Part two of three. Protein, iron, iodine, folate, B6, vitamin D, calcium, magnesium, zinc, omega-3s, and vitamin E: what each one does for you and your baby, and where to find it.

Last time, we talked about how many women start pregnancy already running low, and why the months before conception matter so much. Today we’re going nutrient by nutrient.

I wan…

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Part one of three. Why so many women begin pregnancy already running low, and what to do about it before (and after) that positive test.

When we talk about prenatal nutrition, the conversation usually starts at the positive pregnancy test. You see two lines, you call your provider, someone hands you a prenatal vitamin, and from that moment on everything …

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So far in this series we’ve covered the weird little signs that you might be low on something, and how those same nutrients become your hormones and brain chemicals. If you missed these two articles, go back to my page and give them a read, each one builds on the next. This last piece is about the exit route, dear reader, because a hormone that has done its job still has to leave.

Your liver needs them too

Making hormones is only half the job. Your body also has to break them down and clear them out, and most of that work happens in the liver, in two phases. Both phases require nutrients to complete the job, so you can guess that if you’re low on these nutrients, your body will start to get sluggish in clearing hormone metabolites. When estrogen metabolites in particular aren’t efficiently detoxified, signs and symptoms of “estrogen dominance” can manifest. Now - this isn’t a diagnosis, think of it more as a descriptive term of what happens in the body when estrogen isn’t efficiently detoxified. It manifests as heavy periods, breast tenderness, and mood shifts. Completely different mechanism than what occurs during perimenopause when estrogen becomes erratic.

First, what “detox” really means

The word has been dragged through a lot of juice cleanses, so let me reclaim it. Your liver isn’t a filter that clogs up with toxins and needs to be flushed. It’s a chemical processing plant.

Hormones, medications, alcohol, and caffeine are mostly fat-soluble, which means your body can’t simply rinse them out in urine. The liver’s job is to convert them into water-soluble forms that can leave. It does this around the clock, with no special tea required. What it does need is a steady supply of nutrients.

Phase 1: the first transformation

In phase 1, a family of iron-containing enzymes (cytochrome P450 enzymes if you like the scientific jargon) changes the structure of a hormone like estrogen, producing several different intermediate forms called metabolites. Some of these are fairly benign. Others are more reactive and need to be dealt with quickly.

This step leans on all B vitamins (especially B2, B3, B6, folic acid, B12), iron, and magnesium. It also throws off reactive byproducts, so it needs antioxidants like vitamins A, C, and E, manganese, plus selenium and zinc, to keep things tidy. Glutathione (your body’s major antioxidant) becomes important and is built from Cysteine (often the rate-limiting or controlling factor in how much gets made), Glutamate (glutamic acid), and Glycine. All of these are amino acids and come from PROTEIN in the diet. Flavonoids from colorful fruits and vegetables are important, as are phospholipids from healthy fats in the diet like wild caught salmon, sardines, nuts and seeds, coconut, etc.

A few everyday things pull on the same enzymes. Alcohol, smoking, and a number of medications all go through phase 1, so they compete for its attention. On the helpful side, cruciferous vegetables (broccoli, cabbage, kale, and Brussels sprouts) contain compounds that appear to nudge estrogen toward its gentler metabolites.

Below is a quick guide that I use in my practice to help educate my clients on proper liver detoxification support.

Phase 2: the packaging step

In phase 2, your liver attaches a molecule to each intermediate. That neutralizes it and makes it water-soluble, so it can leave the body. There are several routes, and each has its own shopping list:

• Methylation runs on folate, B12, B6, and magnesium. It’s a main route for neutralizing the more reactive estrogen metabolites.

• Glucuronidation handles a large share of estrogen, and it depends on a steady energy supply.

• Sulfation depends on sulfur-rich amino acids, which come from eggs, fish, meat, and legumes, with extra help from onions, garlic, and cruciferous vegetables.

• Glutathione (conjugation), your body’s main antioxidant, is built from three amino acids, with selenium as a helper.

Notice that protein shows up again and again. A low-protein diet shortchanges phase 2 directly. It’s also why crash diets and juice cleanses work against the very process they claim to support: they supply almost no protein at all.

If phase 1 is humming along but phase 2 is short on supplies, those intermediates can linger. In practice, I think of low protein, low B vitamins, and low magnesium as the most common ways this system gets under-resourced.

Phase 3: the exit

Once a hormone is packaged, it travels in bile to your gut and leaves in your stool, with a smaller share going out through the kidneys. Two things can go wrong at this stage.

The first is constipation. When things move slowly, those packaged hormones sit in the gut longer than they should. The second is that certain gut bacteria make an enzyme that snips the package back off, freeing estrogen to be reabsorbed into your bloodstream. Researchers have a name for the community of gut bacteria that handle estrogen: the estrobolome.

Fiber helps on both counts. It keeps things moving, and it feeds the bacteria you want more of. This is why fiber and regular bowel movements matter more for hormones than anyone wants to discuss at dinner.

What gets in the way

When I’m looking for why a woman’s clearance might be sluggish, these are the usual suspects:

• Not enough protein, which shortchanges phase 2.

• Low B vitamins and magnesium, which slow both phases.

• Alcohol. Your liver treats it as the priority, and processing it uses up B vitamins and glutathione.

• Constipation and low fiber, which back up the exit.

• Chronic under-eating, which leaves the whole system short on energy and raw materials.

One honest note: the biochemistry here is well mapped, but research on how much a mild shortfall changes your day-to-day hormone symptoms is still limited. I treat this as a reason to cover the basics, not a reason to buy a “liver detox” kit.

This starts long before perimenopause

None of this waits until your forties. I see the same pattern in women in their twenties and thirties, where it shows up as the hormone complaints we’re told are just part of being a woman.

• PMS and PMDD. Calcium and vitamin B6 have the best research behind them for easing premenstrual symptoms, and magnesium is often low in women who struggle most.

• Heavy periods. Heavy bleeding drains iron, and low iron leaves you exhausted, anxious, and shedding hair. It’s a loop that’s hard to get out of without addressing both sides.

• Irregular or missing cycles. Under-eating, especially alongside hard training, is one of the most common reasons a cycle goes quiet.

• PMOS and blood sugar swings. Insulin resistance sits at the center, and magnesium, zinc, and vitamin D are frequently low alongside it.

• Thyroid trouble. A thyroid short on iron, selenium, iodine, or zinc has a hard time keeping up.

• The postpartum years. Pregnancy and breastfeeding draw heavily on iron, B12, and omega-3 fats, and many women never get the chance to refill before the next demand arrives.

I think of it as a bank account. A woman who has been running a quiet deficit through her twenties and thirties tends to arrive at perimenopause already overdrawn.

Why it gets louder in perimenopause

Perimenopause and nutrient deficiencies share a symptom list. Fatigue, poor sleep, anxiety, thinning hair, dry skin, and brain fog show up on both, which makes it very easy to blame hormones for all of it.

So when a woman asks me, “Is it perimenopause, or is it low iron?” my honest answer is often: both. One doesn’t cancel out the other. They stack.

Perimenopause can also drain your reserves faster. Periods often get heavier and closer together in these years, and every heavy period is iron walking out the door. Sleep gets choppier, stress runs higher, and plenty of us are eating less (and less protein) than we think.

And remember the two mechanisms from the top of this piece. In perimenopause, estrogen surges and drops erratically because of what the ovaries are doing, which has nothing to do with clearance. But a woman whose clearance was already under-resourced may have less capacity to handle those surges when they come. Both things can be true in the same body.

Meanwhile, falling and fluctuating estrogen is already changing your skin, your hair, and your sleep on its own. A body that’s low on raw materials has less to work with when those shifts arrive.

If you’re in the thick of perimenopause and want structured support, that’s what my virtual programs are for.

So what do you actually do?

The same things I’d tell you whether you’re 28 or 48.

1. Eat enough protein, spread across the day and starting at breakfast.

2. Eat cruciferous vegetables most days. Broccoli, cabbage, kale, and Brussels sprouts all count.

3. Get your B vitamins and magnesium from food first: leafy greens, beans, eggs, nuts, seeds, and whole grains.

4. Feed the exit route. Fiber and water keep things moving.

5. Be honest about alcohol. Even moderate drinking competes for the same pathways.

6. Test before you supplement. Ferritin with a full iron panel, vitamin D, B12, and a thyroid panel are a reasonable start.

7. Ask why. If you’re low, find out whether it’s intake, absorption, or loss.

Correcting a deficiency won’t “fix” perimenopause, and it won’t erase a rough cycle overnight. But it takes one stressor off a system that’s already working hard, and in my experience that can change how the whole thing feels.

Thank you for reading all three parts. If this series sounded like your story, hit reply or leave a comment. I read every one. And if you’d like one-on-one support with hormone balance, you can work with me here.

Chelsie Moore, MS, CNS, LDN, is a functional medicine clinician and integrative nutritionist at Moore Integrative Health in Portland, Oregon.

This post is for educational purposes only and isn’t a substitute for individualized medical advice. Please talk with your provider before starting any supplement.

Part two of three. Hormones and brain chemicals are built from what you eat, and it shows when supplies run short.

Last time, we talked about the weird little signs that you might be low on something: the cracked lips, the restless legs, the nails that bend instead of snap. Today I want to go one layer deeper, dear reader, and look at what those same nutrients are doing on the inside.

Because your body can’t make a hormone or a neurotransmitter out of thin air. It builds them from what you eat, using enzymes that only work when certain vitamins and minerals are on hand.

I think this is one of the most empowering things a woman can understand about her body. Your hormones aren’t a mysterious force that descends on you. They are physical molecules, assembled in your tissues every single day, out of materials you supplied at breakfast, lunch, and dinner.

Three families of hormones

It helps to know that “hormones” aren’t one kind of thing. They come in three broad families, and each is built from something different.

• Steroid hormones (estrogen, progesterone, testosterone, and cortisol) are made from cholesterol.

• Amino acid hormones (thyroid hormone, adrenaline, and melatonin) are made from single amino acids, the building blocks of protein.

• Peptide hormones (insulin, and the brain signals that tell your ovaries and thyroid what to do) are short chains of amino acids linked together.

So two of the three families come directly from protein, and the third comes from fat. All three need vitamins and minerals to be assembled. Which is a long way of saying that hormones are made of food.

The raw materials

Here are the examples I come back to constantly in my practice.

Thyroid hormone. It’s built from the amino acid tyrosine plus iodine, and the enzyme that assembles it needs iron. Your thyroid releases mostly T4, which is a storage form. Converting T4 into active T3 takes selenium and zinc. This is one reason a woman can have thyroid numbers that look fine on paper and still feel cold, tired, and foggy.

Estrogen, progesterone, and cortisol. All of them start from cholesterol, most of which your own liver makes. From there, cholesterol is converted step by step through a chain of enzymes. Those enzymes are iron-containing, and they rely on B vitamins, magnesium, zinc, and vitamin C to do their work. When energy intake drops very low, the body turns down reproductive hormone production to conserve resources, which is why cycles so often go missing with under-eating.

Insulin. It’s a peptide hormone, stored in the pancreas bound up with zinc. Magnesium helps your cells respond to it, and low magnesium is associated with insulin resistance.

Melatonin. Your sleep hormone is made from serotonin, and serotonin is made from the amino acid tryptophan. So good sleep sits two steps downstream of adequate protein.

Notice how the same names keep appearing: iron, zinc, magnesium, B vitamins, protein. When the outside of your body is showing a shortage, the inside is usually feeling it as well.

Amino acids are the lumber

We talk about vitamins and minerals constantly, and protein gets treated like a gym topic. But protein breaks down into amino acids, and amino acids are the literal starting material for your neurotransmitters:

• Tryptophan becomes serotonin, and serotonin becomes melatonin.

• Tyrosine becomes dopamine, then norepinephrine, then adrenaline. (It’s also the backbone of thyroid hormone.)

• Glutamine feeds the production of GABA, your main calming signal.

• Glycine works as a calming neurotransmitter in its own right.

So vitamins and minerals are the tools, and amino acids are the lumber. You need both. A woman who skips breakfast, grabs a salad at lunch, and finally eats a real meal at 7pm may be asking her brain to make a full day of serotonin and dopamine out of very little.

I don’t want to oversimplify this. Eating more turkey won’t cure depression, and your neurotransmitter levels depend on far more than one meal. But a brain that is chronically short on amino acids, iron, and B6 is working with one hand tied behind its back.

This is one reason I’m so insistent about protein at breakfast. It’s often the simplest change with the biggest effect on mood, cravings, and sleep.

The tools: what makes the conversions happen

Amino acids don’t turn into neurotransmitters on their own. Each step is run by an enzyme, and each enzyme needs a helper nutrient to work.

• Vitamin B6 is the workhorse. It’s needed for the final step in making serotonin, dopamine, and GABA.

• Iron runs the first, slowest step in making both serotonin and dopamine. This is one reason low iron can feel like low mood, poor focus, and restless legs all at once.

• Folate and B12 keep a process called methylation running. Your body uses it to make melatonin and adrenaline, and to recycle a helper molecule that serotonin and dopamine production depend on.

• Vitamin C and copper convert dopamine into norepinephrine.

• Magnesium takes part in hundreds of enzyme reactions, including making the cellular energy all of this runs on.

• Zinc supports the production and signaling of several neurotransmitters, and it’s needed to activate thyroid hormone.

This is why I rarely think about one nutrient at a time. The whole assembly line only moves as fast as its scarcest part, so a woman with plenty of protein and very low iron can still come up short.

What a shortfall can feel like

Nobody walks into my office saying, “I believe I’m low on the cofactors for dopamine synthesis.” What I hear sounds more like this:

• A flat mood, or less joy in things that used to be fun.

• Anxiety that doesn’t seem attached to anything.

• Trouble falling asleep, staying asleep, or both.

• An afternoon crash, with strong cravings for sugar or caffeine.

• PMS that’s worse than it used to be.

• Poor focus and a short fuse.

• Feeling cold and tired no matter how much you sleep.

Every item on that list has other possible causes, and none of them proves a deficiency. But when several show up together, especially alongside the outside signs from part one, I start by checking the supplies.

Nutrient by nutrient: a quick guide

Here’s the short version of what each one does, and what it tends to look like when it runs low.

Iron. Your thyroid needs iron to make thyroid hormone, and your brain needs it to make dopamine and serotonin. Low iron can look like fatigue, anxiety, restless sleep, and hair shedding.

Magnesium. It helps muscles relax and supports sleep and the stress response. When it runs low, you may get cramps, twitchy legs, and that wired-but-tired feeling at bedtime.

Zinc. It plays a role in thyroid hormone metabolism, skin repair, and hair growth. Low zinc tends to show up on the outside first: skin, scalp, and hair.

B vitamins. B6, B12, and folate help build the brain chemicals that steady your mood. They also support the pathways your liver uses to process estrogen (more on that next time).

Vitamin D. It behaves more like a hormone than a vitamin. It matters for mood and immunity, and it matters more for your bones as estrogen declines.

Omega-3 fats and vitamin A. Both keep your skin barrier healthy, and omega-3s help calm inflammation.

Protein. Hair, nails, and muscle are all built from it, and muscle gets harder to hold onto in midlife.

What this looks like on a plate

The biochemistry is complicated. The eating doesn’t have to be.

• Protein at every meal, starting with breakfast: eggs, fish, poultry, meat, Greek yogurt, tofu, lentils, and beans.

• Iron-rich foods paired with vitamin C: lentils with a squeeze of lemon, or red meat with peppers or greens.

• B vitamins from leafy greens, legumes, eggs, and animal foods. B12 comes almost entirely from animal foods, so if you eat mostly plants, it’s one to supplement.

• Magnesium from pumpkin seeds, almonds, dark leafy greens, beans, and dark chocolate. (You’re welcome.)

• Zinc from oysters, beef, and pumpkin seeds.

• Healthy fats from olive oil, avocado, nuts, and fatty fish, which also bring omega-3s.

• Iodine and selenium from seafood and eggs. A Brazil nut or two covers selenium for the day, and more isn’t better.

• Enough food overall. Your body won’t prioritize making reproductive hormones if it thinks there’s a famine.

If you’d like a head start, The Women’s Reset is my guide and 7-day meal plan for balanced hormones.

What to take from this

You don’t need to memorize a single pathway. What I hope stays with you is simpler: your mood, your sleep, and your cycle are built out of your meals. When those feel off, it’s worth asking whether the supplies are getting through before assuming your hormones have gone rogue.

Next time, in part three: how your liver clears hormones, which nutrients it needs to do that, and why all of this starts long before perimenopause.

Chelsie Moore, MS, CNS, LDN, is a functional medicine clinician and integrative nutritionist at Moore Integrative Health in Portland, Oregon.

This post is for educational purposes only and isn’t a substitute for individualized medical advice. Please talk with your provider before starting any supplement.

Your body has a funny way of asking for what it needs. It doesn’t send a memo or schedule a meeting. It cracks the corners of your lips, makes your legs twitch at 11pm, and leaves a small animal’s worth of hair in the shower drain.

I pay attention to these odd little signs in my practice, because they’re often the earliest clue that a woman is running low on something. They tend to show up long before a lab flags a problem, and long before anyone thinks to ask.

Here’s the part I find most interesting: the nutrients behind these signs are the same ones your body leans on to make, use, and clear its hormones. So whether you’re 28 with brutal PMS or 45 and deep in perimenopause, a quiet deficiency can turn the volume up on everything.

Why the outside shows it first

When nutrients run short, your body triages. The heart, the brain, and the other vital organs get first claim on whatever is available, and the tissues that aren’t essential for survival wait at the back of the line.

Skin, hair, nails, and the lining of your mouth are those tissues. They also happen to be some of the fastest-growing cells you have, constantly being replaced, so they need a steady supply of raw materials. That combination (high demand, low priority) is why a shortage often shows up there before it shows up anywhere else.

