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Welcome to The Modern Midlife Collective—where midlife isn’t a crisis, it’s a rebirth. Hosted by Dr. Ade Akindipe, DNP, and Dr. Jillian Woodruff, MD, this is the podcast for women ready to unapologetically own their power, thrive through the ups and downs of hormones, weight, and self-care, and show the world that thriving at 40 and beyond isn’t just possible—it’s your birthright.
Biweekly, we bring you science-backed insights on hormones, menopause, longevity, and sexual health—real tools to empower women in midlife and beyond. With a fearless blend of functional medicine, real-life wisdom, and no-nonsense empowerment, we’re here to challenge the norms, break through the barriers, and help you step into a life of vitality, confidence, and unstoppable strength.
Ready to rise? Let’s do this.
Jillian Woodruff MD (00:25)
Welcome back to the Modern Midlife Collective. If you listen to part one of my conversation with functional nutritionist Ashley Koch, you know we covered a lot of ground. had so much to talk about, so we simply kept recording. We just kept talking and decided to break this into two parts so we could give this topic the depth that it deserves. So today this is just a continuation of that conversation. So if you didn't hear.
Modern Midlife Collective episode 27. Then go back and listen to that one. It was from two weeks ago. And this is episode 28. So just a reminder, Ashley is a dear friend of mine who has provided both nutrition and metabolic care for myself, many members of my family, and many of my patients. So she's deeply passionate about nutrition and gut health.
and especially how both of those things impact women in midlife. So Ashley, thank you for continuing this conversation with me. There's so much to talk about. So for anyone that may be jumping in at this episode, can you just briefly reintroduce yourself and what you do?
Ashley Koch, MS, CNS (01:31)
Yeah, I'm so happy to be here and keep talking. I am a functional nutritionist. I am based out of Portland, Oregon, but I work with clients in a range of states across the country, including Alaska, Oregon, Washington, California. And I have a background, a master's in functional medicine and nutrition. And I know Dr. Day has talked about functional medicine on this podcast in the past.
And it's very similar to lifestyle medicine, really understanding the choices we're making every day. There's a why as to why our body is having these symptoms or showing these diseases. And we can use nutrition and lifestyle factors to influence the outcomes and get more relief in our body. And so I practice nutrition and lifestyle medicine through that lens of really trying to understand what's happening in your body, why it's happening, and then figure out how to improve the landscape in your body so you get the results you're wanting and you feel better.
Jillian Woodruff MD (02:23)
Thank you and thanks for mentioning Dr. Day. She was not with us the last episode since this is just one long conversation. She's not here today, but this is something also like Ashley mentioned that she's passionate about and that she takes care of in her office every day, metabolic health, gut health and weight. So this is something she is super interested in, but we are going to bring this to you again today. And part one.
What did we do? We basically laid the foundation for what is really happening metabolically in midlife. And we talked about this sort of metabolic recalibration that takes place and how estrogen shifts affect insulin sensitivity. They affect fat distribution where you carry your fat, muscle mass. We unpacked these hormonal drivers and this deeper metabolic shift that occurs.
and began exploring how nutrition has to shift with the physiology instead of fighting against it. So Ashley, when it comes to the gut, people are hearing more than ever about how it influences everything from metabolism to mood to even brain health. And estrogen does not only influence our ovaries, it's not only the sex hormone, but it also influences, as we said, fat distribution.
digestion, inflammation, the movement of our gut, our gut motility, and the microbial diversity, and the gut microbiome really fascinates me. So tell us, what is changing in digestion during perimenopause and menopause?
