In this episode of unPAUSED, Dr. Mary Claire Haver sits down with Dr. Amy Shah, a physician trained in internal medicine and immunology with a nutrition background from Cornell, and author of the new book Hormone Havoc.
Dr. Haver and Dr. Shah begin the conversation with the gut-hormone-brain connection, explaining how 40% of estrogen is recirculated through the gut, how the estrobolome, the collection of gut bacteria responsible for metabolizing estrogen, determines how much the body retains, and why declining estrogen in perimenopause and menopause triggers a cascade that loosens the tight junctions meant to keep food particles, toxins, and viruses from entering the bloodstream. This leaky gut drives inflammation that accelerates every symptom women are already experiencing, from weight gain and mood changes to sleep disruption and brain health decline. The gut-brain axis, the constant two-way communication between the gut and the brain, means that what is happening in the gut is directly shaping cognitive function, motivation, and emotional resilience in menopause. She also covers how 95% of serotonin is made in the gut, why chronic inflammation reroutes tryptophan away from serotonin and melatonin, and what that means for mood, sleep, and appetite in midlife.
The conversation moves into dysbiosis, what it is, why it is so difficult to diagnose, and why the food sensitivity tests and gut health panels many women are spending thousands of dollars on are currently no more reliable than a coin flip. From there Dr. Shah explains what women can actually do about it through nutrition, which is the foundation of her 30-30-3 framework: 30 grams of protein at the first meal of the day, 30 grams of fiber throughout the day, and three servings of probiotic fermented foods. She covers what each piece does, why most women are falling short on all three, how to read a label to identify genuinely probiotic foods, and why the gut microbiome can shift meaningfully in as little as three days.
Dr. Shah and Dr. Haver also cover cortisol dysregulation and insulin resistance in perimenopause, circadian fasting and why aggressive fasting can backfire for women under stress, and Dr. Shah's 4-3-2-1 exercise framework covering movement, resistance training, heat therapy, and sprints. They also cover the emerging data on fiber intake and Alzheimer's prevention, the anti-inflammatory diet principles that support hormonal and brain health in midlife, and why hormone therapy and nutrition are not competing approaches but complementary ones.
Guest links:
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Dr. Amy Shah (Instagram)
- Dr. Amy Shah
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Dr. Amy Shah (TikTok)
- Save Yourself With Dr. Amy Shah (Apple Podcasts)
Books:
- “Hormone Havoc: A Science-Backed Protocol for Perimenopause and Menopause: Sleep Better. Think Better. Feel Better,” by Dr. Amy Shah
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“The New Perimenopause,” by Dr. Mary Claire Haver
- “The New Menopause," by Dr. Mary Claire Haver
Articles:
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Current Capabilities of Gut Microbiome–Based Diagnostics and the Promise of Clinical Application (The Journal of Infectious Diseases)
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Dietary fiber intake and risk of incident disabling dementia: the Circulatory Risk in Communities Study (Clinical Nutrition)
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Relationship of endogenous circadian melatonin and temperature rhythms to self-reported preference for morning or evening activity in young and older people (Journal of Investigative Medicine)
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Meal Skipping and Shorter Meal Intervals Are Associated with Increased Risk of All-Cause and Cardiovascular Disease Mortality among US Adults (Journal of the Academy of Nutrition and Dietetics)
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American Gut: an Open Platform for Citizen Science Microbiome Research (American Society for Microbiology)
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Association between sauna bathing and fatal cardiovascular and all-cause mortality events (JAMA Internal Medicine)
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Habitual tub bathing and risks of incident coronary heart disease and stroke (BMJ)
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Reversing the Cardiac Effects of Sedentary Aging in Middle Age—A Randomized Controlled Trial: Implications For Heart Failure Prevention (Circulation)
Other Resources:
