I have.

Appointments move fast. You start talking about one issue, remember another halfway through, try to explain when everything started, and suddenly the appointment is over.

And when you’ve been dealing with something for week…

Read more

I have three golden retrievers, so I live in a house where hair is ambient. It’s on the rug, the sofa, every piece of clothing I own. I wish I had a little less golden retriever hair and a little more of my hair.

I’ve lost more than half of mine in the last two years.

It started the way these things do, with a wad in the brush that got bigger without ever getting alarming. I did nothing about it for a while, which I would like to call research. Then I ran labs and found out my ferritin was 5.

My hematologist thinks the whole story is heavy perimenopausal bleeding. I get an iron infusion every couple of years now, and my hair is coming back slowly enough that I mostly notice it in photographs.

Almost every conversation about women’s hair collapses two separate problems into one word.

Subscribe now

Shedding and thinning are different problems

Shedding means hairs leaving. A lot of them, fast, from all over your head, usually a few months after something rough happened to your body. Your follicles were interrupted mid-job, and they often return to their usual cycle once the trigger resolves.

With thinning, the strands themselves shrink. Each cycle produces a finer hair than the last, so density drops across years while the brush stays boringly normal.

Sudden shedding sends you hunting for a trigger. Gradual thinning sends you to someone who can look closely at the follicles. Plenty of women have both at once.

Fifty to a hundred hairs a day is normal, which sounds alarming until you consider how many are up there. What matters is a change from your own baseline. Nobody needs you counting hairs on a bath mat.

Symptoms that go straight to a dermatologist

Make the appointment first if you have round bald patches, scalp pain, redness or heavy scaling, hairs snapping off rather than releasing, eyebrow loss, or a hairline that’s changing fast.

Some of those causes respond better to early treatment, and a calendar has nothing useful to say about any of them.

Sudden shedding, and why the timing confuses everyone

Your follicles run staggered clocks. Most are growing, a smaller share are resting, and the resting ones release a few at a time so you never notice.

A stressor knocks a large batch out of growth and into rest all at once. They sit there for two to three months. Then they let go together, like the world’s least helpful surprise party.

The medical name is telogen effluvium, the most common cause of diffuse hair loss and the one women bring to dermatologists most often. The lag is why so many can’t identify a cause. You’re auditing last Tuesday when the answer is a season back.

What sets it off:

• A hard season. Surgery, anesthesia, a high fever, a virus, a death, a divorce, a move. The bill arrives in July for something that happened in April.

• Rapid weight loss, GLP-1s included. A 2026 review of 24 studies found semaglutide and tirzepatide reported hair loss most often, with tirzepatide, which produces the greatest weight loss of the class, linked to shedding most frequently. Women were affected more than men. Researchers have not pulled apart what the drug does from what the weight loss does, so both are still suspects.

• Eating too little. Hair sits dead last on your body’s priority list. Your heart gets amino acids. Your liver gets amino acids. Your hair gets whatever’s still on the table, which during a hard stretch is a crumb.

• Thyroid. Thyroid hormone tells resting follicles to wake up. Without enough of that signal, growth phases shorten and rest phases stretch out.

• Medication changes. Bring a full list of anything you started, stopped, or adjusted in that window, birth control included. Take the list to your prescriber. Quitting a prescription over a hairbrush is how you trade one problem for a worse one.

Low iron- which deserves its own section

A meta-analysis of 36 studies and 10,029 women found ferritin ran about 18 points lower in women with non-scarring hair loss, while iron-deficiency anemia was no more common between the groups.

Your blood count can look respectable while the tank is empty. Mine was 5.

For some women over 40, heavy bleeding is the missing piece. Perimenopausal periods can become heavier, longer, or closer together, and that loss drains iron stores across years while everyone involved keeps calling it normal.

Heavy bleeding earns its own workup. Perimenopause explains a change in your cycle, and the investigation should keep going past that, because fibroids and endometrial problems live in the same neighborhood. My hematologist decided I needed infusions.

The calendar exercise

Go back twelve weeks from the day you first noticed, then read forward two. Look for a fever, a surgery, a medication change, a crash diet, a stretch where you barely ate, or a month you’d describe to a friend as the worst one.

The answer may be something you stopped thinking about months ago.

What you find is a clue. Shedding runs alongside pattern thinning, thyroid disease, and low iron all the time, and no timeline sorts that out for you. Take the date to someone who can look at your scalp.

Gradual thinning, which no calendar will explain

If your part has been widening for a couple of years, or your ponytail has gotten thinner with no dramatic morning in the bathroom, look at female pattern hair loss.

One study of 178 healthy postmenopausal women found it in 52% of them. Other populations run differently and one study is one study, though the number tells you how ordinary gradual thinning is in women your age.

The causes are tangled. Genetics, follicle sensitivity to androgens, falling estrogen, and age all contribute, and researchers still argue about the weighting.

Follicles miniaturize over years, often while the front hairline remains largely intact. There’s no bad week to look back at.

This is the one that goes undiagnosed for a decade, because nothing ever happens dramatically enough to make an appointment about. Treatment works best when it starts early, which beats fear as a reason to go. Shedding has treatments too, once somebody finds the cause that’s still running.

What the dermatologist looks for

Here’s the part that answers the question you came in with, and it isn’t something you can do in your bathroom.

A dermatologist looks at the overall pattern, examines your scalp under magnification, and may do a gentle pull test. Telogen effluvium tends to show widespread shedding with follicles that are still the size they always were.

Female pattern hair loss shows hairs of different widths, because some follicles have been producing finer strands for years while their neighbors carry on as usual. That variation is the tell, and it lives at a magnification your bathroom mirror does not offer.

Bloodwork can point to a trigger. The scalp exam is what tells you which kind of loss you’re having.

What to ask for

Depending on your history and what the scalp exam shows, your clinician may start with a blood count, ferritin, and thyroid function. Other tests should follow your symptoms rather than a generic hair-loss panel.

Ask specifically whether ferritin makes sense for you. A normal blood count does not mean your iron stores are full. Mine were empty while my hemoglobin sat there looking fine.

New facial hair, acne, or cycles gone strange are worth raising, with the workup and timing left to your clinician. And if your periods are heavy, say the word heavy out loud, because it’s the detail most likely to get skipped.

Tell them about your supplements

High-dose biotin interferes with lab assays, including thyroid, hormone, ferritin, and cardiac tests, and which direction the error goes depends on the dose and the machine.

Biotin produces lab results that look completely convincing and are wrong.

Many hair, skin, and nail supplements contain 5,000 to 10,000 micrograms, which is a different universe from what you get eating food. Read your label, tell your clinician what you take, and ask the lab how long to stop before testing.

What recovery looks like

Once the trigger clears, shedding slows over three to six months, and the AAD puts return to normal fullness at six to nine months. That is a maddening stretch of time to be gracious about.

That timeline assumes the trigger is gone. Shedding that continues past six months is called chronic telogen effluvium. Sometimes the cause is still running, sometimes several causes overlap, and sometimes nobody finds a clear trigger at all.

Watch your hairline for short wispy pieces that stick straight up and refuse to lie down. Those are either regrowth or breakage, and only a scalp exam settles which. When they’re regrowth, they look ridiculous, and they’re the best news you’ll get all year.

The part I want you to keep

You’ve been reading your hairbrush as a verdict on how you’re aging. Hair is a symptom, and symptoms have sources.

Look at the pattern first. Count back twelve weeks if it came on fast, and take photographs if it’s been slow. You can grieve this and gather evidence in the same week. I’ve been doing both for two years.

My ferritin was 5, and finding it took one blood draw and one question nobody had asked. I’m still growing it back, which turns out to be a place you can live for a while.

Eat a bigger, protein-heavier dinner.

I ate a beautiful dinner for about three years. Grilled salmon, a pile of arugula, olive oil, done by 6:30. And then most nights around 9:40 I’d end up in the pantry with the light on, negotiating with myself about whether almonds count, three golden retrievers lined up behind me in the dark like a jury.

I assumed I was the problem. I was eating roughly 22 grams of protein at dinner and calling it a meal.

That hunger is not a willpower problem showing up on schedule. Your evening biology changed.

Estrogen was ending your meals for you

During a meal, your small intestine releases cholecystokinin, or CCK, which travels up the vagus nerve and tells your brainstem the fork can go down. Estrogen sharpens that signal.

Most of what we know comes from research in rats and mice. In that research, removing estrogen produces bigger meals and adding it back shrinks them again. The human version shows up on the menstrual cycle, where women eat less during the ovulation window, when estradiol peaks.

The drag on a fishing reel decides when the line stops going out. Yours got loosened, and the fish never noticed a thing.

Your appetite has an 8pm setting

Researchers at Brigham and Women’s Hospital and Harvard studied twelve adults for thirteen days, feeding everyone the same meals on the same sleep schedule, spread evenly around the clock, so time of day was the only thing left to measure. Hunger still swung 17%, lowest at 8 in the morning and highest at 8 at night.

Your appetite peaks around 8pm whether or not you ate dinner at 6.

Then perimenopause takes your sleep, and short nights raise ghrelin 28% and drop leptin 18%, with the appetite spike landing squarely on crackers, cookies, and bread. You cannot fix that one at dinner, so protect the sleep separately.

Every study above ran in young adults or in men. Nobody has done this trial in perimenopausal women, which tells you something about research funding and nothing about your body.

The dinner most of us are eating

Now stack all of that on the dinner a woman over 40 has been taught to eat. Something light. A big salad with four ounces of chicken lying across the top, apologizing. (I HATE these dinners)

Twenty-five to thirty grams of protein per meal is where the satiety research clusters. Heather Leidy’s review found only two trials testing meals below that line, neither of which moved satiety.

Her group also ran a twelve-week trial in 27 men, average age 47, on identical calorie deficits, one group at 25% protein and one at 14%. Daily hunger came out the same. The difference showed up after dark.

Right before bed, the higher-protein group wanted food about half as much. Same calories, same deficit, same twelve weeks.

Their reported thoughts about food dropped by roughly two thirds. That trial raised protein across the whole day rather than at dinner, so the dinner application is mine, not theirs. I’d still put the protein where the hunger is.

The 30 Gram Dinner Rule

Dinner is the only meal you have to change. Your palm is about 25 grams, so you’re going for a palm and a half.

• Thirty to forty grams of protein. Two boneless chicken thighs, a salmon fillet the length of your phone, or a burger patty as wide as your palm. Eight ounces raw comes out as six cooked, which is where most women lose ten grams they were sure they ate.

• A fist of real carbohydrate. Potatoes, rice, beans, winter squash. Not two forkfuls beside the protein.

• Half the plate in vegetables. Fiber slows digestion and feeds the GLP-1 system you already own.

• Fat, on purpose. A tablespoon of olive oil, half an avocado, a real pat of butter.

• Sit down for it. Your brain discounts food you eat standing at the counter over the sink.

What about dessert. Have dessert. A third of a dark chocolate bar after a 40-gram dinner behaves like a different substance than a sleeve of crackers after a salad, because the protein got there first.

Still hungry at nine. Then eat, and make it protein. A cup of Greek yogurt, a cup of cottage cheese, or whatever chicken is left in the fridge.

The part I want you to keep

Your body lost its satiety amplifier and kept its evening clock, and now it runs the whole operation on six broken hours.

You cannot out-discipline that. You can feed it.

So you stop auditing yourself at 9:40 and start trusting what your body reports. The hunger becomes information. You answer it at 6:30 instead of arguing with it at nine.

I still get hungry at eight. I just don’t take it personally anymore. :)

Fiber works. Most of us are wasting it.

Nobody has ever been excited about fiber. It has the branding of something your grandmother kept in a canister next to the prunes, and for forty years the entire marketing pitch was regularity, which has never moved a single product off a shelf.

Then the research caught up.

Fiber does more for a woman over 40 than almost anything else you can put on a spoon. It slows how fast sugar arrives in your blood, which matters more every year as estrogen declines and takes some of your insulin sensitivity with it. It feeds the bacteria doing quiet work in your gut. And higher intake tracks with lower cardiovascular risk across a very large pile of studies.

Meanwhile American women average around 15 grams a day against a recommendation of 25.

So eat more fiber. Everyone knows that part.

The better question is whether the fiber you’re already eating is doing what you think it’s doing. I spent years getting that wrong, in one specific and irritating way, while feeling enormously good about myself.

Two tablespoons

A 2024 meta-analysis in Nutrition & Metabolism pooled ten randomized controlled trials of chia in adults with overweight. Waist circumference dropped 2.82 centimeters against controls. BMI did nothing.

The tape measure moved before the scale did.

Chia did not burn anyone’s fat. Several of those trials paired the seeds with a reduced-calorie diet, so some of that inch belongs to the diet. The seed gets partial credit at best. And a separate 2024 meta-analysis found no waist effect at all.

The signal is small. It’s also real, and still being argued about by people with much better statistics training than mine. I’d rather hand you that caveat now than let somebody’s cardiologist husband hand it to you in the comments.

Why your waist and your weight stopped agreeing

Last spring I pulled a dress out of the closet that I’d worn to a wedding two years earlier. The zipper made it about two thirds of the way up and then simply declined. I had not gained five pounds. I checked.

That’s the part nobody warns you about. The scale holds steady and the clothes stage a revolt.

Estrogen has opinions about where your body files fat. As it declines through perimenopause, storage shifts off the hips and thighs and toward the middle. More of it lands as visceral fat, packed around your organs rather than sitting under your skin where you can pinch it.

You didn’t imagine it. Your body reorganized and never sent a memo.

Visceral fat is metabolically active tissue, which is why waist circumference is the more honest measurement after 40. It’s the fat that talks back.