Ashley Koch, MS, CNS (03:55)
Yeah, so there's a lot that's happening in midlife with digestion. And I'd say about half of the clients I get to interact with are coming with one of their top symptoms being something's changed with digestion. Or maybe they've had some digestive issues a lot of their life, and then at midlife, those digestive issues get amplified. And that's incredibly common. And so we see a few things that start happening. One is that the microbiome changes it really the diversity of the microbiome, which
We haven't really talked about the gut microbiome and I don't know how much you have on your podcast, but essentially the gut microbiome are trillions of organisms that live in your digestive tract. It really starts from your mouth and it goes all the way to your stool. You have those organisms in your mouth, you have them all down that digestive tract, and then the majority of them are in your colon. What we understand is really important about the gut microbiome is that we have a diversity of organisms living there. There's a lot of commensal organisms that protect our health.
And then there's some pathogenic ones and we all have pathogenic ones, but we want balance in there. And what we see in midlife is that women start to see a decline in the commensal, the beneficial bacteria, which then can create an imbalance and it can help the not so beneficial bacteria thrive. And that can create problems for digestion. We also see a change in gut permeability. So in your digestive tract, you have a barrier, like you have a skin barrier.
You have a barrier that protects things from getting out of your digestive tract into the rest of your body. And we also know with midlife, with the decline in estrogen, that barrier becomes more permeable and things can escape through that barrier into the rest of the body and create inflammation. So we see a decline in bacteria that are positive. We see more gut permeability and we also see changes in motility, how fast food moves from mouth to stool. And that can create issues like bloating or all kinds of symptoms.
I'd say, I see clients with stool changes, reflux, brain fog. It can look like fatigue after eating or fatigue in any time of the day. But mostly there's a lot of women experience bloating or constipation can happen as well.
Jillian Woodruff MD (05:58)
I personally noticed that my digestion has changed in a very specific way, whereas in the past I could have steak and it would be fine. know, great. I can have whatever size, whatever I want, the steak and I feel good. Now, if I were to have steak, if I go out to restaurant afterwards, I'm going to feel bloated. Probably it's going to disrupt my sleep because I feel like I'm just uncomfortable and so I have a hard time falling asleep and just feel a lot of
gas. I just, you know, avoid steak. If I go out, definitely do maybe a bite of somebody else's. That's it. Because I just don't want to feel bad like that.
Ashley Koch, MS, CNS (06:35)
Yeah, yeah, there's definitely sometimes we notice so there's other things that could be happening too. So one thing is that as we age, some of us lose digestive enzymes. And so if you think about steak or beef, it takes a lot to digest that and you need to be able to break down the protein and fat. And so I see some women as they're getting, they're moving further in life, they start having a reduction in digestive support to break down foods. So then they start eliminating those foods from their diet.
⁓ which maybe that's the right way to go. Or sometimes it's about working on digestion. So how do we give you the digestive support, like a digestive enzyme, to help you in breaking down stakes so you can get the beneficial amino acids and some of the other things that come with steak like iron? Or I also see in midlife, some women get increased in food sensitivities or intolerances that they didn't have prior to midlife.
And that can happen because of the leaky gut, the intestinal permeability. If your gut is leaky and now things are spilling out of the gut that shouldn't be getting out of the gut, foods can be leaving the gut in ways that create inflammation in other parts of the body and so that's inflammatory. So sometimes that gut permeability leads to more food sensitivities and so we have to really work on the gut barrier function so that women can keep a tolerance to a lot of foods.
I also think what's interesting with digestion is that we can also see digestion impact glucose metabolism. So if we have a reduction in beneficial bacteria that help us break down glucose, then we're gonna see that it's harder to control our blood sugar when we take in carbohydrate rich foods. And so there's also even the gut microbiome impacts our glucose control. And then some women can start seeing their A1C creeping up towards pre-diabetic ranges.
And when A1C is creeping up, we know that's inflammatory. That's going to tell our body to build more fat and store more fat. And it creates a vicious cycle. And then with women reducing the good bacteria, they stop making enough of these things called short-chain fatty acids. And short-chain fatty acids help us with insulin sensitivity. So it's this vicious cycle. Like all of these things compile on top of each other. So I think what I want women to understand, like when they come in and see me and they say,
my A1c is elevated, I'm bloated, I'm having digestive symptoms, and I don't know why. We can explain this is very normal in midlife and there's things that we can do about it. There's shifts we can make in your lifestyle so you can be more comfortable and not end up with diabetes and not be bloated all the time. There are solutions to these challenges and these shifts that we're going to naturally experience in midlife and beyond.
