Everyday Wellness: Midlife Hormones, Menopause, and Science for Women 35+

I’m delighted to connect with academic physician-scientist Dr. Majid Fotuhi today. Dr. Fotuhi is a professor of neuroscience at Johns Hopkins Mind Brain Institute, an adjunct professor of psychological and brain sciences at GW, and the medical director of NeuroGrow Brain Fitness Center. He is a Harvard- and Hopkins-trained physician and researcher and is making great strides in changing how we think about brain health.

In our conversation, we explore purpose in life as a factor in brain resilience, how our belief systems and function can help lower cortisol, and why middle-aged people, especially women going through perimenopause and menopause, forget things. We discuss the impact of hormone replacement therapy, common types of cognitive impairment, the dynamic polygon hypothesis, the influence of proper labeling in medicine, and the 2024 Lancet Commission study that demonstrated 45% of dementia is preventable, looking at why the hippocampus truly matters for learning and memory, how stress is cumulative over time, how high A scores can create epigenetic changes, and how the liver and brain are connected, especially for metabolic health. We also explore the importance of parasympathetic tone, anti-inflammatory foods, and brain-supportive supplements, and Dr. Fotuhi shares his personal opinion on GLP-1 drugs.

Stay tuned for today’s fascinating conversation with Dr. Majid Fotuhi, one of the USA’s leading neuroscientists.

IN THIS EPISODE, YOU WILL LEARN:

How having a sense of purpose or feeling passionate about something can reduce stress and lower cortisol

Factors that may contribute to memory-related issues in midlife women

How the 2002 Women’s Health Initiative changed the conversation around HRT

How Dr. Fotuhi evaluates patients for cognitive impairment

What motivated Dr. Fotuhi to develop his Brain Fitness program?

Modifiable risk factors that can contribute to cognitive decline

Why the hippocampus is so critically important for learning and memory

How years of high stress can contribute to hippocampus shrinkage

How liver health is connected to brain health

Dr. Fotuhi shares his thoughts about GLP-1s

Bio:

Dr. Majid Fotuhi earned his PhD in Neuroscience from Johns Hopkins University in 1992 and his Medical Degree from Harvard Medical School in 1997. He currently serves as an adjunct professor at the Mind/Brain Institute at Johns Hopkins University and teaches at George Washington University and Harvard Medical School. With 37 years of experience in teaching, clinical practice, and neuroscience research, Dr. Fotuhi has pioneered a multidisciplinary approach to enhancing brain vitality and cognitive performance at any age. His groundbreaking “Brain Fitness Program” combines a comprehensive baseline “Brain Portfolio” assessment with 12 bi-weekly brain training sessions. This program targets lifestyle optimization and cognitive stimulation to improve memory, focus, and overall brain health. Dr. Fotuhi’s program has delivered measurable success for patients dealing with memory loss due to aging, concussions, and ADHD, as documented in several peer-reviewed journals. He has also authored three books, including the highly acclaimed Boost Your Brain: The New Art and Science Behind Enhanced Brain Performance. Recognized as a leading expert in memory and successful aging, Dr. Fotuhi has delivered lectures at academic institutions and major organizations in over 20 countries, including a TEDx presentation in the Philippines. Passionate about sharing the latest discoveries in brain rehabilitation and neuroplasticity, he has been featured in interviews with more than 50 prominent media outlets in the United States and around the globe.

Connect with Cynthia Thurlow

Cynthia’s website.

Check out the Everyday Podcast on Instagram! www.instagram.com/everydaywellnesspodcast

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Submit your questions to support@cynthiathurlow.com

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

** For more information about Cynthia's upcoming retreat, visit ⁠https://www.cynthiathurlow.com/⁠ and click the Events tab.

Connect with Dr. Majid Fotuhi

On his website

Instagram, LinkedIn

The Invincible Brain (Free app)

Dr. Fotuhi’s latest book, The Invincible Brain

Dr. Fotuhi’s books

Welcome to this week's Midlife Minute episode!

Have you ever been told your fasting glucose and A1c are normal, yet you still feel that something is off with your metabolic health?

Today, we begin a new series exploring metabolic health during perimenopause and menopause. We take a closer look at the metabolic changes that can occur as estrogen declines, why traditional screening may miss early signs of insulin resistance, and which additional lab tests may offer a more complete picture of your health.

Drawing on research and clinical experience, I explain how hormonal changes can affect insulin sensitivity, body composition, and cardiovascular risk. We also explore why it's important to look beyond the number on the scale, understand the differences between standard and advanced metabolic testing, and advocate for more comprehensive conversations with your healthcare practitioner.

Stay tuned to learn which metabolic markers deserve your attention and how a proactive approach to testing can help you better understand your health during midlife.

