looking at fermented vegetables, looking at, if you tolerate dairy, high quality dairy, kefir yogurt if you tolerate it. Unfortunately, I go wax and wane about tolerating dairy. So, I usually will look at other sources. But just know that our body thrives on variety and gets something into your diet a couple times a day. I always use the term polyphenol-rich foods. What does that mean? That's talking about brightly pigmented fruits and vegetables.
[00:39:01] Those pigments in the fruits and vegetables that are really bright actually send information signaling molecules to the gut. And so, we'll talk a little bit more about this later, but I just give this broad overview. When you're looking at your plate, you don't want it to all be monochromatic. Like right now fashion is having-- everything's all about monochromatic palettes, which are beautiful. That's not what we want on our plate. We want it to be diverse and brightly pigmented. Now, we talk about intermittent fasting versus digestive rest. Obviously, I'm known for intermittent fasting. I very transparently have talked about what happened with my father last year. Really was a wakeup call that I needed to start getting very conscientious about lifting heavy enough and not over fasting, which was making it hard to hit my protein goals.
[00:39:49] So, I want everyone listening. If you are an intermittent faster, ask yourself, are you able to get in a 100 g of protein a day? Are you able to maintain muscle? If the answer is no, I would encourage you to rethink what you are doing. And here's the truth about fasting. It's a hormetic stressor. So, if you're going through a divorce, you lost your job, you've got super stress going on, maybe you lost a loved one, maybe you're writing a book, maybe this isn't the time to be adding more stress to your life. Hormetic stressors are beneficial stress in the right amount at the right time. So, it may very well be this time in your life you need less stress. So, just something to consider. I still believe in the value of intermittent fasting. I have not thrown it out the window.
[00:40:31] I just think it's like one of many strategies. And I just find a lot of middle-aged women, they may not be weight loss resistant, but they are in a relative energy deficiency chronically and habitually. And so, we really have to get honest with ourselves or are we eating enough? I think I've already mentioned when not to use it, who should not fast? Let's be honest, if you're underweight, if you can't get in 100 g of protein a day, you should not be fasting. If you have a disordered relationship with food unless your eating disorder specialist has okayed you, have I occasionally met women who have had anorexia, bulimia, binge eating and have been able to augment intermittent fasting? Yes, but they tend to be a rarity.
[00:41:12] And quite honestly, there are a lot of people on social media who I suspect have latent eating disorders and who hide their eating disorder underneath the guise of intermittent fasting. So, just be honest with yourself. There's no judgment here. I'm just trying to be as transparent as possible. Next is stress. We know the changes with our ovaries making less progesterone lead to being less stress resilient. This does not go away. It does not go away with 200 mg of progesterone every night. It means in perimenopause and menopause we have to change what we're doing. We absolutely have to change what we're doing. I do not live the same way I did 10 years ago. In fact, I hit the nine-year mark of leaving the cardiology practice that I worked with for a very long time that was a very hard decision.
[00:41:57] I cannot imagine the amount of stress that I dealt with in a clinical environment continuing to do that for another nine years. It was not the right choice for me. I'm not demeaning anyone who works in traditional allopathic medicine. We need really good providers. I had to make some very big decisions for my health and for my sanity. And knowing that we are less stress resilient is part of that. I had the opportunity. I've now spoken on stages for the last two weeks with Dr. Amy Killen who has become a lovely friend. And we were talking about, [laughs] oh, I used to work in the ER years ago and I, and she was an ER physician. And I said, “Can you imagine that stress now?” And she's like, “No, can’t, can't at all.” So, everyone has to make their own decisions.
