Ep. 655 Hormonal Acne, Melasma, and Botox Safety | Women's Health, Hormones, Acne

Welcome to this week’s Midlife Minute. Today I’m answering listeners’ questions related to acne, melasma, and neurotoxins.  Stay tuned for more! IN THIS EPISODE, YOU WILL LEARN: Why acne is usually hormonal even when blood work looks normal The mechanism that lies behind the connection between sugar, dairy, and acne  The circumstances where blood testing is warranted for acne How women can have acne and completely normal-looking labs and regular cycles, and still have PMOS-level hormone activity occurring The value of screening for PMOS rather than just treating the skin How melasma differs from acne Two factors that cause melasma when both are present  Can Botox trigger autoimmune disease or cause autoimmune flares? How to reduce the risk of problems when using Botox Connect with Cynthia Thurlow   Follow on X, Instagram & LinkedIn Check out Cynthia’s website. Submit your questions to [email protected]  Join other like-minded women in a supportive, nurturing community: The Midlife Pause/Cynthia Thurlow.  Purchase Cynthia’s book, The Menopause Gut. Cynthia’s Intermittent Fasting Transformation Book The Midlife Pause Supplement Line Reference List: Acne, Melasma, and Neurotoxins  Acne References A1. Elhassan YS, Hawley JM, Cussen L, et al. Society for Endocrinology Clinical Practice Guideline for the Evaluation of Androgen Excess in Women. Clinical Endocrinology. 2025. A2. Bienenfeld A, Azarchi S, Lo Sicco K, et al. Androgens in Women: Androgen-Mediated Skin Disease and Patient Evaluation. Journal of the American Academy of Dermatology. 2019. A3. Briganti S, Flori E, Mastrofrancesco A, Ottaviani M. Acne as an altered dermato-endocrine response problem. Experimental Dermatology. 2020. A4. Reynolds RV, Yeung H, Cheng CE, et al. Guidelines of Care for the Management of Acne Vulgaris. Journal of the American Academy of Dermatology. 2024. A5. Moradi Tuchayi S, Makrantonaki E, Ganceviciene R, et al. Acne vulgaris. Nature Reviews Disease Primers. 2015. (Sentinel reference for acne pathophysiology) A6. Liu YT, Wang YW, Tu C, et al. Recommendations for managing adult acne and adolescent acne based on an epidemiological study conducted in China. Scientific Reports. 2024. A7. Xia J, Ding L, Liu G. Metabolic syndrome and dermatological diseases: association and treatment. Nutrition & Metabolism. 2025. A8. Cussen L, McDonnell T, Bennett G, et al. Approach to androgen excess in women: Clinical and biochemical insights. Clinical Endocrinology. 2022. A9. Melnik BC, Schmitz G. Role of insulin, insulin-like growth factor-1, hyperglycaemic food and milk consumption in the pathogenesis of acne vulgaris. Experimental Dermatology. 2009. A10. Chang J, Nock MR, Cohen JM, Bunick CG. Acne accounts for an almost 2.5-fold higher proportion of dermatology visits among adult females compared to adult males in the United States. PLoS One. 2022. A11. Rao Y, Lei Z, Chen S, et al. Differential plasma proteome analysis reveals key proteins associated with insulin resistance in acne vulgaris patients. Scientific Reports. 2025. A12. Roster K, Fleshner L, Karatas TB, et al. Menopause and Common Dermatoses: A Systematic Review. American Journal of Clinical Dermatology. 2026. (Shared reference, also cited in melasma section) A13. Eichenfield DZ, Sprague J, Eichenfield LF. Management of Acne Vulgaris. The Journal of the American Medical Association. 2021. A14. Costa CS, Bagatin E, Yang Z, et al. Systemic pharmacological treatments for acne: an overview of systematic reviews. Cochrane Database of Systematic Reviews. 2021. A15. Hebert A, Thiboutot D, Stein Gold L, et al. Efficacy and Safety of Topical Clascoterone Cream, 1%, for Treatment in Patients With Facial Acne: Two Phase 3 Randomized Clinical Trials. JAMA Dermatology. 2020. A16. Zaenglein AL. Acne Vulgaris. The New England Journal of Medicine. 2018. A17. Teede HJ, Tay CT, Laven JJE, et al. Recommendations From the 2023 International Evidence-Based Guideline for the Assessment and Management of Polycystic Ovary Syndrome. The Journal of Clinical Endocrinology and Metabolism. 2023. A18. Yesiladali M, Unluhizarci K, Attar E, Kelestimur F. Where are we in the diagnosis and treatment of hirsutism? A narrative review. Reviews in Endocrine & Metabolic Disorders. 2026. A19. Committee on Practice Bulletins, Gynecology. ACOG Practice Bulletin No. 194: Polycystic Ovary Syndrome. Obstetrics and Gynecology. 2018. A20. Martin KA, Anderson RR, Chang RJ, et al. Evaluation and Treatment of Hirsutism in Premenopausal Women: An Endocrine Society Clinical Practice Guideline. The Journal of Clinical Endocrinology and Metabolism. 2018. (See full list of references at https: https://www.cynthiathurlow.com/.