It’s also why I look at a woman’s hands, hair, and lips while she’s telling me about her fatigue. The outside of the body is a surprisingly honest record of what’s been happening inside for the past few months.

Eight signs worth noticing

None of these is dramatic on its own, which is exactly why they get ignored. For each one, I’ve included what it may point to and what else could be going on, because both matter.

1. Cracks at the corners of your lips. Those sore little splits at the corners of your mouth (the ones that sting when you yawn or eat something salty) are often tied to low B vitamins, especially B2, B6, B12, and folate, as well as low iron or zinc. They can also come from a yeast overgrowth, cold dry weather, or a habit of licking your lips. If they keep coming back no matter how much lip balm you use, that’s the clue.

2. Spoon-shaped nails. Healthy nails curve gently downward. Spoon nails do the opposite: they thin out and dip in the middle, sometimes enough to hold a drop of water. This is one of the classic signs of iron deficiency, usually one that has been building for a long time. It can occasionally run in families or follow repeated injury to the nail, but in a menstruating woman, iron goes to the top of my list.

3. Dandruff. A flaky, itchy scalp is sometimes linked to low zinc or low B vitamins (B2, B6, and biotin get the most attention). The more common driver is a yeast that lives on everyone’s scalp and tends to flare with stress, cold weather, and certain hair products. I get curious about nutrients when dandruff shows up alongside other signs on this list.

4. Dry, flaky skin. Skin that stays dry and rough despite your best moisturizer can point to low omega-3 fats, vitamin A, or zinc, all of which help maintain the skin’s barrier. Other usual suspects include a sluggish thyroid, long hot showers, winter air, and eczema. Falling estrogen dries the skin too, which is why this one is so easy to write off in midlife.

5. Bumps on the backs of your arms. Those small, rough, “chicken skin” bumps on the upper arms and thighs are sometimes associated with low vitamin A or low essential fats. I want to be honest that they’re very often simply genetic and harmless. If yours appeared in adulthood, or they come with very dry skin, the nutrient question gets more interesting.

6. Restless legs. That crawling, twitchy, can’t-keep-still feeling that arrives the moment you lie down is strongly tied to low iron. Your brain uses iron to make dopamine, and dopamine helps regulate movement. Low magnesium may play a role too. Pregnancy, kidney problems, and some medications (including certain antihistamines and antidepressants) can also set it off.

7. Muscle spasms and cramps. Eyelid twitches, calf cramps at 3am, and feet that seize up in yoga class make me think of magnesium first, then potassium and calcium. These minerals control how muscles contract and release. Dehydration, a hard new workout, and medications like diuretics are common causes that have nothing to do with your diet.

8. Hair falling out. More hair in the brush, in the drain, and on your sweater can point to low iron, zinc, vitamin D, or not enough protein. Shedding also tends to show up about three months after a major stressor like illness, surgery, childbirth, or rapid weight loss, and a struggling thyroid is a frequent cause as well. This is one where I always want labs before guesses.

A quick but important caveat: these are clues, not a diagnosis. Every one of them has other possible causes, and more than one nutrient can sit behind the same symptom.

A few more for the list

Once you start looking, you’ll notice others. A sore, smooth, or swollen tongue can go with low B12, folate, or iron. Tingling or numbness in the hands and feet is a reason to have B12 checked promptly. Bleeding gums and easy bruising can point to low vitamin C. And a strong urge to chew ice is one of the stranger and more reliable signs of low iron.

Protein deserves its own moment

We talk about vitamins and minerals constantly, and protein gets treated like a gym topic. But it may be the most overlooked nutrient of all, and your fingernails are one of the first places a shortfall shows.

Nails are made of keratin, which is a protein, and they grow slowly enough to keep a record. A fingernail takes around six months to grow from base to tip, so what you see today reflects how you were eating last season. When protein intake has been low for a while, I look for:

• Soft, thin, or bendy nails that tear instead of snapping.

• Brittle nails that split or peel in layers at the tips.

• Slow growth, where you can’t remember the last time you needed to trim them.

• Horizontal grooves or white bands running across the nail. These tend to appear with more significant shortfalls or after a stretch of illness, and they’re worth showing to your provider.

Nails rarely travel alone. Low protein often comes with thinning hair, slow-healing cuts, losing muscle, getting sick more often, and being hungry again an hour after eating.

Who runs low? In my practice, it’s rarely women who “eat badly.” It’s women who are busy: coffee for breakfast, something light at lunch, and one proper meal at night. It’s also women who are eating less on purpose, women on appetite-suppressing medications, and women who have moved toward plant-based eating without planning where the protein will come from. (No judgment on any of these. I just want your nails to stop splitting.)

And protein matters for far more than nails. It breaks down into amino acids, which are the starting material for brain chemicals like serotonin and dopamine. That’s the subject of part two. For now, the simplest place to start is protein at breakfast.

Why you might be low in the first place

This is the question I care about most, because topping up a nutrient without asking why it dropped is how you end up back in the same place six months later. There are usually four possibilities.

You’re not taking enough in. Skipped breakfasts, low protein, and long stretches of running on coffee add up. So do years of dieting, and eating patterns that cut out whole food groups without replacing what those foods provided.

You’re losing more than you replace. Heavy periods are the big one. A woman with heavy cycles can lose iron faster than even a very good diet can put it back. Frequent blood donation and endurance training add to the tally.

You’re not absorbing it well. You need enough stomach acid to absorb iron, B12, calcium, and zinc. Acid-blocking medications lower it, and chronic stress can too. Gut conditions like celiac disease, SIBO, and inflammatory bowel disease interfere further down the line. Even coffee or tea with a meal can block some of the iron in it.

You’re using more than usual. Chronic stress, intense training, pregnancy, breastfeeding, and a postpartum season you never fully refilled from all raise the demand.

Most women I work with have more than one of these going on at once, which is why “just take a multivitamin” so rarely solves it.

Please don’t take this list to the supplement aisle

I know it’s tempting. But guessing can backfire, for two reasons. Too much of some nutrients (iron and vitamin A especially) causes real problems of its own. And nutrients compete with each other: high-dose zinc can pull down your copper, and calcium can get in the way of iron. A handful of well-meaning supplements can create a new imbalance while you’re trying to fix the old one.

Here’s what I’d do instead.

1. Notice the pattern. One sign is a shrug. Two or three together, especially alongside fatigue, low mood, or poor sleep, are worth a conversation.

2. Get the right labs. Ferritin with a full iron panel, vitamin D, B12, and a thyroid panel are a reasonable place to start. Your provider can add zinc, magnesium, or folate based on your symptoms.

3. Ask for the actual numbers. “Normal” and “optimal” aren’t always the same thing, and a result at the very bottom of a reference range deserves a second look.

4. Ask why. Is it what you’re eating, how you’re absorbing it, or what you’re losing?

5. Start with food, then supplement on purpose. The right form, the right dose, and a plan to retest in a few months.

6. Give it time. Skin renews in about a month, and hair and nails take several. Signs that took a year to appear won’t vanish in a week.

Your body isn’t being dramatic, and it isn’t betraying you. It’s communicating in the only language it has, and the cracked lips and restless legs are part of the message. You deserve someone who will help you read it.

If any of this sounds like your story, hit reply or leave a comment. I read every one. And if you’d like help connecting your own dots, that’s exactly the kind of work we do together in the clinic.

This is part one of a three-part series. Next time: what your hormones and brain chemicals are made of, and why your meals matter more than you’ve been told.

Chelsie Moore, MS, CNS, LDN, is a functional medicine provider and integrative nutritionist at Moore Integrative Health in Portland, Oregon.

This post is for educational purposes only and isn’t a substitute for individualized medical advice. Please talk with your provider before starting any supplement.

If you’ve had bloodwork done in the last few years and been told your ferritin was “normal,” I want you to hold that thought, because it’s about to get more complicated, in a good way.

The American Society of Hematology (ASH) just released new diagnostic thresholds for ferritin, and they’re a real step forward. For years, the reference range most labs used to flag iron deficiency was embarrassingly low — some labs still list “normal” starting around 10-15 ng/mL, a number that has more to do with decades-old population averages than with what your body actually needs to function well. The new guidelines raise that bar substantially. That’s genuinely good news, and I want to walk you through what changed.

But I also want to be honest with you about something that matters more than the number on the page: even a better diagnostic threshold doesn’t tell you why your iron is low, and it doesn’t guarantee your labs will get flagged as a problem even when you’re deep in the symptoms of iron deficiency. That’s the part I see missed constantly in practice, especially in menstruating women and it’s the part we’re going to actually fix in this piece.

What Iron Actually Does In Your Body

Before we get into the numbers, I think it’s worth slowing down on why iron matters as much as it does, because “low iron” tends to get filed away as a minor, easily-fixed nutrient issue. It isn’t.

Iron’s best-known job is oxygen transport. It sits at the center of hemoglobin, the protein in your red blood cells that picks up oxygen in your lungs and delivers it to every tissue in your body, and in myoglobin, which stores oxygen inside your muscles for use on demand. But that’s really just the beginning.

Iron is also essential to how your cells actually make energy. Deep inside your mitochondria, iron-sulfur clusters and iron-containing cytochromes are part of the electron transport chain, the literal machinery that converts food into usable cellular energy (ATP). This is a big part of why iron deficiency fatigue doesn’t feel like ordinary tiredness: you can be breathing just fine and still have cells that are struggling to produce energy at the mitochondrial level.

Iron is also required for DNA synthesis (via an enzyme called ribonucleotide reductase), for a properly functioning immune system, for thyroid hormone production (the enzyme that helps build thyroid hormone is iron-dependent), and for synthesizing neurotransmitters like dopamine and serotonin. That last one matters more than people realize. It’s part of why iron deficiency so often looks like low mood, poor focus, or a kind of flat affect that gets mistaken for something else entirely.

What Iron Deficiency Actually Looks Like In Women

Because iron touches so many systems, the symptoms rarely announce themselves as “this is an iron problem.” In my practice, the most common presentation is a cluster that includes:

Persistent fatigue that doesn’t fully resolve with sleep, hair shedding or thinning (often one of the first things women notice), restless legs at night, brain fog and difficulty concentrating, feeling cold all the time, a racing or pounding heart with minimal exertion, shortness of breath climbing stairs, brittle or spoon-shaped nails, pica (unusual cravings for ice, in particular), headaches, and a low mood that can look a lot like anxiety or depression on the surface.

Any one of these on its own could be a dozen different things. But this specific cluster, especially in a menstruating woman, should always put iron on the list.

The Fatigue Nobody’s Treating: Ferritin In The 20s and 30s

Here’s where I want to get specific, because this is the gap that affects the most women and gets addressed the least.

A landmark French trial published in the BMJ took nonanemic women with unexplained fatigue and a ferritin level at or below 50 µg/L, and gave half of them oral iron and half a placebo for 12 weeks. The iron group’s fatigue dropped by nearly 50%. A follow-up Canadian trial (CMAJ, 2012) replicated this almost exactly: 198 nonanemic menstruating women with fatigue and ferritin under 50 µg/L, randomized to iron or placebo, again saw a significant reduction in fatigue with iron, roughly 48% versus 29% in the placebo group.

Sit with that for a second: these were women whose hemoglobin was completely normal. No anemia on a standard blood panel. If they’d had routine labs run and their ferritin came back in the 20s or 30s, under most reference ranges (old or new) that result would have been called “normal,” and their fatigue would have been left unexplained, or handed off to another workup entirely. This is, in my experience, one of the most common and most fixable causes of chronic fatigue in women that goes completely unaddressed.

Why Menstruating Women Are Almost Always At Risk

This isn’t a rare edge case. Recent data on U.S. females aged 12-21 found iron deficiency in nearly 39% of them and importantly, the majority of those cases weren’t accompanied by anemia, meaning a huge number would be missed by hemoglobin screening alone. The math behind this is straightforward: menstruation is a monthly, recurring source of blood loss, and blood loss is a direct loss of iron. Layer in a diet that doesn’t consistently include enough bioavailable iron, a pregnancy or two, or any of the absorption issues we’ll get into below, and you have a population that is structurally set up to run low.

What Actually Changed: The New ASH Guidelines

Now, to the update itself. ASH’s new thresholds vary by population, which is itself an improvement. A single flat cutoff never made much sense for such different physiological contexts:

Children age 9 months to 4 years: ferritin at or below 20 ng/mL. Adults, including menstruating and pregnant individuals: at or below 30 ng/mL. High-risk groups, heavy menstrual bleeding, or pregnancy with anemia: at or below 50 ng/mL. And for adults with active inflammation (cancer, inflammatory bowel disease, active infection): ferritin under 100 ng/mL, or a transferrin saturation under 20%, whichever flags the problem.

ASH developed these because the old, inconsistent thresholds were missing an enormous number of cases, by their own estimate, up to 70% of iron deficiency in high-risk groups was going undiagnosed under the old system. Raising the bar to 30 ng/mL as the general threshold, rather than the 10-15 ng/mL many labs still quietly use, is going to catch a meaningfully larger number of deficient women. That’s real progress, and if your ferritin has ever come back in the high teens or 20s and been called normal, this update is squarely about you.

Why This Still Doesn’t Solve The Problem

Here’s the “but.” A few, actually.

Diagnostic cutoff isn’t the same as optimal. Thirty ng/mL is the threshold below which iron deficiency should be diagnosed. It is not the number at which you feel your best. Research out of Yale identified 25 ng/mL as the statistically optimal cutoff specifically for diagnosing deficiency efficiently in women of childbearing age — a research and screening benchmark, not an optimal target. In my clinical experience, and in line with what many integrative and functional practitioners target, most women don’t start feeling genuinely well, I’m talking energized, clear-headed, resilient to stress… until ferritin is closer to 80 ng/mL. There’s a real gap between “no longer technically deficient” and “actually thriving,” and the new guidelines, as good as they are, are only designed to catch the former.

Inflammation can hide a true deficiency. Ferritin isn’t just an iron-storage marker it’s also an acute-phase reactant, meaning your liver ramps up ferritin production during inflammation, independent of how much iron you actually have. The mechanism runs through a signaling molecule called IL-6, which triggers a rise in hepcidin (the master iron-regulating hormone), which in turn locks iron inside your cells and out of circulation. The result: someone can be genuinely iron deficient at the tissue level while their ferritin reads normal or even high, because inflammation is inflating the number. This is exactly why ASH built a separate, higher threshold (under 100 ng/mL, or TSAT under 20%) for people with known inflammatory conditions, but it also means that if you have any degree of chronic, low-grade inflammation that hasn’t been flagged as a diagnosis, your ferritin could be quietly masking a real problem. This is why I always want to see ferritin run alongside hs-CRP: a high-normal ferritin with an elevated hs-CRP is not reassuring, it’s a flag to look closer.

A diagnosis still isn’t a cause. Even a perfectly interpreted, inflammation-adjusted ferritin only tells you that you’re deficient, not why. And “why” is where actual, lasting correction happens.

Beyond Ferritin: Transferrin Saturation, TIBC & Serum Iron

Because ferritin can be pushed around by inflammation, I don’t rely on it alone. A fuller iron panel includes:

Serum iron — the amount of iron currently circulating in your blood, which fluctuates throughout the day and isn’t reliable on its own, but is useful in context.

Total iron-binding capacity (TIBC) — a measure of how much transferrin (the protein that shuttles iron through your blood) is available to carry iron. TIBC tends to rise when you’re iron deficient (your body makes more transport capacity because it’s not being used) and fall with inflammation or iron overload.

Transferrin saturation (TSAT) — calculated from serum iron divided by TIBC, this tells you what percentage of your transport capacity is actually occupied by iron. This is often the most clarifying number when ferritin is ambiguous: a low TSAT alongside a “normal” ferritin, especially with elevated hs-CRP, is a strong signal that inflammation is masking a true deficiency underneath.

Run together, these four markers (ferritin, hs-CRP, TIBC, and TSAT) give a far more honest picture than ferritin alone ever could.

What’s Actually Causing Your Iron To Be Low In The First Place

This is the part worth sitting with, because fixing low iron without addressing why it went low in the first place is a losing game, you’ll be back here again in six months.

Blood loss. Menstrual bleeding is the single most common cause in women of reproductive age, and heavy periods in particular can outpace what a typical diet can replace.

Excessive physical exertion. Intense or prolonged exercise triggers a spike in hepcidin within hours of a hard training session, temporarily blocking iron absorption which is part of why endurance athletes, especially women, run such high rates of iron deficiency.

Poor digestive health. Iron absorption depends on adequate stomach acid to convert dietary iron into an absorbable form, so anything that lowers stomach acid, including chronic stress, can quietly reduce absorption over time. Conditions that damage or inflame the gut lining directly impair absorption further: celiac disease, SIBO, IBS, and inflammatory bowel disease (Crohn’s and ulcerative colitis) are all well-documented causes of iron deficiency, sometimes as the first clue that one of these conditions is present at all.

Certain medications. Proton pump inhibitors and other acid-suppressing medications reduce the stomach acid iron needs for absorption, and research shows PPIs also directly increase hepcidin, compounding the effect through a second pathway. NSAIDs and steroids can contribute through gastrointestinal irritation and low-grade blood loss. GLP-1 medications, by significantly reducing food intake and appetite, can reduce total dietary iron intake enough to matter over time, especially in someone who was already running close to the edge.

Inflammation, acute or chronic. Beyond masking ferritin on a lab report, inflammation itself from an acute illness, autoimmune activity, or ongoing low-grade sources drives up hepcidin and locks iron away from where your body needs it, creating a functional deficiency even when total body iron isn’t technically low.

The Nutrients Your Body Needs To Actually Build Iron Stores

Iron doesn’t work in isolation, a handful of other nutrients are directly involved in how well you absorb it, transport it, and put it to use:

Vitamin C converts non-heme iron (the form found in plants and supplements) into a form your gut absorbs far more easily, and forms a soluble compound with it that resists the inhibitory effects of other foods in the same meal.

