Stop Dieting in Perimenopause: Why Calorie Restriction Worsens Cortisol & Autoimmune
Autoimmune AlchemyShow Notes
Today I'm honored to have Dr. Salome Masghati, OB-GYN and pelvic surgeon who transitioned from operating rooms to preventative medicine. Dr. Salome reveals why autoimmune diseases like Hashimoto's, lupus, and RA spike during perimenopause—estrogen is anti-inflammatory, and when it declines, cortisol dysregulates, inflammation rises, and autoimmune flares. She explains why calorie restriction backfires in midlife, worsening cortisol and weight gain, and shares practical steps: morning sunlight, protein breakfasts, resistance training, gut testing, and hormone optimization. Hormones alone aren't enough—you need proper liver detox, gut health, and anti-inflammatory diet to truly heal. Key Takeaways Autoimmune diseases spike in perimenopause when estrogen (anti-inflammatory) declines Cortisol dysregulates when estrogen drops—overactive to compensate Calorie restriction worsens cortisol dysregulation—don't undereat in midlife Start simple: morning sunlight, protein breakfasts, resistance training (not just cardio) Estrogen & testosterone are immune modulators—decline = autoimmune flares Hashimoto's, lupus, RA improve in pregnancy, worsen in menopause Hormones need gut health, liver detox, anti-inflammatory diet to work Heavy/painful periods, cyclical migraines = hormone-related symptoms COVID disrupted gut microbiome—long COVID worsened autoimmune Individualized testing: gut, heavy metals, micronutrients
Chapters & Timestamps 02:00 Cortisol Clues: Exhausted Mornings, Wired Nights 03:00 Why Cortisol Goes Haywire in Perimenopause 05:00 Metabolic Changes: Weight Gain, Insulin Resistance 07:00 Simple Starts: Sunlight, Protein, Resistance Training 10:00 Autoimmune Diseases Spike When Estrogen Declines 12:00 Hormones Need Gut Health & Liver Detox 14:00 When Is Surgery Needed vs Lifestyle? 16:00 Environmental Toxins & COVID Impact 17:00 Beyond Basic Bloodwork Guest Details Salome Masghati, MD — OB-GYN, Pelvic Surgeon & Hormone Specialist Training: OB-GYN, pelvic surgery, regenerative medicine, advanced hormone therapy, preventative wellness Current Focus: Preventative medicine—balancing hormones to prevent surgeries, addressing root causes (gut health, environmental toxins, metabolic dysfunction) Philosophy: Individualized care. Hormones must be balanced with proper liver detox, gut microbiome, anti-inflammatory diet. Connect: Instagram: @drsalomemasghatimd Website: DrsalomemasghatiIndividualized Hormone Therapy for Women | Dr. Salome Masghati
About Your Hosts Micah Yu, MD, MHA, MS, ABOIM, DipABLM, IFMCP Dr. Micah Yu is a triple board-certified integrative rheumatologist who blends conventional medicine with holistic, nutrition-based healing to treat autoimmune and chronic inflammatory conditions. A patient himself, Dr. Yu brings a deeply personal perspective to his work, having reversed his own autoimmune arthritis through lifestyle and integrative medicine. He is certified in internal medicine, rheumatology, integrative medicine, lifestyle medicine, and functional medicine. As the founder of MyAutoimmuneMD and co-founder of Dr. Lifestyle Clinic, Dr. Yu empowers patients to address the root causes of illness and reclaim their health from the inside out. Melissa Mondala, MD, MHA, MS, DipABLM Dr. Melissa Mondala is a dual board-certified physician in Family and Lifestyle Medicine, with advanced training in Integrative Psychiatry and Integrative Medicine. As President of Dr. Lifestyle Clinic in Newport Beach—recognized by UC Irvine as a Public Health Site of Excellence—she pioneers a holistic, patient-centered approach to chronic disease. Dr. Mondala is a nationally recognized Lifestyle Medicine Intensivist, core faculty at Loma Linda University's Preventive Medicine Department, and a passionate advocate for plant-based nutrition, mental health, and women's wellness. A sought-after speaker and educator, she combines cutting-edge science with deep compassion to empower lasting healing, especially for those silently suffering from autoimmun
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