# Midlife Weight Gain Starts In The Gut! Fix THIS First - Cynthia Thurlow, NP

## Метаданные

- **Канал:** Max Lugavere
- **YouTube:** https://www.youtube.com/watch?v=42kPV_Rg4eA
- **Дата:** 30.04.2026
- **Длительность:** 55:38
- **Просмотры:** 1,912

## Описание

15 Daily Steps to Lose Weight and Prevent Disease PDF: https://bit.ly/3FcEAHw - Get my FREE eBook now!

Why hunger spirals, why fat loss feels harder—especially in midlife—and the simple, science-backed ways to regain control using protein, satiety, and smarter nutrition, with Cynthia Thurlow, a functional medicine nurse practitioner and author of The Menopause Gut.

00:00 The Role Gut Microbiome Plays In Menopause
6:04 Steps To Improve Our Gut Microbiome
10:03 Foods To Prioritize
16:26 What Are The Benefits Of Butyrate?
20:25 Why Is Weight Gain Common In Midlife?
26:17 Understanding Protein Leverage Hypothesis
34:36 Is Intermittent Fasting Useful?
37:14 Raising Awareness Of Menopause
39:25 Knowing If HRT Is Right For You
42:00 Managing A Healthy Calorie Intake
53:44 Cynthia's New Book

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## Содержание

### [0:00](https://www.youtube.com/watch?v=42kPV_Rg4eA) The Role Gut Microbiome Plays In Menopause

Cynthia Thurlo, welcome back to the show. How you doing? — I'm doing great. So good to be here, Max. — It's great to have you. I'm excited to celebrate your new book, The Menopause Gut. Very exciting. We've done a number of episodes uh on menopause as of late because it's a big topic. Millennials are in this like weird transitory transitional phase where many well millennials are now in their 40s. — Yeah. — At the upper end of the millennial spectrum, myself being one of them. And so it's a question on everybody's minds. I think the the women of the millennial cohort, those that love them, and of course, Gen X and beyond. So, I'm excited to get into it, but let's dive right in. Why do you think that the gut has been almost completely left out of the menopause conversation until now? — I think that there's a twofold issue. I think the gut microbiome as a whole is something that we've really just started to learn a bit about in the last 5 to 10 years. It's definitely not something that I learned during my medical training. And so I think that we've been so focused in many instances on replacing hormones and thinking about bone, brain, and heart health and not realizing that the microbiome really is the interface for all of these organ systems. And I would actually argue is this key longevity organ that many of us were not focusing on before. So, as I started interviewing experts on the podcast and I started getting more curious, I was like, there's a conversation we're not actually having that I think is critically important that is equally as important as all those other things I just mentioned, but helps explain quite a bit in terms of symptomatology and a lot of the concerns that women express in middle age. — So, interesting. Well, let's take a step back. What is the microbiome? And you refer to it as an organ. Why do you call it an organ? Well, I really think about it first and foremost. It's, you know, 40 trillion species of bacteria, viruses, prozzoa, fungi that it's its own little ecosystem. And so, although we can't see it, like we can look at a heart or look at a lung brain, it is equally important. It's part of the large intestine, the colon. And when I think about it, because it interfaces, like as an example, there is a gut bone access, there's a gut brain vagina access. I mean nearly every single organ system in the body communicates with the gut. So I think about it as like an assembly system where it communication and information signaling molecules, hormones are all neurotransmitters are all interplaying with this hub system of the microbiome. And so my hope and my intent is that, you know, by having these conversations, not just the lay public and listeners and people that are watching are going to be able to start advocating for themselves and understanding, you know, in the context of a larger conversation. We need to be thinking about the gut with every conversation. — And what role does the gut and the gut microbiome play in the symptoms related to menopause? — It plays everything. So I think about the changes that occur in the pmenopause to menopause transition. Things as simple as we have changes in keystone bacteria bacterial diversity changes quite significantly microbial diversity. So as an example we have less lactobacillus less bifidobacttor more inflammatory species that can contribute to a lot of the symptoms. So women are complaining of bloating, having hot flashes, having digestive issues. A lot of it can be attributed to the changes that are ongoing with these hormonal fluctuations, estrogen, progesterone in particular, and then the downstream effects of changes and alterations in neurotransmitters like serotonin, dopamine, etc. — You have argued in the book, I believe, that estrogen is normally protective of the gut. — So as estrogen is going down, we see changes in microbial diversity. We see more inflammation. We see more insulin resistance. We see alterations in things like short- chain fatty acids, which are these signaling molecules that are critically important. Um, we see alterations in other microbiome. So, you know, whether it's the oral microbiome, the vaginal microbiome, but estrogen really is this key player. And I think there's the most research on the alterations in estrogen that impact, you know, leaky gut and impact, you know, our ability to fight infections. And as I talk about in the book, the menopause gut, you know, as estrogen is declining, we have something called immun immunosiness. So the aging of the immune system and all of a sudden women in middle age are going to find that they're having more opportunistic infections. They may not respond quite as well to treatment modalities. We see more autoimmune conditions. And so that just becomes this domino effect. It is crazy because um well, it's very it's counterintuitive that um factors beyond just what we're putting into our mouths can impact the gut microbial ecosystem. I mean, I remember reading a study a couple years ago, I forget the details of it, but showing how exercise um modulates can modulate the you know, the gut microbiome. — Absolutely. I forget which outcomes they were looking at, but it's yeah, it's super interesting, you know, because often times a conversation about the gut microbiome is dominated by fiber and phytonutrients and the foods that we're eating ultimately, but that there could be this sort of hormonal aspect to it as well. It's uh yeah, very compelling and counterintuitive. — Yeah, it's interesting because exercise depending on the intensity can lead to a transient leaky gut. And when I mean transient truly it's transient because of the impact of the intensity of the exercise but just about any lifestyle measure impacts the microbiome positively and negatively. And I think that's part of that larger conversation where we say like lifestyle is still very important. But understanding it's all interconnected. We're not siloed. Like traditional alopathic medicine which is great for urgencies and emergencies sometimes is not thinking beyond the bucket in which they fall. So if you're a gastroenterenterologist, you're thinking just about the GI system. If you're a cardiologist, you're thinking just about the heart, but there's all this interplay and communication that we have to be considering.

