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

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.

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Check out Cynthia’s website.

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. 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 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

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 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

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 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 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 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 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.