#111: Intermittent Fasting Transformation with Cynthia Thurlow

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Hi, I'm Dr. Tabatha, the Gutsy Gynecologist. I'm a triple board-certified OB-GYN and functional medicine physician. I've embraced the world of functional medicine and wellness through my own personal health journey, and I'm super excited to share my wisdom and unique perspective as it pertains to women's health. After caring for thousands of women, I've come to realize that your gut health determines your gyn health and your overall And it's a super gutsy thing for me to go against conventional gynecology practice to bring you the truth. No more Band-Aid medicine, ladies. We're talking root cause resolution on this show. So if you're struggling with hormone imbalance, weight gain, period issues, anxiety, insomnia, you name it, then you've come to the right place. And I want to be your gutsy gynecologist. So welcome.

Thank you.

Welcome back, ladies. I'm so excited for this episode. My beautiful and super-wise friend Cynthia Thurlow is coming out with her new book, Intermittent Fasting Transformation. I'm so excited for her. And she's back on the podcast to talk about this today because this is for all women. And the beautiful thing is Cynthia has broken it down into what season you are in your life. It depends on if you're cycling or if you're in perimenopause or menopause or if you're postmenopausal. So it really is a way of living for us as humans. I mean, you look ancestral to the beginning of time, we were created to feast and famine and to be able to be metabolically flexible, to be able to burn fat for fuel or carbohydrates or sugar for fuel. And so Cynthia has spent years really helping women and studying all of her patients' and clients' results and figuring out what works best. And she's created this IF45 program, but it's very bio-individualized for what season of life you're in. So I'm really excited to talk to her today because intermittent fasting definitely changed my life. You know, when I was on the road to healing and I couldn't get my weight under control and I couldn't get my fatigue and my brain fog under control, all of these things, like, a big piece of it was definitely sleeping again, so giving up obstetrics. But the bigger piece was my food. I was eating, like, all day long. All hours of the night, you know. Imagine I would be woken up at 3 AM for a delivery. I would have to go into the hospital and I would just grab what's at the nurse's station because I'm bored. I'm wasting time sitting around waiting for the baby to come, waiting to check the patient again or whatever. So I'm popping M&M's and cake or whatever's sitting there, or even healthy foods, trail mix, this and that, you know what I mean? But it was food and I was putting it in my body at the wrong times, and that was really wreaking havoc on my system. And so she's going to talk about why it's really important, not only what you eat, but when you eat. Like, how does that affect our other systems of our body, our brain health, our immune system, our gut health, our circadian rhythms, all of these things? So she addresses all of this in the book. Her book is amazing. You need to go get it. You need to do her program because you can't not feel better doing it. It really does work. I mean, I teach intermittent fasting with my programs and the way she has this dialed in is just so beautiful. So I would love to just speak her praises really quickly before we get going here because she is a force to be reckoned with. She's really— Done a lot in a short period of time, and she's just such a sweetheart. So Cynthia Thurlow is a nurse practitioner. She's the CEO and founder of the Everyday Wellness Project. She's an international speaker with over 9.6 million views for her second TEDx talk on intermittent fasting. With over 20 years' experience in health and wellness, Cynthia is a globally recognized expert in intermittent fasting and nutritional health, and she's been featured on ABC, Fox 5, KTLA, The CW, Medium, Entrepreneur, and The Megyn Kelly Show. Super impressive. She was listed in Yahoo Finance as one of the 21 founders changing the way we do business. That's pretty cool. Cynthia hosts the Everyday Wellness podcast, which was also considered Of one of the 21 podcasts to expand your mind in 2021 by Business Insider. Her mission is to educate women on the benefits of intermittent fasting and overall holistic health and wellness so they feel empowered to live their most optimal lives. So you can see why I connect so much with Cynthia. She is on the same mission as I am. To just help women reclaim their health, live amazing lives, especially the second half of your life. You know, she and I are both north of 40, as she likes to say, and it can be the best time of your life, but there's things that you have to do differently. And so we're going to talk about that. And this is just a really awesome episode. So here we go. Well, welcome Cynthia to the Gutsy Gynecologist Show. Thank you.

I'm so excited to connect with you and your listeners.

Yeah. I loved our conversation we had last year and you have just taken intermittent fasting to a whole nother level. So now you're back, right?

Yeah. You know, it's, it's the ironic thing is that the decision to do a talk about a subject I knew a lot about, I had no idea that that was just going to catapult everything forward. Like, I mean, literally what the thought was, What do I know a lot about? And I was like, fasting. And that was like, boom, just not realizing that would turn into so much more. So it's very grateful.

Oh my gosh. You are just changing millions of women's lives. This is amazing. And so I'm really excited that you're finally getting your book out, Intermittent Fasting Transformation. So let's talk about this. You know, I know my listeners have heard your story before, but I really want them to understand, like, Why intermittent fasting was the key for your shift in your health? Like, why was that the one thing that made the difference?