### [6:04](https://www.youtube.com/watch?v=42kPV_Rg4eA&t=364s) Steps To Improve Our Gut Microbiome

— And what is the direction of causality? Because that would I guess lead us to potential actionable steps that we could take to improve our symptoms, right? I mean, I'm saying our I'm never going to go through menopause, but like is it just a decline in this hormonal millu that's contributing to gut, you know, an impaired gut microbiome? Can modulating the gut microbiome impact the symptoms that women experience? — Absolutely. It's such a great question. I think for so many people that are experiencing this middle-aged transition, they realize when they start making better choices for themselves, and by that I mean, you know, someone that's going from an ultrarocessed diet to a more nutrient-dense diet. someone that maybe wasn't getting for was get just getting four or five hours a night of sleep suddenly starts getting seven or eight hours a night of sleep and they experience you know less bloating less hot flashes we know that people that don't get enough sleep that in and of itself is a risk factor for poor metabolic health and I think about all of the patients I've taken care of over the years that are shift workers and it doesn't necessarily be in healthcare could be a police officer could be an EMS these people are at greater risk for poor metabolic health and how the modulation of the microbiome in and of itself it is in response. So thinking just on a very basic level, people think about the penile gland and melatonin and I'm like, we have melatonin clocks. Our circadian biology is rooted in our digestive system. And so whether it's we're eating in odd hours, we're not getting sufficient amount of sleep, it can you know redistribute, reeregulate and you know lead to this circadian dysregulation that I think a lot of people aren't recognizing as quite significant. Like I would say what you got away with in your teens, 20s, and 30s probably won't serve you well in your 40s, 50s or beyond in many instances. But absolutely to your point, the better care we take of ourselves, the less likely we are to experience significant symptoms. And certainly the lifestyle piece has to always be part of the conversation. Just giving yourself an estrogen patch is not going to fix your microbiome. — Yeah, we've talked we've had a number of conversations about HRT where I was I've been schooled on it. you know, I was uh made aware of the women's health um initiative and how misleading that was for so many women for so many years. — Um and the general tenor seems to be that it's a positive thing if you're a fit for the therapy. — Correct. And I think you know that the message always has to be HRT should be part of the conversation and then the clinician or prescriber and the patient then make a decision what the next step should be. I think that my mother's generation were the ones that were most impacted by the WHI. And certainly I was just coming out of training when the WHI came out. So I was part of that, you know, younger clinicians like fearful of hormones, fearful to talk about hormones, it's going to cause cancer. That was the message that was sent. And now we have a total 360. And so when I think about those conversations with patients, it's really helping them understand like what are your risk factors? What are we most concerned about? What are you most concerned about? I think a lot about brain health. I mean, that is something that's at the forefront of my brain when I'm thinking about like what are the reasons that I take HRT. That's one of many, but that is, you know, kind of right there. And the research has not yet shown that taking HRT is necessarily going to improve the microbiome, but I think that's the direction things are going. So, you know, we know that there are bone benefits and cardiovascular benefits and there's evolving research on the brain health and cognition benefits, but I think for a lot of people, we're realizing just because the research isn't out yet, it doesn't mean that there's very likely going to come in the future that will show that there's benefits beyond just like the big three that I think about. — It's also timing matters a lot. Like there's that — the timing hypothesis is important. I think the longer you go without estrogen, you know, the harder it can be. And it's interesting because there are women that I have in groups and they'll say I'm 73 or I'm 60. Does this mean I can't have this conversation? I would say uh no, but it means fully informed consent to see what would what makes the most sense at this point in time.

### [10:03](https://www.youtube.com/watch?v=42kPV_Rg4eA&t=603s) Foods To Prioritize

— Very interesting. Okay. So, let's talk about diet from a you know, because that is still the primary input um when it comes to the gut microbiome, what you're feeding the the bacteria that live in your large intestine. What are the kinds of foods that you think are worth um prioritizing? — I think that nutrient-dense whole foods as a kind of blanket statement to talk about eating less ultrarocessed foods because we know that there are a lot of health detriments that come from ultrarocessed foods. But I also think about at a very basic level level, sorry about that. Um fiber, you know, fiber has become the new f-word. I jokingly say that, but I it's very polarizing. And so having conversations, I have not been up until five years ago, I was not as diligent about my fiber intake. But the more that I read and understood about why fiber is so important, especially as the microbiome is changing in this pmenopause to menopause transition, um I think fiber needs to be part of the conversation. And it doesn't mean that you go from eating 10 grams of fiber a day to 50 because you'll probably be pretty unhappy. But it does mean like being purposeful and thoughtful about your fiber intake. Um that's number one because we know as we are aging especially for women we're making less short- chain fatty acids. Short chain fatty acids are signaling molecules are really important and they interface with the fiber and they have all these other benefits. I think a great deal about you know toxins that we are exposed to. So I think about alcohol, you know, changing our relationship with alcohol. And this is not to say that everyone needs to stop drinking, but just understanding that alcohol consumption leads to a transient leaky gut situation. And if women are already more prone to that at that stage of life, you know, really deciding for themselves, is this in my best interest to be continuing this practice. Um I think about polyphenols, you know, brightly pigmented fruits and vegetables. I think about like key um you know pre and postbiotics like uraliththn a I think is very the information around that is really compelling. Um a lot of people like to supplement with nitric oxide but I like to remind people nitric oxide is a very important potent signaling molecule in the body. As estrogen is declining we're making less of it. So another kind of nod to estrogen to saying replacing our estrogen is certainly going to be beneficial for helping with nitric oxide production which dilates not just blood vessels but also is instrumental in the intervation of the gut um along with progesterone which is this um smooth muscle relaxant. So from a top down approach fiber needs to be part of the conversation. you know, polyphenol rich diets. Protein is obviously important for a variety of different reasons, not just for the fact that we're trying to maintain muscle mass, but also in trying to kind of preserve satiety. Um, I'm not anti-carb, although people think that. I think high quality fats are important. Um, and those are kind of the biggest thing, but I would say fiber is probably the single most important nutrient that I think a lot of people are probably not tailoring into their diet. like they may be conscientious about protein, they may be thoughtful about what types of carbohydrates they're consuming, but just being intentional about your fiber intake and that doesn't mean grandma's metamucil. It means, you know, trying to get fiber dense foods into your diet and not going from 10 to 50 will probably get people to where they need to be to support the microbiome as it's ultra as it's changing. — What are your favorite fiber richch foods — lately? I would say um I don't know why, but I'm going through a chia and flax seed phase. So, because that's so easy to put into a smoothie, it's easy to put on top of a salad. Um you know, I think a great deal about cruciferous vegetables, which to me are so beneficial. So, really thinking thoughtfully about um nutrient-dense vegetables and you know, arugula. And I know that um there are people out there that hate kale, but just being thoughtful about cruciferous veggies. I think the other thing that I found to be really interesting is, you know, eating some fruit with the skin on, you know, getting some fiber from that. I think so many people are just peeling all their apples or, you know, they're every fruit that they consume that they can peel the skin off of. I'm like, there's ways to just — Who peels their apples? Cereal killers. — I know. — My mother was an apple peeler. — She was. She was. And so like now when I eat an apple I know. So apple, I core out the center and then I just eat the apple. Hm. — But just like simple things that you can do. — The skin on the apple. It's also a great source of flavonol which we know is really beneficial to heart health. — Polyphenols. Yeah. Fiber. Yeah. It's crucially important. 14 grams per thousand calories. That's the guideline and I think it's a very reasonable one. So that nets out for women to roughly around what is it like 28 grams or — Yeah, I would say 25 to 30 is kind of what we're aiming for. But I always say to patients like track first. So if you're eating five, don't try to go to 25. you'll be really unhappy. Um, but you know, kind of slowly increasing and just be doing it thoughtfully. Don't obsess over it, but just be thoughtful about your intake. I think that is certainly really important for people to be considering. And the irony is there are — uh rigid dogmatists in the nutrition space as we both know. No. — And uh I had someone say to me, I'd love to bring you back my podcast, but you can't talk about fiber. So I was like I said, that's kind of a main tenant of the book, but okay. I'll be happy to just avoid talking about fiber. — I'm out of the food fight. It's so annoying. I don't Why would anybody I mean I guess like carnivores carnivore — ders. Yeah. — I mean but fiber you know it is there is no oneizefits-all recommendation, right? — It's very bio-individual and that's why I always say like why don't you try the end of one try what works for you. Find you know where's your happy point. I have a patient who can like consumes 50 grams a day and feels good and I'm like you do you. If that works for you and you feel great, that's totally fine. I know that plenty of other patients wouldn't do well on 50 grams. — Yeah. You would you adapt to it though. — Correct. And that's the if you slowly increase it, you'll get to a point where you'll do really well with it. — Yeah. We there's data suggesting that like our ancestors consumed about 150 grams a day of fiber back before the industrialization of our fruits and vegetables. — Well, they were eating like twigs and seeds and nuts. Yeah. and like you know ancient forms of what we now call broccoli like way more fibrous — and it probably wasn't cooked. — Yeah, exactly. You talk about in the