Today, I’m delighted to continue my conversation with Dr. Shivani Gupta about curcumin's science and its impact on mitochondrial and brain health. Dr. Gupta is the founder and CEO of Fusionary Formulas and the author of The Inflammation Code. She holds a master's degree and a PhD in Vedic sciences, and her dissertation focused on turmeric's role in inflammation, joint health, and cardiovascular health. In this conversation, we explore Ayurvedic medicine and daily rituals, body types and the five elements, and how they shape how we navigate our lives. We also spend significant time discussing how to find balance in midlife and the rituals Dr. Gupta has found particularly impactful for midlife women. This is another truly invaluable conversation with Dr. Shivani Gupta — one you will most likely want to revisit more than once. IN THIS EPISODE, YOU WILL LEARN: How much turmeric or curcumin you need to take daily to buffer inflammation  How curcumin supports the creation of new mitochondria as we age Dr. Gupta explains how Ayurveda uses the Vata, Pitta, and Kapha body types to understand individual differences How trauma or a major change can shift your Ayurvedic constitution The shift toward Vata many women tend to experience during the perimenopause to menopause transition, and how that may show up How to strengthen weak digestive fire  Dr. Gupta describes an Ayurvedic morning routine The value of using dry brushing as a simple daily ritual to support circulation and lymphatic flow The benefits of using abhyang massage as an Ayurvedic self-care ritual during menopause How stress and dysregulation affect the vagus nerve Bio: Dr. Shivani Gupta is an Ayurvedic practitioner, turmeric researcher, and founder of Fusionary Formulas. She holds a Master's degree in Ayurvedic Sciences and completed her PhD dissertation on turmeric, making her one of the world's foremost experts on its pharmacology and clinical application. She is the author of The Inflammation Code, published by Hay House, bridging ancient Ayurvedic wisdom with modern inflammation science. Dr. Gupta is known for making complex science accessible without dumbing it down — her work speaks equally to the everyday health-conscious woman and to clinicians who want to go deeper. ***Use the code CYNTHIA for 15% off at FusionaryFormulas.com. Connect with Cynthia Thurlow   Follow on X, Instagram & LinkedIn Check out Cynthia’s website. Submit your questions to [email protected]  Join other like-minded women in a supportive, nurturing community: The Midlife Pause/Cynthia Thurlow.  Purchase Cynthia’s book, The Menopause Gut. Cynthia’s Intermittent Fasting Transformation Book The Midlife Pause Supplement Line Connect with Dr. Shivani Gupta On her website Use the code CYNTHIA for 15% off at FusionaryFormulas.com Instagram YouTube Facebook Pinterest Fusionary Formulas  The Inflammation Code (Book Website) The Inflammation Code Podcast

Today’s podcast episode is brought to you by CrowdHealth. I’m delighted to sit down with Andy Schoonover, co-founder and CEO of CrowdHealth, today. CrowdHealth is a community-powered alternative to health insurance, offering a revolutionary way to pay healthcare bills through crowdfunding. Previously, Andy was CEO of VRI, a healthcare technology company that focused on monitoring patients with chronic conditions out of their homes. He is a proud graduate of the University of Virginia and Stanford University's Graduate School of Business. Andy and I discuss the scale of medical debt in the United States, including claim denials and at-risk vulnerable populations. We examine the impact of hospital takeovers and the medical system, looking at how insurance companies and hospitals, which are actually oligopolies, drive price increases that directly affect our insurance premiums and out-of-pocket costs. We discuss how hospitals influence private practice, and how this is actually a microcosm of much larger challenges. Andy also shares his origin story, explains how clinicians need to encourage patients to take care of their health in their 20s and 30s to avoid developing chronic diseases, and clarifies how CrowdHealth works, who it’s for, and how it is a growing response to our broken medical system. This conversation is particularly important due to the poor understanding of how health insurance works in the United States, while medical debt is becoming a huge issue for millions of Americans today. It may even get you thinking about your own medical insurance and how much coverage you actually receive. IN THIS EPISODE, YOU WILL LEARN: Why CrowdHealth encourages members to know