IN THIS EPISODE, YOU WILL LEARN:

Why normal fasting glucose and A1c levels may not reveal early insulin resistance

How declining estrogen affects insulin sensitivity, body composition, and cardiovascular health

Why visceral fat and changes in muscle mass matter, even when your weight stays the same

Which foundational metabolic markers to discuss with your healthcare practitioner, including ApoB, fasting glucose, A1c, blood pressure, and waist circumference

How fasting insulin, HOMA-IR, and the triglyceride-glucose (TyG) index can provide additional insight into insulin resistance

Why a two-hour oral glucose tolerance test may identify changes missed by fasting measurements

What NMR lipoprotein profiling and C-peptide testing can reveal, and why they are considered additional tools rather than first-line screening

How to approach metabolic testing in a practical, step-by-step way

Why understanding your metabolic health during midlife requires looking beyond standard laboratory results

Connect with Cynthia Thurlow

Cynthia's website: https://cynthiathurlow.com/

Everyday Wellness Podcast on Instagram: https://www.instagram.com/everydaywellnesspodcast/

Follow Cynthia on Instagram: https://www.instagram.com/cynthia_thurlow_/

Submit your questions: support@cynthiathurlow.com

Join The Midlife Pause community: https://www.facebook.com/groups/themidlifepause

Cynthia's book, The Menopause Gut: https://www.penguinrandomhouse.com/books/777129/the-menopause-gut-by-cynthia-thurlow-np/

Intermittent Fasting Transformation: https://www.penguinrandomhouse.com/books/678861/intermittent-fasting-transformation-by-cynthia-thurlow-np/

The Midlife Pause Supplement Line: https://themidlifepause.com/

** For more information about Cynthia's upcoming retreat, visit ⁠https://www.cynthiathurlow.com/⁠ and click the Events tab.

References:

El Khoudary SR, Aggarwal B, Beckie TM, et al. Menopause Transition and Cardiovascular Disease Risk: Implications for Timing of Early Prevention. AHA Scientific Statement. Circulation. 2020.

Nappi RE, Chedraui P, Lambrinoudaki I, Simoncini T. Menopause: A Cardiometabolic Transition. Lancet Diabetes Endocrinol. 2022.

D'Costa Z, Spertus E, Hingorany S, et al. Cardiovascular Risk Associated with Menopause and Menopause Hormone Therapy. Curr Atheroscler Rep. 2025.

Cybulska AM, Schneider-Matyka D, Wieder-Huszla S, et al. Diagnostic Markers of Insulin Resistance to Discriminate Between Prediabetes and Diabetes in Menopausal Women. Eur Rev Med Pharmacol Sci. 2023.

Song Y, Manson JE, Tinker L, et al. Insulin Sensitivity and Insulin Secretion by HOMA and Risk of Diabetes in a Multiethnic Cohort of Women: WHI. Diabetes Care. 2007.

Tsai SF, Yang CT, Liu WJ, Lee CL. Development and Validation of an Insulin Resistance Model for a Population Without Diabetes Mellitus. EClinicalMedicine. 2023.

Doi SA, Ward GM. Examination of the fasting and 2-h plasma glucose in light of impaired beta-cell function. Endocrine. 2015.

Abbasi F, Silvers A, Viren J, Reaven GM. Relationship Between Several Surrogate Estimates of Insulin Resistance and a Direct Measure of Insulin-Mediated Glucose Disposal. Diabetes Res Clin Pract. 2018.

Piché ME, Lemieux S, Corneau L, et al. Measuring Insulin Sensitivity in Postmenopausal Women Covering a Range of Glucose Tolerance. Metabolism. 2007.

Bhasin G, Dafale RS, Kamath SU, et al. Comparative performance of invasive, semi-invasive, and non-invasive insulin resistance-related indices. PLoS One. 2025.

Wang Q, Ferreira DLS, Nelson SM, et al. Metabolic characterization of menopause: cross-sectional and longitudinal evidence. BMC Med. 2018.

Today, I’m delighted to connect with Dr. Zach Spiritos. A double board-certified gastroenterologist in internal medicine with a fellowship in neurogastroenterology, he founded Ever Better Medicine, a practice built around treating complex, chronic, and often underrecognized conditions at the intersection of the gut and the nervous system.

In today’s conversation, Dr. Spiritos and I speak at length about how patients get dismissed by the medical system. We explore irritable bowel syndrome as immune dysregulation and common symptoms that he sees with this diagnosis. We discuss hypermobility and the 13 subtypes of Ehlers-Danlos syndrome, with hypermobility closely linked to inflammation, MCAS, and immune dysregulation. We cover several commonly missed GI complications in hypermobile patients, including how POTS and MCAS often overlap with GI dysmotility, MALS, and how nutrition and stress influence symptoms. Dr. Spiritos also shares his views on constipation and the importance of staying curious.