### [16:26](https://www.youtube.com/watch?v=42kPV_Rg4eA&t=986s) What Are The Benefits Of Butyrate?

book quite a bit uh about short- chain fatty acids but in particular you hone in on butyrate. — What's so special about butyrate? — It's so interesting. So, it's interesting as you're writing a book and you're learning about these short- chain fatty acids and butyrate is probably the best known and when I think about it, it's this very important signaling molecule and it's critically important for the health of the microbiome. And so, we think about it, it can cross the bloodb brain barrier. So, it's a signaling molecule to the brain. It helps reduce inflammation. Um, it's critically important for supporting metabolic health. Um, there are, you know, it's anti-inflammatory properties. And so when I'm thinking about, you know, people think about butyrate, oh, you get that from butter, but it's really, you know, grass-fed, grass-finished butter, but it's helpful for people to understand that, you know, these molecules don't just do one thing. They're they've got multiple things and functions in the body that are so helpful. But to me, what I found fascinating is it actually is a signaling molecule to the brain. So it can cross the bloodb brain barrier, which the bloodb brain barrier is designed to be impermeable, you know, for a reason. and it protects the brain, but it's one of these healthy things that can help support, you know, the brain. And so, I found that to be fascinating. As I was doing research around the book, I was like, "Wow, that was something I didn't actually know. " — So, how do we get more puty? — Well, um I usually say if people tolerate, you know, things like butter, you know, grass-fed, grass-finish butter or butter in general, I think that's probably a really easy way to um get more into your diet. And I think for people, it's finding, you know, what do you like? Like I don't honestly know anyone who doesn't like butter, but um you know whether it's you know ghee is clarified butter, so probably less short- chain fatty support there, but butter is probably like the number one that I think about — but mainly probably like small the amount that you that's derived from butter is small in comparison to what you would get from fiber, right? I mean doesn't fiber — Yes, fiber can help as well. I mean, and that's why that fiber intake piece is so important that helping people understand like there's a lot of different reasons that um short- chain fatty acid support is so critically uh crucial as we are navigating this aging process. But understanding like short- chain fatty acid production goes down with these hormonal changes. And in response to that, the way to help support your microbiome and your gut and your diversity and all these other things is just to ensure that you are consuming fiber on a daily basis. And not so that again I go back to we're not talking about Metamucil, we're just talking about, you know, get it from nutrient-dense whole foods. I love that you said that because I've had a number of uh gut health experts on the show who come on extolling the virtues of fiber, but coincidentally or perhaps not coincidentally, they they're all they all have a fiber supplement that they're selling, which I'm not hating, you know, m make a buck. We know that fiber is beneficial, but I was going to ask like what your take is on fiber supplements. — I mean, I think there there's absolutely a place for it if someone is really struggling to get fiber into their diet. And the more that I understand, there are some products that are out there that um are designed to uh support different parts of the large intestine, which I find fascinating. Uh you know, different types of polysaccharides and um you know, different fermentable fibers that can act in different parts of the large intestine. And so, you know, that kind of makes me sit back and think, you know, there's probably a place for this, but what I don't want the message to be is to take more supplements. It's like get as much as you can from your food. And if you need more, that's the time to add in the supplement. And that's where I think the benefit can be. Um, which is not to throw shade on anybody because I think that there are many people out there that are just trying to find solutions to problems like just make it easy for our patients or easier for consumers to be able to get to the levels of fiber intake that they need. — Yeah. And it's like supplements have it a place. — Correct. But meant to supplement. — Yeah. Exactly. Why do you think weight