What the gel is doing in there

I once left chia in yogurt overnight and came back to something a spoon could stand up in. The texture had gone somewhere between pudding and grout. I ate it anyway, because I’d made it and I don’t waste food.

That gel is the whole point.

Chia runs about a third fiber by weight, so two tablespoons puts you near 8 to 10 grams. For a nutrient most of us are running ten grams short on, that’s a serious contribution from something that fits in a spoon.

When chia meets liquid it swells and forms that gel. The gel adds volume and slows how fast your stomach empties, which softens the spike when glucose hits your blood.

The fiber makes a reasonable amount of food feel like enough. That’s what it does. Same mechanism running underneath the 4pm sugar craving. Nothing on the bag about blocking or burning is true.

The Two-Hour Gap

Here is where I was going wrong.

I take my supplements in the morning with a high-protein breakfast, which is sensible. For a long stretch I put the chia in that same breakfast, because I was doing every healthy thing at once, in one sitting, like a woman collecting merit badges.

Then I was listening to Dr. Rhonda Patrick when she mentioned, almost in passing, that fiber like this can interfere with the absorption of medications and supplements.

I sat there doing math on how many mornings I’d spent gelling my own minerals into uselessness right before swallowing them. The number was not small. And I had been so proud of that breakfast.

When I told my husband, he said, “So the healthy thing was cancelling out the other healthy thing.” Yes. That is precisely what it was.

Viscous fiber makes no distinction between glucose and the pill you swallowed thirty seconds ago. It gels around whatever else is in there. Roughly what happens when you drop a tablet into a jar of wallpaper paste.

In hypothyroid patients, adding a fiber supplement was enough to reduce levothyroxine absorption and push TSH up while the prescription never changed.

Remove the fiber and the numbers corrected themselves, on the same dose.

• Thyroid medication is the clearest case. Levothyroxine has a narrow margin, and small absorption changes turn up in your labs.

• Digoxin and a few older antidepressants belong on the same list.

• Iron matters here too, particularly if you’ve been working to bring ferritin up.

• Your multivitamin counts. A gel has no idea what you paid for it.

• The fix costs nothing. Two hours between the fiber and the pills. Four if thyroid medication is involved.

I want you to look at your own morning before you change one thing about what you eat. If your supplements and your fiber are arriving together, you have the cheapest fix available to anyone. It requires buying nothing.

So the chia came out of breakfast. It’s a snack now, Greek yogurt with the seeds stirred in, eaten between meals when nothing else is competing with it.

The bigger thing

You don’t need chia seeds to be healthy. Nobody’s next thirty years hinge on a seed. And whether any of this moved my own waist by 2.82 centimeters, I couldn’t tell you. I’ve never measured it. I’m not going to start.

For most of my life, health advice aimed at women was a subtraction problem. Less fat, less sugar, fewer calories, smaller portions. Underneath all of it, a low steady hum of guilt you stop noticing the way you stop hearing a refrigerator.

I wrote about why that stopped working after 40 a while back. The part I keep returning to is how many years I spent taking things away from myself and calling it discipline.

Somewhere in my forties I ran out of interest in shrinking.

Now the only question I bring to food is whether it makes this body more capable of carrying me through what’s coming. Protein. Fiber. Fruit. Plants. Two tablespoons of something small that pulls its weight.

I’m not managing my body anymore. I’m building it. It took me until my forties to turn that corner, and I’m not going back around it.

The algorithm has decided you need to walk after dinner.

You’ve seen her. Linen set, kitchen with zero crumbs on the counter, small white glucose monitor stuck to the back of her arm like a barnacle. She is very concerned about your spike.

So you tried it. Four days, maybe five. Then it rained, or the couch did that thing where it becomes a tar pit, and the habit went the way of the standing desk.

The research here is far better than the people selling it. And the finding that surprised me most is that ten minutes beat thirty, which nobody with a monitor on her arm has ever once mentioned. The reason comes down to what muscle does the second it starts working.

What your muscles do with dinner

Carbohydrates break down into glucose. Glucose moves into your bloodstream. Your pancreas releases insulin, which goes cell to cell asking them to open up and take some in.

Blood sugar rising after you eat is your body succeeding.

What gets left out of the caption is what happens when muscle starts contracting.

Working muscle pulls glucose straight out of your blood without waiting for insulin to approve it. Possibly the only system in your body that runs better without the paperwork.

Your muscles are the biggest place your body can put the meal you just ate. Walking turns the lights on in there.

Ten minutes beat thirty

Researchers at Ritsumeikan University ran a small crossover trial that tested this almost exactly. Twelve healthy adults drank 75 grams of glucose, the standard tolerance test, which tastes like flat orange soda that has personally wronged you.

Then they did one of three things. Sit. Walk ten minutes immediately. Or wait thirty minutes and walk for thirty.

A ten minute walk taken immediately dropped peak blood sugar from 182 mg/dL to 164. The thirty minute walk was three times longer and didn’t move the peak at all.

Timing did the work.

Ten minutes at a comfortable pace, roughly 2.4 miles per hour. Their muscles started using the fuel while it was still arriving.

One honest caveat. Twelve healthy young adults is a small study, and not one of them was a woman over forty standing barefoot in a Nashville kitchen in August.

Sooner beats later

That result holds up in the wider literature. A systematic review pooled eight randomized trials comparing exercise before eating with exercise after, and found that moving after the meal beat moving before it, and beat sitting still. The gap between the food and the movement mattered, and sooner beat later every time.

The paper is titled “After Dinner Rest a While, After Supper Walk a Mile?” after an old proverb, which tells you those researchers were having a lovely time at work.

Anyone who’s canned tomatoes knows the jars go into the water bath while everything is still hot. Wait an hour and you’ve performed every one of the same steps in the wrong order and produced a shelf of very expensive soup. Same ingredients, different afternoon.

Your morning walk builds strength and insulin sensitivity over years. The walk after dinner is doing a separate job, which is meeting the glucose while it’s arriving.

Ten minutes is the whole ask

Women hear “walk after dinner” and convert it instantly into a workout they’re already failing.

Please don’t. Thirty is wonderful if you have it. Five is still muscle contracting instead of a decision that the whole thing doesn’t count.

And while we’re lowering the stakes, glucose-fear has become its own wellness genre and it makes people miserable. Your blood sugar is supposed to rise after eating. Healthy people spike.

A perfectly flat glucose line is available to you, of course. It’s called not eating, and the reviews are terrible.

One bowl of pasta is not a medical event. We’re helping your body use the fuel you gave it, and if your afternoon energy has been unreliable, the 4pm crash piece covers the other half of that story

The Wise Woman 10-Minute Rule

Finish eating. Get up within about fifteen to thirty minutes, then walk for ten at a pace where you could still hold a conversation.

• Walk the dog, who has been waiting years for this development.

• A loop around the block. No route required, no watch.

• Target, where you will claim you need one thing and come home with a candle.

• Pace the kitchen while you call your mother.

• Unload the dishwasher standing up and moving on purpose, for the nights it’s storming. (I have strong feelings about people who don’t rinse first. Anyway.)

The goal is contracting muscle.

What about dessert

Eat the cake. Then take your husband for a walk.

More carbohydrate arriving means more fuel in circulation, which gives your muscles more to do with. The dessert walk might be the highest-value ten minutes in the whole system.

And nothing about this is penance.

You are not walking off the cake. The cake is already yours, filed and processed and distributed by a pancreas that has never once asked you for input. You’re opening a second door for it.

Does it help you lose weight

Probably not directly, and I’d rather say so than sell you something.

Ten minutes of walking doesn’t burn enough to explain fat loss. Its strongest evidence sits in post-meal glucose control.

Insulin sensitivity and consistent movement matter enormously over decades. Muscle is metabolically active tissue, and it sits right alongside bone as tissue worth protecting after forty.

But smaller spike, smaller waist is Instagram science, and I’m not doing it.

The oldest advice in the book

We have collectively spent a fortune trying to improve our metabolism. Supplements, monitors, apps, powders that taste like chalk with a citrus problem. The most reliable version of it becomes available roughly four minutes after you put down your fork.

Our grandparents walked after dinner and everyone decided it was charming. They were doing the science the whole time, in real shoes, without a single sensor.

Ten minutes is a small thing that quietly turns you into a woman who understands her own machinery. Which is a very different woman from the one scrolling past the linen set, feeling vaguely guilty about her pasta.

What’s your ten minutes going to look like tonight?

In August of 2023, I decided to get serious about my health. I had made that decision before, usually in January, usually while holding a brand new water bottle I would abandon by Valentine’s Day.

But everyone around me was talking about keto. A friend lost twenty pounds. A woman at church lost thirty and started saying things like “I just don’t think about food anymore,” which at the time sounded to me like a sentence spoken in Portuguese.

So I tried it.

And I fell hard. Within about three days my sugar cravings vanished. All of them. The 4 p.m. pull toward whatever was in the pantry stopped, and I remember standing in my kitchen at four o’clock on a Tuesday, listening to the ice maker dump a load, waiting to want something. Nothing came.

I wasn’t hungry. I had energy that lasted past lunch. My head was clear in a way it hadn’t been in years. Over the next several months I lost about thirty pounds, which was every extra pound I’d been hauling around since my thirties.

I thought I would do keto for the rest of my life, and I said so out loud, to actual people, with the kind of confidence that ages badly.

Why keto felt like magic

The appetite thing wasn’t in my head.

Drop carbohydrates low enough and your liver starts making ketones. Ketones do something interesting to hunger. When people lose weight, ghrelin (the hormone that makes you want to eat) climbs as the pounds come off, which is why most diets end with a woman standing in front of her refrigerator at 10 p.m. negotiating with herself. In people who stayed in ketosis, that ghrelin increase was suppressed.

My body stopped filing the complaint.

Blood sugar flattens out too. No spikes, no crash, no 2 p.m. face-plant into the desk. After a decade on that particular rollercoaster, it felt like someone had walked over and turned the volume down.

I was thrilled. I was also starving something.

The test that ruined my good time

My nutritionist had me do a GI map. It’s a stool test that functional medicine practitioners use to see what’s living in your gut, the beneficial bacteria, the opportunistic ones, the parasites, the assorted things you’d rather not read about over breakfast. It’s a functional medicine test, which means it points you in a direction. A starting place for a conversation, not the last word.

My snapshot was ugly.

Plenty of the bacteria you don’t want. Almost nothing you do. She told me to start eating walnuts, berries, fiber, fermented foods, and to add a probiotic.

I ignored her. Well, ignored is generous. I heard every word and filed it under later.

Because keto was working. I was at a weight I hadn’t seen in fifteen years. I could think. I had energy. You do not take that away from a woman who spent a decade walking through wet sand.

So I kept going for another six months, and I felt great the whole time.

Then I retested. There’s a specific kind of quiet that happens when someone is reading your labs and not talking. She clicked her pen twice, looked up, and said, “I have never seen someone get worse.”

What was happening in there

Keto starves your gut bacteria. It’s a side effect of how the whole thing works.

The bacteria in your colon eat fiber. That’s the job. They ferment it into short-chain fatty acids like butyrate, which feeds the cells lining your colon, keeps inflammation in check, and triggers the GLP-1 your body makes on its own.

Cut carbs low enough for ketosis and the fiber goes with them. In a twelve-week randomized trial at the University of Bath, the keto group averaged around 15 grams of fiber a day, about half the recommended intake. Their Bifidobacteria dropped. Their LDL cholesterol went up.

A systematic review of keto and the human microbiome found the same pattern across the literature: persistent reductions in Bifidobacterium, fewer butyrate-producing species, less butyrate overall.

There’s also evidence that ketone bodies themselves suppress bifidobacterial growth. The fuel I was so proud of making was part of the problem.

It was like keeping a sourdough starter in the back of the fridge and never feeding it. Looks fine. Technically alive. Ask it to do anything and you find out.

Getting off keto was the scary part

I was afraid. I thought the clear head and the steady energy belonged to ketosis, and that one apple would undo two years of work.

I added fruit, then vegetables, then more vegetables than I’d eaten in the previous two years combined.

Nothing bad happened.

That’s when it landed. The energy came from what I had removed. No sugar. No processed food. No drive-through at three in the afternoon. Keto was the strictest elimination diet I have ever done, and the elimination was doing the heavy lifting.

There’s good research on this. Researchers at the NIH fed people ultra-processed and unprocessed diets matched for calories, sugar, fat, and fiber. On the ultra-processed version, people ate about 500 more calories a day and gained weight. Same numbers on paper. Different bodies after two weeks.

I hadn’t found a magic macronutrient ratio. I had stopped eating food that was built to be overeaten.

What I eat now

• Protein at every meal. Chicken, salmon, shrimp, tuna. I aim for about 150 grams a day.

• Vegetables with basically everything

• Fruit, especially berries. A cup of blueberries most days.

• Nuts and seeds, walnuts included

• Greek yogurt with berries

• Fermented beets and strawberry kefir, most days

• Very few grains, because grains are a slippery slope for me and I know it

Almost no processed food. That part I kept, and it’s the part that mattered.

If your gut needs rebuilding

• Walnuts. In a controlled feeding trial, 42 grams a day raised butyrate-producing bacteria like Faecalibacterium and Roseburia.

• Fermented foods. A Stanford trial found that ten weeks of yogurt, kefir, kimchi, and kombucha increased microbial diversity and lowered inflammatory markers. The high-fiber group in that same study didn’t get the diversity bump, which surprised the researchers too.

• Plant variety. In the American Gut Project, people eating more than thirty different plants a week had more diverse microbiomes than people eating fewer than ten. Herbs count. Spices count.

• A probiotic, if your practitioner recommends one

• Fiber, added back slowly, unless you enjoy dramatic trips to the bathroom

Where I landed

I’m grateful for keto. It handed me back a body I’d been trying to get to for fifteen years, and it did it without a prescription.