Jillian Woodruff MD (09:03)
You just shared so much information. Fascinating. You basically described a series of processes that happen or that can happen, be happening in our body that all lead to the same symptom, one of which is bloating. So you can have bloating from food intolerances, food sensitivities, the digestion not breaking down the same way, inflammation from leaky gut, I mean,
This is overload and so important. it may end, but the important thing I guess that we should grasp from this is that there are changes that we can make that you can help us and direct us in that could eliminate some of these issues or things that we think are issues like an intolerance or sensitivity. We could reverse that with the changes that we make.
or things that we may need to adopt into our diet or supplements like those digestive enzymes can help us to have what we need in order to break down or metabolize our food and use it.
Ashley Koch, MS, CNS (10:05)
Yeah, and I think we also have to be cautious about, know, there's a lot of supplements, digestive enzymes on the market. There's not all of them are created equal. And so there are tools we can use to improve digestion. For some women, we do a gut reset. So we might, they might be having a lot of sensitivities and bloating and we can do a lot of work to relieve that. And often when I'm done working with clients, they're no longer bloated. They're a lot more comfortable. And then we get back some of those foods they weren't eating back into their diet.
That often can happen. So it's not just because you're sensitive to a food now doesn't mean you're always going to be and there could be some work you can do. And I encourage you to work with someone who does work on digestive health because there are some tools that are great and then there's a lot of tools that aren't. So we want to make sure we're working with someone who's using the right tools because not all of the supplements or digestive enzymes are created equal.
Jillian Woodruff MD (10:55)
Exactly. I also think it's important to add something here from the gynecologic side because the connection of the gut health and the hormones is incredibly important. Inside, and please, you help me if you can explain this better, because you probably have tools that you use, but inside the digestive tract, we have bacteria that help process and regulate our hormones. So as we said, estrogen affects the gut, but the gut also affects our estrogen.
So after estrogen is being used by the body, it's like packaged up and it's sent to the gut to be eliminated. And certain bacteria can reactivate it and allow it to be reabsorbed into our circulation. So if the gut environment is balanced, that recycling process happens and it's regulated appropriately. But when the gut is inflamed or disrupted or leaky or disrupted from stress or our diet or alcohol or other things, the hormone regulation can shift.
And this leads to our fluctuating hormone levels or fluctuating estrogen levels and then symptoms of estrogen excess or not having enough estrogen. So it's not just bloating and our gut, but about how it affects the hormone balance and then how the hormone balance affects the gut.
Ashley Koch, MS, CNS (12:10)
Yeah, yeah, I think this is something we've talked about in the past when we've shared patients. So estrogen needs an exit. And so I really struggle with women who are constipated. They need to focus. The first thing I want them to do is work on constipation because bowel movements is how things exit the body. And so estrogen, we know, is beautiful and helpful, and it can create a lot of positive things in the body, and then it becomes toxic. And so then it gets sent to the liver, and the liver packages it up.
if it has all the nutrients it needs, which is amino acids, B vitamins, of nutrients the liver needs to be able to take that estrogen, makes it more toxic. And then the liver sends that estrogen to the colon and that's where the colon binds it and sends it out with bowel movements in that same cycle you were just talking about. And that cycle is impossible without beneficial bacteria in the colon. So we have to protect those.
And it's also not possible if we don't support ourselves with nutrition. So one of the biggest tools for that is fiber. That estrogen cannot get bound and taken out of the bowel movement without fiber. And yet we look at how much fiber Americans are eating. We have a huge fiber gap. We're talking so much about protein and protein is really important, but we've got to close the fiber gap. And so women who are having breast tenderness and perimetopause or having PMS,
Those are symptoms that estrogen is not leaving the body properly or constipation. And so I think it's really important to know that you have to pay attention to constipation and your fiber intake if you want this process to go well in your body. And it is this like reinforcing loop. So now you're not eating fiber, you're constipated, you're reabsorbing toxic estrogen over and over again, and it puts a burden on your body and it can increase your risk for other issues.