### [20:25](https://www.youtube.com/watch?v=42kPV_Rg4eA&t=1225s) Why Is Weight Gain Common In Midlife?

gain is so common in midlife? So many women complain about weight gain. — That's the million-dollar question, isn't it? So, there's so many things that are happening. We are losing skeletal muscle mass, so we're becoming sarcopenic. And less skeletal muscle mass we have or muscle, the less insulin sensitive we are. Um, we think about the body composition changes as we're losing insulin sensitivity just overall. So, less lean muscle, more body fat, more visceral fat, which tends to be more inflammatory. um as estrogen or estradiol which is the predominant form of estrogen is declining we're seeing alterations in testosterone and I actually think it is a component of this loss of estrogen but I think testosterone for most about 75% of women is also contributo especially for that visceral fat accumulation um a lot of women don't sleep well which we know wrecks metabolic health a lot of people don't manage their stress we become less stress resilient with declining levels of progesterone and less GABA um that's being uh stimulated So, you know, when I think about it, it's gut health. I always there's always a contra contribution of gut health, latent infections, um poor digestive enzymes or poor digestive fire. And then, you know, one of the probably lesser known things that I think contributes is, you know, whether it's adverse childhood events or ongoing trauma that people experience, I think that can lead to a heightened stress response. And so, I think it's multiple things that contribute. It's never just one. But I think it there's nothing more frustrating as a middle-aged woman to be told — it's just your age. You know, you're 45 now, you should just accept it. Because I certainly heard that and I didn't like that at all. — No, I can imagine. Now, is weight gain what actually happens? Is weight gain inevitable or is there is it more of a redistribution of body fat? If you look at the research, women that are younger will typically have fat accumulation around their buttocks and their thighs, which I know can be a source of frustration. As we get older, it tends to accumulate more viscerally, right? And so that is, you know, it's this hormonal piece, this interplay that is definitely driving some of that. Is it inevitable? No. However, let me dovetail this caveat and say you have to work really hard. Like it is much harder a as a 50-year-old pl 50 plus year old female than it was at 30. And so it just understand you have to take better care of yourself. Like the word pause per menopause I always say that pause is designed to make you think like not just to viscerally react and say you know what's going on my body is not working right. You got to change it all. You have to change the way you approach sleep and stress and exercise and your nutrition. And you can't eat, you know, you can't eat at 11:00 at night and drink a six-ack of beer and think that that's going to deliver not only good sleep, but that you're going to wake up in the morning and have this, you know, perfect body composition. That's not going to happen. — Does it I wonder if it does the fat redist distribution take on more of like a male phenotype because of the decline in estrogen? I mean is that — well you just tend to have more yeah you tend to have so you have you go from being gynoid to more an like more apples-shaped and so that is that visceral fat but it's partly because of this loss of insulin sensitivity suddenly you're depositing fat around your visceral organs which is the pathogenic problematic type of atapose or fat accumulation um I think it is that it is changes in alterations in appetite um you know there's something called the protein leverage hypothesis is that if you're not consuming an adequate amount of protein as your FSH is going up and your estrogen is going down, guess what? Your body's going to be looking for calories. And that's why women will say to me, I don't know what happened. I'm in the pantry at 9:00 at night. What am I looking for? And it's because they've, you know, they've had a busy day. They didn't sit down and have two or three good meals. And so at 9:00 at night, their body's like, I'm starving. You're just not nourishing me. So I think it's multiple things that contribute to alterations in body composition, not the least of which is hormones, but appetite regulation. I mean, there's so many things. And I think, you know, I certainly was raised in a culture of thin is in. I mean, thankfully now that's changing. I think there's a lot of emphasis on being strong over skinny, which is fantastic. Amen. — But certainly my generation, what were we taught? Skinny is better. And so women have very uh disordered relationships with food. Not necessarily every woman, but a vast majority, I think, do. — Yeah. I mean, I think mo most children of the 80s and 90s remember that famous Kate Moss quote that nothing tastes as good as skinny feels. — Yep. — Which I actually I've uh co-opted and I, you know, I think another a better way to think about it is nothing tastes as good as healthy feels or nothing tastes as good as strong feels. I think that there's like — there's an inherent kind of brilliance to the pathiness of that line. It's just it's heading in the wrong direction with the word skinny. — Yeah. Well, and I think, you know, we could unpack GLP-1s right now, which I think are, you know, the single most important drug of probably my lifetime in terms of effects. However, you have people that are using it in a way that is destructive, you know, and I I've had people say to me, I've lost 40 pounds on this drug, and I'm never going to stop it, and I don't care how much muscle mass I've lost. And I'm like, well, at 45 you maybe think that way, but when you can't get off a bedside toilet or you can't get out of bed when you're 60, that's going to be a whole other conversation. — Yeah, it's we don't know the health implications of somebody who's normal weight who goes on one of these drugs. I mean, these drugs are indicated for people who are overweight and obese, morbidly obese. — Yeah. I mean, it it's interesting because I have colleagues that are using these drugs in an off label responsible way with people that have autoimmune conditions. We know like women have a four to five times greater likelihood of developing autoimmune conditions, especially middle age. You know, using it off label to see if they can get improvement in some of these inflammatory um disorders that are happening. And it's interesting. I'm going to be curious to see where the direction those things go.

