Ep. 535 Masterclass: Inflammation, Hormones & Weight Loss | Hormones & Menopause

Today, we have the second episode of a two-part mashup series focused on weight-loss resistance.  For today’s episode, I am delighted to welcome experts Dr. Mary Claire Haver, Dr. Rocio Salas-Whalen, and Physician’s Assistant McCall McPherson.  Dr. Haver and I explore how inflammation drives weight gain and unpack specific strategies for macronutrients, meal timing, and more. Dr. Salas-Whalen and I examine body composition changes during perimenopause and menopause, our family responsibilities, the importance of strength training for maintaining muscle mass, and the targeted use of GLP-1 agonist drugs. Finally, McCall and I break down the labs that help guide decision-making, also discussing informed consent, the effects of hormonal replenishment therapy (now known as personalized endocrine treatment), the strategic use of GLP-1s, personalized dosages, and microdosing. This mashup includes many timely and relevant insights from three experts at the forefront of women’s health. Join us as we explore the science, strategies, and solutions shaping the future of weight loss resistance. IN THIS EPISODE, YOU WILL LEARN: How slowing sugar absorption reduces insulin spikes and inflammation The value of combining healthy fats, complex carbs, and lean protein at every meal  Why spreading protein intake throughout the day is crucial for metabolism, hormone regulation, and muscle preservation How prioritizing self-care and modeling it for children helps break the cycle of parental over-sacrifice Why strength training is more effective than cardio for long-term body composition and metabolic health The mounting stress, family pressures, and reduced self-care that many women face in their 40s and 50s How synthetic hormones in oral contraceptives disrupt thyroid, testosterone, and reproductive hormones How GLP-1 agonists can improve weight loss, food freedom, and metabolic flexibility How supporting adrenal health enhances energy, balances hormones, and improves metabolic flexibility 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)  Cynthia’s Menopause Gut Book is on presale now! Cynthia’s Intermittent Fasting Transformation Book The Midlife Pause supplement line Connect with Dr. Mary Claire Haver On her website Instagram and TikTok The Galveston Diet Book Ep. 308 Weight Gain in Middle Age, Perimenopause and Inflammation with Mary Claire Haver Connect with Dr. Rocio Salas-Whalen On her website Instagram Ep. 384 Why Weight Loss is Complex: Obesity’s Multi-Factorial Nature with Dr. Rocio Salas-Whalen Connect with McCall McPherson Modern Thyroid Clinic On Instagram and TikTok Modern Thyroid and Wellness Podcast Thyroid Lab Guide Ep. 282 Thyroid Health: Hormones, Medications & Weight Loss with McCall McPherson

I am delighted to reconnect with Dr. Jason Fung today. We last connected in October 2020 for Episode 121.  Dr. Fung is a nephrologist and a prominent figure in the intermittent fasting and low-carb space. He has made significant contributions as a founding member of The Fasting Method, providing evidence-based guidance on weight loss and blood glucose management through low-carb diets and intermittent fasting. He has written several books, including The Obesity Code, The Complete Guide to Fasting, The Diabetes Code, and The Cancer Code.  In our discussion today, we look at the forecast for metabolic health in 2024, exploring how the growth of the diabetes population relates to the effects of the pandemic and addressing the conflict of interest with organizations like the ADA and registered dieticians. Dr. Fung shares some of his biggest frustrations, including the shallow and myopic thinking amongst those focusing on calories in and calories out, and we get into various facets of metabolic health, from the nuanced influences of gender, puberty, perimenopause, and menopause to hedonistic eating, sarcopenia, bio-individuality, and therapeutic fasting. Dr. Fung also shares his perspective on GLP-1s, shiftwork, supplements, and more. Join us for valuable insights on various aspects of metabolic health and how they impact our well-being. IN THIS EPISODE YOU WILL LEARN How the influence of food companies has led dieticians and diabetes associations to focus on moderation instead of a balanced diet Dr. Fung shares his frustration with the lack of progress in addressing the diabetes issue How hormones impact weight gain and hunger Why does focusing on calories in and out not provide the solution to weight loss? How intermittent fasting can help to control hormonal issues How middle-aged women need to find balance when fasting to maintain muscle mass and avoid sarcopenia How intermittent fasting can lead to increased strength despite losing muscle mass  What causes shift workers to gain weight? The potential drawbacks of using GLP-1 drugs for weight loss Why magnesium deficiency is a common problem in modern society 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)  Cynthia’s Menopause Gut Book is on presale now! Cynthia’s Intermittent Fasting Transformation Book The Midlife Pause supplement line Connect with Dr. Jason Fung ⁠Website⁠ ⁠Twitter ⁠and ⁠YouTube⁠ ⁠The Fasting Method⁠ Dr. Fung's ⁠books⁠ Previous Episode Featuring Dr. Jason Fung ⁠Ep. 121 – The Truth About Diabetes, Kidney Disease and Insulin Resistance with Dr. Jason Fung⁠

Today, I’m thrilled to reconnect with Dr. Rocio Salas-Whalen, a board-certified endocrinologist and obesity medicine specialist with more than 15 years of clinical experience, widely recognized as one of the earliest adopters of GLP-1 therapies in the United States. She is also the author of the upcoming book Weightless: A Comprehensive Guide to the New Era of GLP-1 Medications. In our discussion, we explore the transgenerational impact of obesity as a complex, chronic, and deeply multifactorial condition. We discuss the effects of environmental exposures and trauma, the essential role of education in overcoming weight-loss resistance and managing obesity, and the physiological changes women experience in the perimenopause-to-menopause transition. We explain the importance of body positivity and image, reframing our thoughts around obesity and being overweight, and why building and maintaining muscle is non-negotiable. We dive into the physiology of GLP-1 medications and specific targets for women in perimenopause and menopause, ways to address weight-loss stalls, and the effects of the weight bias so deeply entrenched in our society. Dr. Salas Whalen also shares her thoughts on alternatives and additions to GLP-1 therapies, clarifying the importance of protein and strength training while using GLP-1 drugs.  This conversation with Dr. Salas-Whalen is truly invaluable, and I highly recommend her upcoming book, Weightless. IN THIS EPISODE, YOU WILL LEARN: • What people come to understand about “normal eating” after starting GLP-1s • How GLP-1s interrupt the binge–guilt–shame cycle • The role GLP-1s play in helping people stay in control of food rather than letting food control them • Strategies for avoiding side effects when using GLP-1 medications • Why certain foods trigger problems on injection days • Importance of proper guidance to prevent severe side effects • The impact a prescriber’s guidance has on your success with GLP-1s • Why treatment plans must be tailored to each patient’s needs and metabolism • Factors doctors consider when deciding whether to add additional medications to a GLP-1 plan 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)  Cynthia’s Menopause Gut Book is on presale now! Cynthia’s Intermittent Fasting Transformation Book The Midlife Pause supplement line Connect with Dr. Rocio Salas-Whalen Website On social media: @drsalaswhalen Dr. Rocio’s Book, Weightless - Pre-order now! (Releases 12-30-25)

We have another AMA episode today, where I answer some of the most frequently asked podcast listener questions. In response to a question from Catherine, we unpack the timing hypothesis in this episode, exploring the cardiovascular nuances and clarifying why individualized care truly matters. IN THIS EPISODE, YOU WILL LEARN: Cardiovascular and metabolic benefits of starting hormone therapy within about 10 years of menopause onset What the timing hypothesis really means in clinical practice Why feeling better does not necessarily imply long-term disease risk has been reduced How endothelial (blood vessel) health influences the effectiveness of hormone therapy  Why metabolic changes after menopause matter more than most women realize How their hormone therapy decisions must change as women move further beyond menopause  Risks and benefits of oral versus transdermal hormone delivery Value of shared patient-clinician decision-making  How lifestyle habits and risk assessment form the foundation for safe, effective, and personalized hormone therapy decisions 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  Cynthia’s Menopause Gut Book is on presale now! Cynthia’s Intermittent Fasting Transformation Book The Midlife Pause Supplement Line

Today, I am honored to connect with doctors Andy Lazris and Alan Roth, the authors of A Return to Healing. Dr. Lazris, a physician practicing geriatric primary care medicine in Maryland, is a Certified Medical Director who orchestrates medical care and provides education for several long-term care facilities. Dr Roth is a physician, practicing family medicine and palliative care in New York. He is the Chairman of the Department of Family Medicine and Ambulatory Care at MediSys Health Network.  In our discussion, we explore the impact of the Flexner Report, including how it has reshaped our medical system and clinical guidelines, expanded the definition of disease, and influenced critical thinking. Drs. Lazris and Roth explain how challenging established medical dogma becomes even more problematic within a Flexnerian framework. They examine the prevalence of ineffective and costly procedures, the manipulation of research studies, the role of documentation in medical literature, and the impact of terms like non-compliant and histrionic on the quality of patient care. They also clarify what actually happens with screening measures and how patients can find excellent care.  Their book, A Return to Healing, is truly a love letter to their communities. It is a must-read for anyone seeking to understand the complexities of our current medical system and how it has gotten derailed. IN THIS EPISODE, YOU WILL LEARN: Why doctors should question dogma and think critically rather than just following medical guidelines How medical training encourages standardized testing and discourages nuanced and patient-centered thinking How our profit-driven system rewards procedures and prescriptions over proper patient care Why drugs can sometimes cause more harm than good, and how elderly patients often suffer due to overprescribing How drug companies manipulate statistics to make small benefits seem huge Why patient noncompliance can often mean informed refusal rather than ignorance or defiance How biased medical documentation may unfairly target women and minorities Modern fast-food-type medicine and eroding trust within the doctor–patient relationship Why shared decision-making is meaningless in a system built on one-size-fits-all dogma Protecting yourself within a dysfunctional medical system 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)  Cynthia’s Menopause Gut Book is on presale now! Cynthia’s Intermittent Fasting Transformation Book The Midlife Pause supplement line Connect with Dr. Andy Lazris and Dr. Alan Roth On their⁠ website⁠ Email Dr. Lazris: ⁠[email protected] ⁠ Email Dr. Roth: ⁠[email protected] ⁠

I am delighted to have my good friend and fan-favorite, Dr. Tabatha Barber, join me again to share her wisdom on the podcast!  Dr. Tabatha is a triple board-certified OB/GYN specializing in menopause and functional medicine. She has a wonderful podcast called The Gutsy Gynecologist Show and is often referred to affectionately as the Gutsy Gynecologist. Dr. Tabatha was with me in two previous podcast episodes, ⁠#206⁠ and ⁠#212⁠, and both are in the top twenty downloaded podcasts in the last 18 months! Many women suffer unnecessarily when going through perimenopause and menopause. Dr. Tabatha and I have an AMA (Ask Me Anything) episode today. We discuss weight gain related to perimenopause and menopause, issues with estrogen replacement therapy, how many different factors can impact libido, how to address a partial hysterectomy and HRT, and bioidenticals versus synthetic hormones. We also get into lab work, skin reactions relative to perimenopause and menopause, emotional eating, leptin resistance, and many other topics.  I’m grateful for all the great questions and have no doubt this episode with Dr. Tabatha will be another fan-favorite! IN THIS EPISODE YOU WILL LEARN: Why do too much estrogen and too little estrogen both cause weight gain?  How fragrances and plastic contribute to the imbalance between estrogen and progesterone. How changing to organic tampons and pads, or using a Diva cup, can be a game-changer for women. Should women who have had a partial hysterectomy and are on HRT still check progesterone and testosterone levels and fast like a post-menopausal female? Dr. Tabatha shares her thoughts on plain estradiol versus Biest and Triest. Dr. Tabatha offers her recommendations for a healthy 48-year-old female with zero libido. What can a 17-year-old with high testosterone do to get her testosterone level within the normal range? Is there a biological or mindset issue at play if you never feel full and always want to eat, irrespective of how healthy or satisfying the foods you eat are? The benefits of fasting.  What can we do to support our pelvic joints? How do our hormones affect our skin? 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)  Cynthia’s Menopause Gut Book is on presale now! Cynthia’s Intermittent Fasting Transformation Book The Midlife Pause supplement line Connect with Dr. Tabatha Barber On her ⁠website⁠ ⁠The Gutsy Gynecologist Show⁠ ⁠Episode 206 Pt 1: A Deep Dive into Perimenopause- Hormonal Imbalances and Birth Control with Dr. Tabatha Barber⁠ ⁠Episode 212 Pt. 2: A Deep Dive into Hormonal Imbalances and Menopause with Dr. Tabatha Barber⁠ Books mentioned: ⁠The XX Brain⁠ by Lisa Mosconi

I am thrilled to reconnect with Dr. Sanjay Bhojraj today. Dr. Bhojraj is a board-certified interventional cardiologist who became a pioneer in functional medicine. In our conversation, we dive into palpitations, which are a common complaint among perimenopausal and menopausal women. We explore red flag symptoms, the physiological effects of progesterone, estrogen, and testosterone as they relate to heart arrhythmias, EKG changes during the perimenopause-to-menopause transition, and wearable technologies. We unpack the differences between benign and more concerning arrhythmias, risk factors for atrial fibrillation, and the process of taking a thorough history, ordering the correct tests, and using imaging or sleep studies when appropriate. We cover treatment pathways, from lifestyle modifications to medications, channelopathies, and the genetic propensities for conditions such as Long QT, Brugada Syndrome, WPW (Wolff-Parkinson-White syndrome), and sudden cardiac death. We also highlight the importance of genetic testing for individuals with a family history of those conditions. Today’s conversation with Dr. Sanjay Bhojraj is full of practical wisdom and clinical pearls, so you will most likely want to listen to it more than once. IN THIS EPISODE, YOU WILL LEARN: Why thyroid function should always be taken into account when assessing heart rhythm issues   How stress and life circumstances can trigger palpitations  The benefits of magnesium supplementation for supporting heart health What ventricular arrhythmias (from the bottom chambers) and atrial arrhythmias (from the top chambers) are commonly related to The value of monitoring for identifying the nature and severity of arrhythmias How sleep apnea can increase the risk of arrhythmia   The importance of exercise, stress management, and healthy lifestyle habits for supporting heart rhythm Why certain arrhythmias may require procedural interventions Why various types of athletic activity matter when evaluating arrhythmias How genetic factors can impact specialized heart assessments 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)  Cynthia’s Menopause Gut Book is on presale now! Cynthia’s Intermittent Fasting Transformation Book The Midlife Pause supplement line Connect with Dr. Sanjay Bhojraj On his website On social media: @DoctorSanjayMD The Curious Cardiologist Podcast

I am dedicating today's entire episode to colonoscopies.  When I had my fifth colonoscopy yesterday, I shared the before-and-after experience online and received a flood of responses. Healthcare professionals thanked me for the transparency, while many followers admitted they were anxious, postponing their own procedures, or worried about the small likelihood of complications.  With my own strong family history of precancerous polyps and years of firsthand experience, I wanted to dive deeper so I can speak from both knowledge and empowerment. Join me as I unpack the facts to dispel your fears and bring a sense of calm confidence to this potentially life-saving procedure. IN THIS EPISODE, YOU WILL LEARN: How the rising incidence of colorectal cancer in younger women has led to a need for earlier detection  How colorectal cancer symptoms often get misattributed to stress, perimenopause, hemorrhoids, or other hormonal changes The risk factors of colonoscopies Various types of colonoscopy prep  How colonoscopy prep impacts the gut microbiome How probiotics can help reduce post-colonoscopy GI symptoms What women need to know about sessile serrated polyps How perimenopause and menopause alter colorectal cancer risk in women What major clinical trials reveal about prevention and long-term protection Some alternatives to traditional colonoscopy 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  Cynthia’s Menopause Gut Book is on presale now! Cynthia’s Intermittent Fasting Transformation Book The Midlife Pause supplement line Research Links: Risk of colorectal cancer seven years after flexible sigmoidoscopy screening: randomised controlled trial  Once-only flexible sigmoidoscopy screening in prevention of colorectal cancer: a multicentre randomised controlled trial Effect of Colonoscopy Screening on Risks of Colorectal Cancer and Related Death Response: Re: Mobile Phone Use and Brain Tumors in Children and Adolescents: A Multicenter Case–Control Study Once-Only Sigmoidoscopy in Colorectal Cancer Screening: Follow-up Findings of the Italian Randomized Controlled Trial—SCORE  Blood Test Could Provide Colonoscopy Alternative for Colorectal Cancer Screening Alteration in gut microbiota after colonoscopy: proposed mechanisms and the role of probiotic interventions Adverse events related to colonoscopy: Global trends and future challenges