their metabolic markers The importance of taking autonomy over your own healthcare How CrowdHealth works as an alternative to the traditional medical-model insurance system How CrowdHealth members can decide who they contribute toward What screening looks like within the CrowdHealth community Andy describes CrowdHealth’s Exit Diabetes program How CrowdHealth’s health coaches and care advocates support members How CrowdHealth is bringing the care back to healthcare Bio:  Andy Schoonover is the founder and CEO of CrowdHealth, a healthcare freedom company built to help Americans escape the broken health insurance system. After spending years watching families get crushed by skyrocketing premiums, confusing policies, and surprise medical bills, Andy launched CrowdHealth to create a simpler, more human alternative to traditional insurance. Connect with Cynthia Thurlow   Check out Cynthia’s website. Check out the Everyday Podcast on Instagram! www.instagram.com/everydaywellnesspodcast Follow on X, Instagram & LinkedIn Submit your questions to [email protected]  Join other like-minded women in a supportive, nurturing community: The Midlife Pause/Cynthia Thurlow.  Purchase Cynthia’s book, The Menopause Gut. Cynthia’s Intermittent Fasting Transformation Book The Midlife Pause Supplement Line Connect with Andy Schoonover Join CrowdHealth CrowdHealth on Instagram and X CrowdHealth on all Social Media: @JoinCrowdHealth

Today, I’m honored to speak with Dr. Kumkum Patel, a double board-certified gastroenterologist and neurogastroenterologist who specializes in the gut-brain-pelvic floor connection. In our conversation, we talk about IBS and stress in midlife, exploring the impact of the enteric nervous system, key risk factors for colorectal cancer, and how stress affects women differently in perimenopause and menopause. We discuss the influence of proton pump inhibitors, bile acid diarrhea after gallbladder removal, how women’s microbiome changes through the menopausal transition, and clues that indicate the estrobulome is optimized. Dr. Patel explains visceral hypersensitivity, the influence of motility, pelvic floor dysfunction, constipation, and why constipation should not be normalized. She also explains how she addresses tears, hemorrhoids, and fissures; what to do when standard approaches stop working; nutritional interventions; and how she uses microbiome testing. Stay tuned for today’s insightful conversation with Dr. Kumkum Patel about IBS, the gut-brain axis, and the menopausal transition. IN THIS EPISODE, YOU WILL LEARN: How stress affects the gut-brain axis The red flags that help Dr. Patel distinguish IBS from colorectal cancer or other conditions, and why midlife bowel changes should be evaluated How long-term PPI use can create additional problems, and how automatic refills contribute to prolonged use How bile acid diarrhea can occur after gallbladder removal, and other causes that may explain persistent diarrhea Symptoms that could indicate that a woman’s gut microbiome and estrobolome may not be functioning optimally How gastrointestinal and pelvic symptoms change during the menstrual cycle as women approach menopause How pelvic-floor dysfunction contributes to constipation Lifestyle changes that can help manage hemorrhoids and fissures and reduce further irritation How people who can eat most foods can improve their diet before adding supplements Where microbiome testing fits into Dr. Patel’s practice and why she uses it cautiously Bio: Dr. Kumkum Sarkar Patel is a double-board-certified gastroenterologist practicing in Orange County, California. She specializes in irritable bowel syndrome, swallowing disorders, pelvic floor disorders, and women's GI health. She graduated Magna Cum Laude with honors, with a Bachelor of Science degree in Biomedical Engineering from Virginia Commonwealth University. She earned a Master's degree in Public Health from Dartmouth Medical School at the Dartmouth Institute for Health Policy and Clinical Practice, and her medical degree from St. George’s University School of Medicine. She completed her internal medicine residency at NYU Winthrop Hospital and then did a Gastroenterology fellowship at the University of Illinois in Chicago. Dr. Patel completed specialized training in GI motility disorders at Washington University in St. Louis through the American Neurogastroenterology and Motility Society.  