### [26:17](https://www.youtube.com/watch?v=42kPV_Rg4eA&t=1577s) Understanding Protein Leverage Hypothesis

— So, talk to us more about the protein leverage hypothesis. I'm a huge fan of that concept. I've done a bit of reading um into it and anecdotally, I mean, I feel like when I'm uh undereating protein, I tend to be hungry for everything else and um and I tend to eat to meet my protein requirement, which usually today means reaching for ultrarocessed foods in my pantry — because it's easy. I mean, I always say to women, you know, one of the things that happens in that transitional time in our lives, uh we have a hormone that is secreted in the brain. It's called follicular stimulating hormone and it's kind of yelling at the ovaries release an egg and as it's going up and up and estrogen's going down it kind of magnifies this protein leverage hypothesis and I always explain it to patients that you know your body is really smart it's looking for a solution for real if you're not consuming enough food in general it is going to ensure you continue to eat and generally what happens if you're not consuming adequate protein which helps with satiety and helps with maintaining muscle mass um and so many other benefits It's your body's like, hm, I'm going to get the calories that I need from probably fat and carbohydrates. Now, are fat and carbohydrates bad? Absolutely not. The unprocessed variety, but that's generally lending itself to, you know, it's like that cookies look good, the ice cream looks great. Um, it's this pantry eating that people are consuming, you know, late into the evening and not understanding why that's happening. And it's because they're undernourishing their bodies. And that's a bigger message that, you know, as women are making this transition, so many of us, myself included, because this did happen to me. It's like you start to think, oh, well, if I eat less and exercise more, because of course that's what we're taught and that's what we teach to our patients, that's going to be effective for middle-aged weight gain. It's couldn't be farther from the truth. And so I think women get to a point where they're chronically undernourishing their bodies at the expense of adequate protein intake, not realizing what the long-term detriment is of that, which is not just loss of skeletal muscle mass. It's the bigger issue with loss of metabolic flexibility, loss of insulin resist. You become insulin resistant and that's when the visceral fat piece comes on. You know, women are told they're having non-alcoholic fatty liver disease. You know, it becomes this domino effect unfortunately. So protein leverage hypothesis is part of every conversation to help women understand. I'm not saying it has to become your second job, but it is very important that you're hitting your protein macros. And if you can't hit them, we need to figure out why. — So how much uh protein should women be eating over the course of the day? — I would say 100 grams a day distributed over two to three meals. I think it depends. Some patients um you know they want two meals a day and so they're eating 50 grams of protein. Maybe they started at 20 and so we're slowly increasing their protein intake, but that is the goal. Um, I know that there are people out there who advocate for more protein, but I would say realistically most of my patients I just try to get them to eat more than where they are. So, let's get a baseline assessment. You're eating 60 grams a day. Okay, let's get to 70. And so, slowly increasing it and helping them understand like what are the benefits that you're noticing? Their sleep is better. Their hair is better. They feel like they're able to work out harder in the gym. um you know they're more satiated so they're not looking in the pantry at nine o'clock at night and wondering why they're derailing their diets. Uh so I think that there's a lot of benefit but wrapping their head around eating more protein for a lot of people it forces them to eat differently. — Well look the dietary guidelines were just updated for the first time in decades to reflect the necessity the the growing body of literature showing how protein is crucial for aging well. I mean, we now have a dietary a recommended daily allowance for protein that's 50% more than what it has been for the past 40, 50 years. — And what's ironic to me is when I say to women, you actually need more protein now than you ever did. Like I look at my very athletic teenage, well, young adult sons, and I'm like, they could probably sneeze at 10 grams of protein and trigger muscle protein synthesis. I'm like, guess what? We need more. We need more to be able to trigger the same response. And so again, helping women understand, I'm not doing this to punish you. I just want you to understand the science so that you're doing all the things that you can do to ward off losing muscle so you don't lose independence. Like that's really I can see that it's closer, you know, that whole aging process is closer to me now than it was when I started in medicine. — But I think a whole lot more about like you don't want to lose independence. Like if that's what the end result, if that's what I have to say to you to make you understand why it's so important to eat more protein, you don't want to be dependent on someone else to take care of you. — Well, what do you say to women who are hearing, you know, terms like muscle protein synthesis and fear that it's going to make them big and bulky? — It is physiologically impossible for a woman to be big and bulky unless you are consuming a lot of anabolic steroids andor super physiologic doses of testosterone. So, let me back up and say, what does that mean? steroids. Like if you're using steroids like some bodybuilders use, yes, if a female used anabolic steroids at very high doses, you could get bigger and bulkier. If you were using superphysiologic dosing of testosterone, you could get more androgenic. And I do see some of that. Um, and I sometimes am uh, you know, I sometimes humbly as a clinician, I just kind of, you know, observationally looking at someone saying, you're on a lot of testosterone, but that is unusual. That is not going to happen naturally. with your uh your onetenth of a dose of androgel. That is not going to happen with your compounded testosterone. Um that big and bulky comment. It's like if anything, you want to be strong and healthy and that's not coming from normal physiologic dosing of testosterone. — Yeah. I think people forget that muscle protein synthesis is um it's required to maintain your muscle. — Correct. like it doesn't grow muscle like on its own. You need to be resistance training hard over the course of years to grow meaning a meaningful amount of muscle. — Yes. — Um but you still need to stimulate muscle protein synthesis regularly on a not just on a daily basis but regular on a regular interval throughout the day to adequately maintain your muscle mass. — Yeah. And I think again it goes back to that whole conversation like ultimately yes it's about muscle but what is it really speaking to? We want you to be independent, a strong independent middle and older aged adult. And I think, you know, the thing that struck me, and I talked about this recently, um, what struck me during the pandemic was I went a period of time without seeing my parents and my mom was in her 70s and my dad was in his 70s and the first time I saw them after it had been probably six months, I was like, gosh, they're so frail. They had lost so much muscle mass during the pandemic. And so I go back to what are the things we don't want to have to deal with? I don't want to lose my independence. I want to be able to drive my car and go up and down the stairs and carry groceries and get off a toilet. All those things we take for granted can be problematic if you lose too much muscle. — And from an aesthetic standpoint, like again, muscle doesn't make you bulky, right? Like — no. Makes you look lean and strong. That's why I don't let anyone help me with my bag on a plane. You have these very chivalous men and I'm like, "Thank you, but no thank you. I need to be able to do this myself. But thank you very much. I appreciate that. — It's so true. Do you um What about protein distribution? Like do you make a recommendation for how to distribute that over the course of a day? — Yeah, I'm not a fan of OMAD if that was what you were kind of leaning towards. So I think that two to three bololises of protein I think is probably ideal. Um, you know, when you look at the research on OMAD, which is one meal a day for those that are unfamiliar with it, and sometimes is kind of tucked away nicely into the intermittent fasting kind of genre of options. Um, I genuinely worry about people being able, women in particular, to be able to get 100 grams of protein into one meal. I don't know any women that can do that. I I can't do that. I get to 60 and I'm like, my body's like, we're done. Um, so I think two to three distributions of protein over the day. And for some patients that may be two meals and a whey protein shake. And I'm totally okay with that. I'm not someone that's going to pass judgment. And even myself, I occasionally have protein shakes when I'm having a really busy day. It's like I need 30 more grams of protein and to be able to close my feeding window. This is a great way to do it. — Yeah. What about Have you changed your