Today, I am delighted to connect with Dr. Sameena Rahman, a board-certified OBGYN and certified menopause practitioner with over a decade of expertise in midlife sexual medicine and concierge gynecology. Dr. Rahman founded the GSM Collective in downtown Chicago to deliver a more personalized patient-first model of health care for women.  In our conversation, we explore how cultural and racial factors influence care for women, particularly during the menopausal transition. We discuss the heart disease risk of women with a baseline of inflammation and insulin resistance, the effects of allostatic load on minority women, why cognitive health is crucial, the impact of alcohol, and why the current medical model is a systemic failure that gaslights women. We also examine the impact of pelvic floor therapy, appropriate pelvic examinations, specific autoimmune vulvar conditions, and how oral contraceptives affect sexual health, and Dr. Rahman shares her recommendations for preventing frailty and loss of independence. I am a big admirer of Dr. Rahman’s work and look forward to having her join us again after her new book is published. IN THIS EPISODE, YOU WILL LEARN: Why Hormone Replacement Therapy alone might not solve all menopausal genital issues How pelvic floor issues can even affect women who have not given vaginal births What a routine Pap smear can miss, regarding vulvar and vestibular health What a simple Q-tip test can reveal about vulvar pain How untreated pain can create a cycle of pelvic floor problems How local hormone therapy can target vulvar and vestibular pain where systemic hormones may fall short The benefits of trauma-informed exams  The value of integrating pelvic floor therapy with local hormone treatment  How long-term birth control use might affect vulvar tissue What to consider for balancing contraception with sexual health Bio: Dr. Sameena Rahman Dr. Sameena Rahman is a board-certified OB/GYN, sex-med gynecologist, menopause specialist, and a clinical assistant professor of OB/GYN at the Northwestern Feinberg School of Medicine.  She is the founder of the GYN & Sexual Medicine Collective, a successful concierge practice that emphasizes evidence-based medicine, and an affiliate of Ms. Medicine. Dr. Rahman is dedicated to evaluating and treating each patient with compassion, trauma-informed care, and an awareness of personal bias. Additionally, she hosts the podcast Gyno Girl Presents: Sex, Drugs & Hormones and will release her first book, Brown Girls Disease? A Guide To Sexual Health and Empowerment through a South Asian Lens in 2026.  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)⁠ ⁠ Cynthia’s⁠ Menopause Gut Book⁠ is on presale now! Cynthia’s⁠ Intermittent Fasting Transformation⁠ Book ⁠The Midlife Pause supplement line⁠ Connect with Dr. Sameena Rahman The GSM Collective Dr. Sameena Rahman on Instagram (@gynogirl) Gyno Girl Presents Sex, Drugs and Hormones (Podcast) Resources Find a practitioner to assist with your sexual concerns The International Society for Vulvo Vaginal Diseases The National Vulvodynia Association Prosayla (Female Sexual Health Education)

Today, I am privileged to connect with Sal Di Stefano. Sal is a sought-after fitness and health expert with a straightforward, uncomplicated communication style. He is also a co-host of the immensely popular Mind Pump Podcast. In our discussion, we explore why the scale is an ineffective measure of success in our culture, particularly for women. We dive into the effects of body image and dysfunctional relationships with our bodies, contrasting self-hate patterns with self-love patterns. We look at ways to train differently in middle age with the challenges of perimenopause and menopause, and consider the impact of physiological changes during pregnancy and the postpartum period. We also cover signs of overtraining and intuitive nutrition and address many listeners' questions about reverse dieting, hormetic strategies, and authenticity.  I am sure you will love this conversation, and I look forward to having Sal back on the show in 2024. IN THIS EPISODE YOU WILL LEARN: The limitations of relying solely on weight as a measure of success in health and wellness Why we should focus on the full scope of fitness and diet rather than a specific number or metric How patterns of self-hatred can lead to unhealthy behaviors  How to practice self-care with exercise and a healthy diet Why exercise routines should be founded on factors like sleep, stress, fitness levels, and diet The importance of starting with small, manageable steps toward self-care and weight loss Why strength training is the most effective exercise for women in perimenopause and menopause How high-performing athletes prioritize recovery and rest to prevent burnout and injury Post-pregnancy muscle recruitment patterns and exercises Diet and nutrition for improved mental clarity and physical performance The benefits of strength training for muscle growth and hormone balance 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)  Cynthia’s Menopause Gut Book is on presale now! Cynthia’s Intermittent Fasting Transformation Book The Midlife Pause supplement line Connect with Sal Di Stefano On ⁠YouTube⁠ ⁠Mind Pump Podcast