Vitamin A works alongside iron in a more surprising way: it helps mobilize iron that’s already stored in your liver so it can actually be used, and research shows correcting a vitamin A deficiency alongside iron improves anemia outcomes more than iron alone.

Copper is required to make ceruloplasmin, an enzyme that oxidizes iron into the form that can actually load onto transferrin for transport. Without adequate copper, iron can be sitting right there and still functionally stuck.

Zinc and iron share an absorption pathway in the gut, so they need to be in reasonable balance with each other; too much of one taken in isolation can interfere with the other.

Magnesium supports the broader enzymatic and energy-production systems iron is part of, and

protein supplies the amino acids your body needs to actually build transferrin, ferritin, and hemoglobin in the first place. You can have plenty of iron on board and still struggle to put it to use if protein intake is inadequate.

How To Actually Rebuild Your Iron Stores

Putting all of this together, here’s how I approach correcting iron deficiency with clients, in order:

Heal the gut first, or at least alongside. If you have undiagnosed celiac disease, active SIBO, or inflammatory bowel disease, supplementing iron without addressing the underlying absorption problem is working against yourself. You’ll keep needing more iron than you should, and you may not absorb what you take. This is often the single most overlooked step.

Pair iron with vitamin C. A glass of orange juice or a vitamin C supplement alongside your iron dose meaningfully improves absorption of the non-heme form.

Choose a better-tolerated, better-absorbed form. Traditional ferrous sulfate is cheap and effective but comes with a well-earned reputation for GI side effects that cause a lot of people to quietly stop taking it, like constipation, nausea, and cramping. Gentler forms like iron bisglycinate are generally better tolerated with comparable absorption.

Consider alternate-day dosing. This one surprises people: research on hepcidin shows that taking iron every single day, or worse, twice a day, actually triggers a bigger hepcidin response that blocks absorption of your next dose. Studies comparing dosing schedules found meaningfully higher fractional iron absorption with alternate-day dosing compared to daily dosing in iron-deficient women. Sometimes less is genuinely more here, and it’s easier to tolerate GI-wise, too.

Avoid taking iron alongside high-calcium foods, coffee, tea, or chocolate. Calcium competes with iron for absorption, and the tannins and polyphenols in coffee, tea, and chocolate bind to iron and block it from being absorbed. Space these by a couple of hours from your iron dose if you can.

Consider lactoferrin as an alternative or complement. This one is newer to a lot of people, but the research is genuinely compelling. Lactoferrin, an iron-binding protein found in milk (and available as a supplement, often derived from whey), delivers iron to intestinal cells through a different receptor pathway than standard iron supplements, and appears to lower hepcidin itself rather than triggering the same absorption-blocking response. A meta-analysis of 11 trials found lactoferrin produced superior improvements in iron status markers compared to ferrous sulfate, with meaningfully fewer GI side effects — less constipation, less nausea, better tolerability across the board. It’s been studied specifically in pregnant women and in children with inflammatory bowel disease, both groups where standard iron is often poorly tolerated or complicated by inflammation, with good results in both. For anyone who has tried iron supplements and simply couldn’t tolerate them, this is genuinely worth a conversation with your provider.

The new ASH guidelines are a real and overdue improvement — they will catch women who were being told their fatigue had nothing to do with their iron when it very much did. But a better cutoff on a lab report was never going to be the whole story. If you’ve been told your iron is “fine” and you still don’t feel like yourself, I’d encourage you to ask for the fuller picture: ferritin alongside hs-CRP, TIBC, and transferrin saturation AND a real conversation about why your iron went low in the first place, not just a prescription to take more of it.

If any of this sounds like your own story, I’d love to hear it! Hit reply or drop a comment. And if you want help interpreting your own iron panel, that’s exactly the kind of thing we dig into together in the clinic.

Sources referenced:

• ASH Sets New Standards for Diagnosing Iron Deficiency — American Society of Hematology

• Ferritin Levels Redefined: Optimal Threshold for Women — Yale School of Medicine

• Oral iron therapy reduced unexplained fatigue in nonanemic women with serum ferritin levels ≤ 50 µg/L — ACP Journal Club

• Effect of iron supplementation on fatigue in nonanemic menstruating women with low ferritin: a randomized controlled trial — CMAJ

• Prevalence of Iron Deficiency and Iron-Deficiency Anemia in US Females Aged 12-21 Years, 2003-2020 — JAMA

• A Simple Guide to the Ferritin/CRP Ratio — Superpower

• Proton Pump Inhibitors and Iron Deficiency — The Blood Project

• Oral Supplementation of Iron: Evolving Best Practices — Clinical Correlations

• Bovine lactoferrin and its potential use as a functional ingredient for tackling the global challenge of iron deficiency — ScienceDirect

• Comparative Effects between Oral Lactoferrin and Ferrous Sulfate Supplementation on Iron-Deficiency Anemia — PMC

• Impact of Vitamin A Deficiency on Iron Metabolism and Anemia — Nutrition Reviews

I don’t use the term “adrenal fatigue” with clients. Not because I don’t believe them when they tell me they’re running on empty, I absolutely do. But because that phrase points to the wrong organ, and it quietly lets a much more useful explanation go unexamined.

“Adrenal fatigue” isn’t a recognized medical diagnosis. No major endocrine or medical organization — not the Endocrine Society, not the American Association of Clinical Endocrinologists — recognizes it as a condition. A systematic review that pooled 58 studies looking specifically for evidence of it found no consistent proof that the adrenal glands “wear out” or under-produce cortisol as a result of chronic stress. Your adrenal glands, as it turns out, are remarkably resilient. What’s actually going wrong has a real name, and it isn’t gland failure.

What’s Actually Happening: The HPA Axis Gets Dysregulated

Chronic stress disrupts the communication loop between your brain and your adrenal glands, or what’s called the hypothalamic-pituitary-adrenal (HPA) axis. Your hypothalamus and pituitary gland send signals down to your adrenals telling them how much cortisol to release and when. Under healthy conditions, that signal follows a rhythm: cortisol rises sharply in the first hour after waking (this is called the cortisol awakening response) and gradually tapers as the day goes on, dipping low at night so you can fall and stay asleep.

Under chronic stress, that rhythm flattens. Instead of a strong morning rise and a gentle evening fall, you get something closer to a flat line, or even an inverted pattern: you wake up already depleted, and you feel “tired but wired” again by the time you should be winding down. That’s not your adrenal glands giving out. That’s a stress-response system that has been asked to run in emergency mode for too long, and has adapted by dysregulating its own signaling. It’s a communication problem, not a production problem, and that distinction matters because it changes what actually helps.

Two Different Experiences of the Same Thing: Physical vs. Mental Burnout

The World Health Organization defines burnout by three features: exhaustion, growing cynicism or detachment, and a reduced sense of effectiveness. But in practice burnout doesn’t show up identically in every person, and I think this is where a lot of people get confused trying to self-diagnose from an Instagram infographic.

Mental burnout tends to look like brain fog, flattened motivation, difficulty concentrating, and a kind of emotional numbness. You’re going through the motions, but the part of you that used to feel engaged has gone quiet. Physical burnout tends to look more somatic: persistent fatigue that sleep doesn’t touch, disrupted or unrefreshing sleep, getting sick more often, and a body that just feels heavier to move through the world in.

These are two expressions of the same underlying dysregulated stress response, showing up in whichever system, cognitive or physical, was already carrying more of the load for you. Most people I work with have some of both, in different proportions, and naming which one is dominant for you is often the first useful step in figuring out where to actually direct your energy for recovery.

The Pattern Underneath: Perfectionism, Type A Drive & Disappearing Boundaries

I can walk any client through the HPA axis, and it genuinely helps to understand the mechanism. But if we stop there, we miss the part that actually explains why it was your nervous system that ended up dysregulated in the first place and why, if we don’t touch this piece, recovery tends to be temporary.

In my practice, the women who end up here tend to share a pattern, and it usually isn’t a single hard season. It’s perfectionism, a Type A pace, and a habit of dropping boundaries long before dropping standards.

Perfectionism isn’t one thing, researchers actually break it into a few distinct flavors and they don’t all carry the same risk. Holding yourself to high personal standards isn’t, by itself, what predicts burnout. What predicts it most strongly is socially prescribed perfectionism: the sense that other people expect perfection from you, and that falling short will be noticed and judged. That’s a subtle but important distinction, because it means the exhaustion isn’t really coming from your own ambition. It’s coming from a nervous system that has learned to treat other people’s potential disappointment as a threat worth mobilizing cortisol for, over and over, indefinitely.

Type A drive compounds it. The classic description of competitiveness, time urgency, a chronic sense that there’s never quite enough time, difficulty simply sitting still, was originally studied because it predicted heart disease. The mechanism is the same one we’re talking about here: a stress-response system that gets activated not just by genuine emergencies, but by an ordinary Tuesday with a full inbox. If your baseline setting is “go,” your baseline cortisol pattern eventually reflects that, whether or not anything is actually wrong.

And then there’s the boundaries piece, which I’d argue is the part that turns the first two from a personality trait into a physiology problem. So many of the women I work with are fluent in giving to patients, kids, partners, aging parents, teams, friends who need a listening ear, and far less practiced in saying “I don’t have capacity for that right now” without guilt attached. That’s not a character flaw; it’s a pattern most women are quietly socialized into from very early on, reinforced by workplaces and families that run more smoothly when someone absorbs the overflow. But your HPA axis doesn’t know the difference between a boundary you didn’t set because you were being generous and one you didn’t set because you didn’t feel allowed to. Either way, it registers as one more demand with no corresponding recovery, and over months and years, that’s precisely the pattern that flattens a healthy cortisol rhythm.

None of this is a reason to feel diagnosed by your own personality. It’s the opposite, actually. It’s usually a relief to realize that “I just need to relax more” was never going to touch this, because the exhaustion was never really about a lack of willpower or a lack of trying. It was about a nervous system that had no template for stopping until something external forced it to. Naming the pattern is what makes it possible to start interrupting it on purpose, instead of waiting for your body to do it for you.

From a Nutrition Standpoint: Steady Blood Sugar, Steadier Cortisol

Here’s a piece that gets skipped constantly in the burnout conversation: a blood sugar dip is its own physical stressor. Whether or not anything else is happening in your life, a drop in blood glucose triggers cortisol and adrenaline release to push glucose back up because from your body’s perspective, low blood sugar reads as a threat to survival, full stop.

If you’re already stress-dysregulated and then skipping meals, running on coffee, or eating meals that are mostly refined carbohydrate with little protein or fat, you are stacking additional cortisol spikes on top of a system that is already struggling to regulate cortisol well. Regular meals built around enough protein, fiber, and fat to actually slow glucose absorption reduce how often that emergency signal fires. This is not about a specific diet or eliminating entire food groups. It’s about giving your body fewer reasons to sound the alarm.

Movement, Breathwork & Sleep: Calm the System, Don’t Tax It Further

Gentle, consistent movement supports recovery from burnout. High-intensity training, on the other hand, can raise cortisol further in a system that’s already dysregulated which is often exactly why a daily walk or a slow yoga practice outperforms a punishing workout when you’re in this state. This isn’t a permanent rule against intensity; it’s a recognition that your nervous system needs a different input right now than it did before burnout set in.

Slow, paced breathing (a longer exhale than inhale, or box breathing) activates your parasympathetic nervous system directly and can shift you out of a stress response in real time, which is part of why it’s one of the few interventions here with an almost immediate effect. And consistent, protected sleep is what actually helps restore a healthy cortisol awakening response over time, the strong morning rise that chronic stress flattens.

How to Properly Execute a Rest Day

I want to spend more time here, because “just rest” is the advice everyone gives and almost no one explains well enough to actually use.

Rest is not the same as collapsing on the couch scrolling your phone, and it’s also not the same as a hard workout you’ve relabeled “self-care.” Sports science actually draws a useful distinction here: a true rest day is the absence of planned stress on your system, while an active recovery day is intentionally low-effort but still purposeful movement, like a slow walk, gentle stretching, restorative yoga. The test for whether something qualifies as genuine rest isn’t how it looks from the outside; it’s how you feel afterward. Real recovery, whether it’s full rest or active recovery, should leave you calmer and more restored than when you started, not more depleted, and not artificially “energized” in the wired, cortisol-driven way a hard workout or a third cup of coffee can produce.

How do you know which one you need on a given day? If your sleep, your stress load, or your nutrition have already been compromised, or if you’re noticing real physical soreness or systemic fatigue, that’s a full-rest day with no structured movement at all. If your body still moves well and a slow walk sounds appealing rather than dreadful, active recovery is likely the better fit. The deciding factor is rarely willpower; it’s an honest read of your current capacity, which is worth checking in on rather than assuming.

When Burnout Disrupts Sleep: What CBT-I Actually Offers

For a lot of people in burnout, the cruelest irony is that the body is exhausted but sleep itself becomes unreliable — you’re wired at bedtime, or you fall asleep fine and then wake at 3 a.m. with your mind racing. This is where Cognitive Behavioral Therapy for Insomnia (CBT-I) becomes genuinely useful, and it’s worth knowing about even outside a formal burnout diagnosis.

CBT-I is a structured, short-term approach not a single technique but a small set of them used together, typically over several weeks:

• Cognitive restructuring, which addresses the anxious or catastrophizing thoughts about sleep itself (”I’ll be a wreck tomorrow if I don’t fall asleep right now”) that end up perpetuating the very wakefulness they’re worried about.

• Stimulus control, which retrains your brain to associate your bed with sleep. If you’re awake for more than about 10 minutes, you get up and return only when drowsy, rather than lying there in mounting frustration.

• Sleep restriction (let me it known that I hate the term restriction and would prefer to use the term “sleep window”), counterintuitively, which temporarily limits time in bed to closer to your actual average sleep duration, consolidating fragmented sleep into a deeper, more efficient block before gradually expanding it back out.

• Relaxation training — paced breathing, progressive muscle relaxation — to down-regulate the nervous system activation that’s keeping you alert at the exact moment you need to be winding down.

The evidence behind CBT-I is strong: research consistently shows meaningful improvement in the large majority of people who use it, and the American College of Physicians recommends it as a first-line approach for chronic insomnia, ahead of sleep medication. It’s also been specifically studied in people whose insomnia is driven by chronic stress and trauma, which makes it a natural fit for burnout-induced sleep disruption rather than just insomnia in the abstract. If sleep has become a nightly source of dread for you, this is worth pursuing with a trained provider rather than white-knuckling it through more sleep hygiene tips alone.

Nutrition’s Role in Actually Recovering, Not Just Coping

Everything I mentioned earlier about blood sugar stability applies here too, but during active rest days it matters even more. This is when your body is doing the actual repair work restoring the HPA axis, consolidating sleep, rebuilding the reserves that got depleted, and that repair work is nutrient-dependent. It needs protein to rebuild tissue and support neurotransmitter production, it needs B vitamins and magnesium to support the nervous system and energy metabolism, and it needs enough steady fuel, so your body isn’t simultaneously trying to recover from burnout and manage a self-imposed famine.

This is not the moment for a restrictive diet, however well intentioned. Nutrient dense whole foods like vegetables, quality protein, whole grains, and healthy fats give your body the raw materials for repair instead of asking it to do that repair on emergency rations. Rest days go further when they’re paired with real, adequate meals, not treated as an opportunity to also “clean up your eating” through restriction.

Recovery Is a Marathon, Not a Sprint

If there’s one thing I want you to walk away with, it’s this: burnout recovery doesn’t happen in a weekend, and it isn’t linear. The HPA axis dysregulation that took months or years to develop doesn’t resolve with one great week of sleep or one clean grocery haul. Expect good days and setback days. Expect that your capacity for stress will still feel lower than it used to for a while, even as you’re doing everything “right.”

The goal isn’t to white knuckle your way back to your old pace as fast as possible, that’s often exactly the pattern that led here in the first place. The goal is steady, sustainable inputs held consistently over months: regular meals, protected sleep, movement that matches your actual capacity on a given day, and rest days that are truly restful. Small, boring, repeated choices are what actually rebuild a dysregulated stress response. Not a single dramatic reset.

Where Adaptogens Actually Fit

Herbs like rhodiola and ashwagandha show promising, though still emerging, research for supporting the stress response and modulating cortisol. I get asked about them constantly, and my honest answer is: they’re a support, not a fix. They’re most useful layered on top of steady food, gentle movement, real sleep, and properly executed rest, never as a replacement for any of those things, and never as a way to keep pushing through a pace your body has already told you it can’t sustain.

If this resonated, I’d love to hear which part of your own experience with burnout matched or didn’t match what’s here. And if you want the fuller research behind any of this, just ask; I’m always happy to dig into the primary sources with you.

Sources referenced:

• Cognitive Behavioral Therapy for Insomnia (CBT-I): How It Works — Sleep Foundation

• Active Recovery vs Rest Day: How Personal Trainers Should Program Both — NASM

• The Perfectionism-Burnout Connection: Breaking the Cycle — Simply Psychology

• Coping Resources as Mediators of Multidimensional Perfectionism and Burnout — American Psychological Association

If there’s one conversation I find myself having on repeat in my practice, it’s this one. Not hot flashes. Not mood swings. Blood sugar.

It comes up when we’re talking about PMOS. It comes up when we’re talking about postpartum recovery. It comes up, especially, when we’re talking about perimenopause, because somewhere in the last few years, your afternoon energy crash stopped being “just a busy week” and started being a pattern. The cravings got louder and the number on your labs started creeping. Somewhere along the way, someone probably told you it was “just hormones,” or “just getting older,” and left it at that.

I want to do better than that today. Because blood sugar and cholesterol aren’t side conversations to hormone health, they’re deeply and physiologically tangled up in it. And once you understand the mechanics, you have real leverage. Not through restriction, through food.

The part where insulin actually does its job

Every time you eat carbohydrates, your blood sugar rises, and your pancreas releases insulin to usher that glucose out of your bloodstream and into your cells. In a well-regulated system, this is smooth and almost invisible: a small rise, a small response, back to baseline within a couple of hours.

