The INSANE BENEFITS Of Fasting For Women & How To Do It CORRECTLY | Cynthia Thurlow

When we're in this unfed state, 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.

I wonder if you break down for us the different types of fasting, which ones are the best and where you might get the biggest bang for your buck in terms of approaching the strategy of how to use fasting or intermittent fasting or whatever you want to call it for your health.

You know, you're so right that intermittent fasting is not new or novel. It dates back to biblical times. And for a lot of individuals, goals like wrapping their heads around doing something that's completely contrary to what we've been telling our patients to do for years. It 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 an irregular 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 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, 92 to 93% of Americans are not metabolically healthy, so they're stuck using sugar as a fuel source when 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 that 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 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 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 as a 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 gonna talk about the kinds of fasting a little bit more because 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, you increase mental clarity, improve inflammation, you help regulate your blood sugar or your blood pressure, 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 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 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 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? 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, you know, 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 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. Yes. 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 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 gonna force you to reallocate your macronutrients, your protein, fat and carbs with your meals. And then, and only then, is someone really in a position where they can say, okay, I'm not gonna 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. You don't need to die.

Right.

Snacks and mini meals. I mean, stoke your metabolism. You need all these things. And so we're having to all of this cognitive kind of disconnect that they've, 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, you know, 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 3 to 5 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 and 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 someone like me who, you know, baby has 10% body fat, I, I can do a 24 hour fast, but I, I tend to kind of lose weight pretty fast and I worry about losing muscle at 63. So, like, today, for example, it 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 have 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'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 Ansel 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're, they wanted to take the focus off of sugar, put the focus on fat. that, you know, with the rise of this processed food industry, I think it really created opportunities for, you know, 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. You know, don't eat butter, don't eat nuts, don't eat avocado. Instead, these adulterated seed oils, you know, try these processed, highly inflammatory, fake sugars, you know, even high fructose corn syrup, which is a about as far away from what real sugar is like. So I think it started to pivot in the 1950s, you know, based on everything that I'm aware of or what changed here in the United States, but certainly Ancel 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 MP, 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 low fat.

It was six to 11 servings of bread, rice, cereal, and pasta.

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. 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, 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. 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 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 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 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.

Dr. Alternate day like intermittent fasting, you mean? Dr. 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 a 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.

Great. So in terms of the obvious, is nobody should be snacking in between meals and giving yourself at least 12 hours. And then you can kind of push it to 14. And it's not hard. If you dinner at six o'clock at night, that's eating breakfast at eight in the morning. Right. It's not, it's not. We're not talking about something that's unachievable. It's just sort of a little bit foreign to most of us because we're, you know, taught to snack and have bedtime snacks and eat late. And that's the worst thing we can do. I want to, I want to sort of dive in a little bit to the mechanisms, and then I want to get into, like, really more detail about who should fast, who shouldn't fast, why, and what some of the benefits are. So can you take us through some of the mechanisms? We talked about some of the benefits, right? The cholesterol, the blood sugar, the blood pressure, the weight, the metabolism, but how does it actually work? What are the sort of mechanisms of action from a scientific perspective about how fasting can activate all these longevity pathways.

And these healing pathways? Well, I think I really start with talking about autophagy. So when we're in an unfed state, we have much like anything in the body, it's all about balance. We have something called autophagy and we have something called mTOR and they're always looking for balance. It's not as if one gets turned off and one gets turned on, but understand this upregulation. So when we're in an unfed state, our body can go in and effectively get rid of trash. You can go in and get rid of diseased, disordered organelles, mitochondria, things that have the potential, again, emphasis on potential, to go on to create disease. And so when we're able to effectively take out the trash, it can lower our risk for developing certain neurocognitive issues as well as cancer. I also like to think about the fact that we have specific types of proteins called sirtuins that get upregulated specifically with fasting and these along with other mechanisms AMPK and NAD can be very, very effective for helping with longevity pathways in the body. I think that when I- so when.

You'Re fasting, you mean NAD, you mean NAD, right? NAD+? which people hear about NMN, NAD, and NR. What you're saying is when you fast, you increase the amount of NAD, which then stimulates this pathway called sirtuins, which has all these longevity benefits, right? Improving mitochondrial function, improving insulin resistance, reducing inflammation, activating DNA repair, inducing autophagy. So, it's all this incredible stuff that happens just from the simple act of not eating. that activates these ancient pathways.

Absolutely. And I think a lot of people have probably heard of the term mitochondria, but they are like the spark plugs of our cells. But after the age of 40, for many of us, we have some degree of mitochondrial dysfunction and usually is at the basis for most of the chronic disease states that we see. So anything that's going to be improving mitochondrial function, like with fasting and upregulation of these different pathways, can be hugely impactful And I unfortunately think that there's so much focus, as you know, in traditional allopathic medicine to addressing symptoms as opposed to root cause. What I love best about fasting is it's looking at these mechanisms in a way that allows our bodies to intrinsically help heal themselves.

Yeah, it's pretty amazing actually. It's like when you look at the science of the, you know, one of the hallmarks of aging, which is a lot of the ways in which fasting works. It works on these pathways that have been termed when they go wrong, deregulated nutrient sensing. And, that's something I talked about in my book, Young Forever. And, I think it's sort of the meta hallmark that's above all the other hallmarks in a sense, because it drives changes in all the other things that we see go wrong with aging. So, it's almost like you have this secret weapon of fasting to do things that are really powerful that almost no drug can do. maybe rapamycin might have similar benefits. It's sort of like a, it's like a drug that actually seems to mimic fasting without fasting, because it inhibits the pathways called mTOR, which fasting does, that induces autophagy, which what you just talked about, it's basically a way to, to kind of activate this longevity switch, I call it. And so you've got these four different pathways that you mentioned, AMPK, sirtuins, mTOR, which you implied through autophagy and also insulin signaling, all are improved through fasting. And I talk a lot about these in my book as essential things that you have to focus on that are regulated about what we eat that drive all the chronic diseases of aging, that drive all the accelerated biological aging. And we can influence these dramatically through a whole range of different lifestyle factors, through the quality of our diet, through reducing sugar, But fasting and time-restricted eating are a very powerful set of tools that we have as a drug, literally I would consider them as a drug medicine, to activate these things. So really we talk about food as medicine, but in a sense fasting is medicine too.

And I couldn't agree more. And to me it's such a powerful kind of statement that there are more and more of us that are speaking so openly. I think many people come to fasting out of a curiosity to change body composition or lose weight, but I always say there's so much more to fasting that maybe perhaps people are less aware of that I think is far more powerful and certainly more impactful.

Yeah. So tell me, you know, there are some people who shouldn't do this, right? So if people are listening and they go, this sounds great. I understand the mechanisms. It seems simple, it's free, it's accessible, anybody on the planet can do it. But maybe who shouldn't do it? Old, young, sick, hormonal state, like what's the right person to really focus on this and who shouldn't.

I would say let's start with who should not. Obviously, people that are still growing. So I have teenagers at home. I always say if you're not a fully grown adult, this is not a strategy to use with children or teenagers. I would start with pregnant or breastfeeding women. I know this can be controversial, but I always remind people if you're growing a human or feeding a human, this is not the time to restrict your caloric intake. Anyone that's got a disordered relationship with food, obviously there are extreme eating disorders. So, you have eating disorder. Correct. So, if you have a history of anorexia, bulimia, binge eating, unless you are in conjunction with your eating disorder specialist, feel that you're in a position to be able to engage in these activities, probably not a good idea. I always say individuals that are frail. Unfortunately, I got hammered in my TED Talk because the organizers asked me to say above a certain age, so I said 70. and I've just gotten hammered by, you know, very healthy 70 plus year old. So I think it's less about age. Exactly. Less about age and more about if you're frail, if you are brittle diabetic, you're not aware when you have hypoglycemic episodes. If you're someone who just left the hospital, you know, I lost 15 pounds in 2019 and better believe I didn't fast for about four or five months. Anyone that's got a chronic health condition, it's not that it's a contraindication. But I think it's helpful to get your healthcare practitioner involved, your internist, if you're on diabetes medicines or blood pressure medicines, because you may need adjustments.

It's not to suggest that it's a true contraindication. If you have a lot of health issues, you might actually end up having a problem because you might need less medication.

Yep, exactly. Exactly. So kind of looping in your internist, your primary care provider, so they can be monitoring you more closely. But beyond that, I find most people do really well. I think the other caveat I would add is, if you went through a divorce, you just went through a contentious move, you had some major stressor in your life, intermittent fasting is a form of hormesis, a beneficial stress in the right amount at the right time. Don't add gasoline point in time. That might not be a beneficial thing for you to do. So, kind of looking at women in different stages of life is also important.

I think that's important to mention because I think, you know, for women and things changed out their life. And, and, you know, if you're menstruating, it's probably gonna be a day if you, if you have different hormonal issues, but it can be also helpful too. Right. If you're sort of an overweight premenopausal woman with fibroids or severe estrogen excess, I mean, maybe this is a therapy.

That can actually help reduce some of that.

Yeah.

And I've definitely have had some patients with PCOS, so polycystic ovarian syndrome that have done really well because at the basis of PCOS as an example, is this insulin resistance inflammatory oxidative stress component. And so eating less often for them can oftentimes help them kind of reverse the degree of insulin resistance they're experiencing. So I think it's always in the context of who is the individual, what life stage are they in, what other stressors are going on in their lives.

Now, you had your own personal experience with this, right? You actually had an autoimmune disease. , and you use fasting as part of the approach, including eliminating gluten. Can you talk about what that was like and what you did and, you know, what you learned from it? Yeah.

So I'm sure most of your listeners know that if you have one autoimmune condition, you're more prone to others. And so by the time I was 40, I had two autoimmune conditions and just on a whim, I decided to go gluten free. And what was amazing was that my dermatologist kept saying, what are you doing differently? And so my psoriasis has never come back. I had pretty mild psoriasis, but I still had it nonetheless after being treated for Lyme. And then with the intermittent fasting piece, allowing my Hashimoto's, although I had negative antibodies, allowing my Hashimoto's to go into remission and to, you know, I have very, very stable thyroid function with the gluten-free diet and also adding in the intermittent fasting. I don't over fast because I think that's important to kind of identify But for me, I felt better almost instantaneously, even better than I did when I started thyroid replacement therapy with the intermittent fasting. So I think it's a powerful statement because there's so much misinformation like, oh, if you have a thyroid condition, then you can't tolerate intermittent fasting. I think it actually helps improve mitochondrial function if you're doing it properly.

Interesting. So, Most people think if your thyroid's not working, it may not be a great idea because your metabolism's already slow and you shouldn't probably do it. But you're saying with an autoimmune condition like Hashimoto's, you can actually see changes. And did your autoimmune condition get better?

Did the antibodies go away or what happened? Yeah, I mean, I haven't had positive antibodies and at least initially my functional medicine provider thought maybe I didn't have Hashimoto's, but we've come to learn that that's not the case. With that being said, I have very, very stable numbers and I have to believe because I'm very conscientious the lifestyle piece. And this is where it's important for people to understand, like, I sleep well, I manage my stress, I don't over exercise, I make sure I get enough food in during the day. As you mentioned, more often than not, patients that have hypothyroidism, if they've got a slowed metabolism, they're gaining weight. They just keep thinking less is more, less food is going to be better, more fasting is better. And having to kind of find that reframe to help them understand that actually eating less food and over fasting is going to exacerbate what's what's going on with their body. So finding a very happy medium. And I always say the power of the N of one, but I have lots of patients that have found the same thing, that their thyroid function has actually gotten better, making sure they're, they're understanding how to properly fast or not.

Hmm, absolutely interesting. So in terms of muscle, let's talk about muscle for a minute because as we get older, we need to be more diligent about protecting, maintaining, building, increasing muscle mass and function. and fasting and, you know, can actually cause you to lose muscle potentially. So how do you navigate and thread that needle between the benefits of fasting and the need for building muscle? Because a lot, you know, a lot of people specifically in the, in the field of longevity are talking about how we really need to do everything we can to mimic fasting and to reduce our, our stimulation of mTOR. And we should all be vegan. And what should, you know, so, but then you can't build muscle. So it's really, it's really an interesting conversation. I'd love to know your perspective on it? Yeah.

And I actually get this question often, as I'm sure you probably do as well. I think it really comes down to understanding the role of sarcopenia, which is this muscle loss with aging. And after the age of 40, most of us are, it's this kind of accelerated muscle aging and understanding that, and I love this analogy that I use, if you want to think about young muscle, it looks like a filet. Filets are delicious and wonderful, right? And then, Yeah, exactly. And then as we're getting older, we're starting to replace muscle tissue with adipose tissue, and that's like a ribeye, which is equally delicious, but we don't want to become the ribeye. So helping individuals understand that there has to be adequate muscle protein synthesis, so you need enough stimulus on the muscle. So strength training is important, understanding that you're eating enough protein. And I'm going to go out on a limb and say that, you know, for me personally, this is the N of one. I find that animal-based protein, I do much better having animal-based protein in my diet, getting at least 40 to 50 grams of protein with each one of my meals combined with good quality sleep and not over fasting. So how do I do that? It means that I'm diligently lifting heavy weights at least three times a week. It means I'm eating at least two good-sized boluses of protein twice a day. Sometimes I might do three. It depends on where I am and what I'm doing. getting enough sleep is the way that I've been able to continue to maintain and build muscle even as a menopausal female. I'm 51. And for me, it's very, very important. I would say the other piece of that and this is very much personal preference, you know, how you and whatever relationship you have with your GYN or your functional medicine provider are using hormone replacement therapy because, you know, about 75% of women are going to have much lower levels of testosterone in perimenopause and menopause. And I'm definitely one of them. And so I do believe that hormone replacement therapy, testosterone and estrogen and progesterone can be very beneficial for helping me to continue to build and create more muscle. So again, that's a very much a personal preference, and I'm happy to talk more about that. But I do think for me personally, muscle is what I equate with having this organ of continued longevity, maintaining insulin sensitivity, metabolic flexibility. I feel fervently that muscle is very important. So this is why I don't over fast. This is why I'm conscientious about not doing a lot of long fasts, but I am metabolically flexible. If I were not, I would have to rethink that strategy.

Interesting. So we talked a little bit, you mentioned bioidentical hormone therapy and and I like to talk about that. And it's a little bit different than the fasting conversation, but it's related because, you know, what happens to women after menopause is often their metabolism slows down. They get that belly fat. They feel like this is just inevitable. And I hear this over and over for women, and I know it's not inevitable. I know it's not something people have to expect as normal, but it is. It is very common. And the question is, you know, what's causing that? And how do they combat that? Because one of the biggest questions I get all the time from my patients who are menopausal women. And, and, and two, what role does hormone therapy play in managing all that?

Yeah, that's a great question. I think there are many things that contribute. I know that women are less stress resilient. We go through adrenal pause, not just menopause. We go through adrenal pause. And as our ovaries, even in menopause, we still have some ovarian function left. It's just as our ovaries are producing less progesterone, our adrenal glands are helping to produce some progesterone. And our adrenal glands are designed to be this emergency backup system. So if you're chronically stressed, not sleeping, cortisol levels are high. We have 40 times more cortisol receptors in our abdomens. So women describe this cortisol belly. That's a source of frustration. So I think about that. I think about if cortisol is up, you know, chronically, we've got high insulin, we've got high blood sugar. blood sugar goes up and then insulin is secreted to help bring it down. I think about the changes just with testosterone that we know that I fervently believe that that is probably one of the largest contributors to changes in body composition for women, an endless source of frustration. So I think testosterone absolutely contributes. We know that estrogen is this anabolic hormone. And so if you're losing estrogen, and so it's interesting in perimenopause, if you look at the research, we have some of the highest amounts of estrogen in our bodies during perimenopause because our brain is desperately trying to send this SOS to the ovaries and pumping out. So sometimes you have very high levels of estrogen and then you sometimes have lower levels. But as women are at the tail end of perimenopause into menopause, losing estrogen is also contributing to some of these body habitus changes as well as changes in insulin sensitivity. So you can be doing all the right things, you know, exercise, eating right, sleeping, and end up having some metabolic changes. So From my perspective, I think there's multiple things that come together and also, you know, just the amount of hypothyroidism or thyroid disease that we see in.

Women in middle age. Yeah, it's one in five women who many are undiagnosed.

Yep, it also really contributes to... So I think it's multifactorial, which is the fancy way of saying it's multiple reasons why this happens. I think the degree of changes in sleep architecture also contribute. We know if you sleep less than six hours a night, you know, you're less likely to be able to have properly managed leptin and growth hormone levels, these appetites, the tight hormones, blood sugar regulation. And how many women I speak to, they fall asleep, they can't stay asleep, they toss and turn for hours, they're having hot flashes. And so I think there's a lot that contributes along with the, you know, women treat their bodies like they did in their twenties and thirties. And I always say jokingly, everything changes and not in a bad way. We have to do the right types of exercise. We have to change the way we're eating. I know we're both huge proponents of anti-inflammatory diets and nutrition and then managing stress. It's not five minutes of meditation once a day, but I think all of those things can absolutely impact. And I'm starting to read more and understand more about the research surrounding adverse childhood events and how the impact of trauma can impact women's weight loss resistance later in life, their risk for autoimmune conditions. And so I think there's a lot of different things that at the stage of a woman's life that can really impact their frustration with the way their bodies are changing.

Yeah, I often talk about the four hormonal changes that happen around perimenopause and menopause that are hugely impactful for women's health and metabolism, more insulin resistance, more stress because they're in the sandwich generation between their kids and their parents who they have to manage and their careers. thyroid dysfunction, and sex hormone changes. So you've got those four interacting hormonal systems that are all kind of going a little bit off center, and that's what drives so much of the symptoms and dysfunction. And they're all treatable, they're all fixable. A lot of it's through dietary and lifestyle practices, sometimes hormonal therapy, but it's super important. So what I want to sort of talk about next is, is some of the things you use sort of help with with muscle and to sort of accelerate some of the benefits of fasting. Because you talked about creatine and myoinositol. Can we kind of dive into what is the use of these compounds? What are they? What's creatine? What does it do? And why supplementing it with a so beneficial? Who should be taking it and why?

Oh, that's a good question.

Go to myoinositol. Yeah.

Yeah. So creatine monohydrate is probably one of the most well researched supplements or ergogenic aids on the market. I think unfortunately, you know, 20 plus years ago, it really got a bad rap because the bodybuilders were using that in conjunction with a lot of anabolic steroids at very high doses. What it is is it's actually something that we have intracellularly. So inside our cells, creatine monohydrate, interestingly enough, women make 70 to 80% less than men. So I like to say like we are already at a disadvantage that we make less of it. And that's why supplementation can be so beneficial I think about it in terms of muscle protein synthesis, but I also think about cognition and brain health and sleep support. And a lot of what I find are huge pain points for women, especially at middle age, is they struggle to build muscle and maintain muscle and they struggle to sleep. And creatine, you know, to me has been a game changer. I have 70 year old patients that are using it and they're on leg press machines. I myself have been using it for the past year and from my perspective, it has helped with sleep architecture and also helped me continue to build and maintain lean muscle. But helping people understand that if you look at the research, we have different creatine needs throughout our menstrual cycle, which I find fascinating.

Interesting.

And then helping women understand that we just make less of it. Like men actually have much more of it in their muscles, muscles and their muscle cells. But we actually need we can't get enough just from eating meat. I would love to be able to say, yes, you can get everything that you need in terms of dietary needs just from meat, but it doesn't work that easily. So supplementation can be hugely helpful for muscle and cognition. And these are things that consistently women are concerned about at this stage of life, that they feel like they have to work so much harder, they're just not seeing the same gains that they want to see in the gym, or their sleep quality is eroded. You know, for me, it has really been a very humble experience. to understand and to look at creatine very differently than I used to because I used to think about it as a gym bro science. Yeah, yeah, exactly.

Exactly.

Gym bro science.

Muscle heads and the gym muscle heads in the gym all pounded down the creatine to build muscle. Exactly. Here you are, the woman talking about it as a therapy for both sleep and maintaining and building muscle throughout your life. So, how does it exactly work for building muscle and how does it work for sleep?

It's interesting when I kind of started diving into this because initially I wasn't, I was kind of skeptical like I am about a lot of things. We know that we have creatine monohydrate, we have creatine actually in our muscle cells. And so it's helping to replete those muscle cells, which actually will then contribute to, you know, being able to build more myocytes and, you know, get to a point where you're able to help with strength and duration of mechanism of action. When we think about the brain piece, it helps with sleep onset, it helps with that sleep architecture. So I think for a lot of not, I think I know for many women, one of the big pain points is deep sleep, you know, having that kind of restorative sleep that when the glymphatic system is upregulated, when this waste and recycling process goes on in the brain, we're getting rid of, you know, plaques and proteins that have the potential to go on again, potential to go on to, you know, impact neurocognitive function. But understanding that creatine can be very beneficial with promoting deep sleep, which can help with this upregulation of the glymphatic system and this waste and recycling process in the brain.

I'm surprised to hear, you know, I'm trying to think about as a doctor what the mechanism of action is for creatine and sleep. I understand what it's for muscle.

How does it, how do we know how it works for sleep? It's interesting. So initially when I started looking at this, I thought, okay, it's just about muscle. and then when I started looking at the sleep, and I'm happy to share some of the studies that I have kind of cataloged to support it for sleep. But my understanding is that it's helping with that deep sleep, that restorative sleep, helping with the waste and recycling process that goes on in this glymphatic system. And like I said, I'm happy to pass along the research that I've looked at, which you might find interesting because I was surprised. I kind of stumbled upon that as a secondary kind of indication.

We'll share that in our show notes, but it's interesting that mitochondria is really the key to all this. And creatine is a key mitochondrial compound that helps with energy production. So, I think that probably is explaining why through the mechanism of mitochondria, which we often have less of than we need. They're often not functioning as well as we need, and they're often poisoned by our environmental toxins by sugar, by an overload of calories, by our changes in our microbiome by anything that causes inflammation. So they're kind of under constant assault by our modern lifestyle. And we can do a lot about keeping our mitochondria healthy. And a lot of the aging research is really ultimately comes down to mitochondrial function. That's how a lot of these four longevity switches that we talked about earlier, sirtuins, AMPK, insulin signaling and Mtor work, working in part by actually helping to recycle old mitochondria to build new ones to improve their function. So there's a lot of interesting science around the mitochondria and as a common thread for all of this, it's really pretty cool. I think you also talk about myoinositol. So tell us about what that is and what are the benefits and who should take it. And by the way, with creatine, before we drop off of creatine, what's the dose? Should it be five grams, 10, 20 grams? What do you recommend for the average.

Person or is it 5 grams? Yeah, I say for so if I'm looking at women, I usually say 3 grams a day unless you are a vegetarian or vegan. So we know that vegetarians and vegans actually need more because they're not consuming this animal-based protein. Men and vegetarians and vegans should be 5 grams a day. And that's based on the best study research that I've been able to look at. When you mentioned the 10, 20 grams, there used to be loading doses. You don't need to actually do that. We do know that there's benefits from consuming it every day, taking the creatine every day in terms of the muscle and brain health benefits. Even if you're not exercising. Correct.

Correct. It's like five grams a day.

Yep.

So five grams for men, vegetarians and.

Vegans, three grams for women. In terms of myo-inositol, I think that's a different story.

Before you jump onto that, a lot of people like about loading dose of creatine, like 20 milligrams for five days, 10 grams after exercise. Is there a benefit to more?

Based on my research, the loading doses weren't necessarily necessary. And if people understand that creatine monohydrate is going to hydrate the muscles, this is where people will get flaxseed over, oh my gosh, I stepped on the scale and I gained some water weight and I don't know what happened. And I just explained that if you start doing loading doses, you may in fact gain some water weight, which will be improved upon when you get to kind of the standard dosing pattern. And I don't think that there's any clinical benefit from doing loading dosing. I think based on everything that I looked at and other experts that I spoke to in that field, they fervently believed, as did I based on the current research, that three to five grams is really a good standard dose for most individuals.

That's good. Okay, so you don't need to go up higher than that, even when you're working out and training, you shouldn't go.

To 10 or 15 or 20. not based on my research that I did. Then when we talk about myoinositol, this is another one of these kind of interesting fell off my radar supplements. I think a lot of us are familiarized with research related to polycystic ovarian syndrome. This is actually a secondary messenger for hormone signaling. It's actually part of the cellular membrane. It was interesting when I first started doing research, it used to be called B8 as an old name. but it's actually a misnomer because you can actually, you don't actually need to, per se, you can actually get some of it in your diet. Your body can make some of this myoinositol, but it's very helpful for metabolic syndrome, insulin sensitivity, polycystic ovarian syndrome. You'll see quite a bit of research on infertility. I mean, obviously that's not my area of expertise, but reproductive health can be helpful and that kind of ties into this insulin piece with you know, polycystic ovarian syndrome as well has some neurologic benefits. I personally started taking it guinea pigging well over a year ago, and it's very helpful for sleep architecture. It goes back to inducing and maintaining sleep. So if you get up in the middle of the night, it's very helpful to kind of quiet the autonomic nervous system, fall back to sleep, which is a huge pain point for a lot of middle-aged women. They, their sleep quality kind of erodes, especially with the waking up between 1 to 4 a.m. as being something that is very, very common. We can get some from our diet, but it goes back to, you know, the things that you can get in the diet. We start to think about beans, nuts and grains. I know not everyone is consuming those things in their diets, but I have found that for a lot of people, myself included, that this is a particularly helpful adjunct to other you know, lifestyle mechanisms that you're doing to support sleep. I've had really great success with a lot of women that have PCOS, even the thin type PCOS. So people that are about 25% of women with PCOS are thin and they oftentimes get lost in the medical system because people assume there's no way that you're insulin resistant and they can actually be insulin resistant. Kind of standard dosing is to start with one gram a day. and then people can work their way up. I'm not a clinical psychologist or a psychiatrist, but I do have colleagues that use this with great success in their patients that have mood disorders and even obsessive compulsive disorders. So there's good research to show that it has some mental health benefits, but that is not my area of expertise. And so I always leave it to the experts to touch on that.

Yeah, it's interesting because it does affect Serotonin production, dopamine, it infects dopamine, improves blood sugar control and helps fertility in women with PCOS and can help depression and, and it's pretty safe and effective. So the interesting thing about the, N-acetyl is that there's different forms. So myoinositol is the one you're talking about. The studies I've seen on PCOS and insulin resistance are more on D-chiro-inositol. Can you talk about the difference and, do need to take d-chiro, it's harder to get than my own nasal spray.

Yeah, it's interesting because I looked at d-chiro because initially I wanted to understand why some are used over others. I do have GYN colleagues that will use a combination of both with their PCOS patients. In terms of like broad reach, when I looked at the research on myoinositol, this is the one that is most abundant in like brain and nerve tissue and most impactful for serotonin and dopamine pathways. The research I read was that melatonin was the one that would be most beneficial for sleep support. And so I do think you can use a combination, but what was interesting for me was that I wanted to simplify things and I wanted to use the version of inositol that would be most efficacious. And everything that I was reading was suggesting that melatonin was going to be more efficacious and more advantageous for a broader variety of conditions or concerns.

It seems like for things like mental disorders, you might need more like up to 12 grams a day or PCOS, you might need two grams or four grams.

So yeah, so starting is usually one gram and then I actually have an expert coming on to talk about the mood, depression, anxiety, OCD next month. When you're looking at PCOS, I've seen anywhere from two to two grams twice a day or two grams BID with individuals with like OCD and anxiety and depression and again, talk to your healthcare provider if you're on an antidepressant or have these issues to get their input. I've seen as much as five grams a day, but really I think the starting dose is one gram and then kind of a titration based on symptoms. We've already gotten some feedback that some individuals are having improvement with two grams a day, both with mood and with sleep.

Wow, amazing. Amazing stuff. And in terms of other therapies around sleep. You talked about the importance of sleep. You talked about myoinositol for sleep, creatine for sleep. Sleep is really key for our overall health and well-being and a lot of our sleep quality has declined. And we've talked about a bit, a bit about this on the podcast, but we, we have less deep sleep, less REM sleep, more disrupted sleep. How do we fix our sleep? How do we get to deeper sleep and improve deep sleep?

Cause that seems to be the most restorative sleep. And, and actually, what are the techniques we can use to help sort that out.

Yeah.

One of my favorite questions. So I tell patients that when you wake up in the morning, that's when I want you to think about sleep. I want you to get light exposure on your retinas within, you know, within the first hour of sleep. So 10 or 15 minutes of getting outside, whether you walk your dogs, have a cup of coffee, cup of tea, that's very important to help suppress melatonin and increase cortisol to tell your body it's time to get moving. I think really simple things can be helpful. Are you hydrated? Are you physically active? And it doesn't mean that you have to do CrossFit. It just means being physically active throughout the day confers benefits. I think managing your stress, there's no one without stress, but I always say, you know, you get a little bit of oxytocin release if you hug your pet or your significant other or your family, your loved ones, your friends, just getting in some oxytocin hits throughout the day. I think it's also helpful to have a sleep strategy. So just like when my kids were babies and toddlers, there were things I did in the evening that were telling them that or telling their bodies that it was time to go to sleep. So, you know, wearing blue blockers if you're going to be on your iPad or you're in front of your computer, you know, not having bright lights shining on your on your face after it starts getting dark. I think, you know, keeping the thermostat low, you know, in our house, it's 65 degrees at night. I wear a sleep mask. That is probably one of the least expensive, low tech, easy things I've done for sleep quality. I mean, My husband laughs at me, my whole family laughs at me, but I'm like, my sleep is golden. And then thinking of things that you can wind down. For some people, they like to rub essential oils, you know, maybe lavender on their skin. I like to get on my PMF mat and I don't fully understand the technology. I know it impacts the mitochondria, but it's very relaxing. You know, for me, things that gear me down get, you know, kind of tap into that parasympathetic rest and repose side of the body, I think is very helpful. And then, you know, thinking about magnesium, like I will soak in magnesium, whether it's Epsom salts. I don't do this every night because I don't like to be like, Sounds.

Like my program for sleep.

That is really helpful. And if I can share with your listeners, probably one of my favorite ways to kind of potentiate the absorption of magnesium is to combine magnesium and borax and baking soda. So I usually do a cup of magnesium flakes, a cup of baking soda, and then I'll do a tablespoon or two of borax. And borax is safe outside the body. I think everyone always says the same thing, oh my God, I'm like, no, you're soaking it. You're soaking it, whether it's your feet or your body, it really helps potentiate it. This is coming back from my cardiology days where we did a lot of electrolyte replacement. And then I would say the other thing is just putting yourself to bed earlier than you think you need to. It's not a super sexy strategy, but more often than not, I don't sit in bed and read a book or get on my iPad. I will just go to sleep because very likely, and I can track it on my aura, my sleep latency isn't very long. So, even if I don't think I need to go to bed, I will put myself to bed by 9:30 or 10:00, and I just do really well with those strategies. And those are all, for the most part, pretty low tech, but very, very effective.

Yeah, very simple stuff. And it's amazing how some of the simplest stuff can be the most effective and the most healing to our bodies. And I think, you know, the strategy we talked about, ranging from intermittent fasting to sleep modification, to balancing of hormones, to using certain nutraceuticals can be extremely effective in helping us to sort of modulate our biology. And I think, I think your work is so important. Are there any kind of, like, take homes, you know, punch lines that you want to share with the audience about what actually can be the most effective in terms of these strategies? Where do they start? How do they begin? Yeah, I think that's such an important question.

So tangible things that you can walk away with today. Number one, stop snacking. I sometimes will walk through airports and I'm surprised at like six o'clock in the morning how many people have a bag of, you know, a thing, a container pringles out and I'm like, oh my goodness. So stop snacking. We don't need to snack. And if you're putting your meals together properly, have enough protein, have healthy fats, you shouldn't be hungry in between meals. In fact, if you are, it's a sign you didn't eat enough. Find a way to get more physically active. I don't care if you just walk every day. You don't even have to start with strength training. Find a hobby. Find something that brings you joy. I think if the last three years have taught us nothing, it's really important to understand that something small could be reading a book, it could be getting on Audible and listening to a book, it could be connecting with a loved one. I mean, find things that bring you joy in your life. and definitely embrace them. And then I would say lastly, don't be afraid to intermittent fast. I think that eating less often doesn't have to be a practice that you do every day, but I just find that for many of the patients and clients that I work with, their health improves exponentially when they realize that they don't have to be tethered to worrying about food all the time. That food obsession that we've been kind of conditioned, oh, we can't go more than two to three hours without eating. that doesn't have to be your destiny. And we can change things at any time. So irrespective of what life stage you're in, understanding that there are always things that you can do to improve your health.

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