Fueling & Moving Through the Change: A Menopause Awareness Month Guide

Plants first, variety over volume. Aim for 30+ different plant foods a week — vegetables, fruits, legumes, nuts, seeds, whole grains, herbs, and spices all count. Rotate colors instead of the same “safe” salad daily. Fermented foods (kimchi, sauerkraut, tempeh) support gut health, tied to hormone metabolism.

Rethinking protein. Skip the 180–200g targets aimed at bodybuilders. Simple formula: body weight in pounds ÷ 2 = a reasonable daily minimum in grams (roughly 75–100g for a 150 lb woman). Regular strength training? Lean toward the higher end. Spread it across meals — plant proteins (lentils, beans, tofu, edamame) count too, and bring fiber and phytoestrogens along.

KEY NUTRIENTS + SOURCES:

Calcium: dairy or fortified plant milk, leafy greens, tofu, canned salmon/sardines with bones, almonds

Vitamin D: fatty fish, egg yolks, fortified foods, sun exposure — many benefit from a supplement (ask your doctor)

Omega-3s: fatty fish, walnuts, chia and flax seeds

Fiber: beans, lentils, oats, berries, artichokes, whole grains

Women-specific research points to: heavy strength work, short strategic intensity, and less moderate “in-between” cardio.

Strength, 2–3x/week. Go heavy when you can — struggling to finish 3 reps by your 5th set is a good benchmark — but consistency matters more than the number. Options: free weights (squats, deadlifts, rows, presses), bodyweight (push-ups, step-ups, glute bridges), resistance bands, strength classes (BODYPUMP, barre, functional fitness), or Pilates. Two full-body sessions a week, 20–30 minutes each, is enough. Heavy lifting won’t “bulk you up” — that takes far more volume and food than this.

Add bone-specific jump training. Three 10-minute sessions a week of low-amplitude jumps (jumping jacks, small box jumps, jump squats) — one of the most effective moves for bone density.

Long, easy-paced sessions as your main training can blunt strength gains. Keep intervals short and infrequent — 1–2x/week, ~30 minutes: sprint intervals (30 sec hard/90 sec easy × 6–8), hill sprints, or hard bike/rower work where you can’t talk. Save easy walks and swims for recovery days.

Fuel how your body prefers. A pre-workout protein + carb snack (Greek yogurt with fruit, a shake with a banana) helps some feel steadier. Others — especially the 5am class crowd — feel strongest fasted; the science isn’t settled. Trust what works.

Don’t skip: balance/mobility work (single-leg stands, yoga, tai chi) and real rest days — recovery matters more now.

Ready to put this into practice?

Schedule an appointment with your health coach for personalized guidance on eating and exercising through this transition.

September 11, 2026September 9, 2026

Progesterone Vs. Progestins: What Matters for Menopause Hormone Therapy

While the physicians at Carolina Total Wellness are thrilled that the use of hormone replacement therapy (HRT) in menopause has gained acceptance in conventional medicine and social media conversations, there is one area that is still causing some confusion.

If you are taking or considering taking HRT you may hear two similar-sounding words: progesterone and progestin. They are not the same—and the difference can matter for your long-term safety.

Progesterone is the natural hormone your ovaries made before menopause. The form used in many modern regimens is micronized progesterone—chemically identical to your body’s own hormone. You may hear micronized progesterone described as bio-identical progesterone.

Progestins are synthetic (lab-made) compounds designed to mimic some of progesterone’s effects. Common examples include medroxyprogesterone acetate (MPA), the progestin used in the large Women’s Health Initiative (WHI) trials.