Jillian Woodruff MD (13:51)
Yes, let's make this really practical because we do here eat more fiber all the time or get more fiber, I should say. But do we actually know what this means? Maybe you can explain the difference between soluble and insoluble fiber in a way that really makes sense for us when we're out grocery shopping or we're ordering our groceries.
Ashley Koch, MS, CNS (14:10)
Yeah.
Yeah, this is where I start with clients. Like one of the first things I try to do is get them to eat more soluble fiber. That's probably one of the first asks I make of most of my clients. And so soluble fiber comes in, there's several foods I rely on. There's things like beans and lentils, which not everyone can digest really well. And if you can't, that's something we can work on. We have tools on how we help you digest beans and lentils. Soluble fiber is also comes in ⁓ avocado.
It comes in a couple of vegetables that are vital like carrots, sweet potato, broccoli. Then we also have it in chia and flax seeds. And so when I work with clients, I want to increase your soluble fiber. We're really supposed to be getting four to five servings of soluble fiber a day, and that's a lot. So I encourage clients to start spreading out their day. And how do you add soluble fiber to breakfast? How do you add soluble fiber to lunch? How do you add soluble fiber to dinner? And I really think most people should be eating about four meals a day with protein and fiber.
⁓ So even that's I don't call it a snack but that fourth meal like how do you get soluble fiber in it? So that could look like at breakfast having avocado or chia seeds with your breakfast and that's about one medium avocado or two tablespoons of chia seeds and then at lunch if you tolerate beans and lentils that could be eating, you know, three-quarters of a cup of beans or lentils at lunch and then at dinner I always try to have one of those vegetables. So the sweet potato, the Brussels sprouts, the broccoli or the carrots. How do we have those at dinner every night?
And so now you have soluble fiber three times a day. So I encourage clients to start with one meal. What meal can you add soluble fiber to? And once you get really good at that, what's the second meal you can add it to? And then I think of insoluble fiber as all the other vegetables, right? And so I encourage clients when you're building a plate, the way I'm thinking about a plate is like, where is my soluble fiber? Where are my other vegetables? And where is my protein? Those are some of the checklists that I'd be thinking about. And so I see insoluble fiber as all the other
All the other vegetables, and those are incredibly valuable. We're supposed to be eating eight to 10 vegetables a day. So if you are getting to that higher number, then you're gonna get a lot of insoluble fiber. And both of those things combined help you have healthy bowel movements and help the movement of food from mouth to stool. So lots of insoluble fiber and lots of soluble fiber.
Jillian Woodruff MD (16:19)
So what do you think about fiber supplements, the powders that you can put in water or in your smoothie or whatnot?
Ashley Koch, MS, CNS (16:25)
Yeah, so I play with those for sure. I think what we know for a fact is that the gut microbiome likes diversity. So the fiber, the soluble fiber you're eating will get to the colon intact and then it will get eaten by the bacteria and they'll create short chain fatty acids that help heal your colon. And those are great and we want them through food as much as possible, but I do play with soluble fiber supplements. I look for good quality ones and I like soluble fiber supplements that have variety.
You know, we have got psyllium husk, that's great. But then there are some on the market that have psyllium husk and they have other things in it that are valuable, other soluble fibers. So I will play with those with clients. And for some super busy clients who can't get two meals, three days, three meals a day, you might use a soluble fiber supplement to fill in the gaps. ⁓ Sun fiber is a great fiber. So there's a lot of different fiber products on the market. They're not all created equal. I love to supplement with soluble fiber.
I don't often supplement with insoluble fiber. I think we can get enough of that through the diet.
Jillian Woodruff MD (17:22)
Great, what about super greens? Are those just other fiber supplements?