Dr. Patel moved to Southern California with her husband and two young sons in July 2020. Dr. Patel currently serves as a healthcare consultant and speaker for medical device and pharmaceutical companies. She also serves on the American College of Gastroenterology's Women in GI Committee to promote advancement for women in GI. Additionally, she is a passionate motivational speaker who has spoken nationally about women's health, work-life balance, postpartum depression, and gut health related to stress and mental health. In September 2022, Dr. Patel hosted the Equity and Levity Summit in Orange County, California, the first-of-its-kind women's empowerment conference. She was named the 2023 Healthcare Innovator of the Year by the Irvine Chamber of Commerce and named a 40 Under 40 Top Leader in Irvine in 2024. She has been featured on KTLA5 News, CBS8, NBC California Live, as well as in print in Good Housekeeping, Popsugar Wellness, Authority magazine, and VoyageLA magazine for her expertise in gut health, IBS, and lifestyle tips. In 2024, Dr. Patel opened her own concierge solo private gastroenterology and wellness practice with 3 offices in Orange County and telehealth available nationwide. She aims to help each patient take charge of their gut and overall health through an integrative mind-body approach. She works closely with pelvic floor physical therapists, dietitians, surgeons, and other practitioners to provide comprehensive GI care. Connect with Cynthia Thurlow   Follow on X, Instagram & LinkedIn Check out Cynthia’s website. Submit your questions to [email protected]  Join other like-minded women in a supportive, nurturing community: The Midlife Pause/Cynthia Thurlow.  Purchase Cynthia’s book, The Menopause Gut. Cynthia’s Intermittent Fasting Transformation Book The Midlife Pause Supplement Line Connect with Dr. Kumkum Patel On her website Instagram

Welcome to the latest Midlife Minute. In this episode, I answer questions related to disordered relationships with food, relative energy deficiency, bone health, and intermittent fasting.  Stay tuned to find out what can happen to your body when you’re undernourished, and how to approach intermittent fasting in a way that supports your health rather than adding more stress. IN THIS EPISODE, YOU WILL LEARN: How fasting culture can sometimes intersect with undernourishing the body The link between a lifetime of anorexia, fasting, and restrictive eating and lower bone mineral density in midlife The importance of restoring energy availability The endocrine and metabolic changes that can accompany loss of the menstrual cycle When transdermal estradiol and progesterone may be appropriate if menstrual recovery does not occur The importance of getting enough protein, fiber, healthy fats, and overall nourishment when fasting intermittently What to consider when using electrolytes during a fast Connect with Cynthia Thurlow   Follow on X, Instagram & LinkedIn Check out Cynthia’s website. Submit your questions to [email protected]  Join other like-minded women in a supportive, nurturing community: The Midlife Pause/Cynthia Thurlow.  Purchase Cynthia’s book, The Menopause Gut. Cynthia’s Intermittent Fasting Transformation Book The Midlife Pause Supplement Line Research: 1. Relative Energy Deficiency in Sport (REDs): Endocrine Manifestations, Pathophysiology and Treatments. Endocrine Reviews. 2024. Angelidi AM, Stefanakis K, Chou SH, et al. Review 2. The IOC Consensus Statement: Beyond the Female Athlete Triad--Relative Energy Deficiency in Sport (RED-S). British Journal of Sports Medicine. 2014. Mountjoy M, Sundgot-Borgen J, Burke L, et al. 3. Eating Disorders. Lancet. 2020. Treasure J, Duarte TA, Schmidt U. Review 4. Eating Disorders. The Journal of the American Medical Association. 2025. Attia E, Walsh BT. Review 5. All-Cause and Cause-Specific Mortality Risk in Individuals With Eating Disorders: Systematic Review and Meta-Analysis of Relative Risk and Aggravating or Attenuating Factors. World Psychiatry: Official Journal of the World Psychiatric Association. 2026. Semchishen SN, Højlund M, Lemaire D, et al. Recent 6. ACOG Committee Opinion No. 740: Gynecologic Care for Adolescents and Young Women With Eating Disorders. Obstetrics and Gynecology. 2018. Committee on Adolescent Health Care Guideline 7. Fractures in women with eating disorders—Incidence, predictive factors, and the impact of disease remission: Cohort study with background population controls. The International Journal of Eating Disorders. 2020. Frølich J, Winkler LA, Abrahamsen B, et al. 8. A Systematic Review and Meta-Analysis of the Association Between Eating Disorders and Bone Density. Osteoporosis International: A Journal Established as Result of Cooperation Between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA. 2016. Robinson L, Aldridge V, Clark EM, Misra M, Micali N. SR 9. Bone Health in Adult Women With ED: A Longitudinal Community-Based Study. Journal of Psychosomatic Research. 