[00:42:38] I just interject that to bring some transparency. And here's the sad thing. Cortisol gets a bad rap. It is not a bad hormone, but it's the only hormone that goes up in menopause. So, lack of stress resiliency can be very detrimental to our health. And we'll talk more about this in a second. We know that chronic stress, not acute stress, use the microbiome towards more inflammation-producing stress species. And we know that chronic stress can lead to leaky gut or hyper permeability of the small intestine, however you'd like to say it. We know that chronically elevated cortisol leads to high blood sugar leads, high blood sugar leads to high insulin. That then leads to an inability to lose fat or weight loss. Chronically elevated cortisol can make us more likely to develop heart disease, digestive issues. It weakens our immune system.
[00:43:31] It can lead to anxiety, depression and headaches. It can raise our blood pressure. There's just a lot that can go on. So, I remind people, like acute stress is normal and part of life. Like I usually will say, “I'm on a stage, I'm talking in front of people. I know my cortisol's up, I'm excited to be here.” That's different. The stress of running through an airport trying to catch a flight, that's acute stress, not chronic stress. It's the chronic stress that gets us into trouble. And then we talk about sleep. So, sleep is very important. And I can always tell in an intake form which women are in perimenopause and which ones are menopause and who's on HRT because the loss of estrogen and progesterone impacts sleep quality as well as our circadian distribution and rhythm, which is worsened by poor gut health.
[00:44:14] So, again, it goes back to the gut health piece. I always say everything is connected to the gut. And poor stress management and poor quality sleep and insomnia go hand in hand. We know good sleep is regulated by our gut microbiome rhythms and impacts blood sugar regulation, digestion and metabolism. So, it goes without saying everything starts in the gut. So, if you're not sleeping well, more often than not it is because you have things going on in the gut. We know the gut helps us make melatonin precursors like tryptophan and serotonin.
[00:44:45] Interestingly enough, estrogen and serotonin are intricately involved. So, when estrogen starts declining, so does serotonin. And that can impact not just mood, but also sleep quality. And we know that women with the lowest gut diversity are 40% more likely to have insomnia and menopause, which is totally modifiable with diet and lifestyle. So, the takeaway message is always there are things we can do. You are not adrift at sea. Let's talk about exercise. And it's very much this Goldilocks effect, right? I think that for many of us, we worked out really intensely in our 20s and 30s and then we find in our 40s, we don't recover as well. We can't do that same intense exercise like CrossFit six days a week. Nope. Orangetheory Fitness six days a week? Nope. Not going to serve you well.
[00:45:27] It's the right exercise and the right amount. So, remember we talked about hormetic stressors with intermittent fasting. Exercise is a hormetic stressor. So, the importance of strength training is undeniable. I would say if you are a chronic cardio bunny and you're still running miles and miles and miles, replace some of your running and chronic cardio with some weight training. We have to maintain muscle mass. Zone 2 training is really important. And I jokingly say I live in a really hilly neighborhood. I do Zone 2 training just walking my dogs every day. I don't have to do a lot of extra Zone 2 training. But Zone 2 training is the training where you can comfortably have a conversation. It is not an all out sprint, Zone 4, Zone 5, which gets us to HITT, high intensity interval training.
[00:46:10] It requires a bigger stimulus at this stage of life to trigger, myokines telling our muscles it's time to grow. So, a sprint not forever, you sprint for 20, 30 seconds, you back off, you have some degree of intensity, you back off. HIIT is not 30 minutes. Hit is 10 to 12 minutes of intense work. And I think for a lot of people, they've been conditioned to believe because they're taking classes like, “Oh, hit is a 30-minute class.” No, it is not. That is not hit. We want to do hit one or two days a week. It is my least favorite thing to do. It's kind of like taking medicine. I remind myself I need to do it. So, I just find days where I've had a good night of sleep, like today is not a good example. I would not do HIIT.
[00:46:51] In fact, I probably won't exercise at all because I probably got two or three hours of sleep, but that's okay. I'm going to go to bed early tonight. But you know, really getting honest with yourself about the intensity of your exercise and what makes sense. And that research suggests that exercise in and of itself has potent anti-inflammatory effects, which is great. We know it can help shift diversity in the microbiome. And if we exercise intensely enough, we will get a transient leaky gut. And that is normal. But we don't want that to be the norm. We don't want it to be every time we exercise that we're getting a leaky gut.
