004: Waking up at 3am, gaining weight—and you have no idea why?

You did everything right. You noticed something had shifted. You went to your doctor — maybe more than once. You described what you were experiencing as clearly and completely as you could. And you were told, in some version of the same sentence, that everything looked normal. That your labs were fine. That it might be stress, aging, or part of this stage of life.

You left without answers. And you left still feeling the same way.

This is a common experience for many women in their 40s and 50s — during the years of perimenopause and the transition into menopause.

Understanding why this happens begins with understanding how conventional medicine is designed to work — and where it can fall short when it comes to your health during this phase.

By the end of this episode, you will understand why conventional medicine often does not have the full picture during these years — and what a genuinely different approach begins to make visible.

It starts further back than most people realize — all the way to 1910.

In 1910, a report commissioned by the Carnegie Foundation — with significant backing from John D. Rockefeller — fundamentally changed the direction of medical education in the United States. The Flexner Report, as it became known, led to the standardization of medical schools around pharmaceutical and surgical approaches. Schools that taught nutritional, naturopathic, and other natural approaches to healing lost their accreditation. Funding flowed toward the new model. The old approaches were set aside.

This was not an accident of history. Rockefeller had significant financial interests in the pharmaceutical industry. A medical system oriented toward drugs and procedures served those interests directly. And the educational model that emerged from that moment — the one still in place today — reflects those origins.

The consequences show up in ways that are measurable and documented. Doctors today graduate having received, on average, fewer than 20 hours of nutrition training in their entire medical education. Twenty hours. In a degree that determines how they will care for you for the rest of their careers.

This is not a criticism of individual doctors. Most are working as well as they can within a system that simply was not designed to address what your body actually needs — particularly during these years. It is simply an honest look at how the system came to be, and where its limits show up most clearly.

For women navigating perimenopause and the transition into menopause, the gap is felt in a particularly direct way.

This phase of life responds most powerfully to nutritional and lifestyle support. It requires an understanding of the whole body — how hormones, gut health, nutrition, stress, and sleep interact with each other. It requires time, listening, and a willingness to look at patterns rather than snapshots.

That is precisely what the current system was not designed to provide.

The numbers behind this are worth sitting with for a moment.

A 2025 national survey of over 1,000 US women found that only 15% felt adequately informed about perimenopause when their symptoms began. Only 26% learned about it from their primary care provider or OB/GYN. And nearly 40% of women who sought care for perimenopause symptoms felt they had been misdiagnosed — many receiving prescriptions for anxiety or depression while the hormonal and nutritional picture went completely unaddressed.

These are not women who failed to describe their experience clearly. These are women who showed up, spoke honestly about what they were experiencing, and were sent home with either no answer — or the wrong one entirely.

In Episode 001, we looked at why the majority of OB/GYN residency programs in the United States do not include a dedicated menopause curriculum — and why most residents finish their training feeling unprepared to support women through this phase. Only 31% of those programs include a dedicated, structured menopause curriculum. When your doctor graduates with fewer than 20 hours of nutrition education and little to no preparation for perimenopause, the gaps you experience in the exam room are not surprising. They are the predictable result of how that education was shaped.

And it does not stop at the training gap. Part of what makes this so frustrating — and so disorienting — is what happens when you do finally get tested.

When you go in for hormone testing, what you are usually given is a standard panel — estrogen and FSH, which stands for follicle-stimulating hormone. It is a single snapshot taken on a single day. But here is the problem with that. Your hormones during these years are not sitting still. They are fluctuating dramatically — across the day, across your cycle, across weeks and months in patterns that one blood draw cannot possibly capture.

So you can walk in on a Tuesday, have your blood drawn, and get a result that looks completely normal. And then go home and feel exhausted, foggy, and unlike yourself — the same way you have been feeling for months. Both things can be true at the same time — and that is exactly what makes this so hard.

FSH is a particularly unreliable marker during these years. It fluctuates so widely that a single normal result does not rule out significant hormonal shifting — even when you are clearly experiencing symptoms. Yet this is the test most commonly used to confirm or dismiss what you are experiencing. When it comes back within range, the conversation frequently ends there.

Reference ranges add another layer to this. These ranges are based on averages drawn from the population at large — and that population includes a significant number of people who are not in optimal health. As the overall health of the population declines, those ranges shift with it. So the bar for what gets called normal moves down over time. Functional medicine takes a different approach. Instead of asking whether your result falls within the broad population average, it looks at the upper tier of those ranges — where true health and optimal function actually live. That distinction matters enormously. Your result can clear the conventional bar and still fall well short of what your body needs to feel and function at its best.

Normal is not the same as optimal. That gap is at the heart of why you may feel genuinely unwell and still be told that everything looks fine.

And when that gap goes unaddressed, the consequences are real.

When the tests come back normal and the approach does not account for what is actually happening, you may be sent in the wrong direction. The same 2025 survey found that over half of the women who sought care during these years had received treatment for depression, anxiety, or panic attacks — and nearly 40% felt those diagnoses missed what was actually driving their symptoms. The hormonal and nutritional picture remained unaddressed.

I want to share something personal here, because I think it illustrates this more clearly than any statistic can.

For nearly three years, I experienced gum recession that was accelerating despite everything I tried — dragon's blood powder, pearl powder, black seed oil swishes, ozonated oil, red light therapy, oral probiotics, and a long list of supplements and natural remedies. I saw six different dentists and spent nearly fifteen hundred dollars in consultations. I told each one immediately that I had been on a vegan diet for three years before returning to animal foods — thinking that information might help them identify a nutritional cause.

Not one of them suggested that my long-term vegan diet or my hormonal changes might be contributing to what was happening in my mouth. One recommended a $3,000 sleep study. Another quoted me $7,000 for gum grafts. A third said the grafts would not hold because of bone loss. Four suggested the recession was caused by brushing technique — even though I use an electronic toothbrush that does the brushing for me, and even though I was already following every oral hygiene protocol they could suggest.

I connected the dots myself. Through my own research. Not through any suggestion from a practitioner. When I finally understood the connection between long-term nutritional depletion, hormonal change, and what was happening in my gums — the picture made complete sense. It had simply never been in anyone's approach to look there.

What I needed was a practitioner trained to look at the whole picture — my nutrition history, my hormonal changes, and how those two things together were showing up in my mouth. Dentists, like most practitioners in the conventional system, are trained to look at the tooth, the gum, the technique. The broader picture — nutrition history, hormonal changes, what the body may have been depleted of over time — sits outside the frame of conventional dental training. And that is exactly what a root-cause approach is designed to change.

A root-cause approach asks different questions. Not which symptom requires which drug — but why these symptoms are appearing in your body at this time, and what the underlying systems need to function well.

It looks at the full hormonal picture — not a snapshot, but a pattern over time. It looks at your gut health, because the gut is where estrogen is processed and cleared, and a gut that is not functioning well makes the entire hormonal picture harder to support regardless of what else is being addressed. It looks at how well your body is absorbing and using the nutrients it receives — not just whether your diet looks adequate on paper. It looks at how cortisol is behaving across your full day. It looks at the whole picture — because in this season of your life, that is what makes the difference.

This is what ancestral nutrition and a root-cause approach make possible. Not a rejection of all medicine. A different set of questions. A more complete approach. One that looks at the system — not just the symptom.

So here is where to begin.

If you have seen doctors or specialists and left without answers — or with answers that did not fit — take some time to write down every symptom or change you have noticed in the last two to three years. Include the ones that seem unrelated to each other. Include the ones you have normalized. Include the ones you were told were fine.

Then look at that list as one picture — not a collection of separate problems. The connections between things that seem unrelated are often where the real story lives. Bringing that full picture into every health conversation you have going forward is one of the most powerful things you can do for yourself — because nobody knows your body's full story better than you do.

Nutrition is where the foundation begins. It is not the whole answer — but for most women, it is where the most meaningful early shifts happen. And it is the place where you have the most direct power right now. That is what I built Nourish for.

Nourish is my 21-day ancestral nutrition immersion — built for any woman who wants to give her body what it actually needs to thrive. It includes daily education, recipes, shopping lists, and a suggested menu plan. And it includes a bonus masterclass called Nourishing Your Hormones, designed specifically for women navigating perimenopause and the decades that follow. You will find it at nourishwithkatrina.com/nourish.

To your vibrant health and freedom,

Katrina

---Research references for this episode:

Flexner, A. (1910). Medical Education in the United States and Canada. Carnegie Foundation for the Advancement of Teaching. The foundational report that restructured US medical education around pharmaceutical and surgical approaches and eliminated naturopathic and nutritional training from accredited schools.

Starr, P. (1982). The Social Transformation of American Medicine. Basic Books. Documents the historical shift in US medical education following the Flexner Report and the role of Rockefeller and Carnegie funding in shaping the pharmaceutical model.

Adams, K.M., et al. (2010). Nutrition education in U.S. medical schools: latest update of a national survey. Academic Medicine. Documents that US medical students receive fewer than 20 hours of nutrition education on average during their entire medical training.

Allen, J.T., et al. (2023). Needs assessment of menopause education in United States obstetrics and gynecology residency training programs. Menopause. Documents that only 31% of OB/GYN residency programs incorporate a dedicated menopause curriculum.

Biote. (2025). Perimenopause Focus: National Survey. Commissioned third-party survey of over 1,000 US women ages 30 to 60. Documents that nearly 40% of women seeking care for perimenopause symptoms felt misdiagnosed, only 15% felt adequately informed when symptoms began, and only 26% learned about perimenopause from their primary care provider or OB/GYN.