Well, I think on so many levels, you know, as a traditionally trained allopathic nurse practitioner, you know, I went to a top-notch research hospital, trained there, and I don't recall ever having any discussions about perimenopause. And most of the stuff about menopause was like scary. Like, that's your grandmother, that's your mother. Like, you'll, that'll never happen. And so I think I kind of blissfully, naively went through my 20s and 30s and into my early 40s. And I worked for a very large, uh, very busy cardiology practice. So I did inpatient, outpatient management, uh, had a lot of autonomy. So a very stressful job, as you can imagine, like working in ICUs and ERs and managing patients throughout the hospital course. And on top of that, I had a husband who did a lot of international travel. I had 2 young boys. And I probably wasn't getting enough sleep, and I was probably doing the wrong types of exercise given where I was in time and space. But again, I had never heard the term perimenopause. Honest to God, I mean, I think about this now and it just makes me feel naive. And so it wasn't until I hit a wall. I literally got to a point where I woke up one morning and I was like, why am I so tired? Like, what am I doing wrong? And so kind of down that rabbit hole I went and realized, okay, this is perimenopause and the reason why this is happening and, you know, just all the physiology that changes with lowered progesterone, you know, relative estrogen dominance, the ability to not be able to manage and mitigate stress as well. The wrong types of exercise, probably too low carb. And, you know, having a stressful job and having 2 little kids and a husband who traveled probably was like the perfect storm. And so I think for me initially, it was the recognition that a lot of things had to change in my lifestyle. I'd always been a healthy eater. I'd always been active, but I started like putting on weight. And when you're 5'3, you know, 5 or 10 pounds makes a big difference in how you look and how you feel in your clothes. And so, you know, from my perspective, I think fasting in many ways was one strategy of many that I embraced and I felt comfortable and confident doing it because I read, you know, Jason Fung's book. And I was like, okay, here's another allopathic-trained healthcare provider who's using this successfully. And so initially it was just the N of 1. It was really just me, but I started feeling so much better so quickly that it was the recognition that maybe this is a strategy that will be helpful for other people. And so I left clinical medicine in 2016, which is hard to believe. That's almost 5 years ago. And, you know, in my traditional, I'm gonna leap and then worry about it later fashion, you know, I almost immediately started attracting women that were at the same stage of life, people who felt ignored. And felt that the kind of traditional medical establishment was suggesting things like synthetic hormones, antidepressants, an IUD, an ablation, a hysterectomy to control symptoms when so much of what they were experiencing could have could be mitigated in many ways by changes in nutrition and lifestyle medicine and maybe eating less often. And so that was another rabbit hole I kind of fell down, and I was having a lot of success with. the women that were coming to me in my practice, my outpatient practice. And I was really just focused on lifestyle medicine. I wasn't prescribing medications. I wasn't really doing that much anymore. And it just occurred to me that there was a lot of value in, in what I was teaching. And so that's initially how that started. But what came from that as an introvert, which a lot of people are surprised to hear that, is that I decided I wanted to challenge myself. And so part of the challenge was I'm going to do a TED Talk. And so the very first talk I did was on perimenopause, which I can retrospectively say now I was really embarrassed to do a talk on that because in my head I didn't feel 47. I didn't feel 47. So I was like, how could I possibly be talking about being close to menopause? And so at the same time I accepted that talk, within a month I was offered a second one. And they said, you know, you can't do the same topic. It has to be something else. And so honestly, To God, I looked at my husband and said, "What do I know a lot about?" He said fasting. I said, "Okay, I'm gonna do it on fasting." And then they asked me to do it on would I do a slant towards women? And I said absolutely. And so I had agreed to two talks. Did one in December of 2018. Did the second one in March of 2019. And the rest is kind of history. And so I never realized that that second talk would change my life in so many profound ways. And so now I can. Share with women sustainable strategies and ways to do fasting. And it's amazing how a talk that, that becomes very popular, suddenly you have to scramble as a business owner to create, create programs and create resources because people want to learn more. They want to be able to do it successfully. And so on the fly, what was created, which was later called IF45, is this program for women, which has evolved and shifted and changed. And as I figured out, as much as I'm sure you do as well, you do something in your business and something works well. You're like, great, do more of that. Do something else in your business that doesn't work well. You're like, okay, don't want to do that. Let's shift this direction. And so this has really been, you know, 3 and a half years or a little over 3 years of, uh, really figuring out like, what are the granular ways that fasting needs to be identified and shifted and changed for women so that they can be successful because we're not mini men. And I think there's this unfortunate— there's 2 schools of thought. There are researchers out there who fearmonger and they're like, all fasting is bad for women. And then you have men, you know, there's mostly a lot of the people that you think about in the fasting space are men. And many of them are applying the same principles that they use with men to women. And we're just, a bit more complicated in a wonderful way. It's what makes us unique. And so I like to kind of take a middle ground and say, yes, fasting can be successful. We have caveats depending on where you are in life, in your life and stages. There are different ways that we fast. And so that's a lot of what the book talks about is what makes us unique, why we need to fast differently. And I don't address the fearmongers. I just like to, you know, mention to people that there are people out there that are anti-fasting and that's okay. They're entitled to their opinion.

I couldn't agree more with anti-fasting as just a healthy way of life. I completely agree that that is how our genetics and our body's chemistry was designed to function. You know, we didn't have grocery stores on every corner 1,000 years ago. That's how our bodies are created. But you hit on so many pain points, like the fact that we don't talk about perimenopause and women don't realize they're going through this multi, many-year transition of hormonal shifts. You know, it's very much ingrained in us that it's just like a light switch, like, oh, you're in menopause, it's just you turn on, you turn off, and it's so not true. And, you know, one of the biggest things that happens is our metabolism slows down, our kidney function slows down, our digestive enzyme production slows down. I mean, you name it, like everything just starts to slow down. And then we compound the issue with eating too much and eating the standard American diet. I would love for you to just talk about like how important it is to clean things up. So we're talking about like when to eat and why that's really important, but it is like important about what you eat, right?