Ashley Koch, MS, CNS (17:27)
I'm not familiar with Super Greens, so I can't speak to Super Greens, that product, but there are...
Jillian Woodruff MD (17:32)
or another product, in general, you know,
they have things where you can like grow your own super greens or, and they're just smaller micro, yes, that's what it is. Micro greens, yes.
Ashley Koch, MS, CNS (17:38)
Micro like microgreens. ⁓ yeah, I love
microgreens not because of their fiber content. I love them because they have tons of like polyphenols or like little like you can get broccoli microgreens and they're like super powered. But like a broccoli microgreens is going to have a different benefit than broccoli. So a piece of broccoli has a lot of soluble fiber versus a microgreens does not have as much soluble fiber. But I love microgreens like I think sprinkling them on whatever you're eating is going to add.
like nutrient power to that bowl of food. And we know variety of plants is important for the diet. And so microgreens create a lot more diversity in your diet by just sprinkling them on everything.
Jillian Woodruff MD (18:16)
That is really good information. Did we talk about protein last time?
Ashley Koch, MS, CNS (18:21)
So we did not get to talk about protein last time, so I'm excited to talk about it today.
Jillian Woodruff MD (18:26)
Because I think we do need to talk about it sooner rather than later because of the connection as well. We're hearing, get more fiber, but of course there's a lot of talk about the protein, the amount of protein that we need, our muscle mass, especially midlife, our physiology shifts, it's sarcopenia, or the loss of our muscle starts earlier than most people realize. And muscle is one of the biggest drivers of insulin sensitivity.
How should women think differently about protein in midlife?
Ashley Koch, MS, CNS (18:56)
Yeah, so I think if you are a woman on social media in this time that you're getting in midlife, you're getting plenty of messages that you should be thinking about protein. And I think they're valuable. Like I think there is a place for protein. I think their protein is unique to each individual. It sort of depends on your circumstances, but we need protein. We're made up of protein. Every inch of our body is made up of protein. And what really happens in midlife, not just for protein, but in general, is we have a high metabolic demand for good nutrition.
we are burning less calories than we used to and we are struggling to balance, know, visceral fat versus muscle in this time. And so our body needs a lot of quality nutrients. Like the bite at the end of the fork, we get to eat less because we're burning less every day and we have to be really smart about it. And protein needs to be a big part of what's on that plate. There are different protein levels depending on what you're working on. So I work with a lot of clients on weight health.
And when you're working on weight health, the protein intake might be really different than when you're working on maintaining your weight because you're at a healthy weight. And so for women, I like to think about, you having protein at every meal? Somewhere upwards of 25 plus grams per meal of protein when possible.
But I also tell women, listen to your body. Like if someone told you, should be eating 25 grams of protein at breakfast and you eat and you're feeling full at like 80 % of your plate is gone and you didn't finish the 25 grams, I don't feel passionate that you need to, you know, force yourself to do that. You gotta listen to your body, but being mindful that you are trying to meet your protein needs at every meal and you start your meal with fiber and protein. Those are the things like your body definitely needs fiber and protein. Many women are overdoing it on the carbohydrate front and that...
is not as valuable as the protein and the fiber. And fiber rich foods have carbohydrates. We don't need an abundance of them at this stage in life, depending on what we're working on. Unless you're, you know, there are some people who need a little more carbohydrates than others.
Jillian Woodruff MD (20:50)
When you talk about overdoing carbohydrates, are you referring to women who are restricting their carbohydrates in this time? Is that what you're talking about or am I off?
Ashley Koch, MS, CNS (20:56)
⁓
I think not necessarily restriction, but I think there is a balance. we do need some carbohydrates. I see a lot of women that are metabolically not as healthy as they should be. So they have pre-diabetes, they have a high fasting insulin, they have a high fasting glucose, they're showing more insulin resistance. And a lot of times you get there, one of the reasons you get there is you've been overdoing carbohydrates for too long.
