Is The Gut The Missing Link To Women's Longevity? An Expert Explains
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What if hormones are only half the story of menopause, and medicine is ignoring the major role the gut plays in this period of women’s lives?
I recently sat down with Cynthia Thurlow, NP, the author of the new book The Menopause Gut, to discuss all things nutrition, healthy aging, and longevity for the latest episode of mindbodygreen podcast. We covered a lot of ground, like why most women are chronically undereating protein, why fiber is what Cynthia calls "the new F word," and the one cholesterol test that changed how I think about my own heart health.
Plus, Thurlow shares something I didn't expect: after years of being one of the loudest voices for intermittent fasting, she's backed off. What changed her mind is worth hearing.
Here's what stood out most from our conversation:
The protein problem
According to Thurlow, despite all the conversations around protein, women are still chronically under-eating it. And the stakes are high. As we age, we lose muscle and insulin sensitivity, which means we actually need more protein, not less.
How much more? Cynthia recommends at least 100 grams per day, with 30 to 50 grams per meal to trigger muscle protein synthesis. As she explained, most women are getting around 50 grams total per day, and that's simply not enough to build and maintain muscle.
The research backs this up. A study published in the British Journal of Nutrition found that women with protein intake of at least 1.2 g/kg body weight (0.7g/lb) had better grip strength, walking speed, and physical performance1.
Why fiber is 'the new F word'
If protein is the macronutrient women are missing, fiber is the one we've completely overlooked. Thurlow jokingly calls it "the new F word."
When you eat fiber, it travels to your colon where your gut microbiome ferments it into short-chain fatty acids. These SCFAs are critical for reducing inflammation and regulating that satiety hormone GLP-1.
Yet, most Americans eat around 10 grams of fiber a day when we should be aiming for at least 25 to 30 grams, Thurlow says. However, she warns not to jump from five to 30 grams too quickly. Your gut microbiome needs time to acclimate to the change, so it's better to increase your intake gradually.
Thurlow shared her own experience with increasing her fiber intake, saying it radically changed her gastrointestinal health. She gets colonoscopies every five years due to a family history of colorectal cancer and, after significantly increasing the amount of fiber she was eating between 2020 and 2025, her gastroenterologist told her he wished every person's colon looked as pristine as hers. He said every bit of minor inflammation and internal hemorrhoids were all gone.
Practically, adding fiber to your diet doesn't have to be complicated. You can add lentils to your grain bowl, throw beans on a salad, or blend flax and chia seeds into a smoothie. You can also lean on a fiber supplement. To get you started, here's a 3-day cheat sheet on how to actually get 30 grams of fiber in your diet.
Building an anti-inflammatory plate
Beyond protein and fiber, Thurlow and I also discussed how to build a plate that actively fights inflammation. The key is diversity and quality, specifically when it comes to healthy fats and produce.
If you're eating meats like salmon, duck, or a ribeye, healthy fats are already built in. But if you're diet is mostly based in lean protein, consider adding salted macadamia nuts, high-quality extra virgin olive oil, or olives.
Thurlow also emphasized the importance of brightly pigmented fruits and vegetables, and specifically bitter foods like radicchio, frisée, and arugula. We've gotten accustomed to bland food, she noted, but that bitter taste in greens or high-quality olive oil? That's actually an identifier that the food has a high polyphenol count, which decrease pro-inflammatory microbes in the gut.
Her goal: 30 plant varieties per week. That includes herbs and spices, which many people don't realize count toward that number.
Why the intermittent fasting expert stopped fasting
Here's the part of our conversation that surprised me most. Thurlow, who gave one of the most watched TEDx talks on intermittent fasting, told me she doesn't do it as much anymore.
After her father passed in 2024, she realized she had the same body type as him: naturally lean, getting leaner with age. She wasn't eating enough protein consistently, and the only way to fix that was to open up her feeding window. When she was fasting for longer and eating 50 or 60 grams of protein in one sitting, she wasn't hungry for another meal for hours.
I found this take incredibly refreshing. Humans are designed to evolve, shift, and change. And that includes being adaptable when it comes to our health.
She now does 12 to 13 hours of digestive rest and focuses on getting two to three solid protein servings throughout the day, as well as all lots of fiber and anti-inflammatory ingredients. She recommends other women do this.
The metabolic markers every woman should track
Thurlow spent years working in clinical cardiology, so she knows a thing or two about testing and biomarkers. If you're in midlife and want to understand your metabolic and cardiovascular health, here are the tests she recommends:
- Fasting insulin: This will often dysregulate way before fasting glucose or A1C. The test is cheap and gives you a snapshot of insulin sensitivity. Ten years ago everyone said Thurlow was crazy for recommending it. Now, it's becoming standard.
- ApoB (apolipoprotein B): As estrogen declines, cardiovascular disease risk accelerates. ApoB is often correlated with high LDL but can be a more prognostic indicator for inflammation and metabolic health.
- Lp(a) (lipoprotein a): This one is genetically mediated and seven to eight times more likely to promote fat build up in your arteries than regular cholesterol. Twenty percent of people have elevated Lp(a), and if you're African American, it's 50%. Unfortunately, it's not lifestyle-mediated, though there are drugs that can treat it.
- Ferritin: This marker of iron storage is often missed. Thurlow noted that the ACOG recently changed their guidelines to recommend levels greater than 60 mg/dL. She sees women with fatigue and tiredness for years who have a ferritin of 20. That's a problem.
- hs-CRP (high-sensitivity C-reactive protein): This is a general marker of inflammation, meaning elevation can come from various sources. Most labs say less than 1.0 is fine, but Thurlow says to aim for less than 0.7.
For people with elevated ApoB levels, Thurlow recommends the Boston Heart cholesterol balance test. It determines whether you're a hyper-absorber of cholesterol (your intestines soak it up like a sponge) or a hyper-synthesizer (your body just makes too much). These are treated very differently, and modern medicine tends to throw statins at everybody without making this distinction.
This recommendation hit home for me, since I did the Boston Heart test when trying to lower my ApoB. The test revealed that I'm a hyper-absorber, which meant no matter how much I cut fat and avoided sweets, the lowest I could get my ApoB was 71. Good, but not great when heart disease runs in your family (like it does in mine).
In our conversation, I learned Thurlow and I are both on ezetimibe for the same reason: high ApoB and Lp(a). As she put it, these levels are not a lifestyle-mediated issue: there's a genetic component. For both of us, it was a no-brainer. Read more about my experience lowering my ApoB levels here.
The takeaway
If there's one theme that ran through my entire conversation with Thurlow, it's that the fundamentals matter more than we think. Protein, fiber, anti-inflammatory foods, and knowing your numbers aren't sexy biohacks, but they're the foundation of healthy aging.
*These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure or prevent any disease.
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