2019. Robinson L, Aldridge VK, Clark EM, Misra M, Micali N. 10. Low Energy Availability and Relative Energy Deficiency in Sport: A Systematic Review and Meta-Analysis. Sports Medicine. 2025. Gallant TL, Ong LF, Wong L, et al. SR 11. Impact of Relative Energy Deficiency in Sport (REDs) on Bone Health in Elite Athletes: A Retrospective Analysis. Journal of Cachexia, Sarcopenia and Muscle. 2025. von Brackel FN, Munzinger R, Bartosik M, et al. Recent 12. Medical Complications of Anorexia Nervosa. Pediatrics. 2025. Trapani S, Rubino C. 13. Screening for Eating Disorders in Adolescents and Adults. The Journal of the American Medical Association. 2022. US Preventive Services Task Force, Davidson KW, Barry MJ, et al. Review

Welcome to the latest Midlife Minute. In this episode, I answer questions related to disordered relationships with food, relative energy deficiency, bone health, and intermittent fasting.  Stay tuned to learn what can happen to your body when you’re undernourished, and how to approach intermittent fasting in a way that supports your health instead of adding more stress. IN THIS EPISODE, YOU WILL LEARN: How fasting culture can sometimes intersect with undernourishing the body The link between a lifetime of anorexia, fasting, and restrictive eating and lower bone mineral density in midlife The importance of restoring energy availability The endocrine and metabolic changes that can accompany loss of the menstrual cycle When transdermal estradiol and progesterone may be appropriate if menstrual recovery does not occur The importance of getting enough protein, fiber, healthy fats, and overall nourishment when fasting intermittently What to consider when using electrolytes during a fast Connect with Cynthia Thurlow   Cynthia’s website. Check out the Everyday Podcast on Instagram! www.instagram.com/everydaywellnesspodcast Follow on X, Instagram & LinkedIn Submit your questions to [email protected]  Join other like-minded women in a supportive, nurturing community: The Midlife Pause/Cynthia Thurlow.  Purchase Cynthia’s book, The Menopause Gut. Cynthia’s Intermittent Fasting Transformation Book The Midlife Pause Supplement Line Research: 1. Relative Energy Deficiency in Sport (REDs): Endocrine Manifestations, Pathophysiology and TreatmentsEndocrine Reviews, 2024. Angelidi AM, Stefanakis K, Chou SH, et al. Review. 2. The IOC Consensus Statement: Beyond the Female Athlete Triad—Relative Energy Deficiency in Sport (RED-S)British Journal of Sports Medicine, 2014. Mountjoy M, Sundgot-Borgen J, Burke L, et al. 3. Eating DisordersThe Lancet, 2020. Treasure J, Duarte TA, Schmidt U. Review. 4. Eating DisordersThe Journal of the American Medical Association, 2025. Attia E, Walsh BT. Review. 5. All-Cause and Cause-Specific Mortality Risk in Individuals With Eating Disorders: Systematic Review and Meta-Analysis of Relative Risk and Aggravating or Attenuating FactorsWorld Psychiatry, 2026. Semchishen SN, Højlund M, Lemaire D, et al. Recent. 6. ACOG Committee Opinion No. 740: Gynecologic Care for Adolescents and Young Women With Eating DisordersObstetrics & Gynecology, 2018. Committee on Adolescent Health Care. Guideline. 7. Fractures in Women With Eating Disorders—Incidence, Predictive Factors, and the Impact of Disease Remission: Cohort Study With Background Population ControlsInternational Journal of Eating Disorders, 2020. Frølich J, Winkler LA, Abrahamsen B, et al. 8. A Systematic Review and Meta-Analysis of the Association Between Eating Disorders and Bone DensityOsteoporosis International, 2016. Robinson L, Aldridge V, Clark EM, Misra M, Micali N. Systematic Review. 9. Bone Health in Adult Women With ED: A Longitudinal Community-Based StudyJournal of Psychosomatic Research, 2019. Robinson L, Aldridge VK, Clark EM, Misra M, Micali N. 10. Low Energy Availability and Relative Energy Deficiency in Sport: A Systematic Review and Meta-AnalysisSports Medicine, 2025. Gallant TL, Ong LF, Wong L, et al. Systematic Review. 11. Impact of Relative Energy Deficiency in Sport (REDs) on Bone Health in Elite Athletes: A Retrospective AnalysisJournal of Cachexia, Sarcopenia and Muscle, 2025. von Brackel FN, Munzinger R, Bartosik M, et al. Recent. 12. Medical Complications of Anorexia NervosaPediatrics, 2025. Trapani S, Rubino C. 13. Screening for Eating Disorders in Adolescents and AdultsThe Journal of the American Medical Association, 2022. US Preventive Services Task Force, Davidson KW, Barry MJ, et al. Review.