So if you think about it, if you take in too many carbohydrates, things like pasta, rice, bread, excess, too much fruit, you can get a blood sugar spike and you're not balancing it with protein and fiber. You get blood sugar spikes and your blood sugar spikes because you're taking in more glucose than you need. So sometimes women do this at night. They have a big bowl of rice with whatever they're eating and then they sit on the couch. Now their body's like, we didn't need all that glucose. So now we're sitting on the couch, we get a glucose spike and that excess glucose, our body has to figure out what to do with it.
So we can either use it, but if we're sitting on the couch, we're not necessarily using it or we have to store it. So we turn that glucose into triglycerides and we store it as fat. And so a lot of people get to this insulin resistance because they've been taking in way more carbohydrates than their body needed. And now their cells are tired. They're like, gosh, we constantly keep seeing too much glucose. so those individuals have probably been overdoing carbohydrates for far too long and we need to pull back and balance that.
And then we do see some women who start gaining weight in midlife and their solution is to start under fueling, eat less to balance their weight. And then they start cutting carbohydrates. And that can be challenging too. You need some carbohydrates. We don't want to cut out all the carbohydrates. We want you to sleep well. We want you to still build as much hormones as you can. And so I think there's issues restricting too much in either direction, under fueling or over fueling.
Jillian Woodruff MD (22:39)
Right, I like how you say that, that with the fueling, because that's what we are supposed to be eating to support our body's processes and eating the correct foods to fuel our body to do what it needs to do. You talked about glucose and being stored as triglycerides and high cholesterol and high blood sugar, something that we see going hand in hand. And if you have one without the other, great, but it can increase your risk of having the other, which then
It's like, it's another cycle that's happening in the body. One thing leading to another leading back to itself. So I do see also that people have normal, perhaps even normal total cholesterol levels, but they have high triglycerides. And I'm always looking for, is there a medication that's increasing their triglycerides? And sometimes they don't have a high fasting blood sugar or a high overall blood sugar like the hemoglobin A1C.
Are you seeing this in your clients that they are taking in maybe over fueling with carbohydrates and is the triglyceride load, could that be a sign that that's what's happening?
Ashley Koch, MS, CNS (23:44)
Yeah, definitely. That can be a sign. even if you're, cause we know that A1C doesn't tell us everything, right? So maybe A1C is looking good, but it doesn't tell us everything about glucose metabolism. And so high triglycerides can be a sign that they're overdoing carbohydrates or possibly alcohol. So we have to consider those factors when we see the elevated triglycerides and really pay attention and assess like the overall diet, look at how much carbohydrates they're taking in or look at things like alcohol consumption.
Jillian Woodruff MD (24:12)
Okay, then I think we do have to talk about alcohol. So there is research that suggests there is no safe amount of alcohol for women when it comes to longevity. It may be different for men, so you can talk about that, but many midlife women use alcohol as a way of relieving stress and their evening routine. So from a metabolic and gut perspective, what is alcohol actually doing in our bodies?
Ashley Koch, MS, CNS (24:35)
Yeah, so I think alcohol is very personal, but it's something we need to think about when having these conversations. It really depends on what's going on in your health. But so often we've highlight how the alcohol is impacting the liver, but we also know it impacts our hormones, our gut, our overall metabolism, our sleep, and other factors. And there isn't a lot of research that...
links a positive relationship between our body and alcohol. So we have to really acknowledge that and the conversation is changing. We used
have a conversation as if alcohol was a great tool for our overall metabolic health. And it really, there's no signs of that. And so is there a place for alcohol in your life? Possibly. For me, I know the risks of alcohol and that doesn't mean I don't occasionally participate. But if you're working on certain things, it might be one of the factors that's impacting you. So we know it can disrupt the gut.