Both can protect the uterine lining when you take estrogen (important if you still have a uterus). At appropriate doses, natural progesterone and synthetic progestins appear similarly effective at preventing endometrial hyperplasia. [1]

The WHI showed that conjugated estrogen plus the synthetic progestin MPA raised breast cancer incidence, while estrogen alone (in women without a uterus) did not and was linked to lower breast cancer rates over long-term follow-up. [2]

Later research comparing formulations suggests the progestogen type is a key factor. Observational data and reviews indicate that estrogen combined with micronized progesterone is associated with a lower breast cancer risk than estrogen plus synthetic progestins. [3][4] One meta-analysis found roughly one-third lower relative breast cancer risk with progesterone versus synthetic progestins when each was paired with estrogen. [4]

Reviews also point to a similar or possibly more favorable profile for cardiovascular and metabolic outcomes with micronized progesterone compared with many synthetic progestins. [1][5][6] Natural progesterone is the preferred choice when breast or cardiovascular risk factors are a concern. [7][6]

What This Means for You

Hormone therapy remains the most effective treatment for bothersome vasomotor symptoms and can support bone, brain, cardiovascular and genitourinary health when started in appropriate candidates. [8][9] If you have a uterus, a progestogen is required with systemic estrogen.

Choosing micronized progesterone (often taken orally at bedtime) is one practical way many clinicians individualize therapy toward a potentially better breast and overall safety profile while still protecting the endometrium. Transdermal estradiol plus oral micronized progesterone is a common evidence-aligned combination.

Therapy should always be personalized—dose, route, timing, and your personal risk factors. If you are interested in HRT or have questions about your current HRT therapy, the physicians at Carolina Total Wellness can help.

June 19, 2026May 13, 2026

What is Visceral Fat—and Why it Matters

Not all body fat is created equal. Visceral fat is the type stored deep inside your abdomen, surrounding vital organs like your liver, pancreas, and intestines. Unlike subcutaneous fat (the kind you can pinch), visceral fat is metabolically active—and that’s where the concern lies.

High levels of visceral fat are strongly linked to insulin resistance, inflammation, and an increased risk of chronic conditions like Type 2 diabetes, heart disease, and metabolic syndrome. Even people at a “normal” weight can carry excess visceral fat, which is why it’s often called hidden fat.

Visceral fat releases inflammatory compounds and hormones that disrupt your body’s normal balance. Over time, this can:

Impair blood sugar control
Increase LDL (“bad”) cholesterol
Elevate blood pressure
Strain liver function

The good news? Visceral fat is highly responsive to diet and lifestyle changes—often more so than other fat stores.

Foods That Help Reduce Visceral Fat

Focusing on whole, nutrient-dense foods can actively support fat loss and metabolic health:

Lean proteins: chicken, fish, eggs, Greek yogurt
Healthy fats: avocados, olive oil, nuts, seeds
High-fiber foods: vegetables, berries, chia seeds, legumes
Whole grains: quinoa, oats, rice
Green tea & polyphenol-rich foods: help support fat metabolism

Protein and fiber are especially powerful—they keep you full, stabilize blood sugar, and reduce cravings.

Foods That Increase Visceral Fat

Regularly consuming the following can promote fat storage around your organs:

Refined carbohydrates: white bread, pastries, sugary cereals
Added sugars: soda, candy, desserts (especially those high in fructose)
Ultra-processed foods: chips, fast food, packaged snacks
Trans fats: found in some fried and processed foods
Excess alcohol: particularly in large or frequent amounts

These foods spike blood sugar and insulin, encouraging fat storage—especially in the abdominal area.

Diet is key—but movement matters just as much. Visceral fat is particularly responsive to exercise, even before you see changes on the scale.

The most effective approaches include:

Strength training: builds muscle, which improves insulin sensitivity and increases metabolic rate
Cardio: especially brisk walking, cycling, or swimming, helps burn stored fat
HIIT (high-intensity interval training): short bursts of intense effort followed by rest can be especially effective

Even moderate, consistent activity (like 30 minutes of walking most days) can significantly lower visceral fat over time.

The Takeaway

You can’t always see visceral fat—but you can influence it daily. Exercising, prioritizing whole foods, balancing blood sugar, and limiting processed sugars and refined carbs can significantly reduce your risk and improve long-term health.

Small, consistent changes = powerful results.

If you’d like to measure your visceral fat and track your progress over time, ask to use our InBody body composition scale during your next visit.

June 5, 2026May 13, 2026

Understanding Peptide Therapy

Peptides are often discussed in wellness and biohacking communities and are one of the fastest growing areas in integrative and functional medicine. However, not all peptides are created equal. Some are FDA-approved medications backed by large clinical trials, while others are experimental compounds with limited human data.