If you want to drop some fat, it’s a great tool to have in your toolbox. A temporary one. I treated it like a lifeline when it was only ever a tool.

Have you ever tried keto? What was your experience like?

The Nashville airport has a particular kind of women’s restroom line. It starts at the door, curls back past the water fountain, and by the time you’ve joined it you have quietly accepted that this is your life now. Meanwhile the men’s room operates like a revolving door at a department store. In and out. No line, no drama, no bargaining with God.

I’d had a large tea somewhere over Georgia. When I got off the plane I needed to use the bathroom, but casually. A four out of ten. The kind of need you can carry through a terminal without thinking about it.

Then I got in the line.

And something happened that I have since learned has a name. The second my brain registered bathroom soon, my bladder heard something closer to now, immediately, this is a crisis. The four became an eight. The eight became a situation. By the time a stall opened up I was taking the small steps. The careful ones. You know the ones.

I made it. Barely.

Ugh. Why at 47 was this happening?

It happened again a few months later in Orlando, same setup, same line, same shameful little shuffle past the hand dryers. That was the trip where I stopped filing it under “weird fluke” and started filing it under “problem.”

So I did what every woman does. I went home and got on the internet, which is where good judgment goes to die.

I did Kegels. I did them at red lights, during conference calls, at my desk at nine in the morning. I read about bladder training and timed voiding and cutting caffeine, which was already a nonissue since I don’t drink coffee. Nothing changed. Not one thing.

Then I did the math, which is the part I’ve never told anybody.

I was 47. If this is what 47 looks like, I thought, what does 60 look like? Because the trajectory only goes one direction. I pictured myself at 60 buying Depends at the Kroger and putting them in the cart underneath the paper towels so nobody would see. I pictured planning my whole day around where the bathrooms were. Not being able to sit through a movie, or a flight, or a sermon.

I didn’t tell my husband. I didn’t tell my friends. I just carried it around for the better part of a year, like a low hum in the background that I got used to.

The thirty-second conversation that fixed it

I mentioned it on passing to my gynecologist at my annual because I didn’t believe that there was actually any hope that she could help. I was already dressed. My hand was on the door. I said it the way you say something you’re hoping the other person will wave off.

She didn’t wave it off. She said, “Oh. You need vaginal estrogen.”

I told her I was already on an estrogen patch.

She said the patch wasn’t going to do it, because the tissue around my urethra needed its own supply, and it wasn’t getting one.

That was it. That was the whole conversation. Roughly the length of time it takes to find your keys.

What’s actually happening down there

Here’s what that means, biologically.

Your urethra and the base of your bladder are not neutral plumbing. They’re covered in estrogen receptors, the same as your vaginal tissue, because they all developed from the same embryonic origin. Estrogen is what keeps that tissue thick, elastic, well supplied with blood, and cushioned with collagen.

Take away the estrogen, and the tissue thins. It loses collagen. Blood flow drops. And two specific things go sideways. The urethra loses some of its ability to stay closed under pressure, and the bladder’s sensory threshold shifts, so it starts sending the alarm at a much lower volume than it used to.

Which is exactly what was happening to me in that line. My bladder wasn’t full. It was just no longer able to tell the difference between “somewhat full” and “code red.”

Think of the rubber gasket on a mason jar lid after about twenty summers of canning. It’s still there. It’s still the right shape. It has simply lost the ability to hold a seal, and no amount of screwing the ring down tighter is going to fix a gasket problem.

That’s why the Kegels didn’t work. Pelvic floor training is genuinely effective and the research backs it up, so if a pelvic floor PT has helped you, keep going. But Kegels train muscle. My problem was tissue. I was strengthening the wrong system entirely, very diligently, for months.

Anyway. This whole cluster of symptoms has a name now: genitourinary syndrome of menopause. It covers vaginal dryness, painful sex, burning, urgency, frequency, getting up at night, and recurrent UTIs. Around 60% of women in menopause have it. Only 7% of providers ever ask about it.

And unlike hot flashes, which tend to ease up over time, this one is progressive. It does not get better on its own. My Depends math was, unfortunately, decent math.

Why the patch wasn’t enough

Systemic estrogen goes everywhere. It handles hot flashes, it protects your bones, it does a lot of heavy lifting. But the dose that reaches your urethra by way of your bloodstream is a rumor of estrogen. A trace. It’s the difference between watering a garden with a hose and hoping for humidity.

Vaginal estrogen is applied right where the receptors are. It’s a very low dose, it skips your liver entirely, and the systemic absorption is minimal, which is why most women don’t need to add a progestin to protect the uterine lining the way you would with systemic therapy.

It does not raise your body’s overall estrogen in any meaningful way. It is not “more hormones.” It’s estrogen delivered to the one address that isn’t receiving mail.

What vaginal estrogen does

Once I started reading the research, the list got long. Long enough to make me mad, since most of this has been sitting in medical journals since the nineties.

• The urgency backs off. A four out of ten stays a four out of ten, which sounds small and is not small at all.

• You stop getting up at night, or at least you stop getting up three times.

• The specific horror of standing right next to the bathroom and still not making it goes away.

• UTIs drop off a cliff. In a randomized trial published in the New England Journal of Medicine, women using vaginal estrogen averaged half an infection a year. The placebo group averaged almost six.

• Your vaginal pH goes back to where it used to be, which brings back the good bacteria that keep the bad ones from moving in.

• Dryness, burning, itching. Gone.

• Sex stops hurting, which is the thing a lot of women came in for and couldn’t make themselves say out loud.

That UTI number deserves a second look. Recurrent UTIs in older women are not a minor quality of life issue. They land women in the hospital. They’re a common reason an otherwise sharp woman shows up at the ER confused. And a great many of them are preventable with a cream that costs almost nothing.

How to ask for it

Say this at your next appointment, ideally before you’re dressed and holding the door: “I’m having urinary urgency and I’d like to try vaginal estrogen.”

That’s the whole script. If you’re already on systemic hormone therapy, say that too, and say you understand this is separate.

It comes as a cream, a tablet, or a ring you replace every three months. Most women start with a loading phase and then drop to twice a week forever, because the moment you stop, the tissue goes back to how it was. I use the cream. It took a few weeks before I noticed I’d stopped scanning for bathrooms.

If your doctor hedges, it’s worth mentioning that the FDA removed the old boxed warning from low dose vaginal estrogen in November 2025, after twenty years of it being there for no good reason. And if that doesn’t move things along, ask for a referral to a menopause specialist or a urogynecologist. Not every physician has been trained on this, and that is not a reason for you to go without.

I have become genuinely unbearable about this. I bring it up at dinner. I’ve told women at church. I told a woman I’d known for eleven minutes.

Because here’s what got me. My fix took thirty seconds of conversation and a prescription that runs about fifteen dollars a month. I spent a year quietly rearranging my life around a problem that had a solution the entire time. Twenty years of women being handed a pamphlet about “normal aging” instead of a prescription, and the only thing standing between me and mine was that nobody had ever said the words out loud.

So I’m saying them. Vaginal estrogen. Tell your friends.

I did everything right. I went to bed at the same time every night. My room was cold. My phone was in another room. I wasn’t eating late. I was getting a full eight hours.

And my Oura ring kept scoring me in the 70s.

The kind of score that makes you stare at your phone at 6am while your tea steeps and think, well, I guess this is just my life now.

I spent a few months like that. Sleeping enough hours but never waking up feeling like sleep had done its job. If sleep were an employee, I would have started documenting performance issues.

So I started digging.

Your body has to get cold to fall into deep sleep. Your actual core body temperature needs to drop about 1 to 1.5 degrees for your brain to shift into slow-wave sleep, which is the stage where your body does its real repair work. Cellular cleanup and muscle recovery. The stuff you assumed was happening while you slept but wasn’t.

The way your body pulls this off is surprisingly mechanical. Blood vessels in your hands and feet dilate, warm blood rushes to your extremities, and your core cools down. Your brain reads that temperature drop as the green light to go deep.

When that cooling process stalls, you stay in lighter sleep stages. All night. You can clock eight full hours, and your body barely touches the sleep that matters. It’s like sitting in a parked car for three hours and calling it a road trip.

For women in midlife, this gets worse. Estrogen plays a role in thermoregulation, and as levels shift during perimenopause, your body’s internal thermostat gets less precise. You don’t have to be having hot flashes for this to affect you. The disruption can be subtle enough that you’d never connect it to sleep quality. You just know you’re tired.

Glycine is the simplest amino acid your body makes. But production can fall short, especially under stress or when your diet isn’t covering the gap. When you take it before bed, it crosses the blood-brain barrier and acts on NMDA receptors in your brain’s master clock, the suprachiasmatic nucleus. (I know. The name sounds like a dinosaur. Stay with me.) Those receptors trigger vasodilation, which is the fancy way of saying your blood vessels open up and heat moves out of your core. The exact sequence your body needs to enter deep sleep.

In clinical trials, 3 grams of glycine before bed improved both how quickly people fell asleep and how much time they spent in restorative sleep stages. It also reduced daytime fatigue the next day. The primary researchers worked for a company that manufactures glycine, which I want to be transparent about. But the mechanism has been independently validated through research at Stanford’s sleep lab, and the safety data is solid.

How to take it: 3 grams, about 30 to 60 minutes before bed. I’ve taken it two hours before bed and it worked just as well. It’s cheap and tastes slightly sweet. Dissolves in water, but I take it with a little bit of strawberry kefir for a probiotic boost.

Since I started taking it, my Oura scores went from the 70s to the mid-90s. I wake up feeling like a new woman.

Who it’s for: Women who are doing the sleep hygiene basics and still not getting restorative sleep. If your body isn’t cooling down properly at night, glycine gives it the nudge it needs.

Who should skip it: Anyone on clozapine, anyone with kidney or liver disease, and anyone who is pregnant or breastfeeding. If you’re on blood sugar medication, talk to your doctor first, because glycine can affect glucose levels. You should always talk to your doctor before taking new supplements, of course.

I spent years thinking I was just a bad sleeper. Turns out my body had forgotten one step. It needed to get cold, and it couldn’t do it on its own anymore. Three grams of a boring little amino acid fixed that.

I ate the same way for most of my thirties and my body just went along with it. Then somewhere around 42, same food, same portions, and my jeans started staging a quiet revolt. I tried eating less, which my body interpreted as a challenge to get more creative about where it stored things.

Turns out the problem was never the food. My hormones had rewritten the rules and I was still cooking from the old playbook.

After 40, estrogen drops and takes your insulin sensitivity with it. Inflammation rises. Your gut bacteria rearrange themselves like they’re redecorating a house they don’t own. And your body develops a new and deeply annoying preference for storing fat around your midsection, which is the biological equivalent of your metabolism saying “I live here now.”

Each of these five foods targets a different piece of that puzzle, and each one has actual published research behind it, which feels worth mentioning in a world where someone on TikTok will tell you that celery juice cures everything.

Fatty Fish

When estrogen drops, you lose one of your body’s best built-in anti-inflammatory tools. That matters because inflammation directly promotes fat storage, especially the visceral kind that packs around your organs. Omega-3s from fatty fish push that inflammation back down, and they improve insulin sensitivity, which is the whole game after 40.

Salmon is the one everyone thinks of, but sardines are technically the better choice. A single can has more omega-3s per ounce than most salmon fillets, plus calcium and vitamin D, which your bones are also asking for right now. I know this because I researched it, got excited, bought a can, opened it, took one bite, and gagged. I wanted to be a sardine person. I am not a sardine person. If you are, I am deeply envious of your palate and your omega-3 levels. The rest of us will stick with salmon, mackerel, or tuna and do just fine.

Aim for fatty fish two to three times a week, and the canned versions absolutely count.

Extra Virgin Olive Oil

This one surprised me. A randomized, double-blinded trial put women with excess body fat on the same calorie-controlled diet, with one group getting two tablespoons of EVOO daily and the other getting soybean oil. The EVOO group lost 80% more body fat on the same number of calories. The only variable was the fat source.

The polyphenols in good olive oil, especially oleocanthal (the compound responsible for that peppery bite at the back of your throat), reduce the exact inflammatory markers that spike when estrogen falls. And a 2025 study of over 120,000 adults found that regular EVOO intake independently associates with lower abdominal obesity regardless of overall diet quality.

Two tablespoons a day, and I would spend the extra money on real EVOO. The inexpensive stuff in the big plastic bottle is often cut with seed oils and has almost none of the polyphenols that make this work. I keep DeLallo in my kitchen. Your visceral fat is not the area of your grocery budget to start economizing.

Poultry

This one doesn’t get a fancy biological mechanism because it doesn’t need one. After 40, you are losing muscle. Muscle is the organ that drives your metabolic rate, and when it goes, your metabolism goes with it. Higher protein intake in midlife women preserves muscle mass, reduces fat mass, and shrinks waist circumference. That’s from a 2025 study in Frontiers in Nutrition that compared standard versus moderately high protein intake in older women, and the differences were significant across every measure.

Chicken and turkey are two of the most efficient ways to hit your protein goals without blowing through your calorie budget. Four ounces of chicken breast has about 35 grams of protein for roughly 180 calories. And protein has another trick: your body burns 20 to 30% of protein calories just digesting and metabolizing them, compared to 5 to 10% for carbs and 0 to 3% for fat. So 100 calories of chicken costs your body roughly 25 calories to process. A hundred calories of bread costs about 7. Try doing that math with pasta.

I eat about five ounces of protein at lunch almost every day, usually chicken or salmon, and I pair it with vegetables and some healthy fat. Greek yogurt is another powerhouse in this category if you want variety. A cup of plain Greek yogurt has 15 to 20 grams of protein plus calcium, which your bones need, and probiotics, which your gut is asking for. Between poultry and Greek yogurt, you can cover a huge amount of your daily protein math without thinking too hard about it.