Oh, absolutely. And I think it also speaks to, as you kind of alluded to, this ancestral health perspective that we would not have survived as a species If we weren't designed to eat less frequently because we had food scarcity, there wasn't a grocery store, there wasn't a convenience store. You couldn't just Amazon groceries to your house. It didn't work that way. And so I think it really diminishes the, I guess, the strategy, the mindset, the philosophy that this isn't something that really is aligned with the way our bodies are designed to thrive. And so when we are eating too frequently, and I want to speak to a study that Satchin Panda did. Earlier last year, he had an app on a phone talking about meal frequency. And, you know, the average American is eating 6 to 10 times a day. And so you think about every time you eat a meal, your body has to process what you've consumed. And if 88.2% of us are metabolically unhealthy, and that's a statistic from 2018, so we can assume that's worse now, given the pandemic, we really think about the frequent feedings are overtaxing our digestive system. You know, it takes 4 to 5 hours between meals for our body to fully kind of process. You know, there's something called the migrating motor complex in our digestive system that acts kind of like a street sweeper. And so it's pushing bacteria, things that don't belong, pushing them forward. And if you're habitually like eating every 2 to 3 hours, not only does your blood sugar not come back down to normal, your insulin levels are not at an optimal level where they should be lower. And so it makes our bodies much less efficient. It's kind of like topping off the gas tank. You know, I don't know if you had a dad like this, but my dad always liked to top off the gas tank. And so it's the same kind of concept. We never get through the whole gas tank to actually work on what's at the bottom. We're just constantly burning what's at the top. And so we don't get efficient at utilizing both carbohydrates and fats for fuel. And that's really what we're speaking to is we want to be metabolically flexible. So if our body needs to burn a little bit of carbohydrate, It can do that. It can burn a little bit of fatty acids. Unfortunately, most people are just burning carbs, which is why they are frequently hangry, you know, that kind of hangry, hungry, you know, they're hungry and they're angry. They have energy slumps. Um, they have, you know, lack of mental clarity. They struggle with weight loss resistance. Um, they may struggle to stay awake after eating a meal versus people that are tapping into this fat fuel source. They have sustained energy. They can go 4 or 5 hours between meals. They can You know, easily lose weight when they want to. And that's the way our bodies— they're designed to not be dealing with a chronic— and I always say it's oftentimes a chronic carbohydrate issue. But if we look at the standard American diet, it's highly processed, hyperpalatable, full of ingredients that more often than not are dysregulating our hormones. I think about things like high fructose corn syrup. I think about seed oils and how these have a profound negative impact. Down to the cellular level. They can damage our cells. They can damage the mitochondria. They can make them less efficient. Mitochondria are powerhouses of our cells. And so down to a cellular level, these highly processed, hyperpalatable foods, along with eating frequently, are dysregulating the normal way that our bodies are designed to thrive. And so I encourage anyone that's listening, even if you do 12 hours, I mean, you're still giving your body digestive rest. You eat at 7 o'clock at night. And that's your dinner and you don't eat again until 7:00 AM, that's 12 hours that you're giving your body an opportunity to break down the food that you've consumed, package it up and get it ready to, for excretion or to utilize it in the cell at a cellular level. And so on so many levels for me personally, I have just come to find that since we have this increasingly metabolically inflexible, unhealthy population, people that are prone to polycystic ovarian syndrome, chronic, you know, this rampant infertility that we're seeing, I'm sure you see quite a bit of this. You know, insulin resistance, leptin resistance, high blood pressure, high uric acid, you know, really thinking about, um, you know, cardiovascular disease risks and cancer risks, um, are all associated with these higher levels of insulin. And insulin is not all bad. I think unfortunately people think of it as a bad hormone. It's, it's a great hormone when it's working effectively. But if our hormone levels are never properly balanced, if we're chronically eating Insulin levels go down and we put ourselves at greater risk for these types of metabolic disorders. And so I would be remiss if I didn't really emphasize that that is my impetus. That is why I feel so passionately that this is a strategy that women, irrespective of life stage, should really be considering because I want to have— I want my children, and I'm sure your children as well, we want them to grow up in a healthier environment than, than what we're currently in. I think about the fact that, you know, the most recent statistics I've, I've read suggest that this population of young people are going to be less healthy than we are. And, you know, for like the first time in, in history. And so this is a trend that will continue unless we do something to change it. And, and unfortunately, I think that in traditional allopathic medicine, as I know you practiced as well, We focus on symptoms. So if someone comes to you and they're tired, you're not going to talk to them about— they're very likely not going to talk to them about their diet, not going to talk to them about sleep. It's going to be like, okay, what can I give you that's going to give you more energy? And it's those kinds of non-root cause approaches that I think are at the forefront for why we're not proactive. I'll give you a good example. There's a lovely former nurse who was a— who's a patient in my practice. And You know, she's in menopause. She has all the signs of someone who has not been on bioidenticals or hormone replacement therapy, which is almost a crime because she has everything you can imagine that happens when you're not on hormonal replacement therapy. So she's got bone issues, she's insulin resistant, she's leptin resistant, she has all the types of GYN-related symptoms, which is just a travesty. Uh, and then just in conversation with her, you know, we did a fasting insulin. Her fasting insulin was There's no way this poor woman, and it should be between like 2 and 5, right? This poor woman is going to be able to lose weight. And so we start like baby steps, like, okay, let's like kind of walk through the things that we can do to help you so that you can be empowered. You can make good decisions. She's now hooked in with a great functional gynecologist, thankfully. And, you know, she's, her sleep is improving. She feels better. Um, but I, I just think we're missing the mark with women and certainly You know, this discussion is not geared to just perimenopause and menopause, but, but I kind of feel like women north of 35 and 40 in many ways, and I'm using their terminology, they feel forgotten, they feel silenced, they feel marginalized. And so in many ways, I want them to have the ability to take their power back and to be able to make good decisions so that they will have high quality of life in, you know, perimenopause, menopause, and beyond, and not feel like they have to just accept things as they are. That's One of those limiting beliefs that really is a source of irritation for me because on so many levels I feel I don't want women to think that things they just have to accept everything that happens with age. I mean, we all will get older, right? I mean, I look different now than I did fifteen years ago, but I have so many wonderful things that are in my life. I'm sure you probably feel the same way that some of the vanity metrics I worry less about those and and a lot of what I think about looking to the future is I want to be able to keep up with my very active. boys, and I want to be able to travel, and I want to be sharp as a tack, just like my grandmother was until she, you know, passed away in her 90s. We want to have a high quality of life, and, you know, finding strategies that can help you embrace that are certainly very important.

Oh my gosh, without a doubt. And that's why I support you so much, because I hear the same thing from my patients. It's like they just get dismissed. The doctors tell them they're fine. This is part of aging. Just deal with it. You know, I had someone yesterday reach out to me and say, my doctor told me that I can't lose weight, so why should I try? I'm menopausal. And I just thought, that is a travesty. Like, we are giving the wrong advice. So I'm glad that you're out there fighting the fight with me because women need us. They need to hear that that is a bunch of crap, actually. And it's just that these— they're not educated to health and wellness.

Right.

And they don't understand They're so stuck in the world of disease. They don't even know what health looks like anymore. You know?