The trouble starts when this happens too often, too intensely, without enough support from protein, fiber, and fat to slow it down. Do that meal after meal, and your cells can start to become less responsive to insulin’s signal through a state called insulin resistance. Your pancreas compensates by producing even more insulin to get the same job done and that cycle contributes to fatigue, stronger cravings, stubborn weight (especially around the midsection), inflammation, and (this is the part that matters for today) changes to your cholesterol.

Here’s why this hits differently depending on where you are hormonally. Estrogen and progesterone both influence insulin sensitivity. During PMOS, insulin resistance is often part of the underlying picture from the start (through a different mechanism than just general insulin resistance). Postpartum, shifting hormones and disrupted sleep can make blood sugar regulation noticeably harder for a while. And in perimenopause, declining and fluctuating estrogen tends to reduce insulin sensitivity on its own, a shift well-documented enough that the American Heart Association issued a formal scientific statement on it, flagging the menopause transition as a distinct window of rising metabolic and cardiovascular risk that deserves earlier attention, not later reaction.¹

None of this is a personal failing. It’s biology responding to a changing hormonal environment. Which also means it can respond to new patterns, too.

Visceral fat: the belly fat that actually matters

I want to pull one thread out of that inflammation-and-insulin-resistance cycle, because it’s one of the most useful things you can understand about your own metabolism: not all body fat behaves the same way.

Subcutaneous fat, the kind you can pinch, sits just under the skin and is, metabolically speaking, fairly quiet. Visceral fat is different. It’s the fat packed around your abdominal organs, and it functions almost like its own endocrine gland. It releases free fatty acids and inflammatory signaling molecules directly into circulation, much of it heading straight to the liver, where it actively interferes with insulin’s ability to do its job.² This is a big part of why waist circumference tends to track more closely with metabolic risk than total body weight does, two people can weigh the same and carry very different amounts of visceral fat.

This also connects directly back to hormones. Estrogen appears to influence where the body preferentially stores fat, which is part of why body composition can shift toward more abdominal, visceral storage during the menopause transition even without a change in overall weight.¹ It’s not in your head, and it’s not simply “getting older.” It’s a measurable shift in where fat is being stored, with real downstream effects on insulin sensitivity.

So how do you actually know how much visceral fat you’re carrying? This is where a DEXA scan can be genuinely useful. Most people think of DEXA as a bone density tool, but modern DEXA machines also estimate visceral adipose tissue (VAT) specifically, not just how much fat you have but where it is. Research validating this technology found that DEXA-derived VAT measurements track closely with more invasive imaging like MRI and CT at the population level, making it a reasonably precise, low-radiation, accessible way to monitor visceral fat over time.³ It gives you something waist circumference and the scale simply can’t: an actual number for the fat that’s doing the most metabolic damage, and a way to track whether your efforts are actually moving that number.

What actually reduces visceral fat

Here’s some genuinely encouraging news, and it’s the part I most want you to walk away with: visceral fat tends to respond disproportionately well to modest changes.

A systematic review looking at dozens of weight-loss studies found that visceral fat is preferentially lost with modest weight loss, meaning that in the early stages of a mild caloric deficit, you tend to lose visceral fat at a faster relative rate than subcutaneous fat. That preferential effect gradually levels out as total weight loss becomes larger.⁴ In plain terms: you don’t need an aggressive, unsustainable deficit to make meaningful progress on the fat that matters most metabolically. A modest, sustainable calorie deficit, paired with adequate protein so you’re not losing muscle in the process, is a reasonable, well-supported place to start.

Movement adds an independent benefit on top of that. A recent meta-analysis of randomized controlled trials found that while both caloric restriction and exercise reduced visceral fat, exercise showed an additional dose-response effect, more weekly activity was associated with progressively greater visceral fat loss, in a way that continued to add benefit at higher volumes.⁵ Diet and movement aren’t competing strategies here. They’re doing different, complementary jobs.

Cholesterol isn’t the villain — the story is more interesting than that

Cholesterol gets blamed for a lot, but your body actually needs it. It’s a building block for your hormones, including estrogen and progesterone, for your cell membranes, and for vitamin D. The real story isn’t “cholesterol is bad.” It’s about balance, and about the behavior of the particles carrying it through your bloodstream.

A quick primer: LDL carries cholesterol out to your tissues, and in excess (particularly when the particles are small and dense) it can contribute to arterial plaque. HDL helps carry cholesterol back to your liver for processing. Triglycerides are a blood fat closely tied to blood sugar regulation: when you eat more refined carbohydrate and sugar than your body needs in the moment, your liver converts the excess into triglycerides.

This is exactly why I don’t separate the blood sugar conversation from the cholesterol conversation. Diets high in refined carbs and added sugar don’t just spike blood sugar, they tend to raise triglycerides and shift LDL toward those smaller, denser particles.

Here’s the part that’s genuinely relevant to hormone health specifically: estrogen has a protective effect on your lipid profile, which is part of why cholesterol markers often shift during perimenopause and menopause even when nothing else about your diet has changed.¹ This isn’t a personal failure of willpower. It’s your hormonal environment changing the rules underneath you, which means your nutrition strategy may need to change with it.

The good news: the same foods support both systems

The dietary pattern that supports healthy blood sugar is, almost entirely, the same pattern that supports healthy cholesterol and a healthier visceral fat trajectory. That’s not a coincidence, it’s because all three systems respond to overlapping signals.

A few things I come back to with almost every client, regardless of what stage they’re in:

Protein and fiber, together, at every meal. Aim for roughly 25–35 grams of protein per meal. It slows glucose absorption and keeps you satisfied for hours, and it protects the muscle you want to hold onto during any caloric deficit. Pair it with fiber (30+ grams a day if you can tolerate it) and you’re doing double duty: fiber slows glucose absorption, and soluble fiber specifically binds to cholesterol in the digestive tract. A recent dose-response meta-analysis of randomized trials found that soluble fiber supplementation measurably lowers LDL cholesterol, with the effect scaling with the amount consumed.⁶

Don’t fear the fat. Healthy fats ( olive oil, avocado, nuts, seeds, fatty fish) slow digestion, blunt blood sugar spikes, and directly support a healthier lipid profile. Omega-3s in particular do real, measurable work here: a continuous dose-response meta-analysis found omega-3 intake meaningfully improves triglyceride levels, with higher intakes associated with greater improvement.⁷

Mind your eating order. Eating vegetables and protein before refined carbohydrates measurably reduces the glucose spike from the same meal. This isn’t a wellness-culture talking point, it’s been shown directly in clinical research on food sequencing.⁸ It sounds almost too simple, but it works.

Move after you eat. Even a short walk after a meal helps your muscles pull glucose out of your bloodstream without needing as much insulin to do it. In one well-cited study, just three 15-minute walks after meals improved 24-hour glycemic control more effectively than one longer walk at a different time of day.⁹

Protect your sleep and your stress load. Cortisol raises blood sugar directly, and just one night of poor sleep can measurably reduce insulin sensitivity the next day. This is where the “it’s all connected” cliché actually turns out to be true.

A few meals that do the work

I get asked constantly for concrete examples, so here are a few of my go-to combinations built specifically around this goal, not as “diet food,” just genuinely good plates made with intention.

Salmon, Lentil & Arugula Bowl (~35g protein, ~12g fiber) Pan-sear or roast 4–5oz salmon with olive oil, salt, and pepper. Whisk together olive oil, lemon juice, Dijon mustard, and garlic for a simple dressing, then toss it with arugula and ¾ cup cooked lentils. Top with the salmon and a few slices of avocado. The salmon brings protein and omega-3s that support healthy triglycerides, the lentils bring soluble fiber and slow-digesting carbohydrate, and the olive oil helps blunt the glucose response of the whole plate.

Steak & Roasted Vegetable Bowl (~35–40g protein, ~9g fiber) Toss broccoli, bell pepper, and a small sweet potato in olive oil and roast at 425°F until tender. Season and sear 5oz of sirloin or flank steak, let it rest, then slice over the vegetables with a drizzle of balsamic. Pairing the sweet potato with steak, olive oil, and fiber-rich vegetables slows digestion and blunts the blood sugar response you’d get from the sweet potato on its own.

Chickpea, Walnut & Herb Salad (~18g protein, ~14g fiber) Combine a cup of chickpeas, ¼ cup chopped walnuts, chopped cucumber and tomato, a bit of crumbled feta, and fresh parsley and mint. Dress with olive oil and lemon juice. This is one of my favorite plant-forward options for cholesterol support specifically — walnuts provide omega-3 ALA and chickpeas bring both fiber and plant protein, a combination linked to healthier LDL levels.

Greek Yogurt, Berry & Chia Bowl (~25g protein, ~11g fiber) Mix a cup of plain Greek yogurt with cinnamon and a splash of milk, then top with mixed berries, a tablespoon and a half of chia seeds, and a small handful of walnuts or almonds. Plain yogurt keeps this breakfast protein-forward without added sugar, chia adds soluble fiber and omega-3s, and berries bring polyphenols with a far smaller glucose impact than a typical sweetened breakfast.

If you remember nothing else

Your blood sugar, your cholesterol, and where your body is storing fat are not something happening to you as some inevitable cost of aging or hormonal change. They’re something you can influence, meal by meal and step by step, in ways that are almost entirely within your reach. Understanding why they’re shifting is what makes it possible to work with your body instead of feeling like you’re fighting it.

If this is a conversation you want to have about your own labs, your own patterns, your own next season of life — that’s exactly what a free 15-minute Connection Call is for. No pressure, no obligation. Just a conversation.

Book a free Connection Call →

If you found this helpful, I’d love it if you shared it with a friend who’s been told her labs are “fine” but still doesn’t feel like herself. That’s usually where this conversation needs to start.

References

1. El Khoudary SR, et al. Menopause Transition and Cardiovascular Disease Risk: Implications for Timing of Early Prevention: A Scientific Statement From the American Heart Association. Circulation. 2020. pubmed.ncbi.nlm.nih.gov/33251828

2. Janochova K, Haluzik M, Buzga M. Visceral fat and insulin resistance – what we know? Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2019. pubmed.ncbi.nlm.nih.gov/30398218

3. Rothney MP, et al. Precision of a new tool to measure visceral adipose tissue (VAT) using dual-energy X-ray absorptiometry (DXA). Obesity. 2013. pubmed.ncbi.nlm.nih.gov/23505194

4. Chaston TB, Dixon JB. Factors associated with percent change in visceral versus subcutaneous abdominal fat during weight loss: findings from a systematic review. International Journal of Obesity. 2008;32:619–628. nature.com/articles/0803761

5. Recchia F, et al. Dose-response effects of exercise and caloric restriction on visceral adiposity in overweight and obese adults: a systematic review and meta-analysis of randomised controlled trials. British Journal of Sports Medicine. 2023. pubmed.ncbi.nlm.nih.gov/36669870

6. Soluble Fiber Supplementation and Serum Lipid Profile: A Systematic Review and Dose-Response Meta-Analysis of Randomized Controlled Trials. Advances in Nutrition. 2023. pubmed.ncbi.nlm.nih.gov/36796439

7. Association Between Omega-3 Fatty Acid Intake and Dyslipidemia: A Continuous Dose-Response Meta-Analysis of Randomized Controlled Trials. Journal of the American Heart Association. 2023. pubmed.ncbi.nlm.nih.gov/37264945

8. Shukla AP, et al. Food Order Has a Significant Impact on Postprandial Glucose and Insulin Levels. Diabetes Care. 2015;38:e98–e99. diabetesjournals.org/care/article/38/7/e98

9. Reynolds AN, et al. Three 15-min Bouts of Moderate Postmeal Walking Significantly Improves 24-h Glycemic Control in Older People at Risk for Impaired Glucose Tolerance. Diabetes Care. 2013;36:3262–3268. pubmed.ncbi.nlm.nih.gov/23761134

If you’ve been here since the beginning you’ve heard this story from me already, but I feel that it deserves a retelling - so many women can relate to this:

It was 5:00 a.m.

I was sitting quietly in my kitchen drinking a cup of bedtime tea, yes bedtime tea, because apparently my morning routine had become trying to calm down from the panic I woke up with before the day had even started. My daughter was two years old and would likely be awake soon. Which meant I had a small window of time before someone needed breakfast, a snuggle, or assistance solving a crisis that only makes sense in the mind of a toddler.

All I could think was: I cannot continue to live my life in survival mode.

I was exhausted. Not the kind of tired that gets fixed by sleeping in on a Saturday. The kind of exhausted where your body feels like it has been running a marathon while your brain is simultaneously trying to keep track of 47 open tabs. I was trying to hold too much at one time.

I was starting to question whether or not this was just what adulthood was supposed to feel like. That constantly feeling behind was normal. That being depleted was the price of being a responsible adult. That maybe the problem was me. But eventually, I started asking a different question:

What if my body wasn’t broken? What if my body was responding exactly as it was designed to respond to the environment I was asking it to survive in?

That question changed everything. Because after years of working with people struggling with chronic hormonal imbalances, and after walking through my own seasons of burnout, health anxiety, motherhood, and major life transitions I have started to believe something deeply: Sometimes the missing piece isn’t another thing we need to add or estrogen and progesterone we need to balance. Sometimes it is acknowledging the conditions we are asking our bodies to function within, and realizing that those conditions are causing all of the imbalances.

I’ve talked in previous articles about some of the bigger changes I’ve made in my life to address this issue, and now I want to talk more about some of the smaller, day to day things we can all do to start unwinding this messy ball of yarn.

We Have Individualized a Collective Problem

After having this realization, I did what I do best: I dove into the books and the research. If I could just learn all that there is to learn about this, maybe then I could finally “fix” it. So I learned about cultural trauma, epigenetics and transgenerational trauma, adrenal health, you name it. What I’ve come to realize, though, is that all of the science and information is great in theory, but if we aren’t structuring our day to day lives in a way that allows us to actually put these lessons into practice, the knowledge alone doesn’t change much. The knowledge alone will not re-regulate a dysregulated cortisol rhythm.

One of the most powerful ideas explored in Gabor Maté’s book The Myth of Normal is that something being common does not necessarily mean it is healthy. Our society has normalized exhaustion. We have normalized being constantly reachable, working through illness, parents carrying impossible mental loads. We have normalized women caring for everyone else while wondering why they feel depleted.

And then, when our bodies eventually say, something isn’t working here, we often interpret that as a personal failure. Why can’t I keep up? Why am I so tired? Why do I feel anxious? Why can’t I lose the weight? Why don’t I feel like myself anymore?

What I am now learning to ask is, what if these symptoms aren’t evidence that we are failing? What if they also aren’t evidence that we are doomed to be chronically ill for the rest of our lives? What if they are information that something needs to change?

The Body Is Always Adapting

Our bodies are remarkable adaptation machines. Every moment of every day, your nervous system is gathering information about whether or not you are safe, whether or not you have enough resources, whether or not you can relax and recover. A lot of what our nervous system picks up on are stories we run over and over again in our minds. Stories that have become much like a rut through a commonly walked short-cut in a grass field. Some of these stories we tell ourselves stem from trauma we’ve experienced at some point in our lives, and some of them are from trauma experienced deep in our family lineage, passed down to us through epigenetic mechanisms. This is not woo woo stuff, this is scientifically proven theory.

When we experience prolonged stress, whether from emotional experiences, financial strain, lack of sleep, overwork, caregiving, trauma, or environmental stressors– the body adapts. This is not a weakness. This is biology.

Researcher Bruce McEwen described this cumulative burden of chronic stress as allostatic load: the wear and tear that occurs when the body is repeatedly required to adapt to stressors over time. Your body is not failing you, it is working incredibly hard to protect you.

So with all of this in mind, the question becomes: Is the environment I am living in allowing my body to return to balance? Does the structure of my day to day send my nervous system the message that it is safe to drop the armor?

The Modern Health Paradox

I see this constantly in my work with women. While this conversation is often centered around women, the reality is that anyone can experience the impact of living in a chronically demanding environment. Many of the people I work with are doing everything. They are raising children, building careers, managing households, supporting aging parents, maintaining relationships, trying to exercise, trying to eat well, trying to sleep, trying to keep track of everyone’s doctors appointments. And then wondering why their nervous systems feel like they are running emergency software all day long.

Aviva Romm’s work (whom I have the immense privilege of studying and learning from) around women’s health and hormones highlights an important truth: We cannot separate physiology from lived experience. The body does not exist in a vacuum. Hormones do not exist in a vacuum. Health does not exist in a vacuum. Your biology is constantly responding to your life.

This Does Not Mean Everything Is “Just Stress”

I want to pause here because nuance matters. Saying our environment impacts our health does not mean:

• Every illness is caused by trauma.

• Every symptom can be fixed by changing your mindset.

• Everything can be solved with therapy.

• Medication is unnecessary.

• Disease is imaginary.

That is not what this is about. Your genetics matter, how your nourish your body with food matters, environmental exposures matter, medical care matters. AND we also cannot ignore the powerful relationship between our lived experiences and our physiology.

The goal is not to blame ourselves for being stressed. The goal is to become curious about what our bodies are communicating and to become curious about how the ways we’ve structured our lives might be contributing to that message.

So What Do We Actually Do?

This is the question I care about most: If the problem is bigger than us, what power do we actually have? The answer is: more than we think. But maybe not in the way we have been taught.

Stop Making Health Another Performance Metric

One of the greatest ironies of modern wellness culture is that we have turned health into another thing to achieve. Another thing for us to add to our already stressful lives. Now people are stressed about whether they are reducing stress correctly.

The goal is not the perfect morning routine, or the perfect diet. It is not having the most impressive supplement cabinet either. Health is about creating conditions where your body can do what it already knows how to do. And often these conditions are shaped not by dramatic interventions or parasite cleanses, but by the mundane, day to day decisions we are making around work, boundaries, nourishment, rest, and how we move through our lives

Create Space

Sometimes the most powerful health intervention is not adding something, it is removing something. Removing unnecessary obligations, learning how to say no to things that don’t align with your priorities, reducing financial stress, setting boundaries, asking for help, hiring a house cleaner, changing the pace, or creating margin. A nervous system cannot heal in a constant state of emergency.