Resistant Starch

If you read my piece on how your body already makes the Ozempic hormone, you know that GLP-1 is the satiety signal that tells your brain to stop thinking about food. Certain foods trigger your body to produce more of it naturally, and resistant starch is one of them.

Your small intestine can’t break resistant starch down, so it reaches your colon intact, where bacteria ferment it and produce butyrate. Butyrate stimulates your gut’s L-cells to release GLP-1, which means your body is manufacturing its own satiety signal. It won’t produce anything close to what a pharmaceutical dose delivers, but it’s a real, measurable effect that adds up, and it directly reduces food noise.

The easiest source is cooked and cooled potatoes, including sweet potatoes. When you cook a potato and refrigerate it, the starch crystallizes into a form your enzymes can’t touch. Potato salad counts. Cold roasted sweet potatoes tossed into a lunch bowl count. Leftover rice does the same thing, and you can reheat all of it without losing the benefit.

I love that potatoes, the food every diet since 1987 told women to avoid, turn out to be working in your favor. You just have to let them cool down first.

Nuts

Women have been avoiding nuts for decades because the calorie count looks terrifying on paper. Almonds, walnuts, pistachios, they all clock in high. And the research says it doesn’t matter.

Multiple clinical trials have found that regular nut consumption does not cause weight gain. USDA researchers ran controlled studies and found that almonds have 32% fewer absorbable calories than what the nutrition label says, because your body can’t break through the rigid cell walls to access all the fat. Walnuts were 21% fewer. The number on the bag is overstating what you actually take in. On top of that, nuts increase thermogenesis (your body burns more energy digesting them) and improve satiety so you eat less later.

Walnuts specifically have the highest omega-3 content of any nut, which brings you back to the inflammation piece. Almonds are protein-dense and have been shown in trials to reduce abdominal fat when eaten as a daily snack. A small handful as an afternoon snack, roughly one ounce, is the dose most studies used.

I keep a container of mixed nuts in my pantry the same way I keep olive oil on the counter. It’s infrastructure.

Bonus: Cruciferous Vegetables and a Word About Pickles

I’m adding this as a bonus because cruciferous vegetables (broccoli, cauliflower, Brussels sprouts, cabbage) are absurdly nutrient-dense for almost no calories. A full cup of broccoli is about 55 calories and it fills real estate on your plate that would otherwise go to something less useful. They keep you full because of the fiber and water content, and they contain compounds like sulforaphane that support overall cellular health in ways researchers are still mapping out.

I roast mine with olive oil and salt, twelve minutes at 425 degrees, and it goes with everything. At 6pm on a Wednesday, “goes with everything and requires almost no thought” is the only criteria I’m working with.

And while we’re here, a quick shout-out to pickles. The acetic acid in pickle brine works the same way the apple cider vinegar in my GLP-1 article does: it slows gastric emptying and helps quiet a sugar craving. A few spears with lunch adds almost no calories and makes a plate of chicken and vegetables feel like an actual meal instead of a punishment.

Your body changed the rules after 40, and these foods play by the new ones.

Which of these surprised you? And what are you already eating from this list? I love hearing what’s working for you.

The most Googled wellness term of the last two years isn’t a supplement or a diet. It’s “food noise.” And if you’ve ever stood in your kitchen, not hungry, fully aware you just ate, and still somehow negotiating with yourself about whether you need a snack, you already know what it means. You just didn’t know it had a name.

I used to plan lunch while eating breakfast. Not in a meal-prep, organized-woman way. In a something is wrong with me way. I’d be standing at my counter eating chicken and vegetables, a perfectly reasonable plate of food, and my brain was already scrolling through what came next. Crackers. Cheese. That one bag of chocolate chips I hid behind the quinoa like a squirrel with a secret. I wasn’t hungry. I’d just started eating. But the mental channel was always on, and I couldn’t find the remote.

I figured this was just how my brain worked. Some women are good at math. Some women are good at not thinking about snacks. I was in the other group.

Then I changed what I was eating, not how much, and the channel went quiet. The silence was so startling I wrote a whole article about it. But the what isn’t as interesting as the why. Because once you understand the biology, you stop blaming yourself. And that matters more than any recipe I could hand you.

Why Everyone’s Talking About Food Noise

GLP-1 medications like Ozempic and Wegovy gave millions of people their first experience of quiet. The constant mental chatter about food just... stopped. That’s a real thing, and for a lot of women, it was life-changing.

A 2025 survey of 550 people on semaglutide found that 62% reported constant food-related thoughts before treatment. After starting the medication, that number dropped to 16%. The drugs work. Full stop.

But what the medications revealed is just as important as what they fix. They showed us that food noise isn’t a character flaw. It’s a biological signal. Your brain keeps rehearsing the food reward because it hasn’t gotten the signal to stop. A 2025 paper in PMC calls this “maladaptive prospection,” which is a fancy way of saying your brain is still looking for something. Whether you quiet it with medication or with food, the biology underneath is the same.

And what it’s looking for is more specific than you’d think.

Your Body Is Hunting for Protein (and It Won’t Stop Until It Finds It)

Two researchers at the University of Sydney, Stephen Simpson and David Raubenheimer, spent years studying what drives animals to overeat. They started with locusts. (Stay with me.) What they found changed how scientists think about human appetite.

They call it the Protein Leverage Hypothesis, published in Obesity Reviews in 2005. The idea is simple: your body has a protein target. It will keep driving you to eat until that target is hit. If your meals are low in protein and high in carbs and fat, your brain never gets the “enough” signal, so the food noise stays loud and the hand keeps reaching for the pantry.

Think about it like a vending machine that only takes quarters. You keep feeding it dimes and nickels, thinking you’re putting in money, but the machine doesn’t care about total coins. It wants quarters. Your body doesn’t care about total calories. It wants protein.

A randomized controlled trial tested this in lean humans. When researchers secretly diluted the protein in people’s food, participants ate 12% more total calories without realizing it. Their bodies were compensating, reaching for more food because the protein target hadn’t been met.

Now here’s where it gets infuriating. A 2018 study in Public Health Nutrition by Raubenheimer, Simpson, and colleagues connected protein leverage directly to ultra-processed foods. Those foods are consistently high in carbs and fat but low in protein, because protein is the most expensive macronutrient to produce. Manufacturers replace it with cheaper carbs and fats, which means the products taste like something substantial but never hit your protein target. Your barbecue chips, your flavored yogurt, your granola bar with the word “protein” on the front that actually contains 6 grams. All dimes, dressed up in better packaging.

The food industry has been feeding you dimes on purpose, because dimes keep you coming back to the vending machine.

A 300-calorie muffin leaves you thinking about lunch by 10am. A 300-calorie plate of chicken and avocado keeps you quiet until noon. Same calories. Completely different signal to your brain.

Your body doesn’t count calories. It counts protein. And it will keep asking for food until the protein arrives.

For me, this was the biggest piece. When I started hitting my protein target at every meal, the mental noise dropped. Not slowly, like a dimmer switch. More like someone walked over and unplugged the speaker. I wasn’t white-knuckling past cravings. I just wasn’t having them. (I’ve written more about the specific math in The Protein Math Your Doctor Never Mentioned.)

The Blood Sugar Roller Coaster Is Making It Worse

Even with good protein, your brain can still get loud if your blood sugar is crashing. And if you’re over 40, your blood sugar is crashing more than it used to, because declining estrogen is making your cells worse at processing insulin. (I wrote a whole piece on this in How to Stop the 4pm Sugar Craving.)

A 2021 study in Nature Metabolism found that the blood sugar dip 2-3 hours after a meal was a stronger predictor of hunger than the spike itself. The crash is the trigger. Not the peak. And when your blood sugar drops, your body releases ghrelin, the hunger hormone. Glucose goes down, ghrelin goes up. Your brain reads that as hunger even if your stomach is physically full.

So you ate a reasonable lunch. Two hours later your glucose dips, ghrelin spikes, and your brain fires up the food channel again. Your stomach is fine. Your blood sugar just told your brain otherwise. It’s like getting a low-battery notification on a phone that’s at 60%.

Pairing protein with fat at meals blunts this whole cycle. Fat slows digestion, which means a gentler glucose curve, which means no crash, which means ghrelin stays in its seat. When ghrelin is quiet, so is your brain. (I realize “eat fat so your hunger hormone doesn’t yell at you” is not a sentence I expected to type on a Wednesday morning, but here we are.)

By the way, this is why I was able to keep my food noise under control even after I stopped eating keto. The diet label didn’t matter. The mechanism did: enough protein, enough fat, stable blood sugar.

The Weird One: Your Brain Might Just Want Salt

Okay, here’s the weird one.

Sometimes what you’re interpreting as food noise, that vague sense of I need something but I don’t know what, is your body asking for sodium. Not calories. Not sugar. Salt.

The biopsychology of salt hunger is well documented. When sodium levels drop, your brain activates reward and motivation circuits that drive you to seek out salty substances. But you don’t always interpret that signal as “I need salt.” You feel a pull toward the kitchen, you open the fridge, you stare at everything and nothing looks right, because what you actually need isn’t in the container of leftover pasta. It’s in the pickle jar.

Your hypothalamus, the part of your brain that manages both hunger and thirst, processes these signals through overlapping pathways. Low sodium and mild dehydration can genuinely register as hunger. Your brain isn’t lying to you. It’s just using the only language it has.

Pickles and olives became a strategy for me, not a snack. When the vague “I need something” feeling shows up between meals, I eat a few pickles straight from the jar (standing in front of the open refrigerator, because apparently that’s where all important decisions happen) or a handful of Castelvetrano olives. Sodium, some fat from the olives, zero blood sugar impact. The noise goes quiet within minutes. It’s the most boring solution imaginable, and that’s exactly why it works. (Nobody’s getting a book deal from the pickle strategy, but my pantry is safe.)

The GLP-1 Piece (Yes, Your Body Makes This)

I wrote an entire article about how your body produces its own GLP-1 and how to support that production with a simple drink made from hibiscus tea, apple cider vinegar, and inulin powder. I’m not going to repeat all of it here because you deserve the full breakdown and the citations.

GLP-1 is one more input your brain is waiting for. It’s the satiety signal, the “you can stop looking now” message. When your gut is producing it well, it adds another layer of quiet. When it’s not, your brain keeps searching.

If food noise is a volume knob, protein is the biggest turn. Blood sugar stability is the second. Sodium is the sneaky third one nobody checks. And GLP-1 support is the final fine-tuning.

What Actually Works (The Short Version)

Protein first, every meal. Make protein the foundation of the plate, not a side character. Aim for 30 grams minimum per meal. Your body will stop asking for food when the protein target is met. Calories are irrelevant. Quarters are everything.

Pair it with fat. Fat slows digestion, blunts the glucose curve, and keeps ghrelin from spiking two hours later. Avocado, olive oil, nuts, the fat on your salmon. Low-fat diet culture lied to us. Your hormones need fat. Your blood sugar needs fat. Your brain needs fat to stop obsessing over the crackers.

Try pickles before a snack. When the “I need something” feeling hits, try sodium first. A few pickles, a handful of olives, a cup of bone broth. Give it ten minutes. If you’re still genuinely hungry after that, eat. But most of the time, the signal resolves, because it was never about food in the first place.

Support your GLP-1 production. Read the full article on the drink. Try it for two weeks. See what happens.

The Part That Actually Matters

I spent years thinking food noise was a discipline problem. That if I could just develop a better “relationship with food” (whatever that means), I’d be able to think about dinner with the casual indifference of someone contemplating the weather in Portugal.

Turns out my relationship with food was fine. My food’s relationship with my brain was the problem. It wasn’t sending the right signals because it didn’t have the right materials.

Protein. Fat. Sodium. GLP-1 support. Four inputs. That’s the whole list.

When I gave my brain what it was actually asking for, the volume turned down on its own. No negotiation. No willpower. Just quiet. I want you to sit with that for a second, because most of us have been told this is a character issue when it’s actually a chemistry issue.

Your brain was never working against you. It was working for you, the only way it knew how.

Give it what it needs and notice what happens when the noise finally goes quiet.

It sounds a lot like peace.

Someone took a photo of me at a friend’s birthday dinner about five years ago. The restaurant was loud, the lighting was doing nobody any favors, and someone had ordered a candle for the cake that smelled like a Yankee Candle store had caught fire.

Same face I’ve had my whole life. But I looked at that photo and thought, “Who is that?” Not in a crisis way. More like looking at a house you used to live in and realizing somebody moved the windows.

I couldn’t point to one thing. It was everything, slightly shifted. And I remember thinking, well, that happened fast.

Turns out there’s a study that explains exactly why it felt that way.

So Here’s What Stanford Found

Researchers tracked over 135,000 molecules and microbes in 108 people between the ages of 25 and 75. They weren’t measuring wrinkles. They were tracking RNA, proteins, lipids, and your microbiome, the stuff happening deep inside your cells that you can’t see from the outside.

Most of these molecules don’t change in a slow, steady, candles-on-a-birthday-cake kind of way. They change in two massive waves. One around age 44. The other around age 60.

“We’re not just changing gradually over time; there are some really dramatic changes,” said Michael Snyder, the geneticist who led the study. “It turns out the mid-40s is a time of dramatic change, as is the early 60s. And that’s true no matter what class of molecules you look at.”

Your body didn’t slowly drift. It called a staff meeting, restructured three departments, and forgot to send you the memo.

What Actually Changes at 44

The first wave is the one that matters most for us, and once you see what shifted, you’re going to recognize every bit of it.

Your lipid metabolism changes. Your cholesterol panel suddenly looks different even though you’re eating the same way you were at 38. I wrote about this in the cortisol belly piece, how your body starts storing fat differently in midlife. Now we know the molecular reason.

Caffeine stops doing its job. If your afternoon pick-me-up stopped picking you up around 44, Stanford would like you to know your body literally processes it differently now. I wrote about the 2pm crash before I even knew about this study.

I sat at my kitchen counter reading the findings with my tea getting cold next to me, thinking, oh. So that’s what that was.

Alcohol hits harder. If you used to handle a glass or two of wine at dinner and now it wrecks your whole next morning, the molecules that process alcohol shift significantly in this wave. Your body rewrote its tolerance policy and forgot to CC you. Sound familiar?

Your cardiovascular markers shift, your skin changes, your muscle composition changes. Not one system having a bad year. The whole building is being rewired.

It gets more interesting, or maybe more validating, depending on how you look at it. A separate 2026 study from Rockefeller University mapped nearly 7 million cells across 21 tissues in mice at three different ages.

About 40% of all aging-related changes were significantly different between males and females. Female mice showed much broader immune activation during aging, which the researchers believe may help explain why autoimmune diseases are more common in women.

This was a mouse study, not a human one. But it adds to a growing picture: aging isn’t the same process in male and female bodies. And most of the “longevity” protocols floating around the internet were designed without that distinction in mind.

(Honestly, I’m surprised the percentage was only 40.)

Your body didn’t break at 44. It shifted. And nobody handed you the updated manual.

If you’ve ever seen raku pottery fired, the piece goes through two separate rounds of extreme heat. The first firing sets the internal structure. The second one transforms the surface. Same vessel, two completely different processes. Your body is doing something similar.

What Happens at 60

I’m spending more time on 44 because that’s where most of you are, and because it’s the wave you can still get ahead of. But the second wave matters too.

Around 60, the shifts hit immune regulation, kidney function, carbohydrate metabolism, and cardiovascular health even harder. The immune changes are the ones researchers are watching most closely, because that’s when your body’s ability to respond to infection and disease starts to meaningfully change.

Both waves showed increased cardiovascular risk. Both showed changes in muscle and skin. Two switches flipped, same body.

The Nuance (Because I Promised)

One study, 108 people, all in California. That’s a meaningful number for this kind of deep molecular tracking, and they generated nearly 250 billion data points (which is more data than your group chat produces in a calendar year, and I mean that literally).

It’s also not a million-person dataset. The researchers can’t fully separate what’s driven by biology from what might be influenced by lifestyle shifts that cluster around the same ages. People in their mid-40s move less, sleep worse, and carry more stress than they did at 35.

Snyder was honest about it: “We don’t always know what’s cause and effect.”

Fair enough. I read that line sitting in bed at 6am with the ceiling fan clicking on every third rotation, and I appreciated that a Stanford geneticist was willing to say it out loud.

What I can tell you is that it’s the first study to track this many molecules across this many years and find that the changes aren’t linear. They cluster at very specific times. And the timing lines up uncomfortably well with what most of us feel in our bodies but can’t quite account for.

Where You Are Right Now

What if you could see this wave coming instead of just getting knocked around by it?

If you’re 41, you’ve got maybe three years before the first wave. That’s a head start most women don’t get.

If you’re somewhere between 44 and 50, you’re in it, and what you’re feeling has a molecular basis, which is both annoying and a little bit of a relief.

If you’re in your mid-50s, you’re between waves. Every bit of muscle and bone density you build now is what you’ll bring into the second one.

I want you to do three things.

Get your labs done. Not the basic panel. Fasting insulin, ferritin, a full thyroid panel, vitamin D, inflammatory markers. I’ve written about ferritin because mine was a 9 when I had it checked, and my doctor had never flagged it.

If your body is reorganizing, you want to know where you’re starting from.

Build muscle like your future depends on it. Because it genuinely does. The study showed changes in muscle-related molecules at both 44 and 60. Your muscles are under molecular pressure at exactly the ages when most women stop challenging them.

Two or three strength training sessions a week. I wrote about why in the bones piece and I will keep writing about it until somebody stops me.

Feed your blood sugar like an adult. The metabolic shifts at both waves mean your body is less forgiving of the spike-and-crash cycle. The 4pm craving conversation all over again. Thirty grams of protein at every meal, not because it’s trendy, but because it’s the floor your metabolism needs to work with.

The Reframe

Your body didn’t betray you at 44. It’s renovating.

And if you’ve ever lived through a kitchen renovation, you know what I mean. The dust on everything. The sound of something being pried off a wall at 7am. Eating takeout on the couch for six weeks because your countertops are somewhere in a warehouse.

Renovations are disorienting. But the house is still standing. And you’re the one holding the blueprint now.

Knowing about this wave at 44 instead of finding out at 60 is the kind of information that changes how you build the next decade. That’s what we’re doing here.

The Fruit Your Brain and Your Bones Are Both Begging For

I eat a cup of blueberries every single day.

If I’m traveling and the hotel breakfast can only give me a cantaloupe slice and the saddest honeydew on earth, I pull blueberry powder out of my bag and stir it into yogurt like a woman who has very specific priorities, because I do.

I’m the kind of woman who reads blueberry research for fun. The kind who travels with powder. I am all in!

Here’s what tipped me over. There are two studies, run by different teams, in different decades, on different parts of the body. One looked at executive function in adults aged 60 to 75. The other looked at bone calcium retention in postmenopausal women.

They used roughly the same dose. They both got results. And nobody really talks about them in the same sentence.

So let’s dive in.

The brain study

A randomized, double-blind, placebo-controlled trial out of the USDA aging research center at Tufts put 37 adults between 60 and 75 on either freeze-dried blueberry equivalent to one cup of fresh blueberries a day, or a matched placebo, for 90 days.

The blueberry group did measurably better on executive function tests, with fewer repetition errors on verbal learning and reduced switch cost on task-switching.

Executive function is the system that handles task-switching, working memory, and inhibition. It’s also why you walk into the kitchen with such purpose and then forget what you came in for.

The blueberry group got better at all of it.

A separate 12-week trial in older adults used the same dose and measured flow-mediated dilation, which is a fancy way of saying how well your blood vessels open and close. Their vessels worked better, and their 24-hour blood pressure dropped about 3.6 mmHg.

That matters because cognitive decline and vascular function are best friends. One drags the other along behind it. Anything that helps the vessels feeding your brain is, by extension, helping your brain.

One cup of blueberries a day for three months gave older adults real cognitive improvement on real tests.

And then I found the bone study.

The bone study

Researchers at Purdue ran a trial in postmenopausal women using a long-lived calcium isotope to actually measure how much calcium their bones were holding onto versus losing. This is the gold standard. The calcium is either staying in the bone or showing up in the urine. You cannot fake it.

They tested three daily doses of freeze-dried blueberry powder for six weeks each: roughly three-quarters of a cup, one and a half cups, and three cups of fresh blueberry equivalent.

The three-quarter cup dose increased net bone calcium retention by 6 percent.

The one and a half cup dose increased it by 4 percent.

The three-cup dose did nothing.

The smallest dose worked best. The largest dose, the one a wellness influencer would recommend on Instagram while holding a smoothie the size of her head, was statistically indistinguishable from no blueberries at all.

This is called a hormetic response, which is the technical term for “your body has a sweet spot and once you blow past it you’ve just made expensive urine.”

For your bones, the sweet spot is roughly one cup. Which is, coincidentally, the dose that also moved the needle on cognition.

If you’ve been reading me for a while, you already know I’m in the osteopenia camp and tracking my bone density with the focus most women apply to their email inbox. Blueberries are not a substitute for strength training. They’re not a substitute for protein. They don’t replace your DEXA scan or the conversation with your doctor.

But they moved a real biological marker in real postmenopausal women, in a properly designed study, at a dose I was already eating. I’ll take it.

Why the same dose does both things

The compound doing most of the work is called anthocyanins. They’re what makes blueberries blue, and they happen to do a few things at once that matter for both brain tissue and bone tissue.

Anthocyanins reduce oxidative stress in cells and support the lining of blood vessels, which is how they get to the brain at all. In the bone study, researchers tracked metabolites of blueberries showing up in urine, including one called hippuric acid, which appears to quietly suppress the cells that break bone down.

Your brain and your bones aren’t unrelated systems. They’re both vascular. They both lose function around menopause for related hormonal reasons, they both respond to inflammation, and they both happen to like the same fruit.

And the heart, briefly

A study of 93,600 women followed for 18 years found that the women with the highest intake of anthocyanins had a 32 percent lower rate of heart attack compared to the lowest. Eating more than three servings of strawberries and blueberries per week was associated with a trend toward 34 percent lower heart attack risk.

This is observational, not a randomized trial, so we can’t claim causation. But the sample size and 18 years of follow-up aren’t nothing.

The part where I tell you what to do

One cup a day.

Fresh, frozen, in yogurt, on top of greek yogurt, stirred into oatmeal, eaten standing in front of the freezer at 4pm. Doesn’t matter. Just eat them.

My favorite treat is frozen blueberries over Chobani vanilla Greek yogurt. To me, it’s basically ice cream

Pair those blueberries with protein, because protein after 40 is its own conversation and the fruit can’t do its job if the foundation isn’t there.

The reason I’m willing to put blueberry powder in my carry-on like a woman moving contraband is that the studies are not huge dramatic interventions. They are one cup of fruit a day, eaten by women in roughly my population window, measured against the exact things I am trying to stay ahead of.

So tell me, are you a daily blueberry person, an occasional blueberry person, or about to become a daily blueberry person?

There may be a way to help clear microplastics out of your body.

I know how that sounds. Every time I read a headline like that I assume someone is about to sell me a charcoal smoothie. But a new study out of the World Institute of Kimchi in Seoul changed how I think about the few spoonfuls of Wildbrine sauerkraut I eat with lunch.

Researchers found that a specific bacterium found in kimchi, Leuconostoc mesenteroides CBA3656, latches onto plastic particles in the intestine like a magnet finding a paperclip. The mice that got the bacterium pooped out more than twice as many nanoplastics as the mice that didn’t. The headlines went a little wild. “Kimchi flushes plastic from your body.”

The gut is the main way ingested plastic gets back out. Certain microbes speed that process up. Which means the question isn’t really about kimchi. It’s about whether your gut is doing the job it’s supposed to do. And for a lot of us in midlife, the answer is that it’s quietly falling behind.

What the kimchi study really showed

The research team, led by Drs. Se Hee Lee and Tae Woong Whon, tested two lactic acid bacteria against polystyrene nanoplastics, the kind that come from broken-down takeout containers and water bottles. In a beaker, both bacteria bound about 87% of the plastic. Impressive, but a beaker is not your intestines.

So they simulated intestinal fluid. The reference strain dropped from 85% to 3%. The kimchi strain, CBA3656, held at 57%. A bacterium that can keep doing its job inside an actual human gut.

Then they tested it in mice. Male and female mice given CBA3656 excreted more than twice the nanoplastics in their feces. The plastic wasn’t disappearing. It was getting bound up by the bacteria and walked out the door.

Mice are not women. (Though somewhere a Korean lab tech spent her week cataloging mouse droppings under a microscope, and I want to send her flowers.) Polystyrene is one type of plastic out of dozens. Grocery store kraut is not the same as a lab-isolated strain at therapeutic dose. Nobody has run this study in humans yet.

What we have is a strong proof of concept that probiotics can bind plastic. We also have a small human study using shellfish-derived fiber that doubled fecal plastic output. Same principle: bind it, move it out.

The kicker on the kimchi research is this. Leuconostoc mesenteroides, the species in the study, is dominant in kimchi and present in raw sauerkraut, especially during early fermentation. Not the exact strain at the exact dose, but the same family doing similar work. So my spoonfuls of Wildbrine are not the answer to microplastics. They are, however, sitting in the same neighborhood as the answer.

Why this gets more interesting in midlife

The gut you had at 28 is not the gut you have at 48. Estrogen helps keep your gut microbiome diverse, and when estrogen drops in perimenopause, the bacteria drop with it. Stomach acid thins out. Bile flow gets lazy. Things take their sweet time. The exit ramp loses speed at the exact moment your lifetime plastic load is highest.

You did not do this to yourself. Nobody told you the plumbing was on a clock. Add it to the list of things nobody mentioned, right between “your favorite jeans will betray you” and “you’ll start sweating at meetings.”

So the women carrying the heaviest cumulative load are the women whose disposal system is slowing down. And those women are us.

What I actually do

You can’t detox plastic out of your brain tissue with green juice. Anyone who tells you otherwise is selling something.

What you can do is support the exit ramp.

Here’s what’s in my own rotation:

Wildbrine raw sauerkraut and fermented beets. A few spoonfuls with lunch, most days. Refrigerated, never pasteurized, full of live lactic acid bacteria including the Leuconostoc family. Real kimchi works the same way.

Fiber to a level your body can use. Most women over 40 eat 12 to 15 grams a day. The target for binding action and regular elimination is closer to 25 to 30. Fiber acts as a physical sponge for plastic particles, and it feeds the bacteria that do the binding. Beans, lentils, raspberries, chia, cooked-and-cooled potatoes, oats. Boring. Effective.

Less plastic going in. The biggest source of dietary microplastic for most American women is bottled water. After that, takeout containers heated in the microwave, polypropylene tea bags, anything wrapped in plastic and warmed. Filtered tap water in a glass or stainless container reduces your daily intake significantly. I still occasionally use bottled water when I have to. Pick your battles.