Stay tuned for today’s fascinating conversation with Dr. Zach Spiritos about complex medical conditions and how they intersect with the gut.

IN THIS EPISODE, YOU WILL LEARN:

How Dr. Spiritos recognizes when symptoms may reflect underlying physiology rather than being purely psychological

Common symptoms that point toward dysautonomia, POTS, or MCAS in women

How connective tissue laxity and hypermobility can contribute to gut dysfunction

GI complications that may be missed when patients do not fit neatly into an IBS diagnosis

How POTS fits within the broader picture of dysautonomia, hypermobility, and MCAS

Meal-related patterns that may point to abnormal gastric motility associated with dysautonomia

The value of using a food and symptom diary when appropriate, and treating elimination diets as trials rather than permanent restriction

How fixating on bowel symptoms can create cycles of anxiety and GI distress

How Dr. Spiritos approaches constipation in patients

Why clinicians should remain open-minded when patients present with multiple medication sensitivities, allergies, and complex symptoms

Bio:

Dr. Zachary Spiritos, MD, MPH, is a neurogastroenterologist who specializes in treating patients with complex and chronic conditions, including disorders of the brain-gut interaction (DBGI), postural orthostatic tachycardia syndrome (POTS), mast cell activation syndrome (MCAS), Ehlers-Danlos syndrome (EDS), and gastrointestinal dysmotility.

He earned his medical degree and Master of Public Health (MPH) from the University of North Carolina at Chapel Hill, where he developed a passion for addressing the systemic challenges patients with underrecognized illnesses face. He completed his Internal Medicine residency at Emory University and his Gastroenterology fellowship at Duke University, where he focused on neurogastroenterology and disorders of gut-brain interaction.

Dr. Spiritos is particularly dedicated to supporting patients who have been dismissed, misdiagnosed, or lost in the medical system. He takes a whole-person approach to care, combining the best of conventional medicine with targeted interventions to regulate the nervous system, improve sleep and movement patterns, address nutritional imbalances, and manage stress physiology.

He works primarily with patients whose symptoms span multiple systems and don’t fit neatly into one diagnosis—individuals who require time, nuance, and interdisciplinary collaboration. Dr. Spiritos partners closely with his patients to build individualized, sustainable care plans that address both symptoms and underlying causes—helping them reclaim their health and quality of life.

** For more information about Cynthia's upcoming retreat, visit ⁠https://www.cynthiathurlow.com/⁠ and click the Events tab.

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 support@cynthiathurlow.com

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. Zachary Spiritos

On the Ever Better Medicine website

Instagram

This episode is another in a series of interviews with highly vetted companies that I consider tremendously beneficial for my Everyday Wellness community.

Today, I’m honored to welcome Katie Emerson, Senior Manager of Scientific Affairs at Kyowa Hakko USA. Katie is a registered dietitian and certified sports nutritionist, and she completed her doctoral work in nutritional science.

In today’s conversation, we discuss women’s mental clarity through midlife, including focus, memory, attention, and mental energy during perimenopause and menopause. We explore how everyday distractions and mental fatigue differ from true cognitive concerns, and Katie explains how citicoline supports brain cell membranes and neurotransmitter production, its key physiologic benefits, and how it works, especially concerning estrogen and phosphatidylcholine synthesis. We also discuss caffeine, citicoline, and creatine, looking at citicoline’s peak efficacy and half-life, key benefits for athletes, students, and the elderly, what glutathione is, and how Setria can support healthy aging through detoxification. We also explain how to choose high-quality glutathione products, how branded ingredients differ from generic ingredients, and why reading supplement labels actually matters.

Stay tuned for an invaluable conversation you will likely revisit more than once.

IN THIS EPISODE, YOU WILL LEARN:

How estrogen fluctuations and declining estrogen levels can affect women’s mental clarity, focus, memory, and attention

How sleep disruption, stress, hot flashes, and mood changes can influence women’s cognitive performance in midlife

How to distinguish everyday distractions and mental fatigue from cognitive concerns

When memory, attention, language, and orientation changes need to be evaluated by a healthcare practitioner

How citicoline supports brain cell structure and communication

How to use citicoline for short-term focus and longer-term cognitive support

How glutathione helps protect cells and support the body’s natural detoxification pathways

How to evaluate the quality of supplements, ingredients, and brands

Bio: Katie Emerson, PhD(c), RD, CISSN

Katie Emerson's role sits deliberately at a crossing point that didn't used to exist in the supplement industry: performance nutrition used to mean muscle and endurance almost exclusively, and now includes focus, attention, and mental energy as an equally serious category. She leads the scientific communication behind Kyowa Hakko's branded ingredients, primarily Cognizin citicoline, translating the same underlying clinical research for three distinct audiences: brand teams deciding what to formulate, clinicians evaluating whether the evidence holds up, and consumers trying to figure out what a supplement label means. That translation work, moving between technical, clinical, and consumer registers without losing accuracy in any direction, is the throughline of her role.