We've talked about the consequences of the disrupted gut. We know it can increase inflammation. It can lead to increase in visceral fat. It can impact our hormones. We also know it can impact how insulin sensitive or insulin resistant we are. And we definitely know it disrupts sleep. And for women in midlife, sleep is incredibly important. And disrupted sleep can lead to more metabolic health issues. So we need sleep so that we can protect our overall health. So there's a vicious cycle that's happening. ⁓ And we have to consider and step back.
and think about our relationship with alcohol. And if we're using alcohol as a tool to manage stress, it's increasing our stress. So it's not a great stress management tool. We're spiking cortisol in midlife, a lot more than we were prior. And then we're drinking this thing that we think is relieving our stress, but it's adding to the vicious cycle of increasing stress on the body. So it's not a great stress reliever. So if women wanna talk about it, I encourage them to think about how they're using it and why they're using it. And is it actually doing what they think it's doing?
Jillian Woodruff MD (26:24)
Right, from the
alcohol significantly interferes with how the liver processes estrogen. So yet another thing that can impact how we get estrogen out of our body, how metabolites can build up in our body instead of the active estrogen that we need to feel good. You brought up cortisol. I think that is also something that is very important. So cortisol.
and stress, right, and stress increases our cortisol levels. So how does cortisol affect our gut?
Ashley Koch, MS, CNS (26:54)
Yeah, so that's a good question. I think when we look, I don't know if I have an answer to how it impacts the gut microbiome entirely. What I do know about cortisol and the gut microbiome, there's probably more to this picture. But what I do know is that stress and cortisol leads to more leaky gut. And so there's many things that lead to leaky gut. know, medication use, antibiotic use, stress. We also know ibuprofen can increase leaky gut.
Toxins can increase leaky gut, eating a lot of inflammatory foods can increase leaky gut, but stress and cortisol can increase leaky gut and leaky gut intestinal permeability leads to more inflammation. And so we have to think about, you know, if we add more stress to the body, it's going to have an impact on that gut permeability. And one of our goals is to try to protect our gut permeability.
Jillian Woodruff MD (27:41)
I think people are many women are saying that they're eating clean. They're doing the same things that they've always done. They're doing everything right, but stress is high. Sleep is fragmented. The gut doesn't function in the same way, which is, you know, really difficult. So we are trying to move with it, right? And we can't adopt every we could, I guess. But I think it's really difficult to change everything at the same time and not everything.
is a priority for us. One thing may be a priority over something else. So I think we have to make the changes that will be most beneficial to each of us individually.
Ashley Koch, MS, CNS (28:19)
Yeah, we've talked earlier about personalized. We practice a personalized approach to care. so everyone's starting point is different. So meeting people where they are. So what are you coming in? What are your biggest priorities? Why are they your priorities? And then understanding and peeling back the layers as to what could be impacting that. And so for some, that means working on digestion. For others, that might be their relationship with alcohol. For others, that might be needing hormones. So you're
personalized approach depends on what's important to you in that moment. It might be about wanting to sleep better. You know, what is the thing getting in the way of your life? And so all of these things we're talking about are great ideas and we're not expecting perfect. We're just trying to figure out how can we improve your health with small changes over time, but not doing everything overnight.
Jillian Woodruff MD (29:03)
What is something women believe about midlife metabolism that simply isn't true? Any myths?
Ashley Koch, MS, CNS (29:08)
Let's see, that's a hard question. Let me think about that. that women think that they should eat less to get better results. So that is something I encounter, know, women doing a lot. So I think it's not always eat less. So I had a client come in, she has mostly been on a low carbohydrate, you know, Mediterranean like diet.
and she's very thoughtful about her carbohydrates. She was paying attention to them all the time. And when I looked at what she was eating, she wasn't eating soluble fiber. so soluble fiber are carbohydrates. we added back soluble fiber, things like sweet potatoes and avocados, and we added in beans and lentils. And she actually felt full. She felt less hungry. She felt less restricted. And she thought coming to see a nutritionist meant we were gonna pull lots of things out.
she didn't realize it might mean we're gonna push some things in. And so I think we're under fueling because we think that's a solution to weight health and that is not always the solution to weight health. Weight health happens in an ecosystem of your body and there's more levers to pull and that it's not just restriction and eating less. So I think that's one myth that women encounter when thinking about this chapter.
