How Fasting Can Support Hormones, Muscle, And Heal The Body

Coming up on this episode of the Doctor's Pharmacy.

If women just looked at those two hormones and used fasting in the right place of the cycle, they started to see all of their hormones balance out. Hey everyone, it's Dr. Mark here.

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Is time-restricted eating bad for you? Is it going to kill you? Is it going to cause you to have a heart attack and die? Well, maybe not. The recent presentation at the American Heart Association meeting of data that was not published, that was not peer reviewed, it was just a poster at a meeting presenting data that was analyzed by some scientists that was pretty sloppy in my view, concluded that there was a 91% increase in the risk of having a heart attack or cardiovascular disease if you did time-restricted eating of eight hours or less compared to a normal eating pattern of 12 to 16 hours during the day. Now let's unpack that a little bit. Now the way they did this study was kind of sloppy in my view. They used an NHANES database from 2003 to 2018. And Essentially what they do in these national health and nutrition examination surveys is they ask people through food frequency questionnaires what they ate. And they use basically just two different days and extrapolated that to a decade plus of data about health risks. And basically, do you remember what you ate last Thursday? I don't. And how much you ate and what hours you ate and, Food frequency questionnaires are extremely unreliable. They're notoriously unreliable. I wrote about this in a number of my books, but I think it's really important to understand that they really allow you a way of collecting nutritional data rather than actually having exact data collection. So that's the first problem. The second problem is that they didn't really compare any of the comorbidities, the other health characteristics. They just looked at the time of eating. And essentially the results are pretty meaningless. And I don't think it dismisses the idea that time-restricted eating is good or bad, it just doesn't tell us anything useful. Even the most basic things you want to track during the study, which is what are the other characteristics of the groups? And when, in other words, were the time-restricted people eating the same amount of food? Were they having the same health characteristics as the group that ate for a longer period of time? Well, no, they didn't track lifestyle habits, they didn't track any comorbidities, and you really can't compare these two groups very effectively at all. And it's unfortunate because now this study is being used to scare people away from time-restricted eating rather than understanding that it's one tool we have in our armamentarium of helping people to improve their metabolism and their overall health. We need more data, we need better data. And sadly, this is an example of the crappy state of nutritional research and the over-sensationalization of findings that really are often misinterpreted and taken out of context. So with that said, let's dive into the conversation with Mindy Pelc to talk about fasting and health.

Welcome, Mindy.

Oh, thank you for having me, Mark. I'm excited to be here and have this conversation with you.

Oh, so great. You know, years ago, I was working at Canyon Ranch as a medical director, and they're pretty much the women were between 40, maybe late 30s and like early 60s. And that was the majority of our guests and clients and patients. And so I got to be very experienced in dealing with all sorts of hormonal problems that were being poorly treated or actually mistreated by the conventional medical system. And, it was just striking to me how the answer for everything before the menopause was take the birth control pill. And, the answer to everything after it was take hormone replacement therapy. And then, of course, the data came out that hormone replacement therapy, Premarin and Provera specifically, which are not human hormones, one is a horse hormone and one is a synthetic progesterone, ended up having more serious consequences for women who took them like heart attacks and strokes and cancer. And so, you know, everybody overnight, boom, 50 million women stopped taking hormones, which created a huge catastrophe for them with no answers in sight. And here we are, gosh, that was 98. So, you know, over 25 years later, still women are struggling and trying to figure it out and doctors are confused. So I wrote an article years ago called the Life Cycles of Women talking about how to use a functional medicine approach to address women throughout their life cycle and the issues that they're suffering from that they really don't need to, that are, I would say, optional if you know what to do. So talk about how you have focused on this, why this is such an important area, to get clear for women and how we really had it wrong and what we need to do to figure out how to get it right?

Oh, wow, that's a loaded question. There's a lot in that. So let me start with the first part of that question. The biggest challenge we have right now with hormones is that we are hormone illiterate. So this is women, this is doctors, this is men. We just don't understand our hormones, both men and women. But for women, this is a massive problem because our hormones run and regulate everything from our menstrual cycle, obviously, but also our appetite, our moods, our sleep, everything is driven through hormones. In fact, when you actually look at the word hormone, it comes from the Greek word meaning to excite. It actually is what will initiate chemical reactions within the cells. so you have to have your hormones in balance in order for your cells to do the job they were meant to do. But when we look at the collective societal way that we approach female health, nobody's being taught how to live a life that works with these hormones. So my passion started when I started seeing my own patients suffering with perimenopause and menopause. I started having my own experiences. And to your point, when you opened up this conversation, there was really only one solution. Well, there was two. And that was, don't do hormone replacement. It's very scary and take the birth control pill. But there was no education about what our hormones were and what lifestyle we should be using to match to the hormonal fluctuations that happen to us, not only monthly, but also throughout our lifetime. so it's really the lack of knowledge that has us in the place that we are at as far as women's health goes.

Yeah, I like that concept of hormone illiteracy because I really think it's true. I just am shocked at how even endocrine experts, you know, they know what they know about what they know, but in terms of how do we impact hormones without using drugs, it's kind of like what? You know, and I think it's really one of the most gratifying parts of my practice and of functional medicine is seeing the power to transform women's lives from painful periods, from heavy periods, from irregular periods, from PMS, from fibroids, from infertility, from perimenopause, from menopausal symptoms, all of it. Sexual dysfunction, libido issues, weight, metabolism changes, all these things are not inevitable parts of being a woman. And I think about it, you know, I I started, you know, jokes. You know, 75% of women have some form of PMS. Like, was that just a design flaw or something actually going on here that we can address and get rid of it?

Yeah.

So on that note, you bring up such a good point. There are two major issues that are going on for women. One is this illiteracy problem. Like, I can't tell you how many women that I've talked to that don't even understand when estrogen comes in during their cycle, when progesterone, most women don't know that they get testosterone. in a big way only at one point of their whole cycle. So we have this lack of knowledge not only with women but doctors, like you said, as well. But then we are in an evolutionary mismatch with our hormones. So we have more physical stressors, emotional stressors, chemical stressors. The world is packed, as you know, with endocrine disruptors. And so the hormonal problems are getting bigger and bigger and bigger because the world is getting more and more toxic, not just from a chemical medical level, but from an emotional level. And then we don't, we don't understand ourselves. So we have this mismatch that's happening, and it's creating this hot mess for women.

So talk about this.

Talk about why are women's hormones so screwed up? And by the way, men's are, too. I see, like, 20 and 30 year olds with testosterone levels of, like, 80 year olds. And I'm like, what is going on here? But a lot of it's due to poor metabolic Health. So let's talk about women because it's a little more complicated with women.

It's not just about, you know, bad diet. It's about a lot of things that are and seeing their hormone function. Well, I mean, each hormone is going to have a different thing that's messing it up is the way that I look at it. So I think the best place to start this conversation is to realize that men are really driven by one hormone, which is testosterone, and testosterone is made in the outer layer of the testes, goes up to the brain and converts to estrogen. Women, we've got testosterone, progesterone, and estrogen. made in not just the ovaries, but the adrenals and some of the peripheral tissues. So we have to really address different lifestyles when we're looking at these different hormones. So when we look at why women are struggling right now, a large part of that is there's a one size fits all approach to health care. I walk into my doctor's office, I have high cholesterol, I have high glucose or high insulin, and we're never asked what part of our cycle we're at. So we have a real challenge just being able to get medical care that can bring in this hormonal picture. So more women are suffering. I don't know if you saw the New York Times article on menopause recently, but one of the things that really stood out to me is that there was this line where they said that we have a societal Acceptance of women suffering with their health.

Yes, 100%. 100%. I'm like, you don't need to suffer. Absolutely.

So, so we, you know, a woman when she's suffering goes into the doctor's office and there's a, there, they're given a one size fits all approach. So, so we have that issue. The second issue we have, and this is a big part of what I'm trying to teach women is that when you look at your menstrual cycle, Estrogen has vastly different qualities and lifestyle habits she wants us to live by, whereas progesterone completely wants us to do something different. So let's just use cortisol as an example. Estrogen is pretty forgiving of cortisol. If you decide to run a marathon or do a really long fast when estrogen is coming in, it's not going to really affect estrogen too much. But progesterone that comes in the week before your period, It does not like when cortisol shows up, when cortisol goes high, progesterone goes shy, like she's out, she's not gonna make her appearance. So then we start to see women losing their periods and then or having really difficult periods once they start because of the lack of progesterone. And that's just with cortisol alone. We could do the same thing with glucose, insulin. I mean, you can take exercise, we should be exercising according to our cycle. but we have to look at these three hormones through the lens of our lifestyle to get them back in balance.

Yeah, so important. And, you know, I think there's a lot of other things that affect women's hormones, too. Obviously, the stress, sugar in our diet, alcohol, environmental toxins, sedentary lifestyles, all these things affect our hormonal balance. And they're things that we can usually do something about toxins in the environment. We can reduce our exposure. It's a little harder. but pretty much everything else, whether it's smoking or caffeine or alcohol or sugar or how we manage stress or sleep, all these are things that are within our control. And I've seen so many patients just recover from, you know, years and years of misery and thought they just had to live with PMS or I thought they had to live with all these menopausal symptoms. And, you know, it's important to realize that you actually can, can fix it. So talk about, you know, let's sort of start the conversation with your, your five-step program and talk about fasting because it's really an unusual framework to think about managing hormones with fasting. I think I'd sort of love to hear your perspective on that, what you've learned and how it works.

I love this question because what I just sort of stumbled into understanding fasting for women because this was about over 10 years ago when we saw Dr. Osuji's work come out into the world talking about this concept of autophagy. We started to see this big wave of people fasting. All of the people, so many people were getting incredible results. I always called them O-Matters. They became the one meal a dayers that are like, I'm just going to eat one meal a day and I'm going to do that forever. I was actually out, I have a popular YouTube channel and I was educating people on the science behind fasting. I started to see that there was a really clear difference between the way women, the results women were getting and the results men were getting. And when I started to dive into that a little deeper, I realized that women got great results at certain points of their cycle. But if they continued to do one meal a day over and over and over again, they actually destroyed their hormones and they started losing their hair. They started having menstrual problems that were pretty severe. If you were in perimenopause and you weren't paying attention, to wear to fast, all of a sudden you started to see women that were going into menopause way too early. So what I started doing is tweaking and looking at, okay, if I look at estrogen, I look at progesterone, they have vastly different requirements. Estrogen likes to have glucose be low. Estrogen likes insulin to be low. Progesterone, we actually need to bring glucose up. We need to bring have we go into more of an insulin resistant the week before our periods. So I started timing like different fasts and different foods to cater to these two hormones. And what I saw was not only my clinic, myself, but now it's been millions of women on my YouTube channel, is that it just balanced their cycles out completely. And it was everything from PCOS to perimenopause symptoms to infertility. We started to see if just those two hormones if women just looked at those two hormones and used fasting in the right place of the cycle, they started to see all of their hormones balance out.

Interesting. And how would you sort of manage someone throughout that process?

Yeah, so in the book I wrote something in the current book, I wrote something called the Fasting Cycle. And it was actually something I created for my patients because I was trying to show them, hey, you know, the first 10 days, you can lean into some longer fasts. And when we hit ovulation, we're going to want to shorten our fast because you have so many hormones coming in. When you come out of ovulation, you can go into some longer fasts and then the week before you want to stop fasting. So it really became working with a woman's lifestyle and teaching her, you know, A, are you tracking your cycle? So it's interesting because a lot of the younger generation is doing this. My son is- With the ADHD, right? Yeah, exactly. My son's 20, my daughter's 23, and they know this. My son is like, oh yeah, all my friends track it, my daughter is tracking it. But ask a 43-year-old woman and she's like, oh, I'm supposed to track my cycle. So, there's a little bit of a generational gap there. But you got to start tracking and you got to know what hormones are coming in when, and then you got to know what these personalities of these hormones are. So, it's really getting into the nuance of what's happening at different parts of your cycle and helping women understand the lifestyle to pair to that. That's how we start it. That's how we start to repair. It's not going to be in a fancy, you know, supplement. It's not going to be in a in us, you know, beating the conversation to the ground about HRT. It's going to be what are we doing for these women's lifestyle so that they can match their lifestyle to their hormonal needs. [Speaking of the snack] Hey everyone, it's Dr. Mark. Now sometimes when I'm traveling I need snacks.

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And how does fasting work to regulate hormones? I mean, what is the mechanism of action? How does it actually do that?

Well, okay. So if we start and we look at what happens, I think this is the best question is what happens when we fast? so the way that I look at fasting is that you have two energy systems, one that comes from sugar and one that comes from fat. And so when we learn how to metabolically switch into this fat burning energy system, we are not just making what we call ketones, and I know there's been a lot of great discussion about the healing power of ketones, but we start to see many healing aspects exist within this fat burning system. So the longer that you're in a fasted state, the more healing mechanisms show up. So for example, we can see testosterone raise. We only have, this is another huge elephant in the hormonal room, which is we have a lot of studies on men. We have a lot of studies on men and women. We don't have a lot of studies on women alone. so but when we look at testosterone in a man, when he fasts 13 to 15 hours, he can raise testosterone by 1300%. He goes to 20 to 24 hours. He gets that testosterone level up to around 2000%, according to the science. A woman, it's going to take it's going to take her 24 hours to even start to see a little blip of increase in testosterone. But what we do appear to know is that it starts to rise about 24 hours. so now can we teach her how to start to train her body that maybe one day a week, maybe one day a month, to start to move into some longer fast to get testosterone coming up. The other thing that we see is that when we start to stimulate autophagy, which comes in around 17 hours, well, what autophagy is, is it's where that intelligence goes within the cell and it starts to repair the cell. Well, guess what's very, very susceptible and highly influenced by autophagy is your hypothalamus and pituitary and the ovaries. So now can we teach a woman how to dip into a little bit of a longer fast so she can start to clean up these areas that might be packed with toxins? So there are like, you know, each I, in the book, I write six different six different length fasts, and each one has a hormonal impact. But that sort of gives you a big picture of why we can use it therapeutically. I'm not talking about this as a fad diet. I'm talking about this as a therapy tool that everybody can afford to do.

Interesting. And so what is the different types of fasting and how do they age differ?

Yeah, so the six different ones that I lay out are intermittent fasting, which is 13 to 15 hours. And just so we're clear, fasting to me is time restriction. It's not calorie restriction. So, and we can talk about what to eat in your fasting window, which I'm sure you've talked about ad nauseam, but when we look at 13 to 15 hours, that's where we start to see growth hormone. We start to see that the body brings down glucose and insulin. We see that the body starts to make ketones. autophagy fasting is 17 hours. I mentioned that where it starts to the cells start to clean themselves up, toxins get pushed out of the cell. 24 hours of fasting, we start to see that actually the whole gut microbiome repairs, which this is also key because estrogen is broken down by a set of bacteria in the gut called the estrobolome. And so we actually have bacteria that needs the help and of something like a fasted state. to start to thrive so we can break estrogen down. When we look at like 36 hours, the research is showing that you can start to tap into more fat burning. 48 hours, we get the whole dopamine system starts to reboot and then Valter Longo brought us the 72-hour fast, which is really resetting your whole immune system. So each one of those pieces has a different implication for both men and women, but especially for women.

So, so, you know, fast up to 72 hours are a long time. How do those work that are different than just, let's say, time restricted eating where you're eating within an eight hour window?

Yeah.

So 72 would be literally going without food for, for 72 hours. So you're, you're staying in that fat burner state for 72 hours. So as daunting as that sounds, I've seen some of the greatest healing happen to people. I don't, have you ever done a, a three day water fast?

I have, I have.

Yeah.

What'd you notice?

I mean, it was hard. I was hungry. But then, you know, after the first couple days, I got really clear, energetic, felt light. You know, it was quite a, it was quite a liberating experience to sort of disconnect from food.

Yeah.

And, and Insight. A lot of people get a lot of great spiritual Insight because the brain calms down, so.

Well, yeah, it's a method of spiritual Quest often is fasting.

Right.

For a long fast, longer fast has been use forever.

Yeah.

So, so, you know, the 72 is, you know, you're not gonna, a woman's maybe doing, gonna do that once a year. You know, one of the things that we know, and I'm sure you, you, you know, you've studied this and looked at this, especially in relation to your new book, but a 72 hour fast is going to get rid of senescent cells, those aging cells. And so it wipes out the cells that are slowing the process down, slowing the, speeding the aging process up, but making the body more not only insulin resistant but hormone resistant, sometimes vitamin D resistant, which is really important for hormonal health. So we can look at a 72-hour fast as, again, therapeutic. We could dip into it to get rid of the cells that are no longer serving us.

How often should someone do something like that?

So 72, you know, again, it's personal preference, but I always say, you know, twice a year. is a great opportunity to get rid of the cells that no longer serve you and reboot your immune system. I personally recommend to my community that we do it January and September. And largely because January is when we come out of the holidays, everybody's overdone it, and then September, you know, if you're living in our hemisphere, you know, summer, now we've overdo it in summer. So it's a great, it's a really good reset to just make sure that you didn't far, you know, veer too far off your, your, your health habits.

And for me, for example, I'm scared about doing a 72 hour fast again, because I'm, I have like 10% body fat. I'll lose weight very fast. Even if I don't eat enough in a day, I'll, I'll lose weight in a day. I probably shouldn't say that in public, but I get death threats in my, at my house. But, I mean, I'm concerned about someone like me. Is it still useful? Is there harm? Will I lose too much muscle? how do I prevent that? What are the downsides?

Such a great question. So here's the thing around the fasting conversation that I don't think we're having enough. So when you're in the fasted state, all of this healing is happening. And so part of that is a breakdown of muscle. There's a lot of studies that show your muscle shrinks while you're fasting, but guess what? Your muscle is breaking down when you're lifting weights too. so when we exercise certain ways, we are breaking muscle down and we know that we're breaking it down so that we can build it stronger. So when we look at the fasted state, there may be a small amount of breaking muscle down because the body is going to go find glucose where it needs to find it. And if you don't have a lot of fat, it's going to find it in the liver and it's going to find it in the muscles. But here's the really cool opportunity. is that when you reintroduce food, that is going to actually be a game changer for building muscle. We've seen it be a game changer for the microbiome. So you would want to come in, and it depends on the length fast you would do, but let's say you do a 72-hour fast and you're like, Whoa, my gosh, my muscles have completely shrunk. That is completely temporary. And if you come in with something like protein cycling, where every couple of hours you are doing 30 grams of protein or more, you're actually going to build up mTOR and you're going to start to see that those muscles start to actually grow stronger. Same thing happens with the microbiome. Yeah, we see like total change in the microbiome that looks like the good and the bad bacteria start to go away in a fasted state. But when we reintroduce food, if we start to bring in the polyphenol, the probiotic, the prebiotic foods, now we're actually are starting to regrow that microbiome to a whole new level. So it's so to answer your question, the answer is absolutely. And you're going to really need to be mindful of what you break that fast with because when you reintroduce food, you have an opportunity to take your health to a whole new level.

So essentially it's the refeeding process that activates all the sort of rebound benefit. So yes, you will have a loss of certain things like muscle perhaps, but you'll also have cleaned out all these senescent cells, this deep cleaning. So the deep cleaning you're talking about is about killing the zombie cells, which are these, one of the hallmarks of aging, which produce these secretory inflammatory products that are spewing them out all over the body and accelerating aging in every possible way. Are there other benefits besides the autophagy and the killing of the senescent cells that happen with a prolonged fast versus like an eight hour a time window every day of eating, like a daily time-restricted eating?

Dr. Yeah. So, you know, Walter Longo brought us the whole resetting of the white blood cells. You know, his original research was looking at patients going through chemotherapy and found that it just decimated the immune system. And so, but what he saw was after, like at that 72-hour mark, it got rid of the bad white blood cells and fresh new ones regrew and it restimulated the whole immune system. So we also have evidence that the dopamine system gets completely rebooted at about 48 hours. So new dopamine receptor sites will actually be will emerge. So now when you enter back into food, you're going to start to enjoy your food a little more.

Interesting. Right.

Each one of these has like a different healing mechanism. and then you pair that with good food and now you've created the two amazing healing states without, again, anything other than using your own body as a tool for healing.

That's amazing. So, you actually accelerate your immune function and you create a reset of your dopamine receptors. Now, dopamine for those people who are listening is the sort of the pleasure molecule. we eat sugar for, or smoke or drink or take cocaine or heroin if we're unlucky. And those are the things that activate these pleasure sensors and they become saturated. And so we need more and more stimulation to achieve the same benefit. So, if you haven't eaten sugar for a month and then you have a bowl of ice cream or a cookie or something sweet, it's going to be like having a big you know, intravenous hit a cocaine and you're just gonna go, whoa. But if you're, if you're eating it all the time, you need more and more, just like an alcoholic needs a lot more alcohol. I can drink one glass of wine and I'm a little tipsy. Other people who are heavy drinkers may need a half a bottle of whiskey to get the same benefit, which is not necessarily a benefit. So I think, I think this is really fascinating. So, so both shorter term time restriction eating and longer periods of fasting you recommend? Not just a sort of daily time restricted eating. And should we do this every day? Should we do time-restricted eating every day and eat only in an eight-hour window or 10-hour window? What's the optimal dose for doing this?

Yeah.

Before I answer that question, I want to go back to one interesting comment about the alcoholic and the drug-addicted person. So one of the things we know about people who are obese is that they're not getting the same pleasure out of food as somebody who's more dopamine sensitive. Their dopamine receptor sites get saturated. And so now they have to eat more food to get the same pleasure. And it's just like the alcoholic has to keep drinking more and more to get the same dopamine response. So what I love about that 48-hour fast and why we do it as a community so much is that it resets that system. So now you're getting more pleasure from your food. You're not needing as much because you're feeling the dopamine effects much quicker.

So.

So I just want to point that out because I think that's something that's just not talked about enough as far as frequency. So, you know, for my. This is the. The big part of fast like a girl is that I want women to move in and out of different fasts according to their menstrual cycle using those six. different fasts as their tool of, you know, they can do anything from 13 to 72, depending on what they're trying to accomplish with their bodies. For men and for post-menopausal women, I think same thing, but in a weekly amount. We want to move in and out of different length fasts. So I'll give you an example. I recommend what I call a 5-1-1, where five days a week you're intermittent fasting, Super easy. One day a week, you want to push that fast. Just make it a little uncomfortable. You know, there's a thing called, as you know, pushing it. It depends if you want to repair your gut. Yeah, if you want to repair your gut, you're going to go to like 24 hours so you can get that gut reset. If you want to detox and get rid of some senescent cells, then make sure you get at least to 17 hours. If you want to get burn some more fat, try going 36 hours. so it really depends on what you're going to do. And then one day a week, don't fast, you know, go, go, skip the fasting and, and actually Feast. So when you go back and you look at our Primal ancestors, they, they were Feast, famine, cycling. They would go long periods without food, and then they'd Feast once they made a big kill. So we're, we're so far from that now. And that's why the variation is getting us back to how we're genetically designed and, and. like our Primal ancestors.

Yeah, that's true. I remember. I remember being in Africa on a safari, and we were out there a number of times in the same area. There was this one big lion. It was a male lion, and he just looked so emaciated and skinny, like he was terrible. And then, like, the next day we saw him, and he looked like. He looked like he was nine months pregnant, and he literally probably killed something and ate the entire thing. So it's that fasting and that. that a feasting cycle that, you know, we do. But is it good to feast like that? Or like, how do you kind of re-enter food? Because I think it's important not just to kind of, like you said, you, how do you reintroduce protein? What are you eating? Are you eating, like, you know, two grams of protein per kilo a day or more when you reintroduce food? How do you, how do you manage that?

So in the book, I mapped out what I call, or I mapped out three different ways that we should be reintroducing so that we can get the healing effect to continue. And it sort of stops that desire to just keep eating. So the three different ways are, and you can combine all three of these. They don't have to be in silos. So one is fat. You want to make sure you have a lot of good fat. That's going to kill the hunger hormone. So like an avocado, one of my favorite things to break a fast with is like a big avocado, and then I'll throw some sauerkraut on it. put some nuts, some seeds, and you're pretty satiated after that, or like a big salad with all of that on there. So if we use fat as a break for the desire to eat, you're not going to go boomerang as much, but as you know, it's got to be good fat. Then we can look at protein. And protein, I'm sure you've had this conversation on your podcast, but it is a conversation that needs to continue. which is we're just not giving protein enough credit. And what most people, especially my menopausal women out there, I just want to emphasize that when you are eating protein, it's another way of building muscle, especially if you're getting at least 30 grams. But what protein also does is it creates the more muscle you have, the more insulin receptor sites you're going to have. So now you're going to be more insulin sensitive. make sure you're going big on protein. And then the third one is what I call the three Ps, and this is polyphenol, probiotic, and prebiotic foods. So, repair your microbiome, get the green leafy vegetables, and get the nuts and the seeds. And if you want to combine all those together in one meal, fabulous. I promise you, you're not going to be hungry after that because this is good quality therapeutic food that is going to make sure that that hunger hormone stops and the healing continues.

And are there people who shouldn't be fasting or who shouldn't do this?

Yeah.

So, and it's a great question. So the first group that I always say is if you have an eating disorder, you need to be really coached through fasting. You don't want to go down that journey by yourself. So if you have a psychologist or a doctor that can work with you, fabulous. so just be mindful that it doesn't trigger any, any old patterns for you. The second group that I really can't emphasize enough is pregnancy. This is not your tool. This is not the, the tool that you want to use. You can, you can support a healthy microbiome. There's a lot of other great tools while you're pregnant. Eat more protein. Fasting is not your tool. And then the third one is the nursing, the nursing mom. I just don't want her fasting longer than 15 hours because the minute she goes into autophagy, now what's going to happen is she's going to start to see some of these, you know, we talked about the senescent cells that are dying off, but there's another process called apoptosis where you're going to see dysfunctional cells that are packed with heavy metals and toxins. They're going to die off and go directly into her breast milk.

So how do you deal with sort of like the detoxification process that happens with fasting? Because, you know, as a physician, where were the biological aspects of detoxification, the requirement for nutrients for phase one and phase two detoxification, the need for fiber, for elimination, the need for amino acids for a lot of the phase two pathways of detoxification. So, how do you sort of navigate that? Because I always wonder about what happens when you just eat nothing and is that a stress that you're not actually taken care of by actually providing the raw materials for your body to process everything that gets metabolized, everything that gets released from your fat tissues, all the toxins you're exposed to that they get actually activated while you're fasting.

How do you address that?

Yeah, it's such a another great point. And what, what I really am trying to get people to understand, both men and women, is that you got to make sure your detox pathways are open. So this is making sure that the lymph that's pulling the toxins out of your internal organs are completely open. So, you know, this is where the dry brushing, this is where infrared saunas, this is where just sweating in general, this is where the breath work, all of that comes into play. Making sure you have bowel movements while you're fasting, which is fascinating. If you've ever, like a three-day water fast, we'll see people still having bowel movements. the third day because they're just, yeah, their body's just getting rid of everything. So just using some of those natural ways to detoxify and opening up those pathways will make it so that when the body goes into that detox state, it can do it really efficiently.

Interesting. And so basically making sure you're drinking plenty of fluids that you're actually not, you don't need the using sweating and dry brushing. You don't need to take the nutrients. You don't need to take the amino acids. You don't need to take all the.

Co-Factors for detoxification is what you're saying. Yeah, I mean, you can. So let's talk about that because there are certain things that you can have in your fasting window. And one of them is minerals. I really recommend that a lot of people, especially when they go into the longer fast, that they've got some sodium, magnesium, potassium in some water and they're just drinking electrolytes. Electrolytes, yeah. And then we and then aminos. So here's a really interesting thing on aminos. Aminos can really help make fasting a lot easier. So to your point, they support the detox pathways and they make those symptoms that can show up that are really uncomfortable, they can make them a lot better. But here's the question that nobody's been able to answer and I just don't think we have any science on it. is what we know stops autophagy is 20 grams of protein or more. So if you're gonna do aminos, is that gonna stop autophagy? It won't stop ketosis, but is it gonna stop autophagy? And that's the million dollar question I haven't seen anybody be able to answer or any research on it. So having said that, I'm a huge fan of minerals and aminos in your fasting window.

Yeah, that's interesting. I think that's always the thing I wondered about and worried about. In terms of women, we sort of got back to this. I kind of like to talk about how do we decide when you need to use hormone therapy? What ways that we can use lifestyle that actually work better than hormone therapy, whether it's the pill, pre-menopausal or hormone replacement after. What are the things you're finding as you're helping women through this process of regulating their hormonal dysfunction with food and lifestyle.

So my philosophy is always lifestyle first. Do lifestyle, clean up your lifestyle, and then see if you need the medication or you need the hormone therapy. So that's my approach. Now, what is a big challenge that we have right now is that I strongly feel as our hormones start to decline around the age of 40, that our lifestyle has to dramatically change. and this is another piece of education that's not getting out to the world. And so there are five things that I recommend women over 40 start to do. Fasting is one and psych cycling their fasts, going in and out of high carb, low carb and making sure that-- Really?-- yeah. So going into low carb so we can balance estrogen and then going into higher carb so we can keep the thyroid happy and we can keep progestrone happy and then making sure you're eating enough protein for sure. And then the third one is you gotta most women, when they get into their 40s, they've got to repair their microbiome. They've been on birth control for decades. They've been on multiple rounds of antibiotics and steroid use. Their microbiome is in bad shape and you need that as you move into those perimenopause and menopausal years. And then you mentioned it, detox is another one. we got to start teaching women how to look at all their beauty products and what are they doing for detox in general. And then the last one is what was actually a phrase coined by Dr. Libby Weaver and it's called Rushing Woman Syndrome. We got to bring in more mindfulness tools. We've got to learn how to chill out a little bit more. And so we got to start with those five steps first. And then if that's not course correcting, now you can go in with more success, whether you choose bioidenticals or hormone replacement, it's up to you. But we've got to stop looking at those tools as being this, I'm going to absolutely do it or I'm not going to do it. Because as we go along the journey, there may be a time you want to pull it in, but you're still going to have to fix your lifestyle.

Dr. Justin yeah, there's no way around that for sure. I think a lot of people just don't realize how powerful it is. And it works better than most medications. And I can't tell you how many women I've helped with all sorts of hormonal disorders from, you know, menstrual issues, PMS, heavy bleeding, painful periods, cramping, to really more serious issues like fibroids and infertility and PCOS. And it's just amazing when you start to apply these principles that a lot of women out there who struggle with these issues can get better and not using hormonal therapy.

Right, right. And I know this is like a hot debate right now, especially amongst women's health groups, is really this idea of should I do hormone replacement? Should I not? I know we're looking at it a little different. But what we have to realize about hormones is that there is the production of a hormone, then there is the breakdown of a hormone, and then there's the hormone being able to get into the cell. so if all you're doing is focusing on the production of a hormone through, through a medication or through a hormone therapy, you're still got to have a good microbiome to be able to break that down. You still got to have a great functioning liver to break it down, and you got to still detox so that hormone can get into the cell. So this is why I, I, you know, doesn't matter if you're going to do it or not do it. It's a personal choice. But those five steps have to be considered. Otherwise, you're going to end up in one of those situations where you're like, I took it, it's not working. You're going to say, and women as women, unfortunately, what we do is we start thinking it's our problem. Yeah, it's our fault. It's our fault. We did something wrong. And that has to stop as well.

Totally.

Amazing. So, you know, where do women start? How do they sort of start thinking about working on this for themselves? How do they begin to begin a strategy, what are the steps they should take, and you have this five-step program, kind of walk us through what it would look like.

Yeah, so the first place, it depends on your age. So this is the other complicated thing about talking about women's hormones is that we've got women that are in their fertile years, you know, the 20s, 30s, teens, 20s, 30s. We've got the perimenopausal years, the 40s, and then we have the post-menopausal. so the first is you got to know where you are and what your hormones are doing. If you have a cycle, make sure that you, you're tracking your cycle. I'm also a huge fan of, of a urinary hormone test so that you know where your hormones are at. Highly recommend that because then you know what you need to work on and you, and you can get to know these. This is why I call them the personalities. Like, we got to get to know the personalities of these hormones and when they're showing up, like, progestrone is going to make you really hungry and crave carbs. And estrogen, estrogen is going to make you very verbal and want to go out and put your party hat on and be out socializing all night long. And testosterone is going to spike your libido and increase your motivation and drive. So get to know these personalities because they're coming in and out every single day. Once you know that, now how do you pair your lifestyle? And this is The five steps that I wrote, I actually wrote that in a book called the Menopause Reset. And so that was my book before Fasts Like a Girl. It's all written out there. But start to take these five steps and ask yourself, am I fasting? Am I varying my foods? Am I working on my microbiome? Am I detoxing? And am I slowing down? Start there. I mean, that could be a decade. That could be a long time working on that. And then from there, you can start to figure out, do I need to supplement? Do I need to go into more hormone therapies? From that point, you can navigate. And it's not a linear absolute approach. And this is perhaps why we have been giving women one size fits all. Because it's much easier for the doctor to say, your cholesterol is high, your blood pressure is high, take this medication, then, hey, you're going to need to eat different. You're going to need to vary your fast. You need to stop stressing, repair your microbiome, and detox. Most women are like, what? I have to do that? Right.

It's a lot.

It's a lot. But it's where health exists. I mean, it's putting the responsibility back on us. And then the other part of that is all of us, I I love this idea of women doing health as a community because when we are in community, we're raising oxytocin. And when you bring oxytocin up, you bring cortisol down. And when you bring cortisol down, you regulate insulin and now you can regulate your sex hormones. So women are so good at connecting in community. Let's do it all in a community and learn from each other and share our stories with each other.

I love that. I love that. I think it's really important because I think when people feel isolated, they feel on their and they feel like they just have to figure everything out, you know, and that they're not getting the answers they want from their doctor. And I'm curious, like, why do you think it is that the medical system is just so blind to hormonal regulation for women?

Well, I think the first part is that we look for absolutes in our healthcare system. You have this symptom, I'm gonna give you this diagnosis, and I'll give you this pill or surgery. So it's very linear like that. I call that more of a patriarchal or masculine approach to health. When we look at a more feminine approach, and I love this, I actually heard Sarah Blakely speak last year, and she was saying that one of her desires was to bring a feminine approach to business and be able to integrate the masculine and the feminine together in business. And she believes that that was one of the reasons why Spanx was such a huge success. I would say the same thing needs to happen with healthcare. We need to bring the feminine back into healthcare. And what that looks like is us understanding our own natural cycles and then not giving our power away to the doctor and just saying, Hey, here's my symptoms. Tell me what to do. But actually to start to collaborate with our doctors and say, Tell me why this is showing up at this part of my cycle. Tell me what I can do that affects the different aspects of my cycle and become educated and have an educated conversation with your doctor. So, I really see an integration of the feminine, the masculine together that's going to change this conversation within the doctor's room. But what's happening is within the doctor's room, it's absolutes, it's guilt, it's shame, it's one size fits all. That has to stop.

And, you know, it's not their fault, honestly, because I never learned about any of this in medical school. And, I think, One of the things I'd love you to talk about a little bit is hormonal testing, because I think we don't know how to manage hormones through testing, whether it's saliva testing, you mentioned urine testing, blood testing. What's the best way to get handle on hormones? The Dutch test, there's urinary estrogen metabolites, there's blood work that you can do to look at hormone levels.

Talk us through some of that. Yeah, so if you're a cycling woman, a blood test is not that helpful for you. I think that your door in is more a Dutch test. I'm a huge fan of the Dutch test. In fact, I don't know what your feelings are on the Dutch test, but I feel like if we could get a Dutch test into every woman's hands, somewhere around in her 30s and her 40s, she could really start to see if her lifestyle was working for her or against her. And one of the reasons I love the a urinary Dutch test over a blood test is that it can tell me the estrogen metabolites and the estrogen metabolites are how is your estrogen breaking down? So you can go and get a blood test and your doctor might say, oh my God, your estrogen is so high. You it's probably coming from toxic estrogen, maybe an estrogen, an endocrine disruptor. But when we look and compare that to a Dutch test, which we've done a ton in my clinic, we start to see, well, maybe it's high because you've been eating really well and you actually have a lot of the good protective estrogen and not as much of the bad estrogens. So the Dutch just gives us so much more than a blood test.

And that's a saliva test or is that?

It's a urine test.

Yeah.

It can be both. Saliva is really for adrenals. A lot tells us a lot more about adrenal function which is also important for hormonal health.

Yeah, I mean, it does test so much, that's all the cortisol hormones, it tests the sex hormones. It gives you a really pretty good picture of where things are and it depends on where you do it in your cycle if you're premenopausal, right?

Yeah, so that's the other thing is Dutch will have you do it somewhere between day 17 and day 21 so that we can see what progesterone is doing, which is really, really important. You also get like DHEA levels, you get an organic acids test with it now, so you can see dopamine and norepinephrine. These are things you just don't get on a blood test. You're just getting a big broad picture, whereas Dutch is giving you the details.

And so what exactly does the Dutch test look for? That's different than you'd get on a regular panel of hormones that your doctor would check, like FSH, LH, estrogen, estradiol, progesterone, testosterone, how is it different and why is it better?

The way that I look at it is I think the Dutch is a more functional. So remember, if we go back to this idea that hormones need your gut, they need your liver, they need the support of the other hormones. So we can't, when we just look at LH FSH and we just give it a big broad picture, we're not really looking at the supporting actors. Let's put it this way. If estrogen, progesterone, and testosterone were the stars, We need to know what the adrenals are doing. We need to know what the liver's doing. We need to know what the thyroid's doing to affect that. And that is what the Dutch gives.

You as opposed to a blood test. And it measures different things too, right? Not just it measures different kinds of sex hormones, not just the ones we.

Typically look at, right? Yeah. So it looks at major ones are estrogen, progesterone, and testosterone. It looks at cortisol. It also will tell you your cortisol pattern. which is super cool because you can see if your pattern of when cortisol comes in is actually in regulation with what it's the circadian rhythm of the day, what is actually supposed to happen. We've read thousands of Dutch tests in my clinic and one of the biggest things we see is that women will have high cortisol at 8:00 at night and very low cortisol at when she wakes up in the morning. and no wonder she can't sleep and she needs coffee to wake up in the morning. So it's really helpful for showing you that pattern. And then it also will show you methylation pathways. So we can see like, are you able to detox efficiently? Or is your body working really hard to detox? Or maybe it's been exhausted because it's been detoxing too much. So, I mean, I could go on and on. so many nuances in the Dutch test that you just don't find anywhere else. That's powerful.

And it's not easy to interpret. There's a lot of numbers on there and the average doctor will have trouble.

So, yeah. Do you use them? Are you familiar with the Dutch test?

Yeah, yeah. We use it in our practice for sure all the time. And I find it very, very helpful as an addition to sort of the overall picture. But, you know, what's really quite encouraging for me in hearing you talk is how a lifestyle is and how things that are within our control without even hormone therapy can make such a difference. And, there are such simple ways through this basic five-step program that you've mapped out with fasting, personalized nutrition, stress management, detox, and lifestyle changes that can basically optimize women's health, men's health too by the way, and basically slow the aging process. I love this idea of personalization and customization. It's central to functional medicine. I also love talking about how we can use fasting in different ways at different times for different results. We covered, for example, just basically time-restricted eating as a way to optimize metabolism and hormone balance, but also deep cleaning fasts, which are three to five, maybe longer fasts. I have 72-hour fasts. Something I want to try again, but I get nervous because at 63, I don't want to lose too much muscle. And so I think that there's always that kind of balance. And I think we do need a time to sort of give ourselves a rest from food. And then we need to refeed, as you said, to optimize our metabolism.

Yeah.

Let me know when you go into 72-hour fast, call me. I'll coach you through it. I'll make sure you do it successfully. But, you know, I want to really highlight this idea around lifestyle. And I so appreciate that that is so much of your message because I feel like we have lost the art of healthy living and we can say that it's causing all kinds of chronic disease problems. But when we bring the hormone, the conversation of hormones to the surface, we can't, we have to start with lifestyle. Otherwise, you know, we've got women that are chasing down supplements that are great. I'm not opposed to them. or we have women that are either so scared of hormone replacement or they're like, it was the greatest thing of my life. Or we've got women that are taking thyroid medication and they're not seeing any results, but their doctor saying, but your thyroid tests are completely normal. It's because we're missing lifestyle. We have to come back to lifestyle. So thank you for saying that. It's such an important piece.

Yeah, it's so key and your work is so great. I think your new book, Fast Like a Girl: A Woman's Guide Using the Healing power fasting to burn fat, boost energy and balance hormones is a great guide. I think your other books are great too for women who have menopause and we're going to learn how to reset. You really have provided a whole wealth of great resources for women to become empowered around taking charge of their own health. And, it always was a pet peeve of mine. And, I think I saw this so much when I worked at Canyon Ranch and even over the last 20 years too, my practice, women just struggle with with being kind of the yellow canaries for all of our poor lifestyle habits. They are more susceptible, they're more sensitive, they're more connected to the things that actually affect them, whether it's dietary changes, whether it's stress, whether it's environmental toxins. They're way more likely to be impacted adversely. And, our healthcare system has sort of ignored that as a whole thing. And, I think the amount of suffering that's needless and it can be easily fixed with simple practices is quite amazing. And I, it's been a very gratifying part of my practice. And even young women who struggle with things like painful periods or PMS, it ain't that hard to fix. I mean, I hate to say it, but you know what you're doing and you know how to apply lifestyle and certain supplements and sometimes even, you know, the bioidentical hormones, you can have remarkable results. And most people can, can do really, really well.

I a thousand percent agree. And I don't know if you know this statistic, but they're saying right now that the most common time for women to commit suicide is from 45 to 55. And when I look at that statistic, what I know is we have no understanding of our hormones. And you're dealing with a decade of women that are not understanding why they're depressed, why they're anxious, why they can't sleep. And so when we look at this hormonal illiteracy, to issue that we have going on when they're in these dark states, they turn with that, you know, on, on everybody else. They turn on their husbands, they turn on their partners, their friends, they think it's external, and they don't realize there's so much they can do to adapt to these hormones. That is how powerful lifestyle can be.

It's really true. And I think your work is a testament to that. I love having you on the podcast. There's so much more to talk about. I think, you know, if people want to learn more, they can go to your website, Dr. Mindy Peltz, P-E-L-Z.com, Instagram channel, Dr. Mini, mini, or Mindy, Mindy, Mindy.

Like, don't you remember Mark and Mindy? It's like Mark and Mindy.

Yes, I do, I do, I do. And your podcast, the Resetter podcast, great for people to listen to if they want to learn more. there's just so much here, but I think you're diving into this deep end of the mess of women's hormones in our society and how to fix it is a huge gift to all of us. I encourage you to check it out and learn more about your work and hopefully you love this podcast. And if you did, please share with your friends and family. They'd love to hear, I'm sure, how to fix hormones because it's a big problem for all of us. thanks for listening today.

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Next time on the Doctor's Pharmacy. This podcast is separate from my clinical practice at the Ultra Wellness Center and my work at Cleveland Clinic and Function Health, where I'm the chief medical officer. This podcast represents my opinions and my guest opinions, and neither myself nor the podcast endorse the views or statements of my guests. This podcast is for educational purposes only. This podcast is not a substitute for professional care by a doctor or other qualified medical professional. This podcast is provided on the understanding that it does not constitute medical or other professional advice or services. If you're looking for your help in your journey, seek out a qualified medical practitioner. You can come see us at the Ultra Wellness Center in Lenox, Massachusetts. Just go to ultrawellnesscenter.com if you're looking for a functional medicine practitioner near you, you can visit ifm.org and search find a practitioner database. It's important that you have someone in your corner who is trained, who's a licensed healthcare practitioner, and can help you make changes, especially when it comes to your health. Keeping this podcast free is part my mission to bring practical ways of improving health to the general public. In keeping with that theme, I'd like to express gratitude to the sponsors that made today's podcast possible. Don't forget, there's a way to listen completely ad-free. With Hyman Plus on Apple Podcasts, you can enjoy every episode without any breaks. Just open Apple Podcasts and tap Try Free to start your seven-day free trial.