I know. And it, and the thing that's, that's funny slash not funny was that when I was, you know, 44 and hit that wall and felt like crap and had to kind of redo everything I was doing, I'd exercise differently, eat differently, et cetera. I remember I had an appointment with my GYN just coincidentally on the day my period started. And I had been telling her my periods were really heavy. And so honest to God, she puts the speculum and takes a look at me. She goes, oh my God, your periods are really heavy. And that started the conversation, synthetic hormones and IUD and ablation and a hysterectomy. And I was like, yeah, no, I'm not going to do that. And so I think, I hope women know that if you're working with someone that tells you, you just have to accept things as they are, and that weight gain is a normal function of aging, you should just suck it up. You need to find a new gynecologist. You need to find a new midwife or NP or whomever it is that you're seeing, because there are so many people out there that want to help women. They, they love helping women. I think that's really what it comes down to. You have to, you have to really genuinely love the work that you do when you want to genuinely help people. And so I, I think on, on so many levels, you know, from my perspective, I just want people to have hope. I don't want them to, to feel that You know, once you get north of 35, that things, you know, all fall apart, the, you know, the wheels come off the bus and you kind of just get parked somewhere and just accept whatever happens happens.

Yeah. I call bullshit on that. I would love for you to talk about the gut microbiome connection a little bit in regards to intermittent fasting, because I just find it so healing. It like, it's a reset for the gut, right?

Yeah. And so I remind people that I talk about digestive rest. So for people who are new to intermittent fasting and they freak out, like, I'm going to starve to death after not eating for 12 hours, even at the 12-hour mark, we know there are benefits of not consuming food with greater frequency. So if you look at the research, you know, talk about stem cell activation, telomere length, et cetera. A lot of the research that's done is on these really long, like longer fasts, 3 to 5 days. But we know you get profound benefits. You get an upregulation in autophagy, this waste and recycling process, or mitophagy, you know, getting rid of diseased and disordered mitochondria within the first 16 to 18 hours as a starting point. It actually continues to ramp up when we're giving our body time to break down food, to be able to absorb nutrients, to be able to create healthy neurotransmitters, utilization of the migrating motor complex, which is like one of these super nerdy terms. But it's almost like a street sweeper that, you know, as we're eating less frequently— so if you're eating with, you know, 4 to 5 hours in between a meal, it's giving your body time to kind of push food forward, get rid of bacteria or other, you know, potential pathogens that you've ingested or have ingested on your food or you've been exposed to. So really starting from the point of digestive rest at 12 hours all the way up to stem cell activation, there's definitely a variety of profound benefits. We know there's a lot of hormonal benefits. We hope that we're able to kind of break down and detoxify hormones like estrogen. I always remind people there's 2 phases of detoxification in the liver, and then that 3rd phase is really in the gut. And so if your gut health is not optimized, you can recirculate these estrogens. And so people say, well, I poop every day, this is really not a big deal. And I remind them, well, you have to test and not guess, but also the onslaught of chemicals we're exposed to in our environment, our personal care products, and our food can really dysregulate that process. And so there are certain things that we look for in a Dutch test or other types of testing that can let us know how well we are getting rid of these waste products that should be working effectively. So when I think about intermittent fasting, one of my favorite benefits is really on the gut microbiome. And we know that the gut microbiome impacts immunity, impacts, you know, blood sugar regulation, and impacts our ability to fight off pathogens. And the unfortunate thing is there are some changes that you kind of alluded to with aging that are a byproduct of just, you know, being north of 40. So you make less hydrochloric acid, which is that first line of defense in the stomach. We may not make as many digestive enzymes. We become a little bit more prone to insulin resistance. And really now it's most of us are prone to insulin resistance. And so Really being knowledgeable about the net impact of food, food choices, along with food frequency or eating frequency can be hugely impactful. And it can be as simple as sometimes people don't even change their nutritional patterns when they first start fasting. They really just start eating less often and they can see huge net benefits. I know a lot of people come to it for the body composition changes, but I always say they stay for so much more.

Exactly. They stay because they have energy and, you know, less brain fog. That's a big thing I want to talk about. Like, that was one of the key things I noticed. Not only was the weight finally falling off without any exercise for me, but I could think again. And, you know, I had memory again, whereas before I was relying on my assistant to, like, remind me of everything the patient had said to me and the plan. I mean, that's how bad things were.

Wow.

But really, like, Just tightening up that eating window, giving my gut a break and burning ketones for fuel, like just shifted how my brain functions. So I would love for you to talk about that.

