Q&A: perimenopause & brain fog; improving gut health; genital herpes; & living with continuous glucose monitors & step trackers

Join me TODAY 2/28 at 3 pm ET for a live Q&A - right here!

ICYMI 👉

• Psychiatric Pills Are Not the Problem—The System Is

• The Pitfalls of the Wellness Industry

• How To Take Control Of Your Health In Times Of Turmoil

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📣 Join me TODAY, February 28, at 3 pm ET for our WEEKLY live chat in the Substack App!

This is a free event! Paid subscribers can submit questions by commenting below or via the paid subscriber group chat here! 📣

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In this week’s reader-submitted Q&A, we’re tackling these questions:

• Is there a connection between perimenopause and brain fog?

• How can I improve my gut health?

• How will a diagnosis of genital herpes affect my health?

• Is tracking various health metrics helping me?

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📣 Send me your questions for future Q&As! Click here to write me. ✍️

Photo by Moritz Kindler on Unsplash

The following subscriber questions have been lightly edited for length and clarity.

QUESTION #1: PERIMENOPAUSE AND BRAIN FOG

I’m in my mid-40s and have noticed more brain fog, forgetfulness, and trouble concentrating. Could this be perimenopause?? or should I be worried about something else?

-Jennifer

Hi Jennifer,

Yes, “brain fog” (i.e., forgetfulness and difficulty concentrating) absolutely can be symptoms of perimenopause. Hormonal shifts, particularly fluctuating estrogen levels, can affect cognition, mood, and memory. Many women in their 40s start to experience these changes, sometimes alongside other perimenopausal symptoms like irregular periods, sleep disturbances, or mood swings. Estrogen plays a key role in brain function, so when levels fluctuate, it can contribute to foggy thinking and difficulty focusing.

That said, I wouldn’t assume it’s perimenopause just because you are in your mid-40s. Other factors could be at play. Stress, poor sleep, nutritional deficiencies (such as low iron, B12, or vitamin D), and even thyroid imbalances can contribute to cognitive changes. Especially if you’re experiencing significant fatigue, mood changes, or other symptoms alongside brain fog, I suggest checking in with your doctor. Depression, seasonal affective disorder, sleep disorders and other medical conditions should be considered. Of course two things could be happening at once.

Let’s assume your symptoms are indeed due to perimenopause. There are ways to support brain health during this transition. Prioritizing good sleep, regular exercise, and a diet rich in healthy fats and antioxidants can help. Managing stress through mindfulness or relaxation techniques may also improve focus. Hormone therapy (either through a low dose birth control pill or formal HRT) can help. Supplements like magnesium or omega-3s make a difference, too. You should talk with your doctor about treatments tailored to your specific symptoms and health history.

Fortunately in most cases, cognitive changes from perimenopause tend to improve with time and/or with hormone therapy. I hope that helps!

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QUESTION #2: IMPROVING GUT HEALTH

I’ve tried probiotics, prebiotics, fermented foods, and gut-health hacks, but my digestion still isn’t great. Am I overcomplicating things? What actually works?

-Rick

Hi Rick,

I get this question all the time. It’s easy to get caught up in the latest gut-health trends, but sometimes the basics matter more than any single supplement or hack. If you’ve tried probiotics, prebiotics, and fermented foods but still have digestive issues, it may be worth simplifying your approach and focusing on foundational habits first.

Start with identifying triggers. Keeping a food and symptom journal can help pinpoint whether certain foods (like dairy, gluten, high-FODMAP foods, or artificial sweeteners) are causing discomfort. Even “healthy” foods like fiber-rich vegetables can be hard to digest for some people, especially if introduced too quickly.

Eating habits matter, too. Eating too fast, not chewing thoroughly, or eating while stressed can lead to bloating and discomfort. Simple changes like slowing down, avoiding excessive snacking, and spacing meals apart to allow for proper digestion can make a big difference.

Hydration and stress management are often overlooked but play a huge role in gut function. Dehydration can lead to constipation, while chronic stress disrupts the gut-brain axis and may worsen bloating, reflux, or IBS symptoms. Practices like deep breathing, yoga, or even a short daily walk can help regulate digestion.

If symptoms persist despite these efforts, it might be time to consider underlying conditions like small intestinal bacterial overgrowth (SIBO), food intolerances, or gut motility issues. Some people actually do worse with probiotics, especially if they have an imbalance in gut bacteria. Working with a doctor or dietitian to assess whether further testing or targeted treatments are needed could be the next step.

Instead of layering on more supplements and hacks, sometimes simplifying—focusing on whole, unprocessed foods, mindful eating, hydration, and stress reduction—works better in the long run. If something isn’t improving, getting a professional’s input can help you find what’s truly effective for your body. Wishing you all the best!

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QUESTION #3: GENITAL HERPES

I'm 52 and was just diagnosed with genital herpes HSV1. I've never had an STI and contracted this from my current partner (M54) who suffers from cold sores. While he didn't have an active outbreak when we had oral sex, I still contracted it. I'm feeling all the emotions and having trouble locating reliable information. I did chat with my provider, but it's a lot to take in. How will this diagnosis affect my health? Are there things I can do to prevent an outbreak? It's painful.

-Lisa

Lisa, I hear you—it’s completely understandable to feel a mix of emotions with this diagnosis. Genital herpes caused by HSV-1 is more common than many people realize, and while it can feel overwhelming at first, it’s important to know that it’s manageable and doesn’t have to define your health or relationships.

Here’s what you need to know moving forward: Genital HSV-1 is typically less frequent and less severe than genital HSV-2. Because HSV-1 prefers the oral region, outbreaks in the genital area tend to occur less often over time. The first outbreak is usually the most painful, but as your immune system adapts, future outbreaks (if they happen) tend to be milder.

To help manage symptoms and reduce the risk of future outbreaks, consider the following:

• Antiviral medications like valacyclovir (Valtrex) or acyclovir, which can shorten outbreaks and make them less painful. Some people take these daily as suppression therapy, while others use them as needed.

• Reducing triggers such as stress, lack of sleep, illness, or hormonal changes, which can sometimes contribute to outbreaks.

• Keeping the area clean and dry during an outbreak and using over-the-counter pain relievers or cool compresses for relief.

• Boosting immune health through a balanced diet, regular exercise, and stress management techniques.

Since your partner has oral HSV-1, it’s possible to transmit the virus even without visible cold sores, as viral shedding can occur. Using barrier protection for oral sex and open communication about symptoms can help minimize future transmission risks.

Most importantly, this diagnosis doesn’t change your worth, nor does it mean you can’t have a healthy sex life or relationship. With time and the right strategies, herpes becomes just another manageable part of your health, not something that defines you. If you have lingering concerns, seeking support—whether through a trusted provider, a therapist, or a support group—can help process this new information. Does that help?

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QUESTION #4: TRACKING GLUCOSE, STEPS, & HRV

I wear a continuous glucose monitor even though I don’t have diabetes, track my steps religiously, and monitor my HRV every morning. Lately, I feel like I’m living by the numbers instead of listening to my body. Do you tell your patients to do this kind of tracking ?

-Katherine

Hi Katherine,

Tracking health metrics like glucose levels, steps, and heart rate variability (HRV) can be a valuable tool for understanding your body, but it’s easy to fall into the trap of letting the numbers dictate your well-being instead of the other way around. When tracking is used as a guide to support healthy habits, it can be beneficial. But when it starts creating stress, anxiety, or a disconnect from how you actually feel, it might be doing more harm than good.

I wrote a piece about this: Is Your Health Tech Device Wearing You?

Continuous glucose monitors (CGMs) are designed for people with diabetes, and while they can offer insight into how different foods or activities affect blood sugar, daily fluctuations are normal. Obsessing over minor changes that may not be clinically significant can lead to unnecessary stress or restrictive eating patterns. Similarly, tracking steps and HRV can be useful, but your body doesn’t always fit neatly into an algorithm. Some days, a lower HRV or fewer steps don’t mean anything is wrong—it could just be natural variation.

The key is to ask yourself whether these numbers are enhancing your health or creating stress. If tracking is making you more mindful of movement, sleep, or nutrition in a positive way, that’s great. But if you’re feeling anxious, guilty, or compulsive about meeting certain targets, it may be time to step back. Try taking a break from tracking or shifting focus to how you feel rather than what the numbers say. Your body’s signals—hunger, energy levels, recovery, and overall well-being—are just as important, if not more, than any device reading. Finding a balance between data and intuition is the real goal of health monitoring.

Let me know if that helps!

Disclaimer: The views expressed here are entirely my own. They are not a substitute for advice from your personal physician.