I assure you, dear reader, that you are enough exactly as you are. You don’t need a bigger job title, a nicer car, or whatever else it is that our culture has taught us to mindlessly chase after. Life is long. We have so much time to work toward things. To chase after things that we want. We don’t have to do it in a day. Close your laptop, lay your body down. Let it rest. We’re playing the long game y’all.

The other day my daughter and I were driving down the road and we saw a man wheeling using a wheelchair to get around. Naturally, she asked me why he needed it. I explained to her that some people’s bodies work differently and tools like wheelchairs help them move through the world the same way legs help the rest of us. She then asked me a question that completely caught me off guard:

Well if their legs don’t work, then why don’t they just get rid of them?

She said it in the most innocent, matter-of-fact way. I gently explained that our bodies aren’t like that; we don’t get to swap parts out and his legs are just as much a part of him as anything else. But something about the simplicity of how she saw the world stuck with me. When we were all younger, life feels that uncomplicated: if something isn’t serving you, you let it go and move forward.

What if, as adults, we could borrow a little of that same clarity, not for our bodies, but for the unbelievably heavy weight we’re all carrying around that stopped serving our higher purposes a long time ago?

Rebuild Connection

Humans are not designed to do life alone.

Connection is not a luxury. Community is not optional. Support is not a weakness. WE NEED EACH OTHER.

Somewhere along the way, we’ve been sold the idea that health is an individual responsibility and that if we could just eat better, exercise more, do all the things, we could somehow figure it all out on our own. Human’s don’t work that way. We are deeply influenced by each other, in both good and not so good ways.

We need people. We need to be cared for sometimes by other people. We need relationships where we can exhale. And we need people who show up when life becomes too heavy to carry by ourselves. Sometimes the healthiest thing we can do isn’t add another intervention, it’s to let someone help us carry the load. Support isn’t a sign that we are failing, it is a part of how we’re designed to survive, and more importantly to thrive.

Whether you receive this support from friends, family, or through the hired support of a therapist, nutritionist, coach, or spiritual community isn’t the point. The point is that you seek it out.

Turning Down the Noise

We live in a noisy world. We’re constantly being bombarded by some form of stimulation. iPhones, iPads, laptops, television, artificial light, notifications, traffic, conversations, and the general hum of modern life. It’s a lot. And while we may have become accustomed to it, our nervous systems are still taking it all in.

One of the ways we can support our nervous system is by creating more intentional boundaries around the stimulation we allow into our lives. Maybe that means deleting social media from our phones and choosing when and how we engage with it, rather than allowing it to interrupt us throughout the day. Maybe it means swapping harsh overhead or fluorescent lighting for softer, warmer light. Maybe it means turning off notifications, spending a few minutes outside without your phone, eating a meal without a screen, or allowing the car ride home to be quiet.

None of this is about creating a perfectly calm, stimulation-free existence. That’s not realistic, and probably not desirable. It’s about giving our nervous systems opportunities to come down from the constant input.

There are so many ways we can turn the volume down. Creating more capacity for healing doesn’t require adding another practice to our already-full lives, it simply means removing some of the noise.

Little By Little, A Little Becomes A Lot

If there’s one thing I want you to walk away from this article believing, it’s that healing doesn’t require a complete overhaul of your life. It doesn’t require the 5 a.m. wake-up, the elimination diet, the perfectly optimized supplement stack, or burning your life down to rebuild it from scratch. In fact, chasing that kind of dramatic transformation often becomes just another way we exhaust ourselves.

What actually changes a nervous system, and a life, is much smaller and much less exciting than that. It’s the small, boring, repeatable decisions we make about food and rest, day after day, that our bodies eventually learn to trust.

Think about what it might look like to add one source of protein to breakfast instead of overhauling your entire diet. To go to bed ten minutes earlier tonight, and ten minutes earlier again next week, instead of forcing yourself into a rigid nine o’clock bedtime you’ll abandon by Thursday. To pause for thirty seconds before a meal and take a few breaths, letting your body know it’s safe enough to actually digest what you’re about to eat. To let yourself rest for five minutes on the couch without immediately reaching for your phone or your to-do list.

None of these things, on their own, will fix allostatic load. That’s not the point. The point is that your nervous system isn’t convinced by a single dramatic gesture. It’s convinced by repetition. By evidence, gathered slowly, that things are different now. That there is enough time. That there is enough food. That rest is allowed. Small, consistent signals, sent over and over, are what eventually teach your body that it doesn’t need to run emergency software anymore.

This is also why I think so many of us get stuck. We look for the one big shift that will finally fix everything, and when it doesn’t, we assume we’ve failed. But healing was never going to come from one big shift. It comes from a hundred small ones, most of which will feel too small to matter. It has taken me YEARS of inner work and a whole lot of falling into the same hole to realize this.

The small shifts matter. Little by little, a little becomes a lot.

The Question I Keep Coming Back To

For years, I thought the question was: What is wrong with me?

Now, I think a better question is: What has my body been trying to tell me?

Our symptoms are not always signs that we are broken, sometimes they are just intelligent signals asking us to pay attention to how our environment is affecting us. Healing does not always begin with fixing ourselves. It begins with listening to our bodies and our needs, listening to the quiet knowing that something about the way we are living may no longer be sustainable. Your body is certainly not your enemy. Your body has been working incredibly hard to carry you through every season you have experienced. How could we do a better job of thanking our body for that service?

Maybe the next chapter is not about optimizing yourself into someone new, maybe it is about creating the conditions where you can finally come home to yourself.

I’d Love To Hear From You

Have you ever had a moment where you realized your health struggles weren’t just about your body but about the life you were trying to carry?

I’d love to hear your story in the comments.

References & Further Reading

Maté, G., & Danaan, D. (2022). The Myth of Normal: Trauma, Illness, and Healing in a Toxic Culture.

McEwen, B. S. (1998). Protective and damaging effects of stress mediators. New England Journal of Medicine, 338(3), 171–179.

Felitti, V. J., et al. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. American Journal of Preventive Medicine, 14(4), 245–258.

Sapolsky, R. M. (2004). Why Zebras Don’t Get Ulcers.

Romm, A. (2021). Hormone Intelligence: The Complete Guide to Calming Hormonal Chaos and Restoring Your Body’s Natural Vitality.

A few years ago, I started noticing subtle changes. My stress tolerance wasn’t what it used to be. My sleep felt less predictable. Workouts that once energized me sometimes left me feeling depleted. There were moments when I felt like I was doing all the “right” things and somehow getting different results.

As a nutritionist, I knew enough to suspect hormones. As a human, I still found myself wondering: What on earth is happening to me?

Like many people, I grew up thinking menopause was something that happened suddenly in your 50s. One day you’re fine. The next day you’re fanning yourself with a restaurant menu and arguing with your partner over absolutely nothing.

Turns out, that’s not how it works.

The reality is that for many people, the transition begins years, at most a decade or more, before menopause itself. And for me, it started earlier than I expected. Not, “I’m just freaked out by all the fear mongering in the news about perimenopause” early, but real early. Tested my hormones early. Met with an OBGYN early. My mother entered menopause early. So did my grandmother. It appears I may be following a similar path.

What I eventually learned changed the way I think about this stage of life entirely. Most people think perimenopause is something to survive. Something that is going to utterly derail our lives. I think it’s one of the greatest opportunities we’ll ever have to influence our future health. And also one of the greatest opportunities we’ll ever have to create a life of vitality for ourselves.

The Retirement Account Nobody Talks About

When people think about retirement, they understand the importance of starting early. A small investment made consistently over time grows into something meaningful because of compound interest. Your health works much the same way.

The choices we make during your 30s and 40s, particularly during the perimenopausal transition, can have an outsized impact on how we feel not only today, but for decades to come. Perimenopause is, in many ways, our body’s retirement planning window. And the earlier we start investing, the greater the return. But what do I mean by investing?

I’m talking about the foundational levers we can start adjusting to alchemize our body’s physiology: how we sleep, the types of foods we choose to nourish our bodies, the amount of alcohol we do or don’t consume, the ways in which we move our body. There is no one size fits all approach like popular media wants you to believe there is. What’s right for one woman may not be right for another. Some of us have young kids, others don’t. Some women need digestive support to properly break down the protein they’re being told to eat, others don’t. Menopause and perimenopause are a $15 billion dollar industry. There is a lot riding on those of us entering this phase of our lives. But what I’ve come to learn is that it’s the most mundane, consistent, daily decisions that actually move the needle—not the latest wellness trend, gadget, or supplement that loses its sparkle after a few months in the media spotlight.

What Exactly Is Perimenopause?

Perimenopause is the transitional period leading up to menopause, when hormone production begins to fluctuate and eventually decline. Historically, discussions about menopause have focused almost exclusively on cisgender women. However, anyone with functioning ovaries may experience perimenopause and menopause, including some transgender men and non-binary individuals.

Most people begin noticing changes during their 40s, though symptoms can appear much earlier. During this transition, estrogen and progesterone levels can fluctuate dramatically, contributing to symptoms such as:

• Fatigue

• Brain fog

• Anxiety or mood changes

• Sleep disturbances

• Heavy or irregular periods

• Hot flashes and night sweats

• Changes in body composition

• Reduced stress resilience

• Vaginal and sexual health changes

Some people barely notice the transition. Others feel like they’ve been handed an entirely different operating system without an instruction manual. Both experiences are normal. In fact, researchers have identified four distinct estradiol (E2) trajectories during the menopause transition that will all manifest with different symptoms:

1. Low E2 / slow decline - ~15%

2. Low E2 / relatively flat - ~41%

3. High E2 / early steep decline - ~14%

4. High E2 / high peak followed by sharp decline - ~30%

This is important to know because, not every woman experiences a simple, gradual decline in estrogen during perimenopause. Some women start low and decline slowly, some maintain stable levels, and some experience higher estrogen levels followed by a much steeper decline.

Why This Transition Deserves More Attention

What fascinates me most about perimenopause isn’t the symptoms. It’s what those symptoms are trying to tell us. Because while hot flashes and irregular periods tend to get the spotlight, the hormonal changes occurring during this transition affect nearly every system in the body.

Estrogen influences cardiovascular health, bone density, metabolism, brain function, immune regulation, and muscle maintenance. As hormone levels decline, the risk for osteoporosis, cardiovascular disease, metabolic dysfunction, and certain mental health concerns increases.

That sounds scary, it’s not meant to be. It’s meant to be empowering. Because understanding what’s happening allows us to act, which is where so much of the conversation gets lost.

But Changing Habits Is Hard

Let’s be honest. Changing habits is hard. Changing habits while raising children is harder. Changing habits while raising children, working, caring for aging parents, maintaining relationships, and trying to remember where your phone, keys, and wallet are? That’s practically an Olympic sport.

Old habits die hard.

But here’s the good news: they don’t have to die all at once. One of the most encouraging findings from health psychology is that humans are remarkably adaptable. Our brains continue to learn, grow, and form new patterns throughout life. Small, consistent changes practiced over time can lead to meaningful improvements in health and well-being. That’s important because when people hear the phrase “optimize your health,” they often imagine a complete life overhaul.

I don’t.

I’m talking about gradual improvements. A little more protein. A little more fiber. A little more strength training. A little more sleep. A little more awareness of what your body is asking for. The goal isn’t to become the person with the perfectly color-coded supplement organizer and a 5 a.m. cold plunge routine. I’m sorry but I just don’t buy into the “biohacking” mentality.

The goal is progress. The goal is presence. The goal is learning to listen to and embrace our natural rhythms. And there may be no better time to start than during the perimenopausal transition.

Beyond Hormones

If you’ve spent any time on social media lately, you might think menopause hormone therapy is the only conversation worth having. To be clear, hormone therapy can be an incredibly valuable tool for many people and may dramatically improve quality of life when appropriately prescribed.

But it isn’t the entire story. No medication can build muscle for you. No prescription can make up for chronic sleep deprivation. No patch, pill, or cream can fully compensate for a nutrient-poor diet, ill gut health, unmanaged stress, or a life with inadequate rest baked into the schedule.

The foundations still matter. In fact, they may matter more than ever. And they are the LEAST talked about in the menopause conversation. Mostly because the mundane daily decisions that actually move the needle overtime are pretty boring things to sell.

Research continues to show that nutrition, resistance training, physical activity, sleep, and metabolic health play significant roles in long-term outcomes during and after the menopausal transition. Which brings us back to retirement planning. The habits you build now are the assets you’ll draw from later. There is no single supplement that can do this for you.

The Most Underrated Health Opportunity of Midlife

I often think of perimenopause as a biological wake-up call. Not because something is wrong, but because something is changing. Change naturally invites us to reevaluate.

How am I nourishing myself?

Am I getting enough protein?

Am I maintaining muscle mass?

Am I sleeping well?

Am I managing stress in a sustainable way?

Am I supporting my body in the same way I support everyone else around me?

For many of us, this transition arrives during one of the busiest periods of life. Careers are demanding. Children need us. Parents may need us. The mental load feels endless. Which is precisely why it’s so easy to ignore ourselves. And precisely why this work matters.

The Bigger Picture

Could I tell you exactly how to optimize your health during perimenopause in one article? Not a chance. If I could, my profession would be a lot simpler. The truth is that every person’s path through this transition is unique and requires personalized recommendations tailored to their unique body and life. Which is why I believe nutrition professionals are sorely needed and underutilized in women’s health care.

But what I hope you’ll take away from this article is that perimenopause is not merely the road to menopause. It’s an opportunity. An opportunity to build strength, to improve nutrition, to address long-standing health concerns, to create habits that support your future self.

The goal isn’t to fight aging. To me aging is a beautiful thing that more women (and society in general) could do a better job of embracing. As a culture we’ve confused youth for beauty.

The goal is to move through this transition feeling resilient, empowered, and at home in your body. That’s a return on investment worth pursuing.

I’d Love to Hear From You

What was the first sign that your body was changing during perimenopause?

For some people it’s changes in their cycle. For others it’s anxiety, sleep disturbances, brain fog, stubborn weight gain, or simply a feeling that something feels different.

Share your experience in the comments. The more we talk openly about this transition, the less alone we all feel navigating it. And the more I learn from YOU on exactly what it is you need to learn, the more I can tailor my writing. Thank you for being here!

References

Bandura, A. (2004). Health promotion by social cognitive means. Health Education & Behavior, 31(2), 143–164.
https://doi.org/10.1177/1090198104263660

Lally, P., van Jaarsveld, C. H. M., Potts, H. W. W., & Wardle, J. (2010). How are habits formed? Modeling habit formation in the real world. European Journal of Social Psychology, 40(6), 998–1009.
https://doi.org/10.1002/ejsp.674

Michie, S., van Stralen, M. M., & West, R. (2011). The behaviour change wheel: A new method for characterising and designing behaviour change interventions. Implementation Science, 6, 42.
https://doi.org/10.1186/1748-5908-6-42

North American Menopause Society. (2023). The 2023 position statement on hormone therapy. https://www.menopause.org

Mayo Clinic Staff. (2024). Perimenopause: Symptoms and causes.

https://www.mayoclinic.org

Azzollini, D., et al. (2024). Nutritional strategies for the management of menopause-related symptoms and long-term health risks. Nutrients, 16(1), 27.
https://www.mdpi.com/2072-6643/16/1/27

Tepper PG, Randolph JF Jr, McConnell DS, et al. “Trajectory clustering of estradiol and follicle-stimulating hormone during the menopausal transition: results from the Study of Women’s Health Across the Nation.”
Journal of Clinical Endocrinology & Metabolism. 2012.

Buckle up friends, this is a long one. A boring yet one of the most important topics for us women to take seriously. I promise it will be worth your while.

Muscle mass and bone density are two topics I never imagined becoming passionate about, but here we are. Both my grandmother and my mother developed osteopenia, so somewhere along the way I realized this isn’t just something that happens to older women. It is likely a part of my future as well. As I move through my late 30s and begin thinking more intentionally about aging, I’ve become less interested in chasing longevity for longevity’s sake and more interested in protecting the things that allow me to fully participate in life.

To hike, to play with my daughter or future grandkids, to travel, to get up and down off the floor without thinking twice, to live in a two story house. You catch my drift. Strong muscles and healthy bones aren’t about looking a certain way. It’s about maintaining quality of life and independence for the duration of our lives.

How Our Bones and Muscles Change During Midlife

Before we dive into what we can do to support our bones, I think it helps to understand what is actually happening underneath the hood. A little science first, if you will. I promise to keep it brief.

Only 49% of the population over age 50 has healthy bone mass, meaning that 51% of the population has low bone mass, with 9% of that group being diagnosed with Osteoporosis (Mahan & Raymond). These numbers are staggering! It is very common for people over 50 to be completely unaware of their bone health, and a lot of osteoporosis cases are undiagnosed.

Our bones are far from static, they’re a living tissue that is constantly being broken down and rebuilt. During childhood, adolescence, and early adulthood we’re in a period of building bone. Bone formation outpaces bone breakdown, enabling us to grow and gradually reach what’s known as our peak bone mass sometime around age 30. After 30, the balance slowly begins to shift. Moving through our 40s and beyond our bodies naturally begin breaking down bone a little faster than they can rebuild it– in other words breakdown starts outpacing formation. For women, this process is accelerated with the loss of estrogen in the menopausal years. Over time, the gradual loss can lead to osteopenia and eventually osteoporosis if enough bone density is lost.

None of this is meant to sound scary–this is all normal physiologic processes of aging. The good news is that while we can’t stop aging (do I need to repeat that louder for the people in the back) we can influence how we age. And that’s where nutrition, movement, and a few evidence based interventions can make a meaningful difference.