[00:47:25] People that are doing like marathons and Iron Mans, they get transient leaky gut but it lasts a whole lot longer because that degree of intensity is so protracted. Now, we're going to talk about supplements because I know this is always a huge topic. We're going to talk about urolithin A, butyrate and TUDCA. We'll talk about digestive supports, we'll talk about probiotics and we'll talk about creatine and how that can help support us. So, Urolithin A, very transparently I've been taking urolithin A, as has my husband. I've been doing it for about three years. My husband's been on it for about a year. We increased it while he was being treated with for tuberculosis. It's a postbiotic. And not everyone can actually create endogenous Urolithin A, meaning that the health of your microbiome has a lot to do with whether or not you can actually create it on your own.
[00:48:18] There is some testing that's emerging that might be helpful. But I have found that people have to eat a lot of a particular food, like pomegranates, like 40 pomegranates to get the amount of Urolithin A they would get in like might appear. Timelines might appear as an example, we know that Urolithin A can improve the tight junctions of the small intestine. It can help support the mucus layer. Remember these are themes we've been talking about over and over again. Things that are changing in the microbiome reduces inflammation. We know it upregulates mitophagy. So, again recycling of disease disordered mitochondria. We can get it nutritionally from pomegranates and strawberries. But you have to eat of a voluminous amount to actually get enough. And the health of our gut determines if you generate enough of this Urolithin Anywhere from 500 mg to a g a day. I'm giving my husband more because he's still recovering from his treatment.
[00:49:08] Then we talk about butyrate and this is one of these short-chain fatty acids that we talked about earlier. It's the primary fuel for the colonocytes. It helps with tight junctions and intestinal strength. Really important for reducing inflammation and supporting immune function. There's some research. It may actually lower heart disease risk. And we know heart disease is the number one killer of women. One in three women will die of heart disease. I think it's so important. October is a very important month. This is a tangent. We talk a lot about breast cancer awareness. It is that is certainly breast cancer screening, breast cancer awareness, super important, more women will die of heart disease.
[00:49:43] So, like this is something that needs to be on our mind all the time. We know that butyrate also protects that mucus layer. Remember we talked about it's one cell layer thick for that small intestine. It can help with osteo-anabolism, so helps build up bone. We can get it from nutrition, we can get it from resistant starches, polyphenols, remember brightly pigmented fruits and vegetables. In some instances, dairy. And I find a lot of my middle-aged women don't tolerate a lot of dairy. And in terms of supplementation, I like tributyrin or sodium butyrate are both excellent options. Then we're talking about TUDCA, which is an acronym for tauroursodeoxycholic. This is one of my favorite supplements. It helps reinforce tight junctions in the small intestine. It can reduce inflammation it improves insulin sensitivity. Really important, especially as we're losing this with that changes in alterations in estrogen. It can improve the microbes and biliary support. So, bile helps break down and emulsify fats. It supports healthy mitochondria, again, very important, including the gut brain axis.
[00:50:48] And usually, we're starting with anywhere from 250 to 500mg with meals max a gram. I've started cycling patients on and off. So, maybe they take a bottle, they take a break. They take a bottle, they take a break. I've actually started doing that myself. I think it can be a little more cost efficacious. Not that TUDCA is super expensive, but it's one of my favorite supplements that I use and recommend and it's something I take personally. Then we're looking at creatine. I know many of you know about creatine for muscle strength.
[00:51:16] We know it supports a healthy gut lining, helps reduce inflammation. You can think of it as energy assurance for gut microbiome integrity. Like just to give you some other perspective. And evidence suggests women need more support than men, especially in perimenopause and menopause. And I typically will say dose depends on what you're taking it for. Like right now I'm high dosing creatine because of traveling on the red eye. I took 10 g today when I had lunch, and I'll probably take 10 g tomorrow and maybe the following day. But starting doses, 5 g, you need more to cross the blood brain barrier. It's usually really good for jet lag or you had a crappy night of sleep like I did. I think I slept two or three hours [laughs] on the plane, but at least I slept right. It could have been worse.