Today, I’m delighted to connect with registered dietitian and certified diabetes care and education specialist, Kara Siedman. Her broad clinical experience spans inpatient oncology, diabetes, and gastroenterology. She is currently the Vice President of Science and Partnerships at Resbiotic.   In today’s conversation, we focus on the value of nutrition at the intersection of the microbiome and overall health. We discuss nutritional dogma, the impact of gastroparesis, IBS, IBD, SIBO, and other similar diagnoses. We explore midlife risk factors and medications that impact the microbiome, the influence of low FODMAP diets and irritable bowel syndrome management, food fears, and disordered food relationships. We also examine the influence of probiotics and prebiotics, clarify why constipation is multifactorial, discuss the hallmarks of aging related to the microbiome and midlife changes, and review evolving research on the microbiome and responses to GLP-1 drugs. This conversation with Kara Siedman is truly invaluable, so stay tuned! IN THIS EPISODE, YOU WILL LEARN: How nutrition has shifted away from hard science toward influencer opinions and social media dogma  Why nutrition should be personalized rather than treated as one-size-fits-all Why carbohydrates should not be demonized, and the important role each macronutrient plays Why Kara views nutrition as a bridge between conventional and functional medicine Why supporting the microbiome is about building stability and resilience through multiple foundational factors rather than one isolated intervention Medications that can disrupt the microbiome Why a low FODMAP diet should be viewed as a bridge for symptom management, and not as a treatment for IBS or something that should necessarily be followed indefinitely How the microbiome changes with aging and menopause Multiple factors that can contribute to constipation What research has revealed about the gut microbiome as a potential factor in GLP-1 responses Bio: Kara Siedman is a registered dietitian and certified diabetes care and education specialist with over 15 years of clinical experience in inpatient care, outpatient program development, and integrative/functional nutrition. Kara’s work in a leading gastroenterology practice sparked her transition into functional nutrition, where she integrated root-cause approaches into GI care and became a mentor and key opinion leader in the field. Her passion for the gut microbiome evolved into a professional specialty, leading her to collaborate with top biotech and microbiome-focused companies. As Senior Director of Science & Partnerships at resbiotic, Kara educates healthcare providers on microbiome science and the clinical application of targeted microbiome therapies. Known for her ability to simplify complex research, she brings clarity, credibility, and passion to gut health education. Connect with Cynthia Thurlow   Follow on X, Instagram & LinkedIn Check out Cynthia’s website. Submit your questions to [email protected]  Join other like-minded women in a supportive, nurturing community: The Midlife Pause/Cynthia Thurlow.  Purchase Cynthia’s book, The Menopause Gut. Cynthia’s Intermittent Fasting Transformation Book The Midlife Pause Supplement Line Connect with Kara Siedman, RD, CDCES Resbiotic On Instagram Resbiotic on LinkedIn

I am thrilled to have Gary Taubes back on the show today. (He was with me before on episode 137. Gary is an investigative science and health journalist whose work has been pivotal in catalyzing the low-carb keto movement. He has written many books, including his most recent, Rethinking Diabetes, and his articles are in many of the best anthologies. He has also received many science awards. Today's discussion is particularly significant, given the recent report from the American Diabetes Association revealing that the annual cost of diabetes in the United States reached a staggering $412.9 billion in 2022, with individuals diagnosed with diabetes now representing one in every four dollars spent on healthcare.  