Exercising for Bone Density & Muscle Mass

It is impossible to talk about bone health without also talking about muscle. Our muscles don’t just help us move through the world, they also provide mechanical forces that tell our bones they need to stay strong. Every time we walk, climb stairs, bike, carry groceries, or challenge muscles through exercise we send our skeleton a message: we need you.

Think about building muscle and supporting bone density in your 30s, 40s, and 50s the same way your financial advisor talks about saving for retirement. The deposits you make today pay dividends decades from now. Muscle becomes much harder to build as we age, particularly after menopause, but that doesn’t mean it’s impossible. It simply means that consistency matters so much more than intensity. And this is where I want to offer a little bit of reassurance.

The internet can make it seem like healthy aging requires spending six days a week in the gym deadlifting 200 pounds. It most certainly doesn’t. We’re not training to become body builders. We’re training for something much more meaningful: health span. The best exercise program isn’t the one that’s trending on instagram, it’s the one we’re still doing ten years from now.

So what we need to ask ourselves is this: what forms of exercise do I actually enjoy doing. Something we see ourselves being able to do consistently for 90-120 minutes per week or a minimum of 6-8 sets per muscle per week. Yoga, walking, cycling, hiking, barre, pilates, resistance bands, or well tolerated strength training in a gym are all great options. Sure, weight training in the gym has the strongest evidence for improving bone density and preserving muscle mass, but please know that it isn’t the only form of movement that matters. You may need support from a trainer to learn technique, or it just may not be for you. And that’s okay. Start with the movement that feels accessible today. Doing something consistently will always beat doing nothing because the “perfect” workout feels out of reach.

One last thing I’d love for us to stop doing is making women afraid of menopause. Muscle mass change is not exclusive to menopause. There is a myth floating around on the internet that we lose 10% of muscle mass during perimenopause and menopause. The research doesn’t support this. Data from the SWAN study shows about .39-1.5% of modest muscle mass loss over the course of the menopausal transition. It’s not catastrophic. Most muscle mass loss actually occurs over the age of 70. That doesn’t mean muscle isn’t important, it just means we don’t need fear to motivate us. We can choose to build strength out of a desire to stay active and do the things that are important to us, not because we’re scared our bodies are falling apart.

To give you an example of what this looks like in real life, let me pull back the curtain on my mornings.

As of this writing, I am a mother to a four year old who’s home with us all summer. I’m running a business, trying to keep up with the cooking and grocery shopping, attempting to keep the house from growing mold, and somehow fitting movement into the day. Like you, I’m not sitting around with an extra hour to spend at the gym.

So I stopped trying to find the perfect workout and started looking for small windows of opportunity to move. I keep a few weights in my living room where I can’t ignore them. After I brush my teeth I do 15 weighted squats. While the eggs are cooking I knock out a set of push-ups. Stir the eggs. Another set. While my daughter is (hopefully) getting dressed or occupied in some way, I do dead bugs and a couple of hamstring exercises on the floor. Sometimes I finish with a wall sit or two while I brush my teeth.

By the time breakfast is over, I’ve squeezed in 15-20 minutes of strength training without ever officially starting a workout. Is it glamorous? Not even a little. But it gets done, and that is the point. The women I know (most of us moms) don’t need a more complicated exercise routine. We need one that fits into reality.

Nutrition: The Other Half of the Equation

If exercise is the biggest lever we have for protecting our bones and muscle as we age, nutrition comes in a close second. And yes, we have to talk about protein. I know. If you’ve spent even less than a second on social media lately, you’ve probably been told to put protein in your coffee, your water, your overnight oats, and somehow even your chocolate bar. I giggled the other day at the grocery store when I saw a heavily sweetened coffee beverage with a big yellow label on the front that said “Now with added protein!” Protein has become the nutrition equivalent of duct tape, apparently it fixes everything. Feeling tired? Just throw some protein at it! Kidding.

The truth is a little less exciting. So let me break it down for you as to what the research actually says. And no, you don’t need to start putting protein in your water.

Protein is indeed incredibly important, particularly as we age, because it provides the building blocks our bodies need to maintain and repair muscle. But that doesn’t mean more is always better. For a generally healthy woman in perimenopause or menopause whose goal is to preserve muscle mass and function, a practical evidence-informed target is roughly 1.2–1.6 g protein/kg body weight/day, alongside progressive resistance training. For women who are sedentary or just beginning strength training, the lower end may be plenty. For women who are actively strength training, dieting, very physically active, or trying to gain lean mass, moving toward 1.4–1.6 g/kg/day makes sense.

So, for a 150-lb / 68-kg woman:

• 1.2 g/kg = ~82 g/day

• 1.4 g/kg = ~95 g/day

• 1.6 g/kg = ~109 g/day

Any more protein than this is just not substantially supported enough by the literature at this point. The good news is you don’t need to obsess over hitting a perfect number every single day.

Aim to include a quality source of protein into three meals divided throughout the day, or three meals and a couple of snacks. However you can hit the target that works with your lifestyle. The best forms of protein are going to be from real foods and not protein powders, protein enhanced snack foods, protein coffee, protein chocolate, protein water, etc. Whether those come from animal foods, legumes, tofu, tempeh or other minimally processed options is far more important than the degree of processing the protein has to go through before it makes it to your plate. I’ll save the deeper dive into protein timing, meal ideas, and practical ways to reach these targets for another article.

Protein gets most of the attention, but it isn’t the only nutritional factor that influences muscle and bone health. A dietary pattern rich in whole, minimally processed foods provides the vitamins and minerals your skeleton depends on. That includes eating plenty of vegetables (5 cups/day), dark leafy greens, ensuring adequate calcium intake from dairy or non dairy sources (women need 1000-1200mg daily), moderating sodium (no more than 1.5-2g daily), moderating alcohol (one serving per day or less), and caffeine, and including foods like legumes, nuts, seeds, and fish with edible bones such as sardines or mackerel. Soy foods like tofu or tempeh also deserve a special mention, which we’ll come back to in a moment.

And one surprisingly interesting food intervention? Prunes. Several randomized trials in postmenopausal women have found that regularly eating prunes may help preserve bone mineral density, potentially through their polyphenols and effects on bone turnover. It's certainly not a replacement for exercise, adequate protein, calcium, or medical treatment when indicated, but it's a pretty delicious example of how food can be part of the bone-health conversation.

To circle back on the calcium subject, I wanted to give you a breakdown of what foods have calcium in them and how much. I won’t go down the dairy versus non-dairy rabbit hole on this one, my general advice is to limit dairy and aim to get some of the calcium from plant based sources:

• Tofu 350 mg per ½ cup serving

• Tapioca 300 mg per ½ cup serving

• Chia seeds 300 mg per 1.5 ounces serving

• Collard greens 210 mg per ½ cup serving

• Kale 205 mg per ½ cup serving

• Bok Choy 190 mg per ½ cup serving

• Figs 135mg per 5 fig serving

• White Beans 120 mg per ½ cup serving

• Turnip Greens 104 mg per ½ cup serving

• Spinach 99 mg per ½ cup serving

• Almonds 93 mg per ¼ cup serving

• Sesame Seeds 51 mg per 1 tablespoon serving

The common thread here isn’t a single superfood or supplement or latest wellness trend. It’s building meals and nourishment around foods that consistently provide your body with the nutrients and building blocks it needs over time. Food first, supplements second. If you are truly unable to get the necessary nutrients from diet, this is where a supplement can come in and support.

Where Supplements Fit In

When I think about supplements in my clinical practice, I tend to divide them into two categories: foundational support and evidence-based interventions for specific conditions or symptoms. The same framework applies to bone health.

There are foundational nutrients that help create an environment where healthy bones can thrive, and there are targeted interventions that may be appropriate for women with diagnosed low bone density. There are also situations where prescription pharmaceuticals are the right tool, and that’s okay too. My goal isn’t to convince anyone that supplements are always better than pharmaceuticals. It’s to help women understand what options exist and where each one fits in. As always talk with your doctor or practitioner before starting anything.

Start With the Foundation

Despite all the attention calcium receives, the evidence for calcium supplementation is surprisingly underwhelming.

A large 2015 review published in The BMJ pooled data from randomized controlled trials and found that calcium supplements increased BMD by only 0.7-1.8%, and these improvements did not translate into clinically meaningful reductions in fracture risk. Similarly, analyses from the SWAN study cohort suggest that calcium supplementation during the menopausal transition does not substantially slow bone loss or reduce fractures. Calcium alone cannot overcome the hormonal changes driving bone resorption.

For that reason, I encourage women to think of food first.

Aim to meet your calcium needs through quality dairy sources (if tolerated), or the plant based sources I outlined in the nutrition section above. Supplements can absolutely help fill nutritional gaps, but I don’t recommend relying on them as your primary strategy.

Vitamin D is a different story.

Vitamin D deficiency is something I see in practice ALL OF THE TIME, particularly here in the Pacific Northwest. Because vitamin D plays an essential role in calcium absorption and bone metabolism, I generally recommend routine testing rather than guessing. For many women, a daily vitamin D3 supplement (often paired with vitamin K2) providing around 2,000 IU/day is a reasonable maintenance dose. Women who are deficient frequently require higher doses, but I strongly recommend working with your healthcare provider to determine the appropriate amount and to monitor blood levels over time.

Magnesium is another nutrient I commonly recommend. It’s involved in hundreds of enzymatic reactions throughout the body, including those that support bone health, and many people simply don’t consume enough through diet alone. I generally recommend around 400mg daily as Magnesium Glycinate because it’s well tolerated, although Magnesium Citrate has more extensively in the bone health literature.

Beyond those three, a quality third party tested multivitamin/mineral that includes Vitamin B6, folate, Vitamin B12, Silicon, Boron, Zinc, Copper, and Manganese will contribute to healthy bone metabolism. Likewise omega-3 fatty acids in the form of a quality fish oil or cod liver oil can fill in the gaps if you aren’t able to get omega-3 rich fish into your diet three times per week.

Struggling to figure out what supplements are third party tested for purity? If you go to my website and scroll on down to the middle of the home page, you’ll see a link to my Fullscript Women’s Health Dispensary where I’ve hand picked a lot of the supplements that have the most literature to support them. I give all of my clients a 15% discount, which you can enjoy as well.

What About Creatine?

We can’t talk about muscle health these days without talking about creatine. So here’s my perspective.

The marketing is ahead of the evidence in my opinion. It’s not overhyped because it doesn’t work, I think it’s overhyped because the marketing often leaves out an important detail. Creatine is not a substitute for resistance training. The literature suggests that creatine alone has little to no meaningful effect on muscle mass. Resistance training alone preserves and builds muscle. When the two are combined, creatine may provide a modest additional benefit for lean muscle mass and, in some studies, strength and physical function.

One of the strongest double-blind randomized trials followed 237 postmenopausal women for two years. Women who combined creatine supplementation with resistance training gained slightly more lean mass than those performing the same exercise program with a placebo. Importantly, creatine had no effect on bone density, and every participant was strength training. (Chilibeck, et al). The key take away here is this supplement wasn’t replacing exercise, it was complementing it.

A Targeted Intervention: Soy Isoflavones

One nutritional intervention that deserves far more attention than it gets is soy isoflavones. Soy has become one of the most controversial foods in nutrition, yet much of that controversy isn’t reflected in the scientific literature. One nutritional intervention that deserves far more attention than it gets is soy isoflavones.

Soy has become one of the most controversial foods in nutrition, yet much of that controversy isn’t reflected in the scientific literature.

Isoflavones are naturally occurring plant compounds that have weak estrogen-like effects in the body. Because estrogen plays such an important role in maintaining bone density, researchers have spent decades studying whether soy might help reduce the accelerated bone loss that occurs during and after menopause.

The results are encouraging.

Clinical trials suggest soy isoflavones can help support bone health by slowing bone breakdown while promoting bone formation. One randomized controlled trial found that a supplement providing 105 mg of mixed soy isoflavones increased bone calcium retention by approximately 3.4% in postmenopausal women. A subsequent meta-analysis reported favorable effects with doses as low as 90 mg/day.

Does that mean every woman should start taking a soy isoflavone supplement?

Not necessarily.

But for women with osteopenia or those at elevated risk of bone loss who are looking for additional evidence-based strategies, it’s certainly a conversation worth having with a knowledgeable healthcare provider.

Like every other intervention we’ve discussed, soy isoflavones work best as part of a larger lifestyle that includes regular movement, adequate protein, and a nutrient-rich diet.

Botanical Support

If you’re a lover of herbal medicine like I am, there are a handful of botanicals that may provide additional support for bone health. While the research isn’t as strong as it is for nutrition, exercise, or soy isoflavones, herbs have a long tradition of being used to nourish the body and can be a beautiful complement to an overall bone-supportive lifestyle.

Some of my favorites include:

• Nettle – A mineral-rich herb that’s naturally high in calcium and other trace minerals. I love it as a long-steeped infusion.

• Oatstraw – Another deeply nourishing, mineral-rich herb that has traditionally been used to support healthy bones and connective tissue.

• Red Clover – Rich in isoflavones, red clover has been studied for its potential role in supporting bone health during menopause.

• Herbal vinegars – Infusing mineral-rich herbs into apple cider vinegar is a traditional way of extracting minerals while creating a delicious addition to salads and vegetables.

I don’t think of these herbs as miracle cures. I think of them as another way to gently nourish the body over time: one cup of nettle tea, one nourishing meal, one walk, one strength session at a time.

Medical Interventions Have a Place

Nutrition, movement, and smart supplementation go a long way, but for some women they aren’t enough on their own, and that’s not a failure. It just means the body needs more support.

Hormone replacement therapy is one of the most effective tools we have for protecting bone density, and timing matters. Menopause hormone therapy tends to work best when started during perimenopause, closer to when estrogen first begins to decline. For women experiencing early menopause, whether from a total hysterectomy, ovarian failure, or other causes, hormone therapy can be especially important for preventing osteoporosis, since they’re losing estrogen’s protective effects earlier and for longer than most.

If bone loss is already significant, pharmaceutical treatment may be the right next step. Bisphosphonates, like Fosamax, are among the most commonly prescribed, slowing the rate at which bone breaks down. Other options include SERMs and calcitonin, each working through a different mechanism.

None of these are decisions to make alone. Work with your doctor to understand your bone density, your personal risk factors, and which of these tools, if any, makes sense for you.

The Bottom Line

The internet has a funny way of making healthy aging feel incredibly complicated. One day you’re told to lift heavy or you’ll become frail. The next day everyone is talking about creatine. Then collagen. Then protein powders. Then another supplement you’ve never heard of. The reality is much less dramatic and overwhelming.

Protecting your muscles and bones doesn’t require perfection and a $500/month supplement bill. It requires consistency. Move your body in ways you genuinely enjoy, challenge your muscles a 2-3 times each week, eat enough protein from real food, build meals around nutrient-dense whole foods, and spend time outside. It’s that simple.

Unfortunately simple doesn’t make the wellness industry billions of dollars. And sometimes simple feels harder to accomplish without the right support in place. That’s where nutrition professionals and personal trainers come in.

If you’re approaching menopause, talk with a trusted healthcare provider about whether interventions like menopause hormone therapy or soy isoflavones are appropriate for you based on your individual health history.

One thing I want to leave you with is this:

I don’t want women to become afraid of aging, I want us to become prepared for it. There’s a huge difference. Aging isn’t something we have to fight it’s something we can support.

And every walk you take, every nourishing meal you eat, every time you challenge your muscles—even just a little—you are making an investment in the woman you’ll become 20 or 30 years from now.

That feels like a much healthier way to think about aging than living in fear of it, wouldn’t you say?

References

Agostini, D., Donati Zeppa, S., Lucertini, F., Annibalini, G., Gervasi, M., Ferri Marini, C., Piccoli, G., Stocchi, V., Barbieri, E., & Sestili, P. (2018). Muscle and bone health in postmenopausal women: Role of protein and vitamin D supplementation combined with exercise training. Nutrients, 10(8), 1103. https://doi.org/10.3390/nu10081103

Chilibeck, P. D., Candow, D. G., Gordon, J. J., Duff, W. R. D., Mason, R., Shaw, K., Taylor-Gjevre, R., Nair, B., & Zello, G. A. (2023). A 2-yr randomized controlled trial on creatine supplementation during exercise for postmenopausal bone health. Medicine & Science in Sports & Exercise, 55(10), 1750–1760. https://doi.org/10.1249/MSS.0000000000003202

Ma, D.-F., Qin, L.-Q., Wang, P.-Y., & Katoh, R. (2008). Soy isoflavone intake inhibits bone resorption and stimulates bone formation in menopausal women: Meta-analysis of randomized controlled trials. European Journal of Clinical Nutrition, 62(2), 155–161. https://doi.org/10.1038/sj.ejcn.1602748

Mahan, L. K., & Raymond, J. L. (2017). Krause’s food and the nutrition care process (14th ed.). Elsevier.

Pawlowski, J. W., Martin, B. R., McCabe, G. P., McCabe, L., Jackson, G. S., Peacock, M., Barnes, S., & Weaver, C. M. (2015). Impact of equol-producing capacity and soy-isoflavone profiles of supplements on bone calcium retention in postmenopausal women: A randomized crossover trial. American Journal of Clinical Nutrition, 102(3), 695–703. https://doi.org/10.3945/ajcn.114.093906

Study of Women’s Health Across the Nation. (n.d.). SWAN: Study of Women’s Health Across the Nation. Retrieved August 11, 2026, from https://www.swanstudy.org/

Tai, V., Leung, W., Grey, A., Reid, I. R., & Bolland, M. J. (2015). Calcium intake and bone mineral density: Systematic review and meta-analysis. BMJ, 351, h4183. https://doi.org/10.1136/bmj.h4183

Weed, S. (2008, October). Anti-cancer lifestyle: Nourishing and tonifying herbs & mineral-rich medicinal vinegars. Wise Woman Herbal Ezine, 8(10). http://www.susunweed.com/herbal_ezine/October08/anti-cancer.htm

Zheng, X., Lee, S.-K., & Chun, O. K. (2016). Soy isoflavones and osteoporotic bone loss: A review with an emphasis on modulation of bone remodeling. Journal of Medicinal Food, 19(1), 1–14. https://doi.org/10.1089/jmf.2015.0045

It was 4am. I had barely slept and I knew that my then two-year-old daughter would be waking up in an hour or two (I mean who really knows when a two year old is going to wake up?). I was staring at the ceiling wondering: how the hell did I end up here? I was burnt out beyond measure. Not the kind that gets fixed with a bubble bath or a day off of parenting. The kind where your nervous system feels like it’s been running a marathon for the past three years.