[00:51:56] Next is hormone replacement therapies. Obviously, we talk a lot on the podcast about estrogen, progesterone, testosterone, but also Getting that tested and getting a sense if yours is low. And one thing to zero in on, pregnenolone, you want to get it tested, you want it greater than 50. It is a memory hormone. I take pregnenolone, I take all of these, but I take pregnenolone. And for me, I had to go really, really low dose. I'm normally not super sensitive to supplements or hormones for that matter, but at higher doses than what I'm taking right now give me headaches. So, I couldn't start at 10 mg, I couldn't start at 25. I'm on a liquid drop and that's what I tolerate. So just know that sometimes people will get headaches from that.
[00:52:38] And then let's talk about estrogen because estrogen and the gut microbiome are so interwoven. We know less estrogen leads to less microbial diversity, changes in microbial metabolism and also more leaky gut. And there's also this crosstalk mechanism between estrogen and the microbiome. So really important, the estrobolome, the microbiome, they're constantly communicating. So, less estrogen means there's less communication. We get alterations in inflammation in menopause and we know that HRT can help support healthier microbial diversity, more insulin sensitivity and less leaky gut. It's not yet a primary indication specific to the gut microbiome. But research is evolving. I just want to be really clear about that. I think that the one thing that was clear when I was writing the book is there's a lot of research on estrogen and immune modulating properties and the gut microbiome.
[00:53:29] There's a little less on progesterone and not a ton on testosterone. But still really important to mention like this is emerging research. There's one particular study that I was looking at that showed that duodenal microbiome changes in menopause, the effects of hormone therapy and implications for cardiovascular risk. So, what this means is the core microbiome is significantly different in menopausal women. We compare those that are younger and these differences are lessened in menopausal women on HRT. I don't have a range like, I can't say like with bone we want the ranges of estradiol to be greater than 60 pg. I don't have a dosage. But we want more than a whiff of estrogen. We don't want our levels to be 20, we want them to be greater than 50 for a lot of benefits.
[00:54:14] Again, there's this bidirectional relationship between the gut microbiome and vaginal microbiomes especially for those of us taking hormone replacement therapy. We don't exist in a vacuum. Let's briefly touch on peptides. I know for any of you that have subscribed to the newsletter. I was talking about different peptides for about six weeks. We're going to talk about GLP-1s. We're going to talk about thymus and alpha and we're going to talk about BPC-157. So, GLP-1s are glucagon like peptides. Examples are like Ozempic and Wegovy, which is also semaglutide or Mounjaro or Zepbound or tirzepatide. They help modulate the gut microbiome. This is important. Microbes and bile acids crosstalk with upregulating GLP-1 levels. So, if you don't have a healthy microbiome, you may not be making sufficient amounts of GLP-1.
[00:55:01] And research shows that GLP-1 use and those taking HRT have more weight loss and beneficial changes in body composition. I'm going to say this again. Last night on social media, I watched a healthcare prescriber denigrate anyone using GLP-1s for anything other than weight loss, like at maximized doses. And I think that's so silly. I'm getting ready to interview doctors Andy Lazris and Alan Roth. They wrote a book called A Return to Healing. I think it's important to say this, that respectfully, I think that modern medicine has gotten so focused on evidence based instead of understanding that just because there hasn't been a research study done yet on a particular benefit or outcome does not mean if used judiciously, cautiously, conservatively, there are other options for these drugs.