In our discussion today, we dive into the history of diabetes, pertinent statistics, the prevailing standard of care, and the transformative influence of insulin on diabetes management and reactive hypoglycemia. Gary provides insights into his reactions to GLP-1s, the integration of medical and nutritional science into medicine, and the influence of organizations such as the American Diabetes Association, AHA, USDA, and NIH. Our discussion also extends to the effects of pharmaceuticals, the shortcomings of our approach to diabetes management and of existing models, and the challenges the low-carb community faces. Stay tuned for today's eye-opening conversation, where we shed light on the complexities of diabetes care and explain how simple lifestyle changes can tremendously improve quality of life. IN THIS EPISODE YOU WILL LEARN: Rethinking Diabetes is a groundbreaking exploration of diabetes diagnosis, management, and treatment Gary discusses the evolution of evidence-based medicine Why the traditional medical approach to treating diabetes is inadequate How the guidelines of the American Diabetes Association were based on outdated assumptions  How medical treatments compare with lifestyle changes for managing diabetes Controversies surrounding how the pharmaceutical industry has influenced the way medical associations have shaped their diabetes management policies How medical guidelines and dietary advice have evolved What constitutes a healthy diet? How patients often have trouble following diet recommendations, despite their best intentions Is obesity a hormonal disorder or caused by overeating?  Connect with Cynthia Thurlow   Check out Cynthia’s website. Check out the Everyday Podcast on Instagram! www.instagram.com/everydaywellnesspodcast Follow on X, Instagram & LinkedIn Submit your questions to [email protected]  Join other like-minded women in a supportive, nurturing community: The Midlife Pause/Cynthia Thurlow.  Purchase Cynthia’s book, The Menopause Gut. Cynthia’s Intermittent Fasting Transformation Book The Midlife Pause Supplement Line Connect with Gary Taubes On his ⁠website⁠ ⁠Twitter⁠ ⁠Facebook⁠ Previous Episode Mentioned ⁠Ep. 137 – High Blood Sugar Levels and Long-Term Damage with Gary Taubes⁠ Book Mentioned: Rethinking Diabetes: What Science Reveals About Diet, Insulin, and Successful Treatments is available from most bookstores or on ⁠Amazon⁠.

Today, I’m honored to reconnect with Dr. Jolene Brighten. She’s an award-winning, board-certified naturopathic endocrinologist, nutrition scientist, and leading voice in women’s health. She’s the author of Beyond the Pill, Healing Your Body Naturally After Childbirth, and her latest book, ADHD and Women: A Guide to Optimizing Your Hormones and Thriving with ADHD, which represents an expansion of her core thesis that women’s symptoms get chronically misattributed when the hormone piece is left out of the picture, which she now applies to ADHD. She also hosts The Dr. Brighten Show. In today’s conversation, we look at why ADHD symptoms surface or worsen at hormonal transitions, the mental health effects of oral contraceptives and synthetic hormones, and the gut-brain connection to ADHD. We explore how gut dysbiosis dysregulates vagal nerve signaling; how butyrate and other short-chain fatty acids influence it; what endobelly is and how it affects histamine and mast cell degranulation; and emerging research on GLP-1s and endometriosis. We also discuss rejection sensitivity disorder and masking, nutritional and o lifestyle recommendations for improving symptomatology, and how key supplements like cytochrome and saffron can improve memory and mitochondrial health. Stay tuned for a truly insightful conversation with Dr. Jolene Brighten and a deeper look at ADHD and Women. IN THIS EPISODE, YOU WILL LEARN: How perimenopause can amplify ADHD symptoms Why ADHD in some women remains unidentified until midlife How gut dysbiosis can influence vagal nerve signaling in the ADHD brain Why butyrate and resistant starches may be important for the ADHD brain The connection between endometriosis, ADHD, and the gut How Dr. Brighten guides neurodivergent women through HRT conversations  How rejection sensitivity dysphoria can affect women with ADHD Dr. Brighten shares lifestyle recommendations for women with ADHD Bio:  Dr. Jolene Brighten is a hormone expert, nutrition scientist, and founder of Dr. Brighten Essentials. Board-certified in naturopathic endocrinology, a certified menopause specialist, and sex counselor, she is the bestselling author of Beyond the Pill, Is This Normal?, and the forthcoming ADHD and Women. She is dedicated to helping women optimize their hormone, brain, and sexual health through evidence-based education. Connect with Cynthia Thurlow   Check out Cynthia’s website. Check out the Everyday Podcast on Instagram! www.instagram.com/everydaywellnesspodcast Follow on X, Instagram & LinkedIn Submit your questions to [email protected]  Join other like-minded women in a supportive, nurturing community: The Midlife Pause/Cynthia Thurlow.  Purchase Cynthia’s book, The Menopause Gut. Cynthia’s Intermittent Fasting Transformation Book The Midlife Pause Supplement Line Connect with Dr. Jolene Brighten Website Pre-order bonuses for ADHD and Women (Meal plans to help optimize hormones and a PMDD workshop) On Social Media: @DrJoleneBrighten The Dr. Brighten Show