I was feeling terrified about my health, both mentally and physically. Terrified about our finances. Most of all, I was worried that this was simply what adulthood was supposed to feel like.

You see, up until that point in time, my partner (god bless him) had been the primary breadwinner in our family as a professional snowboarder. Which sounds glamorous until you’re in your late thirties and realize that sponsorship checks don’t necessarily come with a 401k and tend to disappear with age. For years, his career had allowed me the flexibility to build my nutrition practice at my own pace while spending more time with our daughter. But suddenly the math was no longer mathing.

We had a beautiful home in Lake Tahoe, the kind of house people dream about. We backed up to national forest land and could walk to the beach. We could mountain bike and snowboard out of our backyard. It was our dream house. The problem was, a house this dreamy also comes with dream-house sized expenses. These expenses required a significant amount of energy in the form of work, pressure, hustle, and stress.

I tried to convince myself that we could make it work. We’ll just hustle harder. We’ll figure it out. People figure this stuff out, right?

Turns out that kind of thinking is a recipe for burnout and a freight train of anxiety. What nobody tells you is that parenting is already a full-time job in itself. Maintaining a household is another full-time job. Managing appointments, grocery shopping, meals, emotions, being a present and sane parent, health, a dog, and an endless laundry pile is another two full-time jobs. Then, in the remaining hours we’re supposed to, what, squeeze a career in that mix? Are you kidding me?!

Eventually I started realizing that I wasn’t failing. The system was failing me. I founs myself right smack in the middle of “The Big Squeeze” season of life. The period when there simply isn’t enough time, energy, money or mental bandwidth to do everything asked of us. Somehow our modern culture keeps insisting that the answer is always more. More efficiency, more productivity, more achievement, more optimization, more peptide therapies, more subscriptions, more stuff, nicer cars, bigger house, you catch my drift.

But what if, WHAT IF, the answer is less?

One of the ideas that has stuck with me from a book I recently read called Having It All by Corinne Low is that every choice creates tradeoffs, whether we acknowledge them or not. We can pretend those tradeoffs don’t exist, but eventually reality will send us the bill. For our family, the bill was showing up in the form of stress, anxiety, sleepless nights, and a nervous system that was completely dysregulated.

Around this impossible time, I convinced myself that I had found our answer. I figured that if I just found a carrot to dangle over our head to get us to move, maybe it would make it easier to sell our house.

Enter: me applying to school to become a Naturopathic Doctor. This I had wanted to do for years and thought the ship had sailed once I became a mother. But now with my husband’s career slowing down, I saw a window of opportunity. This had been a dream of mine for years and it felt like the perfect reason to make a major life change. So within two months I was accepted into the program, we sold our house in Tahoe, and downsized to a smaller house in Portland that cost roughly 1/3 of what our house in Tahoe cost.

It happened that fast. I knew it was going to be a rip the bandaid off kind of a situation.

And then, almost immediately, my plans unraveled.

Changes in federal financial aid and higher education accretidation created instability and uncertainty across the entire profession and made pursuing the degree far less feasible than I had anticipated. The carrot I had dangled to get us to Portland disappeared.

And yet, something strange happened amidst all of the rubble. I was actually - way more relaxed? I felt better, not entirely devastated, not entirely defeated, but maybe relieved? For the first time in a few years I could feel my nervous system exhale. The thing I thought was the solution, medical school, turned out not to be the solution at all. The solution was to create space.

Space in our finances, space in our schedule, space in our nervous systems. Space to actually enjoy the life we were trying to build.

As a functional medicine clinician I spend a lot of time talking about food, exercise, sleep, hormones, and protocols. Those things matter. But sometimes (oftentimes) the most powerful intervention isn’t a supplement. Sometimes its selling the house, changing jobs, asking for help, or hiring a house cleaner. Sometimes it’s realizing the peptide craze is praying on women’s vulnerabilities and cancelling the subscription (I said what I said).

Making the decision to sell off and get out of our high overhead decisions was the best decision we have made as parents. Specifically for me as a mother for my mental (and thus physical) health.

“Having it all” often requires defining what “all” actually means for you in your current season of life. I used to think “all” meant the dream house, thriving business, motherhood, medical school, big paycheck, physical health, and enough free time to vacation. Looking back on that, I was trying to carry way more than any one person reasonably can.

Sometimes the prescription isn’t adding something. It’s often removing something, and unfortunately that’d a prescription most health care providers aren’t trained to write. I’m not suggesting the answer for you is the same as it was for me. You may not need a drastic life change.

But I do think every one of us can ask the same question: what is creating unnecessary pressure in my life? And perhaps more importantly, what would happen if I let it go? Because, dear reader, health isn’t just about what we eat. It’s about the environment we live in. The expectations of ourselves that we carry. Obligations we’ve accepted and committed to. The pace at which we have chosen to live our lives.

When we consciously choose to make a big decision like this - we’re actually making a vote to free up energy and time. Energy and time are what enable us to stay healthy humans.

Sometimes improving your health starts with eating more protein. Sometimes it starts with making one brave decision that creates enough space for you to finally breath again. For me, it was selling the dream house. And oddly enough, letting go of the dream gave me a life I’m proud to be living.

I’d Love to Hear From You

Have you ever made a big life change that improved your health in ways you didn’t expect?

I’d love to hear your story in the comments.

I just finished a certification through Yale School of Public Health on behavior change (fancy, I know, I put it on my LinkedIn immediately) and honestly? It kind of wrecked how I think about helping people not only get “healthy,” but to heal from long-term chronic health issues. And I’ve been doing this for almost ten years. It quickly becomes a slippery slope to grab for the “quick fix” in the form of a supplement or a prescription referral when you can sense the desperation in another’s desire to get well.

The reality of integrative healthcare, functional medicine, naturopathic medicine, or whatever label we choose to use, is this: lasting health rarely comes from a pill, a supplement, or a single protocol. It comes from doing the often slow, uncomfortable work of changing the foundation on which life is built.

That’s also why so many people feel like they’re failing. Real healing asks us to change how we eat, sleep, move, manage stress, build relationships, and care for ourselves. There are no shortcuts around that.

Despite what some influencers would have you believe, no supplement is going to single-handedly “cure” your Hashimoto’s or reverse years of physiological dysfunction. Supplements can absolutely be valuable tools, but they’re just that, tools. The person who ultimately moves the needle is you. No practitioner, protocol, or product can do the work on your behalf.

Here’s my confession: for the first few years of clinical practice, I genuinely assumed that if someone came to me for help, they’d go home and just... do the things we talked about. Eat the broccoli. Do the pilates twice a week. Get better sleep. Take the supplements. Just do it, right?

Turns out “just do it” works great for Nike and terribly for the majority of real human beings, because behavior change has shockingly little to do with willpower and everything to do with the environment they are living in. The proof of this is in the fact that recent data shows that less than 1% of the population eats a nutritionally adequate diet while the top 10 chronic diseases in this country are all diet and lifestyle related. Knowledge and information is not the problem.

Why is changing so hard though?

For starters, none of us are working with the same constraints. Some of you have toddlers who wake up at 4am for no reason (personal experience, and yes I’m still recovering). Some of you are caring for aging parents. Some of you are navigating chronic illness, or ADHD, or depression, or financial stress, or grief, or a demanding job, or perimenopause, or if the universe has a sense of humor, several of those at once. Every single decision you make costs you energy, and energy is not an infinite resource no matter how good your intentions are.

Second thing: our brains are gorgeously, annoyingly well-designed to chase immediate rewards and dodge immediate discomfort. Which means your brain would rather watch one more episode of ______ (insert: Grey’s Anatomy, The Bachelor, The Kardashian’s, etc.) than meal prep vegetables. And that’s not a character flaw, that’s just being human. Behavioral psychology has known this for decades. We’re honestly not that different from dogs (I say this with love) — we move toward what feels good and away from what feels hard.

The good news buried in that is this: if that’s actually how our brains work, we can stop fighting them and start working with them instead. So let’s discuss this further.

Stop relying on willpower

This was probably the biggest thing I took from the whole course. Willpower is finite. Life is busy. Kids get sick. Work turns into chaos with zero notice. Somebody forgets to thaw the chicken (it’s usually me, and I’m sure it’s usually you too). If your health plan depends entirely on staying motivated, you are setting yourself up to fail, because motivation is a notoriously unreliable coworker who shows up late and leaves early.

So instead of asking “how do I get more disciplined,” the research pushes you toward a completely different question: how do I make the “healthy” choice, the choice that I know I need to make to imrove my _____ (insert: energy, fatigue, hormone balance, autoimmune condition, anxiety, weight, etc) the easy choice? That one shift changes basically everything. Here are the strategies from the literature I keep coming back to.

1. Start embarrassingly small. The biggest mistake people make is trying to overhaul everything at once. We wildly overestimate what we can pull off in a week and wildly underestimate what we can build in a year. Want to start exercising? Don’t commit to an hour at the gym. Commit to putting your shoes on. That’s it. Once the shoes are on, a short walk suddenly doesn’t feel like such a big ask. This isn’t about heroic effort it’s about lowering the activation energy required to even start.

2. Make your goals SMART. “I want to eat healthier” is a lovely intention and a genuinely terrible goal. The research is clear that goals land better when they’re Specific, Measurable, Achievable, Relevant, and Time-bound. So instead of saying “I’m going to exercise more,” try “I’m walking for 15 minutes after dinner Monday, Wednesday, and Friday.” Your brain stops having to negotiate with you every single day. It just has to follow the plan you already made.

3. Borrow habits you already have. Your brain loves a routine, so instead of building a brand new one from scratch, staple your new behavior onto something you’re already doing on autopilot. After I brush my teeth, I floss one tooth. After I make my morning tea, I take my supplements. After dinner, we walk the block. Behavior scientists call these implementation intentions, or habit stacking. I call it doing Future You a favor.

4. Stop depending on your memory. You don’t have a memory problem, dear reader, you have a cue problem. And not only is it a cue problem, it’s a “we’re all trying to do way too much these days and the human brain cannot keep up” problem. Your environment is already telling you what to do next all day long, whether you notice it or not, so make it work in your favor instead of against you. Vitamins next to the kettle. Walking shoes by the front door. A sticky note on the mirror. A phone reminder. Wash the fruit and leave it out in a bowl instead of letting it become a science experiment in the crisper drawer (we’ve all been there). Researchers call these prompts, and sometimes what you actually need isn’t more motivation it’s a better reminder sitting right where you’ll see it.

5. Bribe yourself. I know how that sounds. It also just works. One of my favorite concepts from the whole course was the Premack Principle: pair something you need to do with something you already love doing. Only let yourself listen to your favorite podcast while walking. Only watch your show while sitting on a spin bike. Or if you’re a Type A perfectionist in recovery like me, only let yourself sit down to pound out e-mails and blog writing once you’ve done a morning meditation. You’re not relying on discipline here, you’re letting pleasure pull the healthy behavior along behind it. Adults respond to bribery just as much as kids do we’re just better at pretending we’re above it.

6. Celebrate the small wins, actually celebrate them. AA has understood this for decades and there’s a reason people get sobriety chips. The chip doesn’t create the recovery, it creates evidence that change is actually happening. And this matters more than we give it credit for. Psychologists call this token reinforcement: every time you acknowledge progress, you make the behavior more likely to happen again. Maybe your version isn’t a chip. Maybe it’s an X on the calendar, a checked box in a habit tracker, moving a marble between two jars, five bucks into the vacation fund every week you hit your walking goal. The reward itself isn’t really the point reinforcing the identity underneath it is.

7. Become the kind of person who... This might’ve been my favorite lesson in the whole certification. Instead of anchoring only to outcomes such as “I want to lose twenty pounds,” try anchoring to identity instead. “I’m becoming someone who prioritizes sleep.” “I’m becoming someone who nourishes her body and takes the time to quiet my mind and rest.” “I’m becoming someone who takes the walk even on the chaotic days.” Identity tends to outlast motivation by a mile, and every small action becomes one more vote for the person you’re actually becoming.

8. Make your environment work for you, not against you. This theme came up over and over in the training: environment matters, a lot, arguably more than knowledge does. In nutrition research, one of the strongest predictors of what people eat isn’t what they know it’s what’s available, and honestly, what everyone around them is eating too. Food marketing, portion sizes, convenience, what’s processed and what’s not, your physical surroundings…all of it shapes your decisions long before willpower ever gets a vote. Which is why I push clients toward designing an environment that supports the goal instead of chasing perfection. Eat at the table, not in front of the TV. Keep the healthy stuff visible. Hide the stuff that turns into mindless habit. Make the healthy choice the easy choice. And (this is the absolute hardest truth to have to confront) take a good look at the people you are surrounding yourself with. Do their choices and behaviors support who it is you are trying to become? Future you will genuinely thank present you for this one.

I tried this on myself while taking the course

Listen, I’m a mom to a four-year old who is at home all summer, I’m coping with the early stages of perimenopause, and I’m running a practice. I have no hidden superpower. I am a flawed human being, just like you. So for two months I forced myself to put these tools into practice in my own life to see what I might learn before I taught them to anyone else.

The thing I really struggle with most is stopping long enough to find mental stillness. Left alone I will “to-do list” myself into the ground. So my focus for the two months of “behavior-change” was to Premack Principle my way into meditating or doing Qi-Gong daily. I was not allowed to start the sprint of my day until I did something to quiet my mind first. Some days this required me to ask a neighbor to hang out with my daughter. Some days it required me to hide in a closet. But I got it done.

And here’s what I learned: once the change actually became a part of my routine, I started craving it. I recognized how much better I felt with it in the line up.

What I got wrong before this Yale Certification

So let’s circle back on the assumption I mentioned, that if people came to me for help they’d just do what I told them to do.

For years I worked with chronically ill patients that were desperate to get their lives back. These individuals are heroes in my book. They’re dragging themselves through the day, doing their own healthcare research, advocating for themselves at appointments, showing up exhausted, and still going home and doing the things we recommended. I’ve been there myself, it was a dark period in my life and I don’t say that lightly.

Here is what I assumed having walked that path both myself and alongside others: that EVERYONE operates this way. Even the people who weren’t quite at the same level of desperation yet. This assumption was wrong. As it turns out, it usually takes real desperation to translate knowledge into action. And that’s the problem.

You see, desperation is not a fun place to build change from. We’re so much better off making these changes while the symptoms are still subtle whispers instead of waiting until they’re shrieking screams and we can no longer hold down a job. And here’s the thing, no matter where someone is on the chronically ill spectrum, it’s all the same changes that still need to be made either way. They’re so much easier to make when we still have a glimmer of functionality to work with. Instead of using our limited energy on things that don’t pay us back (I’m talking to you late night out at the bar), we can put that same energy toward building the foundations instead.

One last thing

As clinicians, we spend an enormous amount of time telling people what they should do. Eat more vegetables. Exercise. Sleep. Manage your stress. Drink more water. None of that advice is wrong exactly. It’s just incomplete because the much harder and much more interesting question is: how do we actually help people do those things in the middle of real, messy, unfolded-laundry, un-made bed kind of life?

Because behavior change doesn’t happen in a vacuum. It happens in kitchens with laundry piled on the table, in carpool lines, in the middle of perimenopause, while caring for young kids and aging parents, while working full time, while grieving something, while standing in the pantry trying to remember what you walked in there for in the first place.

Health isn’t built by turning into a different person overnight. It’s built by designing a life that makes the healthy choice just a little bit easier than it was yesterday. So instead of asking “why don’t I have more willpower,” try asking “how can I make this easier on myself.” Lasting change was never really about trying harder it’s about working with your beautifully, stubbornly human brain instead of constantly fighting it.

And if Yale reinforced one thing for me, it’s this: small changes, repeated consistently, almost always beat one month of heroic effort followed by total burnout. I’d take that bet every single time.

I’d love to hear from you — what’s one tiny habit you’ve actually managed to make stick over the years, and what finally made it click?

If you’d like to dive deeper…

Books

• Atomic Habits — still one of the best books out there on building habits through small, sustainable change and smart environmental design.

• Full Catastrophe Living — a classic on mindfulness-based stress reduction and building resilience through life’s inevitable messes. (This came up as a recommended resource in the Yale course.)

Behavior Change Research

• Yale School of Public Health, Health Behavior Change: From Evidence to Action — the certification course that sparked this whole post, covering the psychology of behavior change, nutrition, physical activity, and public health interventions.

• Gollwitzer, P.M. (1999), Implementation Intentions: Strong Effects of Simple Plans — the foundational paper showing “if-then” planning dramatically boosts follow-through.

• Locke, E.A. & Latham, G.P. (2002), Building a Practically Useful Theory of Goal Setting and Task Motivation — the classic research behind SMART goals.

• Bandura, Self-Efficacy: The Exercise of Control — the work that changed how we think about behavior change through the lens of self-belief.

Nutrition & Healthy Habits

• NIDDK, Changing Habits for Better Health — a practical, evidence-based guide to building habits instead of relying on willpower.

• World Health Organization, Healthy Diet Fact Sheet — a solid overview of healthy dietary patterns grounded in global public health evidence.

• Office of Disease Prevention and Health Promotion, Dietary Guidelines for Americans.

Physical Activity

• Office of Disease Prevention and Health Promotion, Move Your Way — one of my favorite public health campaigns, because it makes clear that movement doesn’t have to mean the gym. Walking the dog, gardening, dancing around your kitchen, chasing your kids around the yard — all of it counts.