Understanding the difference is critical for making safe, informed decisions about your care.

The human body, and the bacteria in our bodies, produce thousands of peptides. Peptides are powerful, short chains of amino acids that act like signaling molecules in the body, supporting healing, metabolism, and hormone balance. Researchers have known about peptides for decades and over 60 are currently FDA approved for use [4]. In functional medicine, they’re gaining popularity for root-cause wellness, but not all are equal.

FDA-approved peptides undergo rigorous testing in large clinical trials for safety, dosing, and efficacy. The FDA ensures consistent manufacturing and monitors side effects.

Common examples:

• GLP-1 agonists (e.g., semaglutide/Ozempic® or tirzepatide/Zepbound®): Used for type 2 diabetes, sleep apnea, and weight loss by mimicking gut hormones to regulate blood sugar [1,2].

• Teriparatide (Forteo®): Builds bone for osteoporosis [3].

• Leuprolide(Lupron®): Hormone therapy for prostate cancer or endometriosis [3].

Non-FDA-approved peptides (compounded or research-grade) lack this oversight. They’re not tested in humans for specific uses and are sourced from laboratories or compounding pharmacies with variable purity and potency risks. Batch testing has shown a wide variety of potency and contamination between supplies.

Common types:

• BPC-157: Gut healing, tissue repair (investigational)

• Thymosin Beta-4: Wound healing, inflammation

• Ipamorelin/CJC-1295: Growth hormone support for anti-aging and muscle recovery

These peptides are sometimes used off-label in integrative clinics for longevity or injury support, but evidence remains preliminary. Many of the proposed benefits are extrapolated from rodent studies, and the long-term effects in humans remain largely unknown [5].

Approved peptides offer proven benefits with known risks. Non-approved peptides may help symptoms but can also carry risks related to contamination, adverse effects, inconsistent dosing, or unknown long-term outcomes.

For example, one proposed mechanism behind BPC-157 is angiogenesis, or new blood vessel formation. While angiogenesis may support healing, it may also theoretically increase cancer growth in certain settings.

Bottom Line —

Peptides are a promising and rapidly emerging area of medicine, and we expect to see many more become FDA-approved in the coming years [6]. However, the use of experimental, non-approved peptides carries meaningful risks.

At Carolina Total Wellness, we strive to guide patients toward evidence-based therapies and strategies that support health optimization without sacrificing safety.

References

Musaimi OA, Shaer DA, et al. 2017 FDA peptide harvest. Pharmaceuticals. 2018.
Musaimi OA, Shaer DA, et al. 2020 FDA tides (peptides and oligonucleotides) harvest. Pharmaceuticals. 2021.
Zhang H, Chen S. Cyclic peptide drugs approved in the last two decades (2001–2021). 2021.
Ji X, Nielsen AL, Heinis C. Cyclic peptides for drug development. 2023.
Newman D, Cragg G. Natural products as sources of new drugs over the nearly four decades from 1981–2019. 2020.
Papapetropoulos A, Topouzis S, et al. Novel drugs approved by the EMA, FDA, and MHRA in 2023. 2024.
Gattu R, Ramesh SS, et al. Peptide-bioactive hybrid molecules in infectious disease therapeutics. 2023.
Ayala-Aguilera CC, Valero T, et al. Small molecule kinase inhibitor drugs (1995–2021). 2021.
Péczka N, Orgován Z, et al. Electrophilic warheads in covalent drug discovery. 2022.
Dalton SE, Pietro OD, Hennessy E. FDA-approved small molecule drugs with covalent mechanisms of action. 2025.

June 5, 2025

Hormone Health Update: Your Guide to Better Balance in Perimenopause and Post menopause

Understanding Hormone Testing: Why saliva might be the best choice

As women transition through perimenopause and into postmenopause, many experience changes in hormone levels that can affect their energy, mood, sleep, weight, and overall well-being. Hormone Replacement Therapy (HRT) is often used to help manage these symptoms and restore balance. But how do we know if your treatment is working?

That’s where hormone testing comes in

Traditionally, blood (serum) tests have been the standard method for measuring hormone levels. However, advances in medical testing have introduced a powerful alternative: saliva hormone testing. This method offers a more accurate and personalized way to evaluate hormone levels—especially for women using HRT.

Let’s explore why saliva testing may be a better option for many women in this stage of life.

Saliva vs. Serum Testing: What’s the difference?

Why Saliva testing works better for HRT

Topical or sublingual HRT absorbs directly into tissues—not your bloodstream. This means blood tests may not reflect what’s available to your cells.

Saliva testing measures the active, free hormones in your tissues, giving you and your provider a clearer picture.

Especially helpful for

Estradiol

Progesterone

Testosterone

Cortisol (stress hormone)

Advantages of Saliva Testing

Convenient & Stress-Free: Collect at home—no needles, no clinic visits.

Ideal for Topical HRT: Reflects hormone levels that reach your tissues.

More Personalized: Captures daily fluctuations for better dosing accuracy.

Cost-Effective & Non-Invasive: No lab fees or blood draws. Just a simple saliva sample.

Who Should Consider Saliva Testing?

Women in perimenopause (irregular periods, mood swings, hot flashes)

Postmenopausal women on HRT

Anyone seeking a personalized look at hormone balance

Final Thoughts

Hormone balance is not one-size-fits-all.

Saliva testing offers a deeper, more accurate view of your hormones—helping you fine-tune treatment and feel like yourself again.

To schedule an appointment with one of our certified Functional Medicine Physicians, please give us a call. We are excited to partner with you on your journey to optimize your health and wellness through personalized care tailored to your unique needs.

919.999.0831

June 21, 2024June 21, 2024

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Foods for Menopause and Perimenopause

The hormonal shifts that accompany perimenopause and menopause lack a clear instruction manual, often leaving many women in a continuous cycle of trial and error when it comes to managing their symptoms. Fortunately, one of the most potent tools available for regaining control of your hormones is the food you consume. Certain foods contribute to hormone balance and can help alleviate perimenopause and menopause symptoms, while others can disrupt your body’s hormonal equilibrium.

When essential nutritional elements are lacking, hormonal imbalances can arise, leading to mood swings, weight gain, hot flashes, and reduced libido. The primary hormones affected during perimenopause and menopause are estrogen, progesterone, insulin, and testosterone, and your dietary choices can significantly impact these hormones. For instance, excessive sugar consumption can elevate insulin levels, trigger inflammation, and exacerbate nearly every perimenopausal symptom. On the other hand, incorporating vegetables, fruits, nuts, and seeds into your diet can provide phytonutrients and healthy fats that aid in managing even the most challenging menopause symptoms.

While there’s no one-size-fits-all diet, several foods have proven beneficial for most people seeking to balance their hormones:

1. Brassica (aka cruciferous) Vegetables: These include broccoli, cauliflower, kale, and cabbage, which contain indole-3-carbinol—a compound that helps metabolize estrogen in the gut and liver. This can be particularly helpful in addressing estrogen dominance.

2. Healthy Fats: Avocados, nuts, seeds, and fish are rich inomega-3 fatty acids and other fats crucial for reducing inflammation and supporting hormone production, especially progesterone.

3. Fiber-Rich Foods: Fiber is essential for gut health, which plays a critical role in hormone balance. Low-starch fruits and veggies, nuts, seeds, and whole grains can boost your fiber intake, aiding in estrogen metabolism and blood sugar regulation.

However, there are also foods and drinks that should be limited or avoided:

1. Caffeine: Excess caffeine can lead to increased stress hormone production and elevated cortisol levels, potentially exacerbating fatigue and estrogen levels.

2. Processed Carbs and Sugar: As tolerance to sugar decreases with age, limiting simple carbohydrates and sugars (like table sugar, baked goods, and packaged foods) becomes crucial for managing blood sugar and insulin levels.

3. Alcohol: Even moderate alcohol consumption can disrupt hormones, affect brain aging, and lead to elevated insulin levels and estrogen dominance.

4. Gluten: Gluten sensitivity can contribute to gut issues, thyroid problems, and autoimmune conditions, making it advisable to assess its impact on your health

Balancing your diet can ease the transition into perimenopause and menopause, regardless of whether you’re just beginning to experience symptoms or are already in the midst of them. By making thoughtful dietary choices, you can navigate this phase of life with greater vitality and well-being.

Your Partner In Health,

Sara Yadlowsky, FMHC

September 27, 2023September 27, 2023

How does Acupuncture work, and what can it treat?

Katie Depre LAc, LMBT, FABORM, NCCAOM

Though often described as traditional or ancient medicine, research has proven that Acupuncture has its place alongside modern medical practices. Hair-thin needles are placed in precise and therapeutic point locations along meridians. Meridians have been shown to mirror the fascial network of the body. Fascia surrounds all of the organs, muscles, bones, and nerve fibers. These points are located alongside nerve endings and blood vessels, thereby directly influencing blood flow and sensory nerves in the area (2,3). Functional brain imaging has shown changes in the brain when these points are needled (1). Since the brain controls the systems of the body (hormones, blood flow, stress responses, organ function, reproduction, etc.), influencing the brain and nervous system with Acupuncture will impact our health. Treatment encourages the body’s own systems of balance, commonly known as homeostasis.

The National Center for Complementary and Integrative Health outlines many of the researched treatable conditions (4); these include: pain management, osteoarthritis, sciatica, fibromyalgia, cancer pain, irritable bowel syndrome, asthma, depression, allergies, infertility, and menopause symptoms. Though more chronic conditions will require a series of treatment for complete resolution, I have personally witnessed immediate relief from insomnia, digestive complaints, anxiety, and pain in my clinic. Especially because it is a non-pharmaceutical approach, many patients search out Acupuncture for treatment to acute and chronic conditions.

As a Fellow of the Acupuncture and Traditional Chinese Medicine Board of Reproductive Medicine, FABORM, I treat many patients with their fertility goals. By regulating the menses, we can prepare the body for pregnancy. Fertility work is best done weekly for three months prior to conception, as it takes three months for the egg to develop in the ovaries. During times of sympathetic stress (the flight or fight response), blood is shunted away from the ovaries and uterus. This can negatively impact egg quality and the thickness of the uterine lining. By encouraging blood flow to these reproductive organs, switching the nervous system into a parasympathetic state (rest, digest, and repair), and regulating the Hypothalamic-Pituitary-Ovarian Axis, we set the body up for success.

For patients undergoing IVF, the Paulus Protocol is utilized. This is a series of points done before and after an embryo transfer. “Clinical pregnancies were documented in 34 of 80 patients (42.5%) in the acupuncture group, whereas the pregnancy rate was only 26.3% (21 out of 80 patients) in the control group (5).”

Please reach out today if you have specific questions on how Acupuncture can help you realize your health goals!

Warmly,

Katie Depre LAc, LMBT, FABORM, NCCAOM

Sacred-sea.com

(919) 808-2638

Huang W, Pach D, Napadow V, Park K, Long X, Neumann J, Maeda Y, Nierhaus T, Liang F, Witt CM. Characterizing acupuncture stimuli using brain imaging with FMRI–a systematic review and meta-analysis of the literature. PLoS One. 2012;7(4):e32960. doi: 10.1371/journal.pone.0032960. Epub 2012 Apr 9. PMID: 22496739; PMCID: PMC3322129.
Langevin HM, Yandow JA. Relationship of acupuncture points and meridians to connective tissue planes. Anat Rec. 2002 Dec 15;269(6):257-65. doi: 10.1002/ar.10185. PMID: 12467083.
Bai Y, Wang J, Wu JP, Dai JX, Sha O, Tai Wai Yew D, Yuan L, Liang QN. Review of evidence suggesting that the fascia network could be the anatomical basis for acupoints and meridians in the human body. Evid Based Complement Alternat Med. 2011;2011:260510. doi: 10.1155/2011/260510. Epub 2011 Apr 26. PMID: 21584283; PMCID: PMC3092510.
Acupuncture: What You Need to Know. National Center for Complementary and Integrative Health. (2022, October). https://www.nccih.nih.gov/health/acupuncture-what-you-need-to-know

April 15, 2023April 29, 2023

Category: Hormones