Skip the fiber supplements. A 2024 study found microplastic contamination in every dietary fiber supplement tested. The fiber supplement industry is selling you the very thing you’re trying to remove. For an easy fiber boost, stir chia seeds or basil seeds into water, yogurt, or a smoothie. Two tablespoons of chia gives you about 10 grams of fiber. The same amount of basil seeds gives you 15, which is roughly 50% more.

Keep things moving. The longer particles sit in your gut, the more time they have to interact with the lining. Water, walking, magnesium glycinate if your doctor approves. The faster the transit, the less re-absorption.

What this is really about

I can’t promise you a body free of plastic. Nobody can.

The body has a disposal system, and it runs through your gut. It depends on bacteria you can feed, fiber you can eat, and a few habits you can change without buying a single supplement.

Your gut is the exit ramp for everything you don’t want to keep. Including the plastic.

Feed it like you mean it for one week. Sauerkraut at lunch. Beans at dinner. Tap water in a glass. See what happens.

A woman who tends her gut is a woman who picks up the broom inside her own house. The plastic is what we sweep out.

I recorded a podcast with Dr. Anne-Laure Le Cunff last year. She’s a neuroscientist at King’s College London who studies ADHD, and she’s the author of Tiny Experiments. After we stopped recording, I asked what she was working on next.

“ADHD and entrepreneurs.”

I told her I had ADHD. Diagnosed in college. Her face did this small knowing thing, like she’d already guessed.

“I had a suspicion from our conversation,” she said.

I’ve managed my ADHD without medication for the last 15 years. Supplements. Systems. The freedom of building a business around the way my brain works instead of fighting it. (There’s a 2016 study in the European Journal of Epidemiology showing ADHD symptoms, especially hyperactivity, are positively associated with self-employment. Combined sample of more than 20,000 people. Of course I ended up here.) The magic trick has held.

But I’m almost 50. And I keep reading the same research showing up in different journals, asking the same question I’m now asking myself.

What happens to ADHD when estrogen leaves?

Something Is Happening, and Midlife Women Are at the Center

The data is striking. CDC numbers show that 6% of U.S. adults carry a current ADHD diagnosis. That’s 15.5 million people. Roughly half got their diagnosis in adulthood. The part that matters for this article: 61% of women with ADHD got their diagnosis as adults, compared to 40% of men. Google searches for “ADHD” jumped an average of 270% across 19 countries between 2019 and 2023.

Something is changing in how women in their 40s see themselves.

What Estrogen Actually Does to Your Brain

Estrogen does a lot of jobs in the female brain, but one of the most important is supporting dopamine. Dopamine is the neurotransmitter your prefrontal cortex uses for focus, working memory, planning, and what neuroscientists call executive function. Picking up the dry cleaning. Remembering you put coffee on the stove. Finishing a thought.

Estrogen helps dopamine do its work by supporting both its production and the sensitivity of the receptors that catch it.

ADHD, at the neurochemical level, is a dopamine regulation problem. The brain doesn’t produce or use dopamine the way a neurotypical brain does.

So when estrogen drops, dopamine takes a hit. For a neurotypical brain, that hit is uncomfortable. Brain fog. Forgetfulness. Words on the tip of the tongue.

For an ADHD brain that’s already running lean on dopamine, that hit lands somewhere different.

The Study That Named What Women Have Been Feeling

In September 2025, a research team led by Unnur Jakobsdóttir Smári at the University of Iceland published the first major population-based study on this exact question. The paper ran in European Psychiatry. They followed 5,392 women aged 35 to 55.

The findings:

Women with ADHD had nearly double the rate of severe perimenopausal symptoms compared to women without (54.2% versus 30.1%). The gap held across every category the researchers measured. Mood symptoms like depression, anxiety, and irritability. Physical symptoms like hot flashes, sleep problems, and joint aches. Symptoms below the belt like vaginal dryness and bladder problems. All worse.

And then this. Women with ADHD reported peak perimenopausal symptoms at ages 35 to 39. Women without ADHD peaked at 45 to 49.

A full decade earlier.

The researchers wrote that the data suggests an onset of perimenopause up to ten years earlier in women with ADHD than in the average population. That’s not the kind of sentence a research team writes lightly. They’re cautious people. They wrote it because the numbers said so. (Other researchers have noted that the study was cross-sectional and cannot establish causation, only correlation. Both things can be true at the same time.)

A separate 2025 expert review by the Eunethydis Special Interest Group on Female ADHD reached a parallel conclusion. Hormones and ADHD symptoms move together across the female lifespan. The biology isn’t a hot take. It’s an established interaction the field is finally measuring.

The Unmasking Question

A lot of women in their 40s are getting an ADHD diagnosis for the first time. The question researchers are wrestling with is whether perimenopause is causing new ADHD, or whether perimenopause is unmasking ADHD that was already there.

You had it all along. Perimenopause is making it visible. That’s what the research keeps pointing to.

ADHD is a lifelong neurodevelopmental condition. You don’t develop it at 44. What you might develop at 44 is the inability to keep hiding it.

Women are more likely than men to have the inattentive form of ADHD rather than the hyperactive form. Inattentive ADHD doesn’t look like a kid bouncing off the walls. It looks like a quiet girl who daydreams in class and never gets flagged. She grows up. She becomes the woman who arrives ten minutes early to everything because she’s spent years engineering against her own lateness. The job that lets her work how she works. She passes for neurotypical for decades.

Then estrogen drops. The coping runs out of fuel.

But the research isn’t settled here. The same Icelandic study found something complicating. About 8% of women without an ADHD diagnosis, aged 35 to 44, reported severe ADHD symptoms that decreased as they got older. The researchers couldn’t tell whether those women had undiagnosed ADHD all along, or whether something else was happening. So the unmasking story is mostly right. Not entirely.

What Tells You Which One You’re Dealing With

The research itself identifies a few markers that distinguish lifelong ADHD from perimenopause brain fog. None of these are diagnostic. They’re conversation starters for your next appointment.

Timing. ADHD symptoms are lifelong. Were you the kid whose teachers said “smart, but doesn’t apply herself”? The teenager who could read a novel in a day but couldn’t start a research paper? That’s a different story than “this started at 44.” Perimenopause brain fog shows up in the 40s and 50s. ADHD has been there the whole time.

Consistency. ADHD shows up across settings. Work, home, friendships, finances. Perimenopause brain fog fluctuates with hormones. It might be worse the week before your period and better the week after.

Hormonal context. Hot flashes, night sweats, irregular cycles, sleep disruption. These point to perimenopause being part of the picture. They don’t rule out ADHD. They just tell you hormones are in the conversation.

What the Research Says About Treatment

This part requires care because the science is moving fast and the guidelines have not caught up.

Estrogen therapy may help cognitive symptoms in some perimenopausal women, especially when symptoms track with hormonal changes. That’s the most established piece. Then there’s a small pilot study by Dr. Sandra Kooij’s group in the Netherlands. Nine women. They found that small adjustments to stimulant ADHD medication dosing helped premenstrual ADHD symptoms. (Nine women is a pilot. It is not a protocol.) But it points at something the field is starting to take seriously. The dose of medication that works in week one of your cycle may not be the dose you need in week four.

Beyond that, the research is genuinely early. Some studies suggest stimulant medication may improve cognitive complaints in perimenopausal women who don’t even have ADHD. That finding is provocative. The treatment guidelines do not exist.

Women are figuring this out alongside doctors who are also figuring it out.

If You Want to Take This Further

Getting an adult ADHD diagnosis as a woman is harder than it should be. Many doctors still picture a hyperactive eight-year-old boy when they hear the word ADHD. That’s why inattentive women get told they have anxiety, depression, or are just tired. Knowing what you are looking for helps.

The screener used in the Smári study is the Adult ADHD Self-Report Scale (ASRS-v1.1), developed by the World Health Organization and Harvard. It is free. It takes about five minutes. It is not a diagnosis. But if you score in the positive range, you have something concrete to bring to a doctor instead of “I think something is wrong.”

For an actual diagnosis, ask for a psychiatrist or psychologist who specializes in adult women’s ADHD. Those four words matter. A general practitioner who treats childhood ADHD will miss what’s happening in a 47-year-old who has spent decades compensating.

What I’m Doing With All This

I’m not picking a side. I’m not telling you whether you have ADHD or perimenopause brain fog or both. I’m not going to tell you to start medication or to avoid it.

I’m telling you what the research shows so you can ask better questions.

For me, this research has changed how I’m thinking about the next decade. I’ve spent 15 years building systems around my ADHD brain. The supplements, the routines, the work I designed. The research is telling me that the next ten years are when those systems get tested. The magic trick that has held since college may need new tools.

That’s the identity shift every woman with ADHD needs to make right now. This is biology. It’s the biology of estrogen and dopamine, and there is a growing body of peer-reviewed research that proves you are not imagining it.

When Anne-Laure smiled and said she’d already guessed, what she was really telling me was that she sees this everywhere. Smart women in their 40s, gritting their way through a decade their bodies were not designed for.

The conversation is just starting. We get to be in it.

If you've been diagnosed in the last few years, or you're wondering if you should be, tell me in the comments. I want to know what your version of this looks like.

No, It’s Not Early Dementia. Your Brain Is in Maintenance Mode.

You walked into the kitchen and forgot why.

You couldn’t find the word for “fork” mid-sentence at dinner.

You stood in the cereal aisle staring at the same box you’ve bought for twelve years and could not, for the life of you, remember what the brand was called. (My friend Mary told me she stood there for a full thirty seconds. The brand was Cheerios.)

And then the thought. Quick, quiet, the one you don’t say out loud.

Is this it? Is this what mom had?

I hear from women in their 40s and 50s every week who are terrified about this. They’re not bringing it up at dinner. They’re not telling their husbands. They’re googling at midnight in the bathroom and going to bed scared.

What you’re feeling has a name. It has a cause. It is not what your mother had.

SWAN data shows that menopause-related cognitive changes are real but mild and transient. The deficits don’t stick. Women in this stage of life are not watching their minds disappear. Their nervous systems are compensating for inputs that have quietly gone thin.

Your brain went into maintenance mode and forgot to tell you.

Maintenance mode is what happens when a system is running on degraded inputs and decides to conserve resources. Your brain isn’t failing. It’s triaging. The lights dim, non-essential processes pause, and the parts of you that used to remember twelve things at once start dropping the twelfth, then the eleventh, then the word for “fork.”

Most doctors only check one input at your annual physical. The reason your memory feels off is rarely one thing. It’s a stack of five things, and your bloodwork only catches one of them. So you go home with “you’re fine” and wonder if it’s in your head.

It’s not in your head. It’s in the inputs. Here are the five.

1. Your mental load

You are anticipating, identifying, deciding, and monitoring on behalf of three to five other humans.

Your mother’s medication refill. The follow-up bloodwork you keep putting off. The bone density scan you scheduled and rescheduled twice. The wedding gift that has to ship by next week. Whether the dog ate something off the floor again. What’s for dinner.

This is real cognitive work. Researchers call it cognitive household labor, and studies show it consumes working memory capacity. Yours is already booked solid, so when you reach for the word “fork,” there’s no shelf space.

That’s maintenance mode. Your brain didn’t lose the word. It rationed the retrieval.

You’re not a forgetful person. You’re a person running a small unincorporated nonprofit out of your nervous system.

So write things down. Writing things down is what running a complicated life looks like.

And if there’s mental load that isn’t yours, give it back. The man you live with is capable of remembering when the dog’s heartworm meds are due.

2. What’s happening while you sleep

Two things, actually. Both common, both fixable, both routinely missed.

Sleep apnea. 93% of women with moderate to severe obstructive sleep apnea are undiagnosed. Why? Because women present differently. Less snoring, more fatigue, more brain fog. Risk jumps after menopause.

A Michigan Medicine study found that women with suspected apnea were more likely than men to show dementia symptoms at every age. If you wake up tired no matter how long you slept, ask for a sleep study.

The 3 a.m. wake-up. It has a cause. It’s a cortisol spike in a body that’s running too hot.

You wake up at 3:14 a.m. The room is dark. The dog is breathing. And your brain is already running a tape of every embarrassing thing you said in 2009. Your heart is faster than it should be. You think about whether you sent that email. You wonder if your son’s car insurance renewed. You remember a conversation from a baby shower fifteen years ago.

Your body is running a survival program. There is no threat.

Chronic elevated cortisol shrinks the hippocampus, the part of the brain where memories form. Adults in their 40s and 50s with elevated cortisol have measurably smaller brain volumes than peers.

This is structural change. And it’s reversible. The loop has to break somewhere.

3. Your thyroid- even when it “looks normal”

You sit down to read a contract your accountant sent over. You get to the second paragraph and realize you have no idea what the first paragraph said. So you start over. Same thing happens. You close the laptop and tell yourself you’ll do it after coffee.

That’s not a focus problem. That’s often a thyroid problem.

If your doctor checked your TSH and said you were fine, ask what number she called fine.

Subclinical hypothyroidism is a TSH that’s slightly elevated while the rest of your panel still falls in the lab’s “normal” range. fMRI studies show measurable prefrontal cortex changes that normalize after treatment.

The lab “normal” range for TSH is 0.4 to 4.5.

Many functional medicine practitioners aim closer to 1.0 to 2.0 for women who want to feel like themselves. At a TSH of 3.2, your bloodwork looks fine on paper while your brain feels like it’s operating from inside a glass jar.

That’s maintenance mode again. Your thyroid is dimming the lights.

Ask for the full panel:

• TSH

• Free T3

• Free T4

• Reverse T3

• TPO antibodies

Don’t accept partial.

4. Your B12

B12 deficiency mimics dementia exactly. There’s no way to tell the difference on cognitive testing alone.

Case reports describe B12 deficiency producing dementia symptoms that resolve completely with treatment. Which is the most hopeful phrase in this entire article.