Mental Health

• SAMHSA — solid information on mental health conditions, finding treatment, and supporting yourself or someone you love.

“Your Labs Are Normal.”

I hear this sentence from new clients more than almost anything else. Every single time, I have to fight the urge to say “okay, and?” Not because it’s wrong. Your labs probably ARE normal. But normal and fine are doing a lot of very different work in that sentence and nobody ever stops to unpack it.

This is what I see time and time again: Someone comes to me exhausted like, waking-up-after-eight-hours-and-still-wanting-to-cry exhausted. Their digestion’s gone sideways. Hair’s thinning. They’re anxious for no reason they can point to. They used to be able to build muscle and now their body just... won’t. Maybe the periods got heavier, maybe the hot flashes started, maybe their brain feels like it’s wrapped in gauze.

But what gives, they did the responsible thing. They went to their doctor, they got blood work, then a few days later they got the message every single one of them describes to me with the exact same flat, deflated tone:

Everything looks normal.

So why don’t they feel normal?

What routine labs are actually built to do

Here’s a misconception I run into constantly: people assume all blood work is asking the same question. It’s not. Routine labs in primary care exist to answer one very specific thing, “Is there disease here that needs a diagnosis and a treatment plan?” That’s it. That’s the whole job.

Your healthcare system is genuinely excellent at that job. If your thyroid is failing, if you’re seriously anemic, if your kidneys are struggling, if your blood sugar has crossed into diabetic territory we absolutely want to catch that. Routine labs save lives, full stop, no sarcasm.

However ,“looking for disease” and “looking for optimal function” are not the same search. There is an enormous amount of room between thriving and technically not sick yet, and that gap is where I live professionally.

Health is not a light switch

I explain this to almost every client with the same image: health isn’t a light switch, it’s a dimmer.

Most of us were raised to think you’re either healthy or you’re sick, on or off. In reality it’s a slider. Maybe you’re sleeping seven hours and never once waking up feeling like a person. Maybe your iron isn’t low enough to earn an anemia diagnosis, but it’s low enough that you’re dragging yourself through every single afternoon by 2pm. Maybe your blood sugar isn’t diabetic, but it’s on a rollercoaster all day that’s quietly feeding your fatigue, your cravings, your inflammation. Maybe your thyroid panel comes back “within range” and your body is still waving a flag that says something needs a closer look.

This is the gap that functional medicine fills in health care. It’s the space between the two ends of the dimmer.

I’m looking for clues, not verdicts

One of my favorite things about doing this work is that I get to stay curious instead of getting to a checkbox. I’m not asking “what’s the diagnosis.” I’m asking “why is your body asking for help right now.”

Lab work gives me clues. Sometimes those clues come from standard bloodwork. Sometimes from more specialized functional testing. Honestly, sometimes the single most useful clue in the whole appointment is just listening to someone tell me their story, in their own words, without me interrupting to steer it toward a number.

What testing looks like when you sit across from me

Depending on someone’s history and what they’re really trying to solve, I might pull or order things like:

• Comprehensive blood chemistry and a CBC

• Iron studies and ferritin

• B12 and folate

• Vitamin D

• Thyroid markers

• Blood sugar and insulin

• Lipids and inflammatory markers

Sometimes that covers it completely. Other times, someone’s symptoms are telling me there’s more to find, and that’s when functional testing comes into play. For example; comprehensive stool testing to look at the gut microbiome and digestive inflammation, micronutrient testing to catch deficiencies that don’t show up on a standard panel, food sensitivity testing when it actually fits the clinical picture (not as a standalone verdict), hormone testing for the perimenopause transitions, and everything that comes with them.

None of this is a template. Every recommendation gets built around the human being sitting in front of me and every human sitting in front of me is different.

Testing is not the goal, I promise

Here’s a thing people assume about functional medicine that drives me a little nuts: that we love ordering a giant stack of expensive tests. We don’t. I’d genuinely rather not, most of the time.

Collecting data for the sake of collecting data isn’t the point. The point is gathering just enough real information to build a plan that actually makes someone feel like themselves again. Sometimes that takes specialized testing and other times it flatly doesn’t. Honestly, one of my favorite sentences to say out loud in an appointment is “I don’t think you need that test.” People are always surprised to hear it. I say it anyway.

The lab result never changes your health. Its your habits that will.

This is the part I want you to actually sit with: no lab result, by itself, ever made anyone healthier. Your habits do that work. The lab result just tells us where to focus the habits.

Maybe that means more protein, correcting an iron deficiency, or gut repair. Maybe it means going back to your physician to chase down something unexpected together. The testing is the map, not some big intervention. You still have to walk the road.

The point of all of this

I love this work because I get to operate in the space before disease shows up, whenever I possibly can. The goal was never just “don’t get sick.” The goal is being energetic enough to actually play with your kids on the floor instead of watching from the couch. Strong enough to hike the mountain instead of turning back at the trailhead. Clear enough in your head to enjoy the work you do all day. Resilient enough to take life’s inevitable gut punches without falling apart.

Lab work is one tool that helps me see where you are today and where your body might be quietly asking for a little more support.

So tell me, dear reader: have you ever been handed the “everything looks normal” line while every part of you knew that wasn’t the whole story? I’d genuinely love to hear it in the comments.

Leave a comment

Suddenly everyone’s talking about estrogen patches.

Hormone therapy.

Hot flashes.

Progesterone.

Protein.

Heavy lifting.

Creatine.

You’d think we all woke up one day and collectively decided that menopause was the newest wellness trend.

But beneath all of the social media conversations is a much more important question:

What is actually happening inside my body?

Because if you’re anything like me, understanding the physiology takes away some of the fear.

When we know why something is happening, it suddenly feels a whole lot less scary.

So let’s walk through what actually happens during one of the biggest biological transitions of our lives.

Act I: The Rumblings

For many people, perimenopause begins quietly.

In fact, it often begins before we realize it.

Although the average age of menopause is around 51, hormonal changes can begin in the late 30s or even earlier for some people. Genetics, smoking, certain medical conditions, and surgeries can all influence when this transition begins.

One of the earliest changes isn’t actually estrogen.

It’s ovulation.

As our ovarian follicle reserve naturally declines with age, ovulation becomes less consistent. That means progesterone—our primary hormone after ovulation—often begins declining before estrogen does.

This is one reason many people notice:

• worsening PMS

• heavier periods

• increased anxiety

• sleep disturbances

• breast tenderness

• mood swings

even while their menstrual cycles are still fairly regular.

At this stage, estrogen is often still being produced in healthy amounts.

It’s just becoming a little... unpredictable.

Supporting your body during this stage

This is one of my favorite times to work with someone because small changes can have a surprisingly large impact.

Rather than trying to “fix” hormones, think about supporting the systems that hormones rely on.

I typically encourage people to focus on:

• Protein: Aim for approximately 25–35 grams of protein per meal to support muscle mass, blood sugar regulation, and hormone production.

• Strength training: Muscle becomes one of your greatest allies as estrogen begins to fluctuate.

• Stress resilience: This is often when chronic stress starts becoming less forgiving.

Herbal support can also be helpful for some people.

For those experiencing anxiety, irritability, or difficulty sleeping, herbs such as ashwagandha (for some individuals), lemon balm, passionflower, or chamomile may help support the nervous system, although they’re not appropriate for everyone and should always be considered within the context of your overall health.

If heavy periods are beginning to develop, it’s also worth checking iron status (including ferritin) before assuming fatigue is simply “getting older.”

Act II: The Rollercoaster

This is the stage most people think of when they hear the word perimenopause.

It can last anywhere from two to ten years.

And honestly?

It’s a bit of a hormonal rollercoaster.

Instead of estrogen steadily declining, it often swings dramatically from month to month—or even day to day.

Some cycles produce plenty of estrogen.

Others produce much less.

The brain notices these fluctuations long before our calendars do.

Because estrogen does far more than regulate the menstrual cycle.

It influences:

• the brain

• serotonin and dopamine signaling

• sleep

• body temperature regulation

• bone remodeling

• muscle maintenance

• insulin sensitivity

• cardiovascular health

• vaginal tissue

• skin and collagen production

When estrogen fluctuates, many people experience symptoms such as:

• irregular periods

• hot flashes

• night sweats

• brain fog

• increased anxiety

• irritability

• lower stress resilience

• joint aches

• decreased libido

• vaginal dryness

• weight redistribution

• difficulty sleeping

Not everyone experiences all of these symptoms.

Some experience very few.

Others feel like someone replaced their body overnight.

Neither experience is “wrong.”

Why Does It Feel Like My Nervous System Is Falling Apart?

This is one of the questions I hear most often.

The answer is fascinating.

Estrogen communicates directly with the brain.

It influences neurotransmitters including serotonin, dopamine, GABA, and norepinephrine—all of which play important roles in mood, motivation, focus, and emotional regulation.

As estrogen fluctuates, many people notice they become less resilient to stress.

Things that once rolled off your back suddenly feel enormous.

You’re not imagining it.

Your nervous system is adapting to a changing hormonal environment.

This is also why nutrition, sleep, movement, social support, and stress management become even more important during this phase of life.

Supporting your body during this stage

This is where consistency becomes more important than perfection.

When hormones feel unpredictable, your routines become your anchor.

Some of the areas I focus on most include:

• prioritizing adequate protein at every meal

• increasing dietary fiber (30+ grams/day if tolerated) to support the gut microbiome and healthy estrogen metabolism

• consuming omega-3-rich foods like salmon, sardines, walnuts, flaxseed, and chia seeds

• resistance training two to four times per week

• regular walking and other enjoyable movement

Many people also benefit from paying closer attention to:

• alcohol intake (which often becomes less well tolerated)

• caffeine (which may worsen anxiety or hot flashes for some)

• sleep consistency

Depending on someone’s symptoms and medical history, herbs with emerging evidence such as black cohosh may help reduce vasomotor symptoms like hot flashes, while sage has also shown promise for some individuals.

Others may benefit from botanical approaches tailored to mood, sleep, or stress physiology.

This is one of the reasons I encourage individualized care rather than recommending the same supplement to everyone.

Act III: The Finish Line

Menopause itself is actually one single day.

Surprised?

The medical definition of menopause is simply 12 consecutive months without a menstrual period, assuming there isn’t another medical explanation.

That’s it.

Everything before that is perimenopause.

Everything after that is postmenopause.

By this point, the ovaries have dramatically reduced their production of estrogen and progesterone.

The hormonal fluctuations settle.

Ironically, some people actually begin feeling more emotionally stable after menopause because the unpredictable hormonal swings have stopped.

Supporting your body during this stage

This is often when I encourage people to think about playing the long game.

Because estrogen helps protect bone, muscle, and cardiovascular health, this becomes an ideal time to prioritize:

• resistance training

• adequate calcium intake through food (women need around 1000mg daily)

• optimizing vitamin D status

• sufficient protein intake (1.2-1.5g/kg body weight)

• balance training and mobility work

It’s also worth discussing menopause hormone therapy with your healthcare provider if you’re experiencing significant symptoms or have concerns about long-term health.

For many people, it can be an incredibly helpful tool.

For others, it may not be appropriate.

It’s one option—not the only option.

Act IV: The Next Chapter

Postmenopause isn’t the end. It’s simply a new hormonal landscape.

Lower estrogen affects nearly every organ system in the body. Without estrogen’s protective effects, the risks of osteoporosis, cardiovascular disease, changes in metabolic health, and vaginal and urinary symptoms increase over time.

But here’s the encouraging part. This is also the stage where healthy habits become incredibly powerful.

Resistance training.

Adequate protein.

Sleep.

Stress reduction.

Bone-supportive nutrition.

Cardiovascular fitness.

Strong social relationships.

These are no longer simply “healthy lifestyle choices.” They’re investments in the next several decades of your life.

Hormone therapy may also be an appropriate option for many people, depending on their symptoms, medical history, and personal preferences. It’s one tool in the toolbox—not the entire toolbox.

Supporting your body during this stage

This chapter is less about reacting to hormonal fluctuations and more about building resilience for the decades ahead.

Think of it as investing in your future self.

Some of the most impactful habits include:

• continuing to build and preserve muscle

• eating enough protein (many women under-eat protein as they age)

• prioritizing colorful plant foods rich in polyphenols

• maintaining cardiovascular fitness

• cultivating meaningful relationships and community

• protecting sleep

Interestingly, research consistently shows that these foundational lifestyle habits have profound effects on healthy aging—often rivaling or exceeding many of the latest longevity trends.

The Bigger Picture

One of the things I wish more people understood is that perimenopause isn’t simply about reproductive hormones.

It’s a neurological transition.

A musculoskeletal transition.

A cardiovascular transition.

A metabolic transition.

A psychological transition.

In many ways, it’s a whole-body remodeling project. Which is exactly why this stage deserves so much more attention than it has historically received.

Knowledge doesn’t eliminate uncertainty. But it does replace fear with understanding. And understanding gives us something incredibly valuable: The ability to work with our bodies instead of feeling like they’re working against us.

One thing I want to emphasize is that supplements and herbs are exactly that—supplements.

They’re meant to supplement an already solid foundation, not replace one.

If someone is sleeping four hours a night, chronically overwhelmed, eating very little protein, and not moving their body, no botanical or supplement can fully compensate for those missing pieces.

That’s not meant to be discouraging. I actually find it incredibly hopeful. Because it means so much of our health remains within our influence.

If you remember nothing else from this article, remember this:

Perimenopause is not your body falling apart.

It’s your body changing. And just as your nutritional needs changed during puberty...

Just as they changed during pregnancy...

Just as they changed during postpartum...

They change again here.

This isn’t the beginning of the end. It’s the beginning of learning how to care for your body in a new season of life.

I’d love to hear from you.

In the comments let me know: What surprised you most about the perimenopause transition?

Or, if you’re currently in it, what symptom made you think,

“Wait...no one warned me about this.”

Further Reading

The North American Menopause Society (2023). The Menopause Guidebook.

Santoro, N., & Randolph, J. F. (2011). Reproductive hormones and the menopause transition. Obstetrics & Gynecology Clinics of North America.

Harlow, S. D., et al. (2012). Executive summary of the Stages of Reproductive Aging Workshop +10 (STRAW+10). Menopause.

The American College of Obstetricians and Gynecologists (ACOG). Practice Bulletin: Management of Menopausal Symptoms.

Avis, N. E., et al. Study of Women’s Health Across the Nation (SWAN) publications on the menopause transition.

Black cohosh: Leach MJ, Moore V. Black cohosh (Cimicifuga spp.) for menopausal symptoms. Cochrane Review.

The Menopause Society. (2023). The 2023 nonhormone therapy position statement of The North American Menopause Society. Menopause, 30(6), 573–590.

Harlow, S. D., Gass, M., Hall, J. E., et al. (2012). Executive Summary of the Stages of Reproductive Aging Workshop +10 (STRAW+10): Addressing the Unfinished Agenda of Staging Reproductive Aging. Menopause, 19(4), 387–395.

A few years ago, I thought I knew exactly where my life was headed.

Then life did what it does best.

It changed the plan.

Motherhood changed me.

Loss changed me.

Healing changed me.

A cross-country move changed me.

The work I thought I would do for the rest of my life changed.

Even the way I think about health changed.

Somewhere along the way, I stopped trying so hard to become someone and started paying attention to who I already was.

And somehow, that led me here.

My name is Chelsie Moore. I’m a Functional Nutritionist based in Portland, Oregon, where I work with women (including cis and trans women) navigating perimenopause, hormone imbalances, autoimmune conditions, fatigue, and the many physical and emotional shifts that can come with midlife.

But this space isn’t just about nutrition.

It’s about being human.

It’s about the reality that women are often expected to hold everything together while their bodies are changing beneath them.

It’s about learning to care for ourselves in a culture that constantly tells us to do more, optimize more, achieve more, and somehow make it all look effortless.

It’s about finding our way back to ourselves.

I’ve spent years studying nutrition, functional medicine, and women’s health. I’ve also spent years living through my own challenges—burnout, trauma healing, brain fog, pregnancy, postpartum, major life transitions, and the ongoing process of learning how to inhabit my body with more trust and less criticism.

Those experiences taught me something I wish more people talked about:

Health is not perfection.

Health is a relationship.

A relationship with your body.
A relationship with your mind.
A relationship with the life you’re creating.

And like any relationship, it requires attention, patience, compassion, and a willingness to listen.

So why Substack?

Because I’m tired of pretending meaningful conversations can happen in ten seconds.

Somewhere along the way, health information became sound bites, hot takes, and attention-grabbing headlines.

But women’s health deserves nuance.

Hormones deserve nuance.

Healing deserves nuance.

Life deserves nuance.

I wanted a place where I could slow down.

A place where I could share longer thoughts, deeper conversations, personal stories, clinical insights, and the lessons I’ve gathered from both my professional work and my own life.

Most importantly, I wanted a place where we could explore these topics together without the pressure of algorithms, trends, or clickbait.

What I’ve learned in my 37 years is that life is both beautiful and brutal.

Sometimes at the exact same time.

The moments that have broken me open have often become the moments that shaped me most profoundly.

The seasons that didn’t go according to plan often led somewhere better than I could have imagined.

Again and again, I find myself returning to the same conclusion:

We are not here to do this perfectly.

We are here to live it fully.

For me, that means continuing to serve others in the ways I feel most called to—through my clinical work, through my writing, and through the conversations we’ll have here.

In this space, you’ll find discussions on perimenopause, hormone health, nutrition, mental health, autoimmune disease, nervous system regulation, motherhood, and all the messy, complicated realities of being a woman in today’s world.

I’ll share what I’m learning.

I’ll share what the research says.

I’ll share what has helped me.

And I’ll share the questions I’m still asking.

For now, everything here will be free.

My hope is that something you read makes you feel a little more informed, a little more grounded, and a little less alone.

I’m grateful you’re here.

Welcome.