### [34:36](https://www.youtube.com/watch?v=42kPV_Rg4eA&t=2076s) Is Intermittent Fasting Useful?

stance at all um over the course of writing the book doing this research on fasting? Because I feel like that's another message that a lot of women get is like intermittent fasting is some sort of like holy grail. Yeah, you know, as someone who's known for intermittent fasting, I very transparently have talked about how um my focus of uh my relationship with fasting changed enormously when my dad got sick and died in 2024. And so my evolution has now really been myopically focused on building muscle. And so the way that I had to build muscle was I had to have three meals a day. So I need three bololises of protein to be able to build muscle. And so intermittent fasting is one of many strategies that I think could be very impactful, very important. I still believe in the value of it. I do a lot less of it because I'm trying to focus myopically on building muscle. Now what I prefer to think of it now is digestive rest. So everyone can do 12 hours of digestive rest. That's good for the gut. It's good for mental clarity. It's good for a variety of things. It's a little less on the severity side than inter formal intermittent fasting. And so for a lot of my women that are in the same boat where they're trying to build muscle, we start talking a lot more about digestive rest. — Yeah. I think um as a tool, it it's it can be very useful. Um especially, you know, when you think about what it is that people tend to eat post dinner. It's usually not lean chicken breasts. It's not a protein shake that you're drinking while you're watching Love Island. What does it tend to be? — Junk. Exactly. — Yeah. So, I think for some people they'll say, uh, okay, my guardrails are still on. I want to have a 10-hour feeding window. I'm like, whatever you need to do. Try to aim for two to three meals a day, getting enough protein in. And if you are using that digestive rest terminology, that's great. If you want to say that I have a 10-hour eating window and I'm still doing, you know, light intermittent fasting light, I think that's great. — Yeah. Um, very important stuff. I think in light of you know what we now know about muscle and its impact on longevity health span I think it's um the the big lever is hitting your protein target every day and if that means if you get home from work late and you've you're outside of your feeding window or whatever you still want to hit your protein target right — absolutely I mean this is where I think you know protein shakes essential aminos I think can be very helpful for buffering and certainly as I'm traveling that's usually what I'm doing especially if I'm on an airplane and I'm not going to eat airplane food, which I don't think anyone does. — Yeah. It's usually so bad.

### [37:14](https://www.youtube.com/watch?v=42kPV_Rg4eA&t=2234s) Raising Awareness Of Menopause

— Yeah. — If the medical system had to change one thing about how it approaches menopause, what should that be? — I think we need to start talking to women in their 20s and 30s, not to scare them, but just to say you may in your mid30s or your late 30s, you may start experiencing some symptoms which may be a sign of early pmenopause. And what does that mean? And what are the things we can do? I think that we wait until women are in the throws of it and then we're trying to undo all of the crazy things that have been happening with their bodies. And crazy things I just mean by the time a woman is really asking for help, she's probably really miserable. Um I think that the medical system unfortunately and appropriately focuses on younger women and contraception, you know, pregnancy, the postpartum period, and then it's kind of like women drop off a cliff. So I think the growing awareness of the fact that you know anticipatory guidance is what I would say you know the medical establishment and it's not unique it should not be just the gyns it should be every single medical specialty should have education around this permenopause to menopause transition because there is no specialty that is not impacted by it there are things that I think about now having spent you know 20 years in ER medicine and cardiology that I'm like oh now I see it so clearly that was the loss of estrogen that precipitated these five things, but we aren't conditioned to think that way. — But yet, it is so catastrophic, this loss of hormonals, these loss of hormones. — At what point um at what point should women bring up HRT to their healthcare providers — before they ever need it? Making sure that they're working with someone that is open to the conversation, is willing to give them options, and is willing to work with them. And that could be someone who's in traditional alopathic medicine. does not just have to be someone who's functionally or integrative medicine trained. Um, I very humbly have met some really incredible clinicians on both sides that are doing incredible work with women, but the conversation should start before you need it. And I think far too many women are suffering with anxiety and depression and terrible sleep in their late 30s. What they probably could benefit from is a week or two of oral progesterone during the month.

### [39:25](https://www.youtube.com/watch?v=42kPV_Rg4eA&t=2365s) Knowing If HRT Is Right For You

— Are there any women who should under no circumstances go on HRT? H you know if you look at the like overt contra indications you know anyone who's being actively treated for cancer like if someone's getting a gyn oncology diagnosis and they're actively breathing or actively under treatment probably not a good idea. Um I think anyone that's having unexplained bleeding anyone that is um you know in a position where they're not able to um report symptoms. I mean the point of what I'm making is it's a very small minority. someone who's currently being treated for like a DVT or a PE probably not a great time to start or initiate HRT but in a lot of other situations there are very few true contraindications. So I think it is a conversation with the provider and with the patient. Um in fact there are people that have coagulation uh disorders who if they're getting appropriate counseling and they're seeing a proper hematologist and working with someone and they're all having a conversation there are not a ton of true contraindications that are out there. — And I think estrogen is what most people get concerned about. But transdermal estrogen or skin absorbed estrogen is very different than taking an oral medication. Is that like topical vaginal creams and stuff? — So, so two different things. So, you can have a an estradiol patch and then concurrently you can be treated um with uh intravaginal estrogen and a lot of women need both and so there's no shame in that. Um I think the question is not if but when women will develop genital urinary syndrome of menopause. I think by the age of 60 it's like 75% of women. So it's not a question of if but when. And so I think that um you know there's it's almost like a pope there's like a poperriy. It's like a platter of options. It's like figuring out you know what's the right option for the patient but understanding that you know estrogen and progesterone plus or minus testosterone plus vaginal estrogen or DHEA or testosterone and there's a lot of different options there. Uh I think for a lot of women and then you know thinking even beyond that like does someone need thyroid replacement? Does someone need a GLP1? because we know the research is demonstrating that if women are taking HRT and a GLP-1, they're going to do better than women that are not on HRT and taking a GLP-1, — which I think is fascinating, but I think it goes back to a lot of the hormonal changes that are occurring, you know, reducing inflammation with the GLP-1, improving insulin sensitivity. I think there's a lot of benefits that, you know, we're just starting to fully understand and appreciate. And where