You read the same paragraph three times and still can’t tell anyone what it said. You stand in your closet at 7:45 a.m. trying to remember if you already took your vitamin. You open Instagram and forget why before the app loads.

Risk factors most women don’t realize they have:

• Taking metformin

• Taking a PPI like Prilosec or Nexium

• Taking Pepcid

• Eating little meat

• Being over 50

A February 2025 paper in Annals of Neurology made it worse. Even “healthy” B12 levels weren’t enough to prevent neurological decline.

Ask for serum B12 plus methylmalonic acid. MMA catches early deficiency that B12 alone misses.

5. Your iron stores

I went deep on this last month in Half of Healthy Women Have No Iron Stores. Nobody Is Screening for It. The comments told me how many of you had been dealing with this for years.

You go to load the dishwasher and forget what you walked into the kitchen for. You check your phone three times in five minutes for the same information. You make it through a conversation and realize twenty minutes later you couldn’t repeat a word of it.

Quick recap. Iron carries oxygen to your brain. Low iron means an oxygen-starved brain. Brain fog and memory lapses are some of the first signs.

Ask for ferritin, not just a CBC. The lab will tell you 15 is fine. The research says women feel best closer to 70.

What to ask your doctor for

Screenshot this. Bring it with you.

1. Full thyroid panel: TSH, free T3, free T4, reverse T3, TPO antibodies

2. B12 serum plus methylmalonic acid

3. Ferritin

4. Sleep study referral if you wake tired

5. Vitamin D and magnesium

You came in afraid this was the start of something terrible.

It’s not.

What it is: maintenance mode. A stack of overlooked, dismissed, undertreated things that built up while you carried everyone else’s load instead of your own. None of which your annual physical is built to catch.

Make the appointment. Bring the screenshot. If your doctor brushes you off, find another one. Or skip the gatekeeping entirely and order the bloodwork yourself through Function Health (affiliate link). One annual membership covers more than 100 biomarkers including the full thyroid panel, ferritin, B12, and inflammation markers. That’s less than most women spend on supplements they don’t need.

Your brain has been doing exactly what a good system does when the inputs run thin. It conserved. It triaged. It kept you upright through years that asked too much of it.

You restore the inputs. The system comes back online. You will remember the word for fork.

What test are you asking for first?

The American Academy of Sleep Medicine ran a survey of 2,007 adults last year and found that 31% of U.S. adults are now sleeping in a separate bed or a separate room from their partner. For couples in their late 30s and 40s, that number jumps to 39%. The trend has a name now. Sleep divorce.

The cultural story says modern couples are too smart to suffer through it, separate beds make for better marriages, and Pinterest has the boards to prove it. For women over 35, that story is missing the part that matters.

Why is this happening now, to a woman who shared a bed with the same man for fifteen years without a problem? He didn’t suddenly develop a snoring problem at 42, and you didn’t replace the mattress this year. Nothing in the room has fundamentally changed.

She has.

You start negotiating with sleep like it’s a hostage situation. One foot out from under the blanket. Fan pointed directly at your face. Sheets twisted into some kind of cooling configuration that requires renegotiation every forty-five minutes. Mentally calculating whether prison time would be worth it if you smothered him with the decorative pillow at 2:11 a.m. because he cleared his throat one time.

If any of this is hitting close, the science is going to make a lot of sense.

Your hormones were running the show

Sleep disturbance is one of the most common symptoms of perimenopause. The data is brutal:

• 37% of women aged 40-55 report difficulty sleeping (Study of Women’s Health Across the Nation)

• Sleep disorders hit 16-47% of women in perimenopause (Journal of Clinical Medicine review)

• That number climbs to 35-60% in postmenopause (same review)

• Women are 1.5x more likely than men to have insomnia

• 20% of women say their partner disrupts their sleep every single night, vs 11% of men (2025 Resmed Global Sleep Survey)

The nervous system on one side of the mattress has changed. The partner on the other side has not.

Estrogen is a sleep bouncer. Most women have no idea.

Research in the Journal of the Endocrine Society shows that women with higher estrogen levels woke up less during the night and stopped having those 4 a.m. eyes-wide-open episodes. Lower estradiol meant lower sleep efficiency and more disturbances throughout the night.

Estrogen was working the door of your deep sleep. It supported melatonin and held your body temperature steady. When estrogen starts dropping in perimenopause, the bouncer clocks out, and every minor disturbance walks right in.

Sounds you used to sleep right through now register at full volume. His breathing comes through like a podcast you didn’t subscribe to. The little blue light on the cable box has somehow become a lighthouse. The dog has decided 3:14 a.m. is when he needs to scratch his ear with great commitment, and you’re up.

Progesterone is doing even more for your sleep than estrogen, and almost no one mentions it. It was your nervous system’s built-in off switch.

Lancel and colleagues showed that progesterone produces sleep changes comparable to drugs that work on the GABA-A receptor. GABA is your brain’s primary brake. The neurotransmitter that tells your nervous system to calm down, slow down, and let you fall asleep.

Progesterone enhanced GABA activity. Your own body was running pharmacy-grade calm on you every night, and you never knew.

In perimenopause, progesterone drops earlier and more steeply than estrogen. The brake on your nervous system loosens. Your central nervous system becomes more responsive to every input, including the man who has been breathing exactly like that since 1998.

That 3 a.m. mental highlight reel is GABA signaling that used to keep your brain quiet and has now clocked out for the night.

The temperature problem

The heat is its own situation. SWAN data shows that 60-80% of women experience hot flashes and night sweats during the menopause transition, and the mechanism comes down to the hypothalamus, which is your brain’s thermostat.

When estrogen drops, the thermostat starts misreading the room. The systematic review in Sleep Medicine Reviews confirms hot flashes are a major driver of perimenopausal sleep disruption.

Your body runs hotter than it used to. The husband who used to feel like a heater on a cold night now feels like a furnace you can’t escape. Your tolerance for body heat has dropped through the floor.

You wake up roasting, throw the covers off, and lie there listening to him breathe like nothing in the world is wrong. At some point you realize you’ve been awake for an hour running through every email you forgot to send and one weird thing your boss said in 2019 you can suddenly remember in cinematic detail.

You decide separate bedrooms might be the only answer.

Sleep is the place this shows up most obviously. It isn’t the only place.

The same nervous system that used to tolerate his breathing now flinches at fluorescent lights at Target. Restaurant noise feels like a personal attack. Your sister-in-law’s laugh is suddenly something you have opinions about.

The bouncer didn’t just leave the deep-sleep door. She left the building. Sleep divorce is the headline. Whole-life sensory overload is the story underneath.

What to do about it

Before you redecorate the guest room, work the actual problem.

1. Bedroom temperature. Aim for 65 to 68 degrees Fahrenheit. If you and your husband disagree about the thermostat, get separate bedding. A lighter blanket on your side, a heavier one on his. Cooling sheets are real, and they’re not a gimmick.

2. Magnesium glycinate. This is the form women keep texting their friends about after three decent nights of sleep in a row. There are seven forms of magnesium on the shelf at Whole Foods, and only glycinate is doing the sleep work. Research from 2024 found that 250 mg of elemental magnesium bisglycinate daily improved insomnia severity in adults reporting poor sleep. Glycinate or bisglycinate (same compound, different label) supports GABA activity and is gentle on digestion. Magnesium oxide is the one your colon orders when it wants a long talk.

3. Talk to your doctor about progesterone. This is the call most women don’t know to make. The same hormone that’s been keeping your nervous system calm for thirty years can be replaced, in a form your body recognizes, in a dose that helps you sleep. Research shows that estrogen and progesterone therapy improved overall sleep quality in perimenopausal women. Oral micronized progesterone is bioidentical, taken at bedtime, and sedating by design because of how it acts on GABA. If you haven’t talked to a menopause-trained provider about it, that’s the call to make this week. The number of women working their way through every supplement on the shelf while never being offered the hormone they’re actually missing is staggering.

4. Address the snoring. A husband who snores so loud the dog leaves the room has a medical situation. He may have undiagnosed sleep apnea, which is dangerous for him and exhausting for you. A sleep study is worth asking for.

For most women over 35, what’s happening at 2 a.m. is biology calling the shots. Your hormones changed the way your brain processes sleep, and your sensory threshold dropped right along with them.

Most of the disruption you’re feeling is happening inside your own body. Well, most of it. Some nights he really is breathing like an industrial appliance, and that’s a separate conversation.

Separate bedrooms work for plenty of couples and that’s a perfectly reasonable choice. Solve the biology first and decide about the bed second. If you move to the guest room without addressing what’s happening hormonally, you’ll still be exhausted. You’ll just be exhausted alone.

The goal isn’t proving you can tolerate this. The goal is getting your brain and body back on your side again.

So tell me. Are you in the same bed, separate beds, somewhere in between, or just lying awake at 2 a.m. dreaming about fixing the whole situation?

Today I have three AI tools for you: the Weekly Focus Filter to organize your week, the How to Fix What’s Draining You interactive tool, and the Wise Woman Quarterly Reset.

And I want to show you what I’ve been working on.

One of the reasons I started Wise Woman Method was to think through everything I wanted to put in my next book, and everything I wished I had room for and didn’t.

The articles you’ve been reading here are part of that work. They’re me figuring out what makes the cut, what gets cut, and what needed a longer home than a chapter could give it.

The book itself doesn’t come out until September 2027. That feels like a long time, and honestly, it is.

I’m in the stage where I don’t know if it’s great or garbage. I do this with every book. This is my sixth go-round.

Which is where you come in.

Because you’re a paid Wise Woman Method member, you’re in the focus group.

You get the introduction and the first three chapters today, while I’m still writing the rest.

And I want your feedback. The real kind.

Tell me what’s working. What’s still rough. What made you nod. What made you skim.

Help me see which parts are great and which parts still need work. I genuinely can’t tell from in here.

Your honest read is one of the best gifts you could give me right now.

If you’ve spent the afternoon trying to remember a word that should be right there, or you’ve hit a 4 p.m. wall that no amount of caffeine fixes, or you’ve quietly gained fifteen pounds without changing anything about how you eat, this book is about why.

And it will tell you step-by-step what to do.

Read the chapters here.

Share your thoughts here.

Here are your three AI tools-

Weekly Focus Filter is my newest one.

You answer a few questions on Sunday night, and it tells you the three things that actually matter for your week. No more starting Monday with a to-do list that owns you instead of the other way around.

Fix What’s Draining Your Energy isn’t a quiz with a generic result at the end.

It talks to you, asks the right questions, figures out where your energy is quietly disappearing, and tells you specifically what to do about it.

Wise Woman Quarterly Reset helps you plan the next 30 or 90 days and move into the next season with clarity.

Great at the start of the year. Works every quarter, or every month if you’re like me and like a clean slate often.

Read the chapters. Use the tools. Tell me the truth.

Thank you for being here. And thank you for helping with my next book!

Love, Alli

Every health headline wants you to know that sitting is the new smoking. Cool. Except my job keeps me at a desk for seven hours a day, and yours probably does too, and we’re not all moving to a ranch to herd cattle just to fix what sitting is doing to us. The standing desk helps a little. It’s not going to save us.

The Post-It on the Tea Cabinet

I have a yellow post-it inside my kitchen cabinet, stuck on the shelf above where I keep all of my teas. It says 10 squats. I re-tape it with cute washi tape every few months. That post-it has outlasted two phones and my beloved first Bosch dishwasher (every dishwasher I will own for the rest of my life is a Bosch, by the way).

Every time I open that cabinet to pour myself a decaf green tea (which is a lot, I drink it all day), I squat ten times before the water hits the mug. No plan. No app. A sticky note and a kettle.

I drink tea three times before lunch, so the post-it had me squatting thirty times before noon. Over time, I just noticed I felt better. A little less foggy at 3pm. A little more energy. Looser in the hips, which I didn’t see coming from a sticky note.

Once I learned about the research on sitting and its dangers, I moved the rule out of the kitchen.

The science on sitting is worse than most people know. But luckily for us, the science on squats keeps getting better. Seven hours at a desk shuts down an enzyme that handles your blood sugar, drains blood from your brain, and flips off the biggest muscles in your body. Ten squats, done throughout the day, turn it all back on. I’ll get into all the nerdy details and studies below. First, the rule.

The Ten Squat Rule, Start to Finish

What it is: Ten squats, every hour, from the time you sit down at your desk to the time you stand up for the day.

How to do it: Set an alarm on your phone or watch for the middle of every hour. When it goes off, stand up and do ten bodyweight squats. Hands forward for balance, chest up, sit back into your heels, stand. Wherever you are, whatever you’re wearing. If your knees don’t love squats, ten sit-to-stands out of your chair count the same.

Why it’s worth it: Your quads and glutes go to sleep when you sit. Ten squats wake them up before the damage sets in. Blood sugar, blood flow to the brain, and the enzymes that decide what your body does with your last meal all hinge on these muscles turning on regularly.

The payoff: Three minutes of total effort a day, scattered in ten-second bursts, does real work that your morning workout doesn’t cover. The science is in the rest of the article.

Your Legs Are the Longevity Organ You Forgot You Had

Here’s a fact I love telling people at dinner. Women with bigger thighs live longer. Not bigger everything. Just bigger thighs.

A cohort study out of the Danish MONICA project found that smaller thigh circumference was linked to higher all-cause mortality in both men and women, with a threshold around 60 cm.

Write that one on a mug.

A meta-analysis of nearly two million people found that higher muscular strength cut all-cause mortality risk substantially, with the protection slightly stronger in women than men.

Strength is what saves you. The Health ABC study in older adults found quadriceps strength predicted mortality better than muscle mass did. You don’t need Thor legs. You need legs that work.