Welcome to this week’s Midlife Minute! Today, I examine partial and full hysterectomies and what we know about their potential long-term effects, clarifying what the research tells us about bone, brain, and cardiovascular health, and what women should discuss with their healthcare providers before and after surgery. IN THIS EPISODE, YOU WILL LEARN: How a partial hysterectomy differs from a full hysterectomy, and the abrupt estrogen changes ovarian removal can produce  Why having a hysterectomy before ages 40-45 can have a greater impact than having surgery closer to natural menopausal age. How a hysterectomy can impact women’s bone health What the research reveals about the connection between surgical menopause at a younger age, cognitive decline, and Alzheimer’s pathology How a hysterectomy can affect women’s cardiovascular health Why starting HRT early after an early-age hysterectomy could be important for your long-term health Why younger women who experience surgical menopause may require higher estradiol doses than the standard menopausal regimens The importance of advocating for yourself, understanding your personal risk, and talking with your clinician about estrogen and other hormone therapy before undergoing surgery Quotes: “Start those conversations early- before you ever have surgery.” “If you are having these surgeries done before 45, before 40, you need HRT!” “We have to manage our stress.” “We have to get enough sleep.” “We should be strength training.” “We should be physically active.” “We should be eating an anti-inflammatory diet.” Connect with Cynthia Thurlow   Follow on X, Instagram & LinkedIn Check out Cynthia’s website. Submit your questions to [email protected]  Join other like-minded women in a supportive, nurturing community: The Midlife Pause/Cynthia Thurlow.  Purchase Cynthia’s book, The Menopause Gut. Cynthia’s Intermittent Fasting Transformation Book The Midlife Pause Supplement Line Research: Increased Risk of Osteoporosis With Hysterectomy: A Longitudinal Follow-Up Study Using a National Sample Cohort. American Journal of Obstetrics and Gynecology. 2019. Choi HG, Jung YJ, Lee SW.  Menopause Transition and Cardiovascular Disease Risk: Implications for Timing of Early Prevention: A Scientific Statement From the American Heart Association. Circulation. 2020. El Khoudary SR, Aggarwal B, Beckie TM, et al. Cardiovascular Disease After Hysterectomy in the Nurses' Health Study and Nurses' Health Study II. Obstetrics and Gynecology. 2025. Thao V, Borah B, Stewart EA, et al. Treatment of Women After Bilateral Salpingo-oophorectomy Performed Prior to Natural Menopause. The Journal of the American Medical Association. 2021. Kaunitz AM, Kapoor E, Faubion S. Hysterectomy, Oophorectomy, and Bone Health: A Systematic Review and Meta-Analysis. European Journal of Endocrinology. 2025. Shariful Islam M, Tuesley KM, Wilson LF, et al. Risk of Osteoporosis and Fracture After Hysterectomies Without Oophorectomies: A Systematic Review and Pooled Analysis. Osteoporosis International. 2022. Xu W, Wu W, Yang S, et al. Hysterectomies Are Associated With an Increased Risk of Osteoporosis and Bone Fracture: A Population-Based Cohort Study. PloS One. 2020. Yeh YT, Li PC, Wu KC, et al. Age at Surgical Menopause Influences Cognitive Decline and Alzheimer Pathology in Older Women. Neurology. 2014. Bove R, Secor E, Chibnik LB, et al. Reproductive Period and Risk of Dementia in a Diverse Cohort of Health Care Members. Neurology. 2019. Gilsanz P, Lee C, Corrada MM, et al.  Examining the Association of Hysterectomy With and Without Oophorectomy on Cardiovascular Disease and All-Cause, Cardiovascular or Cancer Mortality: A Systematic Review and Meta-Analysis. BJOG: An International Journal of Obstetrics and Gynecology. 2024. Chen Y, Li F, Liang L, et al. Association of Premature Natural and Surgical Menopause With Incident Cardiovascular Disease. The Journal of the American Medical Association. 2019. Honigberg MC, Zekavat SM, Aragam K, et al Optimizing Health After Early Menopause. Lancet. 2024. Mishra GD, Davies MC, Hillman S, et al. Hormone Replacement Therapy for Women Previously Treated for Endometrial Cancer. The Cochrane Database of Systematic Reviews. 2018. Edey KA, Rundle S, Hickey M.