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 support@cynthiathurlow.com

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

** For more information about Cynthia's upcoming retreat, visit ⁠https://www.cynthiathurlow.com/⁠ and click the Events tab.

Connect with Katie Emerson

Kyowa Hakko USA

Kyowa Hakko USA on Facebook and LinkedIn

Cognizin Citicoline on Instagram

Katie on Instagram

Today, I’m delighted to welcome Dr. Florence Comite, a clinician, scientist, endocrinologist, and global authority on healthy longevity. She founded the Comite Center for Precision Medicine and Healthy Longevity, with locations in New York, Palo Alto, and Miami Beach, and spent 25 years as a graduate and faculty member at Yale School of Medicine. She is also the author of Invincible, one of my must-read books for 2026.

In our conversation, we discuss why medicine focuses on urgent care, the missing provider relationship, and the hallmarks of aging. We explore how our biological function peaks between 27 and 30, why testosterone is the first hormone to decline in both men and women, bio-individuality, testosterone in women, optimal ranges, and heart disease risk. We explain why midlife is one of our biggest metabolic shifts, how to track it, and why heart disease diagnostics are important. We also cover sarcopenia, GLP-1s for longevity, and the relevance of bioimpedance readings versus BMI.

Stay tuned for today’s fascinating conversation. It’s one of my favorite conversations of the year, and I know you’ll want to listen more than once.

IN THIS EPISODE, YOU WILL LEARN:

Why modern medicine focuses on urgent and emergency care

How the missing provider relationship influences patient care

How genetically similar people can have different health risks, body composition, and responses to medications

What testosterone does for memory, cognition, executive function, bone, muscle, and the heart, and what women need to understand about testosterone ranges

Changes in metabolic health women should be paying attention to in midlife

Dr. Comite compares CAC, CCTA, Cleerly, and HeartFlow, and explains how these diagnostics contribute to heart evaluation

What women need to consider when assessing heart disease risk

Why Dr. Comite suggests starting with small lifestyle changes initially

How to maintain muscle mass, particularly when using GLP-1s

Why BMI does not provide an adequate reflection of body composition

Bio:

Florence Comite MD is a Yale- and National Institutes of Health-trained physician-scientist, a pioneering force in precision medicine, and the world’s leading expert in longevity and endocrinology, who is renowned for her expertise in leveraging proprietary clinical and wearable data collected at her private clinical and virtual practice to detect, predict, and reverse biological aging, disorders of aging, and optimize healthspan and vitality for life.

A graduate of Yale School of Medicine, where she was a faculty member for twenty-five years with a triple appointment in Endocrinology (Internal Medicine and Pediatrics) and Reproductive Endocrinology (Gynecology and Andrology), Dr. Comite trained at the National Institutes of Health and founded Women’s Health at Yale, the nation’s first women-only clinic.

In 2005, Dr. Comite founded the Comite Center for Precision Medicine & Healthy Longevity in New York City, establishing a clinically proven, academic approach to personalized healthcare structured around the individualized clinical process known as Nof1TM, where each patient is treated as a single-subject clinical trial. Her global clientele spans the population, from forward-thinking physicians to industry-disrupting executives and health-enthusiastic entrepreneurs. Each patient benefits from insights and interventions tailored to their physiological make-up. The Center has expanded to Palo Alto and Miami Beach in the last several years.

Dr. Comite has published original research and articles in numerous clinical journals, including the New England Journal of Medicine, JAMA: The Journal of the American Medical Association, and the Journal of the Endocrine Society. She is known for her seminal research on children, women, and men, recognizing that our entire system is critical in aging and disease. In 2013, she authored the bestselling book Keep It Up: The Power of Precision Medicine to Conquer Low T and Revitalize Your Life, focusing on androgen deficiency and vitality in aging men. Her clinical research data and decades of clinical practice informed Dr. Comite’s new book, Invincible: Defy Your Genetic Destiny to Live Better, Longer, available in bookstores everywhere!

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 support@cynthiathurlow.com

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

** For more information about Cynthia's upcoming retreat, visit ⁠https://www.cynthiathurlow.com/⁠ and click the Events tab.

Connect with Dr. Florence Comite

On Instagram, TikTok, LinkedIn, X, YouTube, Facebook, and Substack

Healthy Longevity Podcast

Book: Invincible