Your quads and glutes are the biggest muscles you’ve got. They’re where glucose goes after a meal. They help pump blood back up to your heart. They’re part of why your brain has oxygen to remember why you walked into a room. Turning them on for thirty seconds, ten times a day, is the cheapest thing you can do for the decade ahead.

What Seven Hours of Sitting Turns Off

Three things happen when you sit for a long stretch, and together they explain why 4pm feels like wading through wet cement in a wool coat.

An enzyme called lipoprotein lipase (LPL for short, since we’re friends now) goes dormant within an hour of sitting. LPL pulls fat and sugar out of your blood and parks them in your muscles for fuel. When LPL clocks out, the fuel floats around your bloodstream with nowhere to go. Triglycerides and blood sugar stay elevated even if you ate like a saint at lunch.

Your quads and glutes, those glucose sponges, stop sponging. Sitting takes the mop out of their hands.

Blood pools in your lower legs instead of circulating. Less oxygen reaches your brain, which is why your 2pm self is brilliant and your 3:30pm self is reading an email like it’s in Aramaic.

The scientists call this “active couch potato syndrome,” which is the rudest term I’ve ever read in a peer-reviewed journal, and also accurate. You can spend an hour at barre class and still spend the rest of the day in a metabolic slump.

Why Squats Are as Good as a Walk (Which Is Kind of a Miracle)

A 2021 study in the Journal of Applied Physiology found that interrupting sitting every 30 minutes with one minute of chair stands did the same work for post-meal insulin as two-minute treadmill walks. A minute of squats matched a walking break. Your muscles don’t care about your cardio plans. They care about waking up.

Why I’ll Do This Until I’m 90

My system is an Apple Watch alarm at the middle of the hour, not the top (the middle feels like a nudge, the top feels like a meeting). Jeans, leggings, blazer, doesn’t matter. Airport gates count. My mother-in-law’s kitchen counts, even when she raises an eyebrow.

Total time per day: about three minutes. Less than I spent last week looking for my reading glasses, which were on my head.

Nobody’s going to sell you a ten-squat program, because nobody gets rich off ten squats. Which is why I trust it.

Set your alarm for the middle of the hour. Stand up. Do ten. I’ll be doing mine too.

I was on a coaching call recently with a woman I adore. She’s running a business, she’s sharp, she’s the kind of client who shows up with her notes already made. Somewhere between her goals for the next quarter and her energy levels, she mentioned she’d just started taking NAD+.

“I heard [very popular female podcaster] talk about it,” she said. “And I trust her.”

I had about three seconds to decide if I was going to be that person on the call.

Friend, I was that person.

“I hate to be a downer, but here’s the thing about NAD+ in a capsule. The molecule is too big to get through your gut in one piece. So most of what you just bought isn’t reaching your cells.”

There was a pause. Then she laughed and admitted that after she bought it, she asked AI, and AI said the same thing.

I’m sharing this story because the vast majority of smart women are falling for this influencer nonsense right now, and we need to talk about it.

The Thing I Need to Say About Me

I make my money from my companies and my business coaching. I write about health here because I’m passionate about it, because it turned my life around, and now I’m that person who can’t stop talking about it, not because it’s a revenue-generating function of my company.

When I recommend something, like the creatine I take or the omega-3s my family uses, there’s an Amazon link, and if you buy a bottle, I’ll probably make a nickel. Fine. The nickel isn’t the reason. I got certified as a nutrition specialist because I wanted to read the studies myself, not someone else's summary.

If someone’s entire business is built on them recommending things to you, they’re going to recommend things. A lot of things. Most of them won’t be helpful. Some will be actively not great for you.

That’s not because they’re bad people. It’s because the business model requires a steady stream of new products.

There aren’t enough genuinely useful new products to match influencers’ posting schedule.

So pay attention to the business model driving what you’re hearing. Then decide what to do with it.

Follow the Money

The supplement industry pays influencers 10 to 30 percent commission on everything they sell through their link. Some programs pay recurring commission, meaning every month you keep auto-shipping, they get paid again.

An influencer with 100,000 followers who converts one percent of them to a $60 monthly supplement is pulling $1,800 a month in recurring income. From one product. Most of them are pushing five or six at a time.

That’s the business.

The NAD+ Thing, Since We’re Here

NAD+ is a molecule your cells use to turn food into energy and repair DNA, and it’s one of the most interesting topics in longevity research right now. The good science here is real. If you want a deep dive, listen to Dr. Rhonda Patrick’s recent episode with Dr. Charles Brenner, the scientist who discovered nicotinamide riboside.

The problem is what’s on the shelf next to your magnesium (which is genuinely beneficial, and yes, you do need it).

A bottle labeled NAD+ runs you $60 to $180, and NAD+ itself is a large, fragile molecule. When you swallow it, most of it doesn’t survive the trip through your gut. The 2023 review in the Journal of the American Nutrition Association found oral NAD+ supplementation doesn’t reliably raise tissue NAD+ levels in humans. Translation: you paid $90 to digest something expensive.

IV NAD+ is a different story. Drip it into a vein and you bypass the gut, which is why the clinics exist, and why they charge $400 to $1,000 per session.

Your body can use precursors to NAD+. Smaller molecules that absorb and then get built up into NAD+ inside your cells. The two with human research behind them are nicotinamide riboside (NR) and nicotinamide mononucleotide (NMN). A 2016 study in Nature Communications showed oral NR raises NAD+ in human blood, and a 2022 trial in Frontiers in Nutrition showed the same for oral NMN. Different molecules, real results, published data.

So a bottle labeled NAD+ is mostly decorative. A bottle of NR or NMN is a precursor your body can use. Same shelf. Same price point. Wildly different outcomes inside your body.

My client didn’t know that, because nobody told her. They just told her to buy it.

Two Questions to Ask Before You Click Buy

Has she read the actual studies, or is she passing along what she heard? When someone recommends a supplement, can they tell you what trial it’s based on, who was in the study, and how long they took it? If the answer is a personal testimonial and a vibe, you’re getting marketed to. If the answer is “here’s the study, here’s who funded it, here’s what it showed,” you’re getting something closer to real.

Did she find this product herself, or did a supplement company walk it to her door? This matters more than credentials. The question isn’t whether someone has letters after their name. It’s whether the recommendation started with her reading the research and then finding a product, or with a company reading her audience numbers and then finding her.

What I Want You to Do

Notice the feeling you get when a favorite podcaster or an influencer on Instagram or TikTok raves about something. That warm, confident, she says this is good so it’s probably good feeling is real.

Your body cares about the molecules, not the microphone. It cares whether what you swallowed can be absorbed, and whether the person recommending it has any interest in the answer beyond the commission.

A quick note on the other greatest hits. Vibration plates will not shake fat off your body. Anything marketed as helping you detox is selling you a problem you don’t have. Your liver detoxes on its own, and has been doing it for free your entire life. If the sales pitch requires inventing a crisis your organs were handling already, it’s not solid science.

Next time you hear someone rave about the next big thing, pause before you click. Open a second tab. Look up the ingredient. See if there’s human research. If the answer is murky, keep your eighty dollars.

Your favorite influencer is probably not a nutritionist. And if she is one, ask her to show you the studies.

What’s the craziest wellness product pitch you’ve seen lately? Let’s have fun with this

Most women over 40 don’t have a protein problem. They have a distribution problem. And nobody is explaining this to them.

Here’s what the research says about protein after 40, and what to eat tomorrow morning to stop losing muscle.

The RDA Is a Museum Piece

The current recommended daily allowance for protein is 0.8 grams per kilogram of body weight. That number was set in 1968. It was designed to prevent deficiency in young men. Not to build muscle or protect bone. Not to keep a 47-year-old woman from losing five percent of her muscle mass per decade. The RDA keeps a college-aged guy from wasting away. That’s the whole job.

Dr. Donald Layman, the University of Illinois researcher who’s spent forty years studying protein and muscle, calls this number the minimum for survival, not the target for thriving. Survival is a low bar. You can survive on a futon and a toaster. That doesn’t mean you want to.

The average American woman eats around 69 grams of protein a day, according to USDA national intake data. That’s technically not starving. It’s not building anything either.

Your Muscle at 55 Is That Same Student After Three Jobs and a Mortgage

Here’s the biology nobody tells you.

At 25, your muscle is a straight-A student. You hand it 15 grams of protein and it lights up and gets to work. At 55, that same muscle needs twice the stimulus to show up. Scientists call this anabolic resistance. I call it rude.

What’s happening is that the signal telling your muscle to build itself has gotten weak. Estrogen used to help with that, and now it’s leaving. Growth hormone has clocked out too. Your muscle isn’t broken. The threshold just went up.

It’s like an old garage door opener. The signal has to be stronger to reach it. A weak press does nothing. You stand in the driveway clicking the button, wondering when it stopped working. It didn’t stop. It just needs more.

The Leucine Threshold

There’s an amino acid called leucine, and it’s the ignition key for muscle. Get enough of it in one meal and your muscle starts rebuilding itself. Below a certain amount, you’re just turning the key and nothing’s catching.

A 25-year-old gets that signal off roughly 15 grams of protein. For a woman over 60, and over 40 too, you need almost double that. Around 30 grams of high-quality protein, in a single meal, to get the same response.

Below that threshold, nothing much happens. The protein still gets digested and your body still uses it for energy, but the muscle-building signal never fires.

This is why a 15-gram breakfast, a 20-gram lunch, and a 50-gram dinner gives you exactly one muscle-building meal a day instead of three. You technically ate 85 grams of protein. Your muscle experienced one.

That’s the whole game.

Not All Protein Is Created Equal

The 30-gram threshold assumes you’re eating high-quality protein. That means protein with all nine essential amino acids in the right ratios, and enough leucine to trigger muscle synthesis.

High-quality protein:

• Chicken, turkey, beef, pork, lamb

• Fish and shellfish (salmon, tuna, shrimp, cod, sardines)

• Eggs

• Dairy (cottage cheese, Greek yogurt, milk, whey protein)

• Soy (tofu, tempeh, edamame), the one plant that makes the cut

Lower-quality protein:

• Beans and lentils

• Nuts and nut butters

• Quinoa, rice, oats

• Most plant-based protein bars

• Peanut butter (it’s a snack, not a protein source)

Lower-quality doesn’t mean bad. Beans and nuts are real food with real benefits. They just don’t carry enough leucine per serving to flip the switch on muscle building. If you’re plant-based, you need roughly 35 percent more protein to hit the same target, which is why plant-based eating after 40 takes real planning.

Real food does real work.

Why Bone Broth and Collagen Won’t Build Muscle

Bone broth had a moment. Collagen powder is still having one. The wellness industry markets both as protein, and both show up in routines as if they’re pulling weight they aren’t.

A cup of bone broth has around 6 grams of protein, most of it collagen. Collagen is low in leucine and missing tryptophan entirely. In a 2024 randomized controlled trial, older adults taking 50 grams of collagen a day showed no increase in muscle protein synthesis compared to baseline. The amino acid profile is wrong for muscle. You can drink bone broth all day and your muscle will shrug.

Collagen still earns its place. It supports skin, nails, joints, and bone. I take it every morning for bone density. The issue is the category error. If you’re scooping collagen into your coffee and counting it toward your 30-gram breakfast, your muscle didn’t get the memo.

Use collagen for what it does well. Use real protein for muscle.

The Numbers You Need

Here’s the math, as clean as I can make it.

The daily target is 0.7 to 1 gram per pound of your ideal body weight, which lands between 100 and 140 grams for most women. Dr. Gabrielle Lyon trained under Layman and has spent years translating this research into clinical practice. She recommends 1 gram per pound of ideal body weight as the working target.

Per meal, aim for 30 grams minimum and 40 to 50 at breakfast and dinner if you can swing it. Breakfast matters most. After an overnight fast, your body is in breakdown mode, and a real breakfast reverses that faster than any other meal of the day.

I aim for 150 grams daily at 5’8” and 150 pounds. It sounds like a lot until you do it. Then it sounds like lunch.

Want the five-minute version? Count the protein in the last meal you ate. If it was under 30 grams, you just found your first leak.

What 30 Grams Looks Like

This is where most women get stuck. “30 grams of protein” sounds like a number you’d need a food scale and a spreadsheet to hit. You don’t.

Five ounces of grilled chicken lands around 35 grams. A can of tuna with avocado on top of greens gets you to 30. Five ounces of salmon hits 30. Shrimp stir-fried with vegetables, around 28. A palm-sized portion of beef, 35 to 40. When I’m traveling, sausage or bacon at breakfast does the job on its own.

Notice what’s missing. No protein powder. No special bars. No food that requires a recipe. This is just meat and fish, portioned like a grown woman is eating it and not decorating a salad with it.

My own lunch most days is five ounces of shrimp, chicken, salmon, or tuna with vegetables, some fruit, and healthy fats. It takes about six minutes to put together. It delivers around 30-35 grams of protein. It isn’t impressive. It’s deeply boring. And it works, which is the part that matters.

What to Do Monday

Here’s what to do this week.

1. Track for three days. Don’t change anything yet. Write down what you eat and add up the protein at each meal. Not daily total. Per meal.

2. Look at breakfast. It’s almost always the weak link. If it’s under 20 grams, that’s your fix point.

3. Rebuild breakfast with real protein. Sausage or bacon when you’re in a hotel. Leftover chicken when you’re home. Canned salmon on avocado toast. Something with meat in it, eaten at an hour that counts as morning.

4. Hit 30 grams at lunch and dinner too. Use the examples above. You don’t need a plan. You need a floor.

Your muscle isn’t broken. It’s been whispering for years, and now you know what it’s asking for.

You’re not a woman trying to stay small anymore. You’re a woman building muscle for the next forty years.

That starts tomorrow morning.

Love, Alli