Yeah. So when we think about keeping our fasting insulin low and, you know, we're in this non-fed state, allows our body to kind of, you know, Jason Fung always does a fantastic example. So I want to give him credit. We look at carbs as the refrigerator and the freezer are the fats. And so We want to burn through our carb source so that we can get to the fats, you know, burn fatty acids as a primary fuel source. And you know, what you alluded to is this utilization of a specific type of ketone, these fatty acids called beta-hydroxybutyrate. It's diffused right across the blood-brain barrier, which is what oftentimes we believe is what is the primary precipitant for all that mental clarity, because our, our brains love fat. They really love fat and it's such an efficient utilization of energy. And so yes, that mental clarity, the lowered insulin levels, lowered insulin levels beget keeping your blood sugar stabilized. We know lowered insulin lowers other inflammatory markers. We really think about it lowers our likelihood of developing high blood pressure, diabetes, you know, certain types of lipid disorders. You know, one thing that I certainly, when I was in my training, didn't wasn't taught was that more often than not, a lot of the chronic disease states we see in the United States are a byproduct of high insulin levels. And so high blood pressure is a good, a good representation of this, as opposed to just being related to salt, which is actually, it might be that their diet is, is too low in proper types of salt or sodium. And so, yeah, the cognitive benefits of eating less often are oftentimes Where people are like, heck, I feel so good. I don't want to eat. And it's interesting. We were just on vacation and, you know, I have teenage boys. And so every morning we got up and we had to eat breakfast before we did anything because their metabolisms are like hummingbirds. And so when I'm on vacation, I will switch things up. And so I was like, okay, I didn't, you know, I had a salad for dinner. So I'm actually going to have, I had a big omelet and I had some, um, some potatoes with it and a little bit of fruit. So. But we were having a very active day. I remember saying to my husband, I did get sleepy. You know, it wasn't the wrong choice of food. It's that my body is so unaccustomed to eating that early in the day that I just felt like everything felt off the entire day. I was like, okay, tomorrow I'm going to have an egg white omelet. Let's see if maybe if it's a little less heavy, I'll feel better. But I think when your bodies are kind of primed on using ketones as a fuel source, Um, and for some people that may take longer. Like, obviously it sounds like you felt pretty good almost immediately. I know I did as well, but for people who are insulin resistant or leptin resistant, it may take a little bit longer. I oftentimes will say it may take you 3 to 6 weeks to feel like you're fully fat adapted, meaning your body is able to switch in between using carbs and fats as a fuel source. You know, most Americans are cruising along with carbohydrates. Um, you know, they'll struggle with, you know, weight loss resistance, that hangry sensation that we kind of alluded to. And so it's really, really important for people to understand it may take time. It may not be instantaneous. It may not be in a week or two. You may need to pull on some training wheels, as I affectionately call them, because when we think about the things that will not break a fast, it's, you know, black coffee, bitter teas, water. And unfortunately, there's this misnomer that Bulletproof Coffee— you can have Bulletproof Coffee till the day you die. And I remind people, if you've got weight to lose, I would rather use your body stores of healthy fat as opposed to adding more fat. And you can make the argument that butter is insulinemic, meaning it'll provoke an insulin response. So I always remind people, if you want to fast clean, you want to just be really mindful of what you are consuming so that you're not inadvertently breaking your fast. Like there are a bunch of fit pros that I'm sure are well-meaning. I want to believe that they are, but they'll say things like, well, If you have 5 grapes, then you're not breaking your fast. I'm like, well, yeah, especially if you— for it, you're going to evoke an insulin response, but you know, whether it's chewing gum or eating some fruit or having, you know, a yogurt, uh, you know, we can get very granular about things based on research that we know technically don't break a fast. But I always remind people, I really want them to learn how to clean fast so they'll get the best results.

Yeah, exactly. Especially if they're trying to lose weight, because you can, burn the fat that you're intaking. You know, you'll still be in ketosis, like you mentioned, with Bulletproof Coffee, but you're not tapping into your fat stores and burning your fat for fuel, so you're not going to lose weight. I mean, it's just, you know, just intuition.

Totally.

So many important, amazing points. Oh my gosh. I just think that this is the way of living for women all north of 40. Like, literally, this is how your body best functions. I mean, the evidence is clear. And I see time and time again, as soon as that estrogen starts to drop, everything shifts. And, you know, it might take 3 to 6 months to really reverse insulin resistance and prediabetes and those cardiovascular changes you were talking about, but it can be done. I see it every day in my patients.

Yeah.

Like, we just do follow-up labs. You know, you've got to follow, you have to see your trends and what you're looking like. And I just— the change is amazing. It's— wouldn't you agree?

Oh, I totally— and I think it's also empowering. Like, people feel like they learn a sustainable strategy that they can adjust and be flexible with if they go on vacation or there's a party. Uh, you know, we again just got back from vacation and I definitely had some dessert. I mean, obviously in Costa Rica, their desserts are not like as sweet as they are here. But there were definitely nights and I wear a continuous glucose monitor so I can see exactly how my body responds. But we were so active. I mean, there was a photo I took of my Apple Watch one day and it was like, we had done 22,000 steps in one day. And I was like, oh my gosh, that's, that's unbelievable. But I was like, I feel zero guilt having this teeny tiny dessert, uh, especially after being so incredibly active. But I agree with you that. Unfortunately, we've got a culture that wants instantaneous gratification. Like they want a pill or a potion or a powder that's going to give them the results that they need to invest into a strategy that may take 2, 3, 6 months to be fully kind of actualized. And I think the more weight loss resistant someone is, the more metabolically deranged they are. And I don't mean mentally, metabolically deranged. And it may take, you may have to do more testing. You may have to dig deeper. Like I have women that will come into this program, IF45, and they're frustrated because at week 3, their best friend has lost 10 pounds and they've lost none. And I just remind them, I'm like, you have to dig deeper. Like it may be that you have to really clean up your personal care products. Maybe that you, you know, you have to, you know, did you have a mold exposure? Uh, are you, is your sleep terrible? That's one of the first things I tell people. If you can't sleep through the night, I can't get you to lose weight. And so that kind of flips the switch that it's like, let's deal with the sleep piece first. And I always think of sleep as really being foundational, but again, it goes back to the fact that a lot of women stop sleeping well as they get closer to like those perimenopause years and this loss of progesterone, and then add in the cortisol piece, you know, they're stressed, they wake up, they have racing thoughts. And so really kind of being mindful of the fact that The lifestyle medicine piece is so critically important. I always say, like, what's your tell? For me, if I wake up in the middle of the night, I know that my stress is not as managed as I— as well managed as I think it is. And so that's like almost an instantaneous need for me to, you know, it's like, okay, what do I need to do more of? Do I need to, you know, be really diligent about my meditation? Do I need to do more connection with nature? Good example here, it snowed here and in the part of the country I'm in, when we get A whiff of snow, everything shuts down. We had sleet this morning and snow, so it was very appropriate for school to close. But now it's sunny outside and it's going to freeze tonight, so my kids will probably be off again tomorrow. But it's one of those things where I know that my brain was thinking about this, and I know I woke up because I was thinking— I could hear the sleet on the window. And they're old enough that it's not as if my whole day gets kerfuffled if they're home because they're pretty independent, but It's also one of those things that's reassuring to recognize, like, okay, tonight when I go to bed, I need to do more restorative stuff before I fall asleep. And so I think on so many levels, we're really conditioned our patients to ask for a pill to help with sleep when really what they need— and they may, and they may need oral, they may need oral or transdermal progesterone. I'm by no means not suggesting that's not, that's not helpful. But it may mean that they really have to work diligently at wind-down time. Like I've actually started telling my, like writing a prescription, like you will read for 30 minutes, a physical book, not on a device, but you are going to do that. You're going to soak in magnesium. You're going to read your book. You're going to, you know, have blue blockers on. I mean, all the things that are telling their body, much like we did when we, our kids are babies, like it's time to go to sleep. It's time to gear down. Let's get you into the parasympathetic, out of the fight or flight. Have you read the book Breathe? Breath?

No, I haven't.

So James Nestor. So I started reading it and then I put it aside and then I moved a couple of times and forgot about it, but I'm actually interviewing him in a couple of weeks. And it's fascinating. He does this really deep dive into all these things that impact the parasympathetic versus sympathetic and breath. So obviously it's appropriate, but even like alternate nostril breathing, like I think if you suppress your right nostril, it'll It'll kind of upregulate the parasympathetic. It was fascinating. I was like, oh, I can't wait to try this tonight. Yeah. So all sorts of things that you can do to support your body that don't involve like more prescriptions. Although again, I want to be really clear. Most women in perimenopause and menopause need some progesterone on board because that will help with sleep for sure.

Yeah. They just don't need addictive sleeping pills that don't actually give them restorative REM sleep. Right. It's like this false fake sleep and it, It's not good.

No, absolutely not.

I know for me, it's like I'll wake up if I've drank alcohol or I've eaten a snack before bed. That blood sugar drop wakes me up every time. I'm hot and sweaty. It's miserable. And, you know, as gynecologists, we're trained, oh, that must just be your estrogen. It couldn't possibly be anything else. And it so often is related to our blood sugar. So I think that's so important. Oh my gosh.

Alcohol is definitely a problem. I don't know if you see that, you know, with the pandemic, but I feel like there's this incredible like wine drinking culture and there's no judgment. I mean, I grew up with a parent that was an alcoholic, so I've never been a big drinker. But the one thing I found in perimenopause is anytime I had alcohol, it didn't matter if it was a martini or a glass of wine. I, and I otherwise wouldn't have hot flashes. the hot flashes started. We know that it suppresses melatonin, it increases cortisol, it dysregulates your blood sugar. We don't make good— we don't make good decision— decisions, um, when we've had too much alcohol, unfortunately, which then, you know, begets the carbohydrates, which then dysregulate the blood sugar more.

Yeah.

And so I kind of, I kind of have, during the pandemic, I've kind of no longer drinking alcohol. And I, I think it's, it's interesting On so many levels that that triggers other people. I'm like, hey, I'm not a teetotaler. I'm just saying, like my sleep is so important to me that it's not worth it to do that. And so that that's kind of the I always say, like the sword I will die on. For me, that's what works for me. Other people may not have that problem, but the fact that I don't have any hot flashes in the absence of not drinking alcohol is reinforcement for not drinking it because I just those are so unpleasant. As I'm sure anyone that's listening who's ever experienced one. You know, you just kind of feel like you're incinerating from the inside out.

Yeah, exactly. And I think a lot of women don't realize that alcohol is literally just metabolized into sugar, into glucose, right? And so I hear over and over from patients, well, I don't eat a lot of bread. You know, I don't eat cake. I don't eat candy. Carbohydrates are in so many more things than that, and alcohol is a huge one. And And it doesn't have to be wine or beer. It can be vodka and gin. Like they all get metabolized into sugar, right? So it's all affecting you.

Yeah. And our body will metabolize the alcohol first at the expense of storing all the other food we've consumed in fat. And so I remind people like the way that our body processes alcohol is as a toxin, like it's considered to be a toxin. So it's going to get the highest priority. And I remind people, I'm not saying not to drink, just be— just acknowledge that that's part of the process. And so maybe at 20 and 30 and 35, not a problem. All of a sudden at 40, your sleep's off and you don't think a big deal about it. And then as you start getting a little older, it really becomes hugely problematic. I mean, I'm from a family that really likes wine. And so, you know, I just gotten to a point now I carry around a bottle of sparkling water and some kombucha. And so Takes the pressure off of me because most of the time they think I'm drinking something alcoholic and I'm not. Put a lime wedge in it, it looks like it looks like something completely else. But the point I'm trying to make is really empowering women to make the decisions that are best suited for them and their you know their their you know their goals. And I think for most women north of thirty-five, forty alcohol can be a huge problem. And I think the pandemic has not done done us a it's really done us a disservice because a lot of people. They haven't. They've struggled to cope with a lot of things we have no control over, and so I think that the wine culture has probably upticked. In fact, I met a lovely couple when we were away on vacation, and the wife was talking about this menopause belly that she was frustrated with, and you know she's like, "I couldn't eat the way that you do." And I said, "Well, and that's okay because I don't feel like I like the way I eat. I don't feel like I'm at all deprived in the way that I eat." And you know she was making the point of saying like, "I really love wine," and I said, "That's great. Just recognize." That wine can be the reason why you might be feeling like you have all this weight loss resistance. So maybe just investigate that, you know, maybe with your, your provider at home. And, you know, she came up to me later and said, you know, you're the first person that's ever said that to me. And I'm really going to consider reducing my alcohol intake to see if that helps, because we know that alcohol can also be pro-inflammatory. And so if you're already inflamed and you— it's like adding gasoline onto a fire. What does it do? It's going to, you know, burn a little brighter. It's going to, you know, magnify the degree of inflammation that someone has in their bodies. And again, it goes back to the same metabolic flexibility. We want to dampen, lessen, reduce the amount of inflammation in our bodies to be healthy.

Yeah. Oh my gosh. I couldn't agree more. That is so awesome that you had an impact on somebody on vacation.

Well, and it's, it's kind of, I think, I don't know if you feel this way, but sometimes when You know, I'm on vacation and my kids, like, their eyes look glazed over. Like, she's going to talk about metabolic flexibility. We're so embarrassed. They're like, why do you do that? And I said, because it's just part of what I talk about. But it's also like, people don't even realize because they go into their doctor and their doctor's like, okay, you've gained 20 pounds and now you're menopausal. And I'm just going to give you this estrogen patch maybe. And I'm going to give you some progesterone. And then you're going to gain 10 or 15 more pounds because all the foundational work is not done. You know, we haven't dealt with the sleep and the stress and et cetera. And so I think we really do our patients a disservice by not really focusing on lifestyle medicine first, and then, you know, adding in these other modalities. And I'm, I'm pro hormone replacement therapy and bioidenticals. I'm not anti. Um, in fact, the more I learn about them, the more I kind of feel like the Women's Health Initiative— I know this is a tangential discussion, Women's Health Initiative really kind of shifted, uh, the trajectory of a lot of people's lives. And, and I, in many ways, I, I want to continue the conversation so that people know there are options. And, and ironically enough, I don't know if you've read the book Estrogen Matters. Have you read that book?

Yeah.

Okay. So I'm, I'm down that rabbit hole, like totally geeked out interviewing Blumming on the podcast. Cause I'm like, more people need to hear this information.

Yeah, exactly. I mean, we've just created disease where there didn't need to be. I came out of residency right as that study came out, and so I saw the impact it had. You know, women were happy one day, and the next day their medications were taken away from them and they went downhill.

Yeah.

And so, yeah, it's an important conversation that we need to keep having. We need to support our compounding pharmacies, all of that. But you touched on something really important, and you talk a lot about this in your book, is bio-individuality and like really learning how to do intermittent fasting for you in your time, your season of life. Can you just touch on how important that part is? You mentioned earlier, like, we're not little men. Oh my gosh, amen to that because—

Yeah.

We are cyclical and we have major hormone shifts that we need to Flow with and really embrace, right?

Yeah.

No, I, I think I want to just tie into that last comment that you made before. I finished my nurse practitioner program in 2001.

Yeah.

And the irony is my, my graduate level thesis was talking about endometrial cancer. And so imagine like Women's Health Initiative comes out, boom. I mean, I, there was no way I was going into women's health at that point because I was like, what am I going to do now? Remember, I safely went over to cardiology and then I didn't— I, in my mind, I was like, I don't have to deal with this. So, you know, to me it's like life comes full circle, but I saw so many family members come off of hormone replacement therapy. And now we see the side effects, the cognitive impact, bone health, heart health, et cetera. But when we're talking about women, cycling women, perimenopausal women, menopausal women, all these stages of life, women can benefit from fasting. Remember we talked about at the very beginning, That if the bulk of the population is metabolically unhealthy, there are very few people who shouldn't be fasting. So when a woman is still in her peak fertility years and very lean, that's not someone I would recommend fast every single day. That might be somebody who fasts once a week, or she has 12 hours of digestive rest because our brains are very sensitive to this feast-famine cycle. And I remind people that our bodies, whether we choose to or not, our bodies as women are designed to be fertile. And so what impacts fertility? It can be lack of nutrients. And a lot of people struggle to get enough food in during their feeding window. So cycling lean women, different category, but the average woman, even while still cycling, you know, you can fast differently in your follicular phase, you know, the first predominant phase of the menstrual cycle when estrogen is at its highest, differently than you do in the luteal phase, the last 2 weeks when progesterone predominates. Versus women who are perimenopausal, 5 to 10 years preceding menopause. And ladies, if you're north of 35, you are there, whether you are willing to admit it or not.

Yes.

I have pleasant arguments with people where I'm like, listen, your ovaries are as old as you are. Those eggs are as old as you are, whether you realize it or not, you're not ovulating every month. So perimenopause and then menopause. Menopause is kind of cool because this is a time when there's not as much fluctuation month to month. Day to day as there is when you're still fertile or fertile, tomato, tomato. So I always say women that are menopausal, if their sleep and stress and nutrition are all dialed in, you have the best of all worlds. You're not getting a menstrual cycle anymore. You can probably fast as easily as most men, provided that the lifestyle medicine stuff is dialed in. And I find for a lot of women, like, this is when they're like, holy crap, I'm 57 years old. I haven't been able to get rid of this 30 pounds for 10 years. And with just fasting, I'm successfully losing weight. So I almost feel like women in menopause, provided all the other things are dialed in, get a little bit of a free pass. I worry the most about perimenopause women because it is such a season of fluctuation. And there's, there's research that's out there. You know, I allude to some of it in the book, but there's so much fluctuation because some of the changes are so Subtle. Maybe you're, you know, at 35, your progesterone starting to decrease, your testosterone's not as great. Then you combine it early 40s, you know, you are more prone to losing muscle mass. It starts to accelerate. The less muscle mass you have on your body, the more insulin resistant you become. The more insulin resistant you become, you know, you're not going to have the same hunger cues. Maybe you're trying to eat like you were at 25. It doesn't work for you in your early 40s. The sleep becomes evasive. And so I feel like perimenopause is really this potentially vulnerable time for women. But again, if they dial in the lifestyle piece and they understand what's happening to their bodies, they can navigate this beautifully. In fact, I use perimenopause as a barometer, as well as the menstrual cycle in general, as a barometer of whether or not fasting is working for them. So I kind of dive more deeply into this in the book, but I use the menstrual cycle Really as a barometer to get a sense for how much stress their body can, can manage. And so when we talk about beneficial stress, I'm talking about hormetic stressors, and that can come in— it's not just fasting that does it, but certain types of exercise, certain types of foods, cold or cryotherapy, infrared sauna, et cetera. Those are all examples of hormetic stressors. It's beneficial stress in the right environment makes the organism or makes ourselves organism, not orgasm, makes the organism stronger and more resilient. And so we want our bodies to be stronger and more resilient. And so that's why another reason why, you know, fasting and taxing our body in the right way, in the right amount can be hugely impactful, but you can't do— you can't fast as a woman at 32 the way that the husband can. Like, I sometimes feel like there's this misnomer You know, if we look at research over like 8 weeks, men will almost always lose more weight up front because they generally have lower body fat percentages. Depending on where a woman is in her cycle or what else is going on, we're just more sensitive. Like our bodies are very attuned. It's taking in environment, taking in information around us in our environment. And I remind people, even if you have no desire to get pregnant, that's your body. Like physiologically, your body's like main focus is sustaining life. If there's a possibility of someone ovulating, the egg gets fertilized, and then, you know, you go on to have a fetus and a baby. But it's one of those things where I just remind people that our bodies are so complex as women. But fertile younger women that are lean have to fast very differently than women who are, you know, still in their fertile years versus perimenopause versus menopause. All of which are talked about in the book and in greater detail. But again, I go back to the same point that I don't like the fearmongering that goes on. I think it really does such a huge disservice. You know, there are times in our lives when, when we, we can fast and times that we shouldn't. And as a good example and a relevant example, when I spent 13 days in the hospital in 2019, you better believe I didn't fast when I came out having lost 15 pounds. And, you know, it took months and months and months to gain back healthy weight. I didn't have the blood sugar control. Like I remember I was, I was symptomatic. I was hypoglycemic. I felt symptomatic, my blood sugar dropping, doing anything. And so it took time for my body to, you know, get back to a point where it was healthy enough to be able to fast. So there are times in our lives we may not be able to fast. And there are times in our life when it's completely appropriate, but it's the acknowledgement that we have to be tuned in and aware of what information our body is providing us with. And so I'm sure you do. a lot of that work with your patients, like encouraging women to like lean into what their body is telling them, which is completely the antithesis of what we're taught as providers. We're taught to be the expert telling the patient what needs to happen. Whereas I encourage them to lean in and provide, you know, give me input, like what's working, what is not working for you.

Yeah, exactly. I mean, oh, that's what my next book is about is we just teach our children, our daughters, to ignore their bodies and to mask the symptoms, suppress them, get on the birth control pill, do whatever you've got to do to not be in tune with your body. And, you know, we need to get back to listening to our bodies.

Mm-hmm.

So thank you so much for talking about all of these different stages in your book, because I think it's so important for women to realize that it's not a one-size-fits-all, and it's not even a one-size-fits-all for you for your whole life. Like, you have to do things different in different seasons of your life that work for you, and that changes. So you've just— you've really addressed that so beautifully, and I'm really excited about your book because I just know that it's going to touch so many women's lives.

Oh, thank you. I know it's, it's, uh, definitely a labor of love. That's the one thing that, you know, my, my intent and my hope is that this book will be a resource and will help not only women, but also clinicians as well. Like, that's the one thing that I find, you know, when I connect with people on social media, is that whether it's an MD or a nurse practitioner or a nurse just saying like, I want to learn more about this because I want to be able to teach my patients. Like, there are so many providers out there that need resources and need, you know, opportunities to be able to share resources with their patients that are written from the perspective of a clinician, but also understanding what it's like to be a, be a patient and feel kind of lost. And certainly, you know, pain to purpose. When we talk about the fact that we go through these things, even though I always say, like, I was so embarrassed to talk about perimenopause on a stage. And I was so like, just so embarrassed. Now I laugh about it. I'm like, good Lord, there's so many like worse things to have to talk about. But I think it's so important that we as clinicians are transparent about the fact that I didn't know anything about this. I thought I was fairly woke. I thought I was fairly informed. I certainly went to a good university, and yet I didn't until I hit that wall. And yet that was what changed everything for me and got me to where I am today.

Yeah. Oh my gosh. Well, thank you so much for paying it forward and just creating this. I think it's going to change women's lives. I want all gynecologists to read it and really Take it in and think about doing things differently with their patients, because that is what we need to change this system. So thank you so much.

Thank you for your time. And I'm grateful to connect again with your listeners. And, you know, I, I am grateful that, you know, the work that we do together allows us to inspire women to live healthier, happier lives, irrespective of where they are in their life stage. Amen.

Thank you, Cynthia.

Thank you.

I hope you got so much value out of that episode. I love talking about intermittent fasting because it can— it's just, it's life-changing. It's life-reclaiming. Like, you can get back to feeling how you did back in the day when you had the energy and the brain clarity and you just got up and went about your day and life was beautiful. Like, you literally can have that back if you incorporate intermittent fasting in a healthy, correct way. So get Cynthia's book, okay? You need to read this book. You need to do the IF45. And I think one of my golden nuggets from today's episode was her talking about the migrating motor complex, like this idea that after you eat, Your stomach and intestines have to do this contraction, this peristalsis, and sweep all of the debris and everything else through the system. And it doesn't get a chance to do that if you're eating all of the time. So it's really important to do fasting. So that was a good key takeaway. And she does talk about this in the book, like she really explains how intermittent fasting benefits you from head to toe, how it benefits your brain, how it benefits your hormones and your gut and your cardiovascular system and everything else. It slows down the aging process. Like, if you want to look young, be thin, have energy, and sleep well, you need to incorporate intermittent fasting, without a doubt. It needs to be a way of life and a lifestyle. But the key is how you do it, what you eat, when you are eating, and, you know, make sure that you understand your bio-individuality and how that plays into when you should feast and famine. So that's why I love Cynthia's book so much because she really just lays all that out for you to understand. So go get her book. Let me know what you think about it. I am so super excited for her, and be looking for me on her podcast Everyday Wellness coming out in the spring. So all these links are in the show notes. Follow Cynthia on Instagram. Check out her website. The links are in the show notes, and don't forget to follow me and subscribe and hit the five-star review if you're liking what you're hearing because that lets iTunes. Know that this kind of information is important to you guys and that you want to hear more of it. It's like an algorithm, you know. They see, oh, women want to hear about women's health and wellness, and so they're more apt to push those types of podcasts and shows and things forward as opposed to suppressing them. So it's really important that we support each other as women. This is a sisterhood, not a competition, and we really help each other live our best lives together in community. So follow me at The Gutsy Gynecologist on TikTok now. Oh my gosh, I can't believe I'm doing TikTok, but why not? There's a whole amazing, beautiful world. It's not just for kids doing funny dances. I have so many amazing faith-inspiring TikTokers that I'm following now. It's really awesome, and I'm just Putting out educational content. I'm helping women get hormonal literacy so that they can understand what's going on in their bodies. So follow me on TikTok and Instagram at The Gutsy Gynecologist and help me make this movement huge and amazing so that we can impact women all over the country and hopefully one day all over the world to take back control, understand what's going on in their bodies, and tell conventional gynecology. It's not okay what your options are, and I want a different option. So stick with me, follow me, check me out at drtabatha.com, and I want you to have a kick-ass week as usual. So I'll see you next week. Bye, ladies!