Jillian Woodruff MD (30:19)
Yeah, that's a good one. And we talked about timing of eating. You mentioned having fiber and protein with each meal. Is there something to eating the order in which you eat your foods or is that a myth? Is there something to have your protein before you have your carbohydrates when you're at the table eating your plate?
Ashley Koch, MS, CNS (30:39)
Yeah, so I think there's a couple things to think about there. We do see in research that eating either protein first or fiber first can improve your blood sugar. So if you plan to eat something like potatoes or french fries or rice, it is better to start with your fiber and your protein and then move to that. You're going to get a better blood sugar response. So that's one factor. The other thing is fiber and protein makes us feel full. So protein makes us feel satiated. Fiber makes us feel satiated.
So if we're getting enough of those foods, we're gonna wanna eat less of the carbohydrates that are not serving us. so knowing that the reason, so sometimes people get to the end of the day, they tell me what they eat for breakfast, lunch and dinner, we go through their food journal, and I realize they're eating very little fiber, and they're eating very little protein, and then at the end of the day, all they wanna do is eat sugar. You're going to crave carbohydrates and sugar if you're not getting enough protein and fiber. So I think that's something that's really important to pay attention to is,
Getting enough of that means you're satiated and you don't need to just keep reaching for more carbohydrates is really valuable.
Jillian Woodruff MD (31:41)
That is valuable. You know, if women walk away from this episode having heard just one message about midlife nutrition from you, what should that message be?
Ashley Koch, MS, CNS (31:50)
I think that we're having a moment in midlife where we're talking about all of these things happening to women's bodies and changes and shifts and how we support them. One thing I think is still missing from the conversation is that nutrition matters. And so I'm lucky to get to work with providers like Dr. Day and share patients with her. And I'm lucky to get to work with you because as medical providers, you believe nutrition matters. But this should be a much bigger conversation.
than it is. And so we're talking a lot about hormones, and we're talking a lot about certain supplements that need to be in this conversation, but nutrition needs to be in the conversation. And if we're talking so much in this country about metabolic health, it starts in the kitchen. It starts with what's on your plate. And so I think nutrition is missing from the conversation. We know for some women in midlife, they'll explore things like HRT. But we also know some women won't, and nutrition is a major lever. So
we see women can get a reduction in their symptoms as much as 30 % by just changing what they're eating. And so I think it's really important, whether you do HRT or not, nutrition is something you do every day. You put food in your mouth several times a day, and it matters in this conversation in midlife. And it should definitely be a conversation more providers are having with their patients and sending them in the direction to professionals that really understand what they're thinking about when it comes to nutrition.
Jillian Woodruff MD (33:08)
Midlife isn't a decline, right? It's a recalibration, it's information. And I think when we understand what's happening in our bodies physiologically, what's happening in the gut, in our muscles, in our hormones, we can respond with a strategy, especially if we have a guide like you that can take us through this journey of shifting with our shift and really walking into our power with information.
So thank you, Ashley, for continuing this conversation with me. And I know we've been talking for a very long time now. You have so much wisdom to share. Tell our listeners where they can find you and how they can work with you.
Ashley Koch, MS, CNS (33:48)
Yeah, thank you so much for having me. It's been great talking about all this with you. And if you want to reach out and find me, my website is ashleyknutrition.com. You can find me there. You can send me a message and reach out. I'd love to connect.
Jillian Woodruff MD (34:01)
And we'll certainly add your information to this week's show notes as well. It's already in last week's or two weeks ago now. But thank you so much again for being with us and thank you listeners for being here and listening to this very important conversation. I now have many other questions that I will certainly want to get to perhaps with Ashley again. But if you have any topics that you want to hear about, can email us.
at connect at modernmidlifecollective.com. Thank you for listening.