[00:55:54] And so I'm the first person to say I'm all for people finding the right peptide, hormone replacement therapy, combination and lifestyle supplements that they need for themselves. I think the big takeaway when we're talking about GLP-1s is that it's imperative to consume enough protein and strength train. Like if you're taking a GLP-1 and you're not doing those other things, you're going to end up being skinny fat, and that's bad. I have people that I know personally who are just taking GLP-1s and they're not strength training and not concentrating on protein. And I genuinely get concerned about their health. Thymosin alpha, it's an immune-modulating peptide. Remember we talked about the thymus gland before, very important in the immune functioning and it shrinks after puberty. So, thymus involution, our thymus gland shrinks down.
[00:56:41] But it's really important to understand that as we are going through perimenopause and menopause, there's something called immunosenescence that's related to thymus and thymic involution. Again, involution means shrinks. Really fun thing, right? involution. This improves the balance between Th1 and Th2. Remember, if you recall from our previous conversation, this balance means that cellular and humoral immunity is better balanced, which enhances antibody response. It's Interesting in midlife we get this immune drift and barrier vulnerability. So, the interest in immune modulators I think is really important. We think that thymosin alpha could enhance vaccine response and mucosal defense in theory. Okay, so it's in theory, right? This is not FDA approved. I want to be really clear about that. And the dose is typically 1.5 mg subcutaneously.
[00:57:29] So, it's a little injection that you give yourself subcutaneously, which means right underneath the skin, so it's not in the muscle. Let's talk about BPC-157 and I'm going to try to get things wrapped up because I feel like I've been talking for a while. So, this stands for body protection compound and it offers gastric protection. So, protection to the gut, improves nitric oxide production, really important. Remember we talked about how with less estrogen, less progesterone, less nitric oxide production, it improves GI mucosal integrity, heals tissue. So, sometimes you'll see BPC-157 used for joint pain, chronic pain. Sometimes people are having it injected into joints. I'm talking about the oral compounds in this context. We know it improves angiogenesis, so blood flow. And then we've got neuro and cardioprotective benefits. Typically dose 500 to 1,000 mcg a day.
[00:58:16] Most of the time I see this compounded. Please don't go buy it like off of Amazon and think you're getting a high-quality product, you probably are not. So, the big picture, to wrap things up, women who improve gut health may reduce menopausal symptoms severity by up to 60%. I'm going to say that again. Women who improve their gut health may improve menopausal symptom severity by up to 60%. And your gut health is the foundation for midlife vitality. So, I think it goes without saying the microbiome is malleable. It can change in days with the right inputs, and small steps lead to big shifts in diversity and resilience. The other thing is, I think it's just helpful to say that these kinds of conversations are really important because I don't hear anyone else on social media really making these connections about the microbiome.
[00:59:03] And so, I think it's really helpful for all women and providers and their loved ones to really understand that there's a lot that we can do. I shared a lot of physiology and a lot of information that, especially the immune system stuff which I know can be very technical. I tried to break it down as much as I could, but big takeaways are there's a lot we can do. I don't want the message to ever be that we're like, lost at sea and there's nothing else we can do. So, anyway, keep your questions coming. I really do genuinely-- like my team and I are really attuned to your messages. In fact, we had multiple messages last week asking for information on arrhythmias, atrial fibrillation.
[00:59:44] Ironically enough, Dr. Sanjay, Dr. B is going to be back next week. We were texting over the weekend and I asked him, I said, “Would you feel comfortable talking about arrhythmias and AFib? Because I'm getting a lot of questions.” He said, “Absolutely.” Especially in perimenopause and menopause we know that loss of estrogen in particular can really drive a lot of these arrhythmias. And atrial fibrillation is one of these greatly misunderstood arrhythmias. There's a lot of concern about stroke risk and things like that. So, keep your questions, your comments coming. Obviously, this particular solo episode is really driven by a lot of the feedback we've been getting where people really want to hear me just providing like a little master class. So, think of this as a mini master class for today and let me know what you're interested in learning more about.
[01:00:28] Thanks, my friends. Have a great day.
[01:00:31] If you love this podcast episode, please leave a rating and review. Subscribe and tell a friend.