### [42:00](https://www.youtube.com/watch?v=42kPV_Rg4eA&t=2520s) Managing A Healthy Calorie Intake

does just like a good old-fashioned calorie deficit like fall into your recommendations? I mean, you know, we there's new data suggesting that 70% of the population is not just overweight but obese. — Yes. — Um and so, you know, that's a startling statistic. Um and we know that, you know, energy balance, like whether we like to admit it or not, is still, you know, it's important. It's been time-tested, proven in clinical research. Um, and but on the other hand, I know that women have serious calorie fatigue. I mean, they've been told they've been it's been hammered into their heads over and over again to the point that calories are now considered some sort of like moral instrument. Yeah. — And they're not. — Well, and I think the bigger conversation is like I will say to patients, don't count calories, count your macros. Because it kind of allows them to refocus on what's most important. And you're correct. We have most of our population is eating predominantly ultrarocessed foods. We know that people that consume ultrarocessed foods are consuming anywhere from 500 to a thousand additional calories every day, not even realizing it. And so if we go from, you know, eating predominantly ultrarocessed foods to eating a more nutrient-dense diet by virtue of eating less processed food and eating more, you will probably be satiated in a way that you weren't before. So I sometimes say to patients, you can count the calories, but I really want you to focus in on the macros. like stop obsessing over the calories and the you know what's on the side panel like let's train our bodies or ourselves to understand that how many protein you how much protein macros do we want a day you know where are we at with the carbohydrate threshold I find that's very bio-individual like some of my patients myself included I do better with higher carbs and lower fat I have other patients do really well with higher fat and lower carbs and so there's a degree of personalization but I would hope I always say It's not the calories are irrelevant, but the it's a bigger conversation. There's more to it than that. And I think the more sophisticated way that I think about it is um calories are important. They give our bodies information, but the larger piece that I think I want everyone to understand is that macros and really getting granular about macros is not sexy. I mean, it's not a sexy thing to do, but it allows me to get more information. Like if a woman is saying to me, "I'm only eating 800 calories a day and I'm not hungry for a second meal. " I'm like, "Okay, let's unpack what that means. Let's track your macros for a week. Don't do anything differently. Let's just track your macros and see what's going on. " Inevitably, they are chronically undereating protein. They are unknowingly overeating. They're usually eating too much protein bars, protein powder. I'm like, you know, they're trying to fill in these gaps, thinking that it's being it's benefiting them ultimately, but it really isn't. And so that's part of the conversation that I think is important, but I'm glad that you brought up the calories piece. It's not irrelevant, but I feel like it's not the biggest lever. — Well, yeah. I mean, as you said, like protein leverage, like there are you can act your way into a um you know, if you change your environment and you reduce the friction to eating higher quality sources of protein, higher quality food, your hunger is going to calibrate itself. — And we know that tends to lead to less overeating. Um, — it's hard if you have a big steak. Like the other night I had a big steak and I was like, I can't eat anything else. Like I'm just too full and I'm just going to go back to my hotel and go to bed. Not immediately afterwards. But um I think for a lot of people when they adjust their macros, they're pleasantly surprised that their satiety mechanisms, they're like, I don't even want to think about having that brownie or that ice cream or those chips. I'm just too full. and not full and pleasantly full, but those stretch receptors in your abdomen are stretched and you're like, "Okay, I'm done. I had my broccoli. I had my steak and I feel good. " — Yeah. This uh woman actually DM'd me the other day because I was talking about the value of egg whites, which shouldn't be controversial. I mean, I'm a huge fan of whole eggs. I think I probably single-handedly contributed to gross domestic egg sales o over the years um in this country. And I'm a big fan of whole eggs. But egg whites are a really concentrated source of protein. They could be used to jack up the protein to calorie ratio of your scramles, of your omelettes. And when you're on the road, it's a really easy way if you just get like an egg white scramble. It's a great way to kind of like buy yourself a little bit of leverage later in the day when you find yourself in an environment that's less controllable, you know, because it's pretty easy to control breakfast, what you eat for breakfast. And um it was really funny. She had like a mind-blowing moment because she was like, "Well, I've eaten I've traded my whole eggs for egg whites um just to make sure that I'm hitting my protein target in the morning. It's a lot easier. It's more efficient to get those eggs to get that protein from to hit my protein target with egg whites. " And she was like, "I'm still hungry. " And so my response was, "Well, just eat more of them. " — Yeah. — And that was like, — yeah, — I had — She was like, "Wow, thank you so much. I hadn't thought of that. " — Yeah. I have an 18-year-old that, you know, he's very protein centric and he drinks uh literally drinks just cracks eggs and consumes them that way. And my husband and I are just astounded. We're like, why? And he said, it's I'm too lazy. I don't feel like cooking them. And I'm like, but it is a great source of protein. And I think for a lot of people, it's like we don't have to make things complicated. — Yeah, exactly. I mean, people will even three whole eggs is really not that much protein. Like three whole eggs is gain. not even enough to trigger that muscle protein synthesis. So, I always say, you know, however you have to put it together. I mean, sometimes I laugh. I'm in an airport. I'm like, "All right, I've got to put together a makeshift something. like 30 or 40 grams together. What am I going to do? I've got, you know, I've got protein powder, which is not ideal. I'll put it in a shaker pack and then I have a couple string cheese and, you know, trying to just hit that protein threshold. " And people think it's funny. I've had people ask me like, "What are you doing? " And I'm like, "Oh, I've got my bag of pistachios, so that's like six. " you know, I'm like just trying to maneuver all. It's like I'm maggyvering this meal on the go. — What are some other high protein snacks that you enjoy that you keep around? — Um I would say I mean when I'm traveling it's usually beef jerky, whey protein. Um I don't tolerate a lot of dairy, but I can get away with like a couple cheese sticks. Um you know, nuts, salted pistachios are my personal favorite. Salted macadamia nuts. Um, you know, occasionally I might there aren't a lot of clean bars that are out there, but if I'm desperate, I might have like a clean whey protein bar. It's never my favorite because I don't necessarily love that, but that's usually like my go-to, but if I'm in a restaurant or I'm in an airport, I just get a naked burger. That's usually my go-to with some salad. That's And people look at you funny. They're like, "You want the burger, but you don't want anything on it. " I'm like, "Nope. I just want the burger. " And so that and a salad usually works really well. But that's I mean that's how boring it can be. But um that tends to work while I'm you know in travel mode. — It's so worth it cuz once you start lay you know adding on the sauces, the ketchup, the mystery sauce, whatever the special sauce, the thousand island. It's like you're just adding hundreds sometimes of calories in the restaurant — and you don't even realize it — setting it. They're like invis I think that's the biggest problem today. Yeah. are like invisible calories. And to be honest, I really I believe that um the vast majority of invisible calories today come from creams and oils and fats essentially. People are all up in arms about carbs and avoiding carbs, but I don't think that that's the real problem for most people. — Well, it's interesting. There was a conversation, I think it was on X, um which I it's like a minefield. I mean, some days I don't even want to open up my app to look at it, but someone was bastardizing uh fruit. And I was like, fruit is not the problem. I want people to understand that is not the reason that we have an obesity problem. I was like, you can you can't eat like you literally will get to even if you decide to eat a bowl of grapes or if you eat, you know, a couple banana, I mean, you're going to get to a point where you are going to be full enough that you will stop eating. And so this person was arguing that, you know, fruit is addictive and fruit is the problem. And, you know, I was like, I just shook my head. I was like, "Well, maybe for you, but like in a grand scheme of things, I don't worry if a patient consumes some raspberries and blueberries. " I I do have diabetic patients that I've had in the trajectory of my medical training that have told me things like, "The diabetes educator told me I can have bananas. " And I said, "Okay, you're a diabetic. " Okay. So, I was like, "Tell me what they said. " And he's like, "Well, I have a banana in the morning and with lunch dinner and I have a banana after dinner. " And I said, "Okay, so you're how show me how big the banana is. " And so he's telling me and I said, "You probably just consumed like 60 plus grams of sugar. " And I said, "And you have a sugar handling problem. " Like in those instances, if you are a diabetic, you probably should not be consuming a lot of fruit. But I think for most people, that is not the reason why we get sick and obese. — 100%. Couldn't agree more. Yeah. Fruit is self-limiting and it's packed with water and fiber and you know fruit contains calories and you've got lower calorie options like berries and then you've got higher calorie options like bananas but even so like even a banana like — you're not going to eat the whole pineapple. — Yeah. I mean I could probably eat the whole pineapple but — Well actually no because the bromelain in pineapples will dissolve your tongue. — Yeah. Exactly. — Finish the pineapple. In fact, in my hotel room, I've got raspberries. Yeah. In my little fridge. — No, fruit's amazing. It's Nobody's getting fat from eating whole fruit. It's the ultrarocessed foods. Um I think that's the big lever today. The and the invisible calories, the calories that slide in that add nothing in terms of satiety, the oils, the cream sauces, and things like that. — Or even like the dips. You know, you go to a restaurant, it's like hummus or guac. I mean, in and of itself, guacamole is not the problem, but you just don't realize you're eating all these chips. You're eating these hyper palatable foods. It all tastes delicious. Before you know it, you've finished off a thousand calories of guacamole, which is intrinsically not a bad thing, but combined with the chips and then you're having a dinner drinks and you decide to have dessert. Yeah. You're everything goes sideways. — 100%. I was at a Mexican restaurant the other day and it's just shocking to me. Like I could eat 3,000 calories worth of tortilla chips before my brain says you've had enough. — Like I literally they're minimally satiating. They're totally — They're salted. — Salted and it's the corn and it's the oil. Doesn't matter, by the way, what oil they're made in. Doesn't matter if it's tallow or avocado oil or whatever. The crunch and then the guacamole. And it's like none of these foods are Have you seen that meme on social media where it's like all the components of a burger broken apart and it's like these ingredients are healthy. So why is a burger unhealthy? — Correct. — Well, the burger it's combined in a way that pushes your brain to a reward point that it just makes it way easier to over consume. It's just like neuro neurobiology. Yeah. It becomes hedonistic. It goes from being this is ground beef to now it's hedonistic. And so that is, you know, to your point, you start to understand like all these hyper palatable things are added to the burger. You know, the point you made about the special sauce and, you know, the faux cheese and whatever else is on it and this, you know, hyperprocessed bread like substance. I mean, there's so many things that just take it from intrinsically being something, you know, if you just have, you know, a lettuce wrap versus kind of a conventional burger. I mean, it's I've actually been in restaurants where I've said, "No cheese, no bacon, no. " And my husband's like, "No bacon. " I'm like, "No, because they never make it crispy and that's the only way I like it. " But, you know, looking at the burger and like the burger comes and everyone's like feeling like they have to apologize to me. I'm like, "No, no, no. This just this is my happy burger. I don't need all the other stuff. I wouldn't even feel good. I'd never be able to finish it. " — Exactly. So, you're just like you're optimizing for protein, which I think is super smart.

### [53:44](https://www.youtube.com/watch?v=42kPV_Rg4eA&t=3224s) Cynthia's New Book

— Well, thanks for coming out. Who should pick up the book? The menopause gut. I think anyone that is either in that permenopause to menopause transition clinicians I mean I wrote really wrote this as a labor of love um to all the patients that I've taken care of over the years and also for men you know or for loved ones of women that are going through this pmenopause to menopause transition because this information I think is going to you know help save marriages the more that the partners can understand the more they can support their loved ones. — Well that's crucially important where can people pick it up — where books are sold. So, anywhere Amazon, Barnes & Noble, Target, or if you have a local, you know, brickandmortar business, please go support your local bookstores. They've really had a tough last four or five years. I always say support your local bookstores. I know it's easy and convenient to jump online, but if you do have a local bookstore that you love, pick it up there. — Hell yeah. I mean, I even like to buy books at Barnes & Noble, which is — I do. I get like giddy. I go there before Christmas and like buy a bunch of stuff for my family. I'm like, I love being in a bookstore. — Amen. It's so true. Well, Cynthia Thurlo, thanks for coming out. Thanks for sharing. Always uh I love learning about these topics because, you know, it's never something I'll personally go through, but I I'm surrounded by women in my life, and you know, it's something that all women for the most part will, uh will eventually transition through. And so, to have a resource like this, um I think it's invaluable. So, thanks again for putting it out. — Thanks for having me, Max. — Thank you guys for listening. Share this episode around with friends and loved ones. And if it resonated with you, consider leaving a rating or review on your podcast app of choice. Just make sure that you're subscribed and uh I'll catch you on the next episode. Peace. Hey, if you like that video, you need to check out this one here and I'll see you there.

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*Источник: https://ekstraktznaniy.ru/video/49147*