How To Support Your Body During Perimenopause and Menopause

Coming up on this episode of the Doctor's Pharmacy. We have a societal acceptance of women suffering with their health. Yes.

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Hi, this is Lauren Fein, one of the producers of the Doctor's Pharmacy. Often by midlife, after years of pushing hard in a career, juggling work and.

Parenting, or taking care of aging elders.

Many women experience a breakdown in health. Whether it's constant fatigue, gastrointestinal upset, mood swings or weight gain, regaining health is possible and it can be done by looking at hormones, mitochondrial and cellular health and more. In today's episode, we feature three conversations from the Doctor's Pharmacy on women's hormones, adrenal health and fasting. Dr. Hyman speaks with Dr. Mindy Pelz about the role that hormones play in our bodies, with Dr. Isabella Wentz about the things that affect our adrenal health and how to support the body, and with Cynthia Thurlow about fasting. and how to do it. Let's jump in. 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. Like 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 happened 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 sure 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, 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, or is 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. 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 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 influencing 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, you know, 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 monal 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, a woman when she's suffering goes into the doctor's office and they're given a one-size-fits-all approach. 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's 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 going to 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 that's just with cortisol alone. We could do the same thing with glucose, insulin. I mean, you can take 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, there are 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 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 fix it. How do we decide, you know, 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, premenopausal or hormone replacement after, you know, 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 cycling their fasts, going in and out of high-carb, low-carb, and making sure that yeah. So going into low carbs so we can balance estrogen and then going into higher carbs so we can keep the thyroid happy and we can keep progesterone happy and then making sure you're eating enough protein for sure. And then the third one is you got to most women, when they get into their forties, 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 gonna have to fix your lifestyle.

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 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, you know, 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. 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? You know, you have this five-step program. Kind of walk us through what it would look like. Yeah.

It's. 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 postmenopausal. 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 gonna need to eat different, you're gonna 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, right. It's a lot, right?

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 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. Hey, everyone, it's Dr. Mark here. I want to take a minute to.

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So it could be psychological stress. So you're going through graduate school and you are waking up three times, you know, throughout the week at 5:00 a.m. to go to you, do your exams. That can be incredibly stressful. You have a really annoying boss who's just a jerk. That could be incredibly stressful. You have a lot of family drama that's currently stressful. And people, people recognize these kind of stressors. I know One of my books, somebody wrote a review that was like, I didn't need to do anything that she recommended. I just quit my job and my whole life got better. I didn't have autoimmunity anymore. And I was like, amazing. If you could recognize there's this one thing in your life that's causing you stress and get rid of it, that can be a big game changer. But there's also positive stressors. So you have a beautiful baby and that beautiful baby doesn't sleep, right? So I know that was a stressor for me five years ago. When I got into adrenal dysfunction another time in my life, you got married and you moved across the country, or you got a job promotion. These are positive things in your life, but they can be a bit overwhelming. Then there are kind of like hidden psychological stressors. So maybe you had a history of adverse childhood events, something that happened in your childhood that was traumatic. You probably don't even have a recollection of it. but, or maybe you do, but it has shifted your HPA axis to be more on high alert and kind of put you in that survival mode and you've got that on your plate. So that could be something that people aren't necessarily aware of because it's not present day stress, their present life might be perfectly peaceful. Then we think about like the physiological stressors. So, I'm always like, what is in your life right now that could be causing your ancient genes to think that you're under stress? Let's, like, unpack modern life. If you are not sleeping a lot, if you are skipping meals, if you are exercising over exercising, right? If you're eating foods that are inflammatory to you, your caveman or cavewoman brain is gonna say, holy cow, we must be in a war, in a famine, or being chased by a herd of bears. ears or something, because why on Earth would you be eating stuff that's inflammatory? Why would you be starving yourself? You must be in a famine. So let me help you out, you know, from an evolutionary perspective, and let me shift you into this adrenal fatigue state so that we can conserve your energy, we can conserve your metabolism. So these are some of the modern day stressors and sleep deprivations probably the fastest way to get into this adrenal dysfunction. Yeah.

I mean, you know, what's interesting is that, you know, people don't realize that actually their diet can be a stress that actually sugar and starch when you eat it causes a flood of adrenaline and cortisol in your system, even if it's oatmeal. And David literally showed this. It was really shocking years ago in a study of obese kids where he gave them oatmeal or eggs for breakfast. And the kids who ate the oatmeal had high levels of cortisol and adrenaline. because of the glycemic load of the oatmeal, which we think is a healthy breakfast and cereal is even worse. And that drives higher levels of stress hormones and that it makes you hungrier, it makes you crave sugar, it causes high blood pressure, just all kinds of issues. So, I think it's important to sort of highlight that.

Oh my gosh, absolutely. One of the key stressors is blood sugar imbalances. So just eating too many carbs and too much sugar and then not enough protein and fat, this is a really, really big stressor for many people and being micronutrient deficient. That's actually one of the key transformations as we focus on blood sugar balance. And people will say, I thought I had anxiety. Turns out my blood sugar just needed to get balanced. And I thought I had insomnia. I was waking up at 3 a.m. and I wasn't sleeping through the night. It turns out that it was actually my blood sugar. So this is such a really, really important stressor. And I thank you for bringing that up because this is a core part of transforming your adrenals and transforming your stress response is like the nutritional signals, right? Figuring out how to get yourself in balance. And then there's also the hidden stressors where people might not realize them. They're not in their Lifestyle, their lifestyle might be like spot on and perfect, right? But they might have an H. Pylori infection, or they might have a toxic exposure, perhaps mold exposure, or some other kind of toxin that could just be sending their system haywire and sending them into that survival mode, even though they're like, I'm doing everything right. I'm doing all the things. I'm sleeping well. I'm like, I have a good marriage. And I love my job and all of a sudden I just feel terrible. And usually in that case it could be a hidden source of inflammation in your body.

Totally. And I think that what's interesting is when I had chronic fatigue, it was because I had mercury poisoning and that screwed up my adrenals. So it was some external thing or Lyme disease or mold or whatever it is, it can be anything that drives inflammation, as you said. can cause adrenal dysfunction independent of what your stress levels are psychologically. So that's really, really important. And also rhythm, we talked about, you know, sleep, but having regular waking and sleep cycles is important. Eating at their same times is important. Your body is a biological clock and there's a whole system of medicine called chronobiology, which is the science of even how to, for example, treat cancer with certain chemo drugs given at certain times of day. day. And I think we kind of lose track of that and we just think we can go kind of buffet about our body with all sorts of irregular schedules. And that is really not good for us. And it really requires sort of a discipline of a repeated state of circadian rhythm and of reducing the things that cause adrenal dysfunction to kind of help you help you fix that. You know, one of the things that people don't realize is that the gut plays a big role. and your adrenal function. Can you kind of unpack that for us?

Oh yeah, absolutely. So whenever, and it's kind of a two-way street, right? So whenever we have infections in the gut, and I typically see, you know, we talked about all these different stressors. Some people just have one stressor. For most people, it's like a stress bucket that like overflows when we either have like one major big stressor and a whole bunch of little ones or even just a whole bunch of little ones or or, you know, moderate sized ones, whatever happens is like your stress signals are like you have way too much stress in your life, you have too many danger signals, and you shift into that survival mode. And part of that could be coming from your gut. So a lot of times I'll see people that I've worked with in that chronic fatigue state, and interestingly there's research talking about CFS and some of these things, but people will typically have some sort of gut infection. So they might have an H. Pylori infection, they might have a protozoal infection in their gut, they might have Candida overgrowth, they might have dysbiosis, they might have mold colonization, and all of that shifts the body to have more inflammation. And then the other piece of that is when we're under a lot of stress, our secretory IGA levels are depleted. Our secretory IGA is what keeps our immune function in the gut and the respiratory tract, so people end up being more susceptible to all kinds of illnesses and whatever pathogens are in their gut, they're more likely to kind of take over the gut and like, you know, set up residence when you don't have a good enough secretory IGA response. And you might be the person that you go to a restaurant with your friends and you are all eating the same things, but if your secretory IGA is low, everybody will be fine, but you'll get food poisoning because your body won't be strong enough to overcome whatever microbes are, are, you know, naturally present in the food. And so it's a really, really big two-way street. So part of my plan with the Adrenal Transformation Protocol is utilizing, minimizing inflammatory foods that can cause inflammation in the gut. And then we also focus on utilizing a beneficial yeast called Saccharomyces boulardii, to raise that secretory IGA response. And this can make you more resilient to stress. It can help you overcome food sensitivities. It can clear out some of the pathogens from your gut, like the Candida, like some of the protozoa, like some of the H. Pylori and so on and so forth. Just kind of make your gut a little bit more healthy and a little less inflamed.

Amazing. So yeah, everything is connected. This is Functional Medicine 101. Everything is connected to everything. So I think we have to realize that, you know, I always say our body has only so many ways of saying, oh, so many different insults can disrupt adrenal function and obviously thyroid function, which you've written about. Why do you think it is so prevalent? I think everybody listening is going, God, I recognize those symptoms. I've experienced this. I get it. And it's like, It's just this invisible problem that most people don't get the right therapy for. Why do you think that before we get into what to do about it, so many people and women in particular have thyroid adrenal and autoimmune stuff going on?

Yeah, it's so common that people almost think that it's normal. But I'm like, just because it's common doesn't mean it's normal. And I think really it is a consequence of our modern life because we are disconnected from the circadian rhythm, right? So we are not sleeping well enough so we're not getting that rest and digest period. We are constantly have a culture to keep working harder, to, you know, side hustle and do all the things, and then we end up really, you know, hearing about how we need to lose weight, and so we restrict calories. And I feel like all of these, I guess, signs, you know, with modern signs that get interpreted by our ancient genes, Our genes don't know what to do with like, hey, we're always under stress. They're not adapted to that. Like cavewoman, caveman life was pretty chill. You know, you would like eat your food and then you'd relax. You'd go hunting and gathering and every now and then you'd have a situation, but you weren't, you know, you weren't doing a side hustle. You weren't, you didn't have three different jobs to make ends meet. And certainly there's, there's a lot of things going on in our modern times, especially in the last few years, that I feel like have made us feel like we're not safe in our modern world, right? So we have just the fear in the last few years about like, you know, we don't know what's happening in the world. There's war, there's a pandemic, there are people that are, you know, also worried about their children throughout the pandemic. You're worried about your relatives and elderly relatives throughout the pandemic, or maybe you're immune compromised. And so, I feel like a lot the last I've seen it a lot of it just in the last ten years, but especially in the last few years, I feel like, you know, my girlfriends are like, Hey, I don't have Hashimoto's, but I have all these symptoms. I have the brain fog, I have the fatigue, I have the anxiety, I have all the things. And it's because the body shifts into that stress response and that survival mode when we get the message from our environment that we're not safe. And our body's always just trying to help us. to adapt and protect ours, our survival, right? And so it is very, very common and more common in women because women have more receptors to be tuned into the environment. We do bring new life into this world and so it's like really important to know if it's like a safe time to bring new life into the world or not. And so we're wired with more estrogen and more hormones that are going to be receptive to stress, right?

It's so true. It's so true. So let's talk about the solution because I think everybody's kind of, okay, I get it. I've had this problem or I have some level of it and it can be mild or it can be very severe. What is your adrenal transformation protocol? It's quite different than most sort of integrative doctors who say just get checked, test your adrenals, quit caffeine, sleep a little more, maybe try DHEA. What's different about your approach to restoring adrenal function? Because just to be frankly honest, in terms of functional medicine, it's one of the hardest things to do. And it takes a long time for me to help people to completely reset. It's like a complete revamp of their lifestyle. They have to get off all the inflammatory foods, sugar and processed food. They have to develop a regular rhythm of waking and sleeping. They have to expose to sunlight in the morning. they have to make sure they don't over exercise. They need to practice meditation, yoga, get acupuncture, take a bunch of herbs. It's like a lot and it takes, it's not like oh boy they get better. So it's very slow. So can you talk about how different your protocol is, what is it and help us understand how to restore our adrenal function? Asking for a friend.

So all of the things that you said can work incredibly well but like you said they do take time and they're not the right fit for everybody. So 10 years ago, 10 plus years ago, when I recovered my health, I utilized pregnenolone and DHEA. And then I would, you know, recommend that to my clients and sometimes hydrocortisone, all the sleep, 10 to 12 hours of sleep a night and letting go of a lot of stressors. And that worked really well for a lot of people, but then it didn't work for some people. And I was just like, ah, You know, maybe they're just resistant to change and so on and so forth. And then I became a mom five years ago and I was like, I'm so sleep deprived. My beautiful baby's eight months old. I thought they were supposed to sleep at three months old. Hold on, you know, what's going on here? I was lied to. And so when he was eight months old, I was waking up every 2 to 3 hours to feed him at nighttime and was just like, holy cow, I think I'm, you know, crashed my adrenals. And I did a test for myself and sure enough they were flatlined. But I'm like, I can't take DHEA. I'm a nursing mom. I can't sleep for 12 hours a night. I'm a nursing mom. Like, I wish I could sleep. And then I was like, well, and I can't quit coffee. Like, I just started drinking coffee. Like, it helps me so much. Like, you can't take it out of my hands. And I remember having clients, I would tell them, you know, you're waking up at night and you're so tired throughout the day and you're drinking six cups of coffee. Like, I think you should just quit the coffee and you'll be fine. And they'd be like, well, I quit the coffee and I still feel like crap, right? I'm still waking up all night and I'm still tired throughout the day. So I was like, oh, wow, I guess, you know, I really have to, like, I don't know, like, I have to get out of this. I have to, I have to feel good again. What do I do? And I kind of went deeper into my safety theory where I figured out, you know, what are the stress signals my body's receiving, right? And then how do I counteract that with some safety signals? so that I can shift my body out of that survival state into more of a thriving state. And the beautiful thing is when I was going through the functional medicine process and all of the integrative wonderful tools that would take three months to two years to see results, with this it took like three to four weeks. And I was like, holy cow, this is working. And then I piloted it with over initially with about about 200 people, 92% saw less brain fog, more than 80% had less fatigue, and so on and so forth within just that three to four week time period. So that's why I'm writing a book on it, because I feel like it's a great approach that is complementary to the testing and to all of the wonderful precision of utilizing hormones, if that's a route that person wants to go. But I really focus on supporting the body and its stress response. So you'll see the things that are foundational from functional medicine and from integrative medicine like the adaptogens, those can be utilized. The B vitamins, vitamin C, magnesium and electrolytes, that's kind of the part of the protocol. But I'll also utilize mitochondrial support. so specifically, D-ribose, rhodiola, and carnitine. And that can really transform a person's brain fog, anxiety, and their ability to sleep really quickly, as well as myoinositol to help resolve some of the anxiety, some of the blood sugar swings, and help them sleep better. In addition to blood sugar balancing, aligning with the circadian rhythm, and then a lot of the transformational techniques of building energy. Some of them are really focused on creating pleasurable activities throughout your day. And that can be just a really big game changer for people who don't do things they enjoy throughout the day, right? So connecting in nature, having time with friends, things of that nature. We go through a whole process where I have about 14 different safety signals. to kind of outweigh the stress signals that we're getting. And we're also turning off some of the stress signals throughout the process.

So it's a whole combination of things, including dietary changes, bringing pleasure in your life, getting your circadian rhythm set. And what's different about your approach is some of these unique supplements. Is that what makes it sort of different? Is the rhodiola, the myo-inositol, the carnitine.

So a big focus of it is on the mitochondrial support. So you might have noticed adrenal transformation protocol, it's ATP. So that is part of it, yes. Yes. So ATP is- I didn't catch that. It is our energy, you know, energy throughout the body, how our mitochondria creates energy throughout the body. And so that is a big part of it, but also a lot of transformational work too. So, looking at how to create joy in your life, a lot of times I feel like people are fatigued not because they're doing too many things, but because they're not doing the things that bring them joy and energy, and that really bring the spark into their lives. So, they're drained by doing mundane tasks, and kind of shifting your daily routine to adding some pleasure into your life can actually sometimes be more effective than like utilizing supplements and nutrition. I mean, and I combine it all and this is why I think people have such fabulous results. And I don't ask them to quit caffeine, right? Oh, this is, yeah, yeah.

Missed love coffee in the morning.

Yeah, if you could.

Not 12 cups a day.

Not, gosh, no, not 12 cups of coffee in the morning, but we focus on really building up their energy levels. And so usually by week two or three, they're able to wean off the caffeine naturally and they don't need it. So if you get enough bright lights in your morning, you step outside, you get some bright lights into your morning, you do the adrenal kickstart drink that I recommend, which is a little bit of orange juice and sea salt and protein and fat, you do that in the morning. And then you're going to be like, holy cow, I don't even need my caffeine because that's going to raise your cortisol level naturally. And then people sleep really well at night throughout the program. So then they just naturally wean off. Like, some people are like, you know, I want to be on coffee. I love coffee. Or I love my Earl Grey tea. And that's fine. If you're having an unhealthy relationship with your caffeine, with your sugar, with your wine, then we're going to give you the energy.

You need to break up. And the-- if you have a bad.

Relationship, you have to break up. You have to break up with that, absolutely. But we want to get you to a really healthy relationship with the caffeine. So part of that is making sure you have enough energy so you can actually quit the caffeine. If you don't have enough energy, if you're sleep deprived, you're just going to kind of go back to your habits. So a big part of the process, and we do see shifts in about the first two weeks where I've done the program seven times now with groups of people over 3,500 and initially they're like, I'm so overwhelmed, I'm so tired, I'm so stressed and by week two or three they're like, I'm running up and down my stairs, I clean my whole house like my libido's back, I feel so amazing and it really focuses on supporting your body's energy pathways and also letting go of the things that really weigh us down. So a lot of the transformational work focuses on are we having stories in our heads that maybe are weighing us down and how do we transform that and how do we create a trigger toolkit so that we are not drained on a daily basis by things that trigger us.

For a lot of individuals, like wrapping their heads around doing something that's completely contrary to what we've been telling our patients to do for years, takes a little bit of an adjustment. But I like to start with intermittent fasting and describing it as eating less often. and depending on the individual and what their goals are, as an example, a 16/8, which is 16 hours fasted with an eight hour feeding window, is a good goal to work towards for most individuals. From there, we have lots of other variations. We have people that are doing one meal a day, we've got time restricted eating, we have a 5:2, which is or alternate day fasting, where people are having alterations between a day of a regular eating pattern with a 24-hour fast, with another day of a regular feeding pattern, another day of a 24-hour fast. And I think in terms of what makes the most sense is really figuring out for each individual what their goals are, and then we can help them select the appropriate time in which to fast. I think it also comes down to life stage, you know, where people are in their life and also men and women need to fast a little bit differently. But I think a good rule of thumb is to really think about that 16:8 and understanding that when we're in this unfed state, as you appropriately stated, we have all these benefits that are conferred. It's not starvation. We are just choosing to be purposeful about when we eat and when we're not eating. In an unfed state, we have upregulation of things like autophagy, this waste and recycling process that goes on behind the scenes. We have lowered levels of inflammation. we certainly have improved biophysical markers as we are transitioned to being more metabolically healthy, as our bodies are able to effectively utilize either stored fat or stored carbohydrates as a fuel source. And as you appropriately mentioned, more often than not, you know, 92 to 93% of Americans are not metabolically healthy. So they're stuck using sugar as a fuel source when it, as you become more metabolically flexible, your body's able to use different types of fuel substrates. And it's in these opportunities when our bodies are able to have lowered insulin levels that we can go in and use stored fat as a fuel source. And we know that for individuals that are metabolically flexible, they have a preferred ability to be able to be flexible in terms of using different types of fuel. We know that if our bodies are able to produce things like ketones, we can get diffusion of specific types of ketones across the blood-brain barrier, which can help with mental clarity and energy, things that I know so many individuals are really struggling with these days. But those are some of the kind of high level concepts. And then I think as clinicians, we know that patients that are embracing fasting are going to very likely have improved biophysical markers, improved triglycerides, HDL, they're very likely going to have improved blood pressure. They will go on to have improved inflammatory markers. I think about high sensitivity CRP, homocysteine, and things like this. And that's just the tipping point. You know, as you appropriately mentioned, you just wrote this book on longevity. But we know based on research that individuals, we look at blue zones, we look at specific parts of the world, the people that are that are more physically active and are not eating as many calories per se are having improved quality of life and longevity metrics.

Yeah. You know, the Holocaust survivors often live a very long time. it's interesting. They, they had very, very little, very little food, and they lived to be 90s, hundreds. It's, it's quite interesting, not because it's a genetic thing, because something got reprogrammed in their biology by the act of starvation. Now, I wouldn't recommend that strategy, but I think that it speaks to the power of activating these ancient survival mechanisms that are embedded within our body to keep everything running. Right. And what you just said, just to break it down, was a lot of benefits. I mean, you, and we're going to talk about the kinds of fasting a little bit more. I think it's unclear, but you basically reset your biology to a healthier pattern. You lose fat, you build muscle, you build bone density, increase mental clarity, improve inflammation, and you help regulate your blood sugar or your blood pressure or your cholesterol, your growth hormone, stress hormones, all these things that tend to age us all improve in the right direction with this one simple, you say free and flexible. And what was the other thing you said? Easy to do approach that it's just basically doesn't cost anything. And it's amazing. Now, when people talk about it, you know, they say, well, you could do a 12-hour overnight fast or 14 hour or 16. Or maybe it's better to do a 24 to 36 hour fast a week or a three-day fast a month or a seven-day fast a quarter or water fast. What, what, what do you recommend? And how different are the different types? Because people can go keto and get the same benefit they can do. a calorie restriction with a fasting mimicking diet, which is 800 calories a day for five days. They can do a 5-2 diet where you restrict on two days and eat normally five days. You can do a 12-14 16-hour fast, you know, so it's a lot of different things. What, what is the best thing to do? You're saying 16-8 is really the best thing. Is it that much better than 14-8 or 12-12 or 14-10 or 12-12 or what, what, what's the Nuance here?

Well, I think that it really comes down to who are you as an individual? What stage of life are you in? What are your goals? So, if you are a lean 32-year-old female, I'm going to talk to you about 12 hours of digestive rest as opposed to doing really long fasts because your body is so exquisitely attuned to food and your peak fertile years. Very different than my obese 45-year-old perimenopausal woman that may need to do some longer fasts because she has plenty, all of us really have plenty of stored fat to use as a fuel source. But this is someone who's looking to change body composition, looking to lose weight, probably has a little bit of insulin resistance. And so some of those longer fasts in the context of dialing in on the lifestyle, getting high quality sleep, making sure they're managing their stress, that's an individual that can probably get away with a 24 or a 36 hour fast. I do think that it's a graduated approach, meaning, you know, when we go from irrespective of gender, if we go from a standard American diet being very physically sedentary to suddenly evolving into a paradigm where you're going to eat less often, it starts with stopping snacking. You know, we've been conditioning our patients.

Oh my God, it's the worst thing that ever was invented was snacks. I know. I mean, who the heck, I mean, it's a whole industry of junk food that's been pushed on us and somehow we were taught that we need to snack. And we need snack foods all around us and snack foods in our house and snack foods at the airport and snack foods at every corner. It's just, it's the worst. And I think there's two things people could do to dramatically improve their health is get rid of liquid sugar calories and don't snack.

Yes, and I couldn't agree more. So when we're talking about the standard American, it's really saying, stop snacking, rip that Band-Aid off because it's going to force you to reallocate your macronutrients, your protein, fat and carbs with your meal. and then, and only then, is someone really in a position where they can say, okay, I'm not going to eat from breakfast to lunch and lunch to dinner and from dinner to breakfast. And so it may start with 12 hours of not eating. It may evolve to 13 to 14. And I find for a lot of my patients who are very metabolically inflexible, that are insulin resistant or diabetic, we have to do this pretty slowly because their bodies are so inefficient. It's almost as if they've been putting the wrong type of fuel in their bodies for so many years that their body is not able to tap into fat stores as a first step. So for those individuals, it's a really slow stepwise approach, kind of getting them to a point where they're putting on training wheels so they can get to a point where I can encourage them, go 18 hours, go 20 hours, go 24 hours.

Oh, really?

Yes. I mean, so it's slowly, and I find that I get better results if we do it slowly. Now, do I have magical patients that want to start with a 24-hour fast right off the bat? Yes, but I've come to find that they are few and far between. There's a degree of tentativeness because we've conditioned our patients on so many different.

Levels that you don't need you're gonna die.

Right, snacks and mini meals. I mean, stoke your metabolism, you need all these things. And so we're having to reprogram all of this cognitive kind of disconnect that they've like affirmed for so many years. And even clinicians, I find sometimes are a little reticent to make these recommendations. I'm like, listen, we wouldn't be here as a species if we weren't capable of going through longer periods of time without food, without, you know, and understanding that you're still, your body has plenty of stored fuel to be able to fuel your body. It's just kind of reframing that perspective about meal frequency, what we're eating, how frequently we're eating. And I think for so many of my patients, they feel so much better almost instantaneously that it for them, It's this kind of slow crawl to get to 18 hours, 20 hours, 24 hours, and helping them understand there are different benefits at different intervals. 12 hours to me is digestive rest. It's a great way to, everyone should be doing that, right? I have teenagers, I don't recommend that they fast. They're very metabolically healthy. 12 hours of digestive rest for them is sometimes challenging because they're still growing. But from my perspective, any adult should be able to get to that. And then slowly, depending on the individual, kind of working up to those metrics. You mentioned these longer fasts, you know, doing a fasting mimicking diet, doing a three to five day fast. I think that my perspective on this has started to shift a little bit. As I'm getting older, I know how important muscle mass is to maintain muscle mass with age and how that plays a role in insulin sensitivity. I think you have to be very purposeful about and very, I don't want to use the word calculating, but very exacting about what are you trying to gain and finding that balance. For me, I don't do really long fasts anymore. and I'm happy to explain why. But I do think that there's a lot of therapeutic benefit depending on what people are working towards.

Yeah, that's right. I would say fasting in all the forms, I think it was a medical intervention, like a drug, and you have to find the right dose for each patient and the right exact treatment for each patient. And they're different. If you're a 350-pound obese diabetic with hypertension and heart failure, you might benefit from a 21-day water fast a lot. If you are for someone like me who, you know, baby has 10 body fat, I I can do a 24 hour fast, but I tend to kind of lose weight pretty fast. And I worry about losing muscle at 63. So, like, today, for example, wasn't that hard. I had dinner at six o'clock last night, and I woke up this morning. I did a bit of sort of work and worked out and did a sauna, and I had my healthy aging protein shake, and it was probably 10 o'clock, 10 30 in the morning. So I went from, like, six o'clock at night to 10 30. That's a 16 and a half hour. fast. It wasn't that hard, right? It's not like I'm starving and need to get food first thing in the morning. My body just have that space to not eat. What, you know, what you're saying is such a contradiction to what was so much the dogma nutrition recommendations, which is you need to eat three meals a day, you need to snack, you have multiple small meals to keep your metabolism going and to burn more calories. And you have to stoke the fire of your metabolism. Otherwise, you won't lose weight and. Can you speak to that? How did we get it so wrong and what changed?

Well, I think, you know, I certainly started in medicine in the 1990s and I got as a nurse and as an MP, got little to no nutritional education or information. I think that from my perspective, based on what I know about Ancel Keys and the Seven Countries Study and this kind of shift after President Eisenhower had a heart attack, had an MI, that all of a sudden they wanted to take the focus off of sugar, put the focus on fat. That with the rise of this processed food industry, I think it really created opportunities for healthcare providers to be telling their patients, well, you need to eat these small frequent meals. This is going to be a benefit. No fat, fat is bad. Don't eat butter, don't eat nuts, don't eat avocado. Instead eat these adulterated seed oils. Try these processed highly inflammatory fake sugars, even high fructose corn syrup, which is about as far away from what real sugar is like. So I think it started to pivot in the 1950s, based on everything that I'm aware of or what changed here in the United States, but certainly Ansel Keys gets a lot of the blame, I think, on a lot of different levels deflecting the focus of looking at sugar as being this inflammatory food substance and then making it all about fat. And of course, you and I know that that's not the case. And in fact, when I started in cardiology as an NP, I did that for 16 years. I cringe at what my handouts looked like back then, but it was based on, you know, it was based on my plate and the food guide pyramid and eat heart-healthy grains and eat very small portions of very, very lean meat, but don't eat a lot of meat, eat a lot of those grains.

And you need five to six servings of carbohydrates a day.

And, no, it was six to 11 servings of bread, rice, cereal, and pasta.

Yeah.

Yeah. It's terrible. So, so I think that that has certainly contributed along with this hedonistic, hyper palatable environment that we live in. I mean, I think about Uber Eats. I was trying to, no offense to Uber Eats, but I was trying to make a, I was explaining to my teenagers that, you know, years ago you had to get in a car and go to the store. Things weren't just delivered. And now people can get anything they want, you know, 24/7. And so, yeah, I think there's a.

Years ago you had to go to your dial up phone. It was connected to your wall.

Yeah.

You couldn't walk around with your phone.

There was no cell phones.

Yeah.

We're definitely dating ourselves. But I think it really plays back to the start of being convinced that we needed to eat a lot of processed carbohydrates along with the rise of seed oils. I mean, when I look at the research, seed oils, high fructose corn syrup, the advent of those into our diets and the fact that they proliferate, I mean, the number one consumed fat in the United States right now is soybean oil. And so, so when I reflect on that and I talk to my kids about what soybean oil is, I'm like, that's not a real fat. Our bodies don't recognize that as a real fat. And so I think that there's multiple things combined with an increasingly sedentary population. People don't sleep well. You know, we have this hedonistic culture. We can binge Netflix any time of the day or night. We can order food any time of the day or night. And I just think it's this accessibility, you know, on every level, this kind of dopamine, dopamine, anergic. society that we live in is probably also contributing to why we're seeing such poor metabolic health.

No, I get it. When I go to a city, I'm just amazed at how easy accessible everything is when I live in the country in the Berkshires. And, there's no Uber Eats, there's no Uber, there's no delivery of food. You literally have to go out and get it or make it yourself. I think, you know, what I want to sort of understand is what's the 80-20 for people in terms of the techniques to make it simple. Do you have to do 16? Is 14 enough? Is it better to do 18? Like, where is the 80 20 for people? And how often do you do it? Do you do it every day? Do you do it once a week? Do you do it three times a week? What's the best strategy for people? And why? And for people who may be listening and say, I want to try this. It sounds good. It's going to turn on all my wellness Pathways. It's going to reverse my biological age. It's going to help me lose weight. It's going to improve my metabolism. Sounds great. what's the best place to start and what is the dose in the prescription?

Yeah, I love this question. So we start really conservatively. We start with the stop snacking because that effectively is going to force you to kind of adjust your meals. You know, more protein, more healthy fats, discretionary carbohydrates, depending on what they are. Maybe it's some root vegetables. That's step one and step two. And then step three is going from dinner to breakfast the following day without eating. And so many of us, you know, we're just coming off the tail end of the pandemic. I think so many of us have, you know, through many months of uncertainty and fear, people were doing a lot of drinking and eating in the evening. And so effectively not eating at night after dinner until the following morning. And so starting with 12 to 13 hours and opening it up from there, your question is, what's the prescription? And I think it's really dependent. Are you a woman that's still getting a menstrual cycle? because we know that there's benefit to utilizing fasting as a strategy in the follicular phase when estrogen predominates, when your body is capable of more hormetic stress, when your body can do more intense exercise, you can do a little bit more fasting. And then as we post ovulation, when progesterone predominates, this is when I encourage women to do a little less fasting, kind of back off the gas. Maybe they're doing 12 or 13 hours of digestive rest. is very different than a man and a postmenopausal woman because they have less hormonal fluctuation day to day, week to week. So that is certainly an interplay, you know, where are you life stage wise, you know, what gender do you identify with, and then kind of determining, are you very physically active? You know, if you're doing, if you're training for a race, I'm not going to tell you to restrict your, your food intake because you're actually going to need a little bit more fuel if you're sedentary. then maybe intermittent fasting is going to be helpful for you to embrace most days of the week. I personally, because you asked, I tend to fast anywhere from 14 to 18 hours a day. It really depends on what exercise I'm doing, what my sleep quality is like, how am I managing my stress. I think those are very important, you know, contributing factors. But I think a good starting place, based on the research, based on what I'm seeing, is to aim for 16 hours fast. So with an eight hour feeding window, because eight hours will allow an individual to consume at least two good sized meals. And I'm very big on making sure we're getting sufficient amounts of protein so that we're not impacting and blunting muscle protein synthesis, but also not putting ourselves in a state of muscle loss, which sarcopenia is a real issue. You know, I'm middle aged and it's something I think about a lot. That's why I think finding that balance between not over fasting and making sure I can get in two really good sized meals a day. is certainly very important. But I think there's multiple variables. As I mentioned, you know, life stage, certainly, you know, where you are in life stage, whether you're male or female, whether you're menopausal or not, accounting for that menstrual cycle. And then the lifestyle piece, and this applies to everyone. If you have terrible stress, you're not sleeping, you're over exercising, that is not the time to be adding gasoline to a fire. Maybe you're just doing 12 hours of digestive rest, which is going to still confer some benefits, not as much as, you know, when you're pushing 18, 20, 24 hours. But it's helping patients understand that there are different levers. There's consistency that's important, but helping people understand that depending on where you are in life stage can be very, very beneficial. But it's okay if you don't fast every day. Maybe you start off fasting two days a week. That's why the 5:2 or alternate day fasting, I think, can be very advantageous for people who are just ready to try.

Alternate day, like intermittent fasting, you mean? Yes, yes. Time-restricted eating is maybe a better term you think than intermittent fasting because I think that's a broad category, right? Yeah. Intermittent fasting can be like a week fast or a 21-day fast or two-day fast. It can also be time-restricted eating. So it seems like the overarching category.

Within it there's different techniques, right? Correct. There's different strategies and it really depends. I mean, as you appropriately stated, if you have an obese diabetic patient, doing a prolonged fast might be a really great way to help them break through plateau may be beneficial for helping them recalibrate their palate. Many people feel, and obviously this is not my area of expertise, but in talking to other experts on my podcast, talking about food addiction and individuals that are really struggling with those kinds of cravings, that sometimes those longer fasts can help them kind of recalibrate their palate and get ready to do fasting on a more regular basis